A new device for internal fixation of thoracolumbar and lumbar spine fractures: the ‘fixateur interne’

Abstract

A new system of operative fixation of thoracolumbar and lumbar spine fractures is presented: the 'fixateur interne' (F.I.). From a posterior approach long Schanz screws are inserted through the pedicles into the body of the two vertebrae just adjacent to the lesion and connected by th threaded F.I. rods. By tightening the nuts the Schanz screws are fixed in all directions. The advantages of the F.I. system are: excellent reposition by the long lever-arm of the Schanz screws, immobilization of only two segments and therefore good mobility of the residual spine, stability against flexion forces better than is obtained with Harrington distraction rods, additional rotational stability, and fixation in lordosis or kyphosis as is desired. The F.I. does not act as a four point bending system like all other dorsal spine instrumentation systems, but provides stability in flexion by itself. Therefore it can be Used independently of the condition of all ligaments (including the anterior longitudinal ligament) and of the posterior wall of the fractured vertebrae, and there is no need to fix more than the two immediately adjacent vertebrae, thus avoiding the often painful and cumbersome iatrogenic loss of lumbar lordosis and of mobility and permitting early mobilization of the patient. Experience with the first 45 patients is very promising.

Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients

“…All fractures were treated by instrumental angular reduction, distraction and stabilization with Dick's internal fixator [10,11,12]. Since 1995 we have used the Universal Spine System (Synthes).…”

Treatment of fractures of the thoracolumbar spine by combined anteroposterior fixation using the Harms method

“…The preservation of intact vertebral segments, improvement of the neurological status, and the abandonment of external immobilization were the major objectives proposed for the modern treatment of these fractures [16,30]. Many new implants and systems of vertebral fixation have been developed to fulfill the above objectives [2,8,9].…”

Strategy for the treatment of patients with spinal neoplasms

“…Important innovations in posterior implants came from various SCI centers 3,4 o ering the possibilities of both segmental intraspinal exploration and recalibration of the spinal canal. Moreover, these internal implants with transpedicular ®xation guarantee a high initial stability without the need of postoperative bracing for a period of at least 6 months.…”

“…1 Considering the fact that about 5% of all patients with systemic cancer develop compression of the spinal cord, and that more than 50% of the patients loose the ability to walk, 2 the development of new surgical techniques and the introduction of new stabilising instrumentations has gained high importance in spine surgery. 3,4 Meanwhile, surgery could be established as a su cient tool in the overall treatment of patients with tumor involvement of the spine. 5 ± 8 In the majority of cases, the neurological problems and the progressive vertebral instability are caused by expansive growing tumor masses starting from the preferred location of the tumor, which is the vertebral body itself.…”