Transdiscal L5–S1 Screws for the Fixation of Isthmic Spondylolisthesis: A Biomechanical Evaluation

Minamide, Akihito; Akamaru, Tomoyuki; Yoon, S Tim; Tamaki, Toru; Rhee, John M.; Hutton, William

doi:10.1097/00024720-200304000-00005

Cited by 64 publications

(37 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These authors cited 4 main advantages to this approach: it uses the concept of 3-column fixation achieved from a single posterior approach; it has demonstrated in vivo implementation of superior biomechanical principles, as the triangular construct provides a superior fixation strength; it has better contact with cortical bone; and the use of longer screws and greater penetration provides additional fixation. Subsequent studies of biomechanical properties of the transdiscal approach have demonstrated improvement in resistance against shear forces at the displaced level compared with posterolateral fusion, 4,8 stiffness 1.6-1.8 times higher than that achieved with traditional pedicle screw fixation, 18 and equivalent fixation to that achieved with the combination of interbody fusion and pedicle screw fixation. 23 Another advantage is that a posterior approach is used more frequently in spine surgeries and is more familiar for less-experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Delgado-Fernández¹,

Pulido²,

García-Pallero³

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVESpondylolisthesis is a prevalent spine disease that recent studies estimate could be detected in 9% of the population. High-grade spondylolisthesis (HGS), however, is much less frequent, which makes it difficult to develop a general recommendation for its treatment. Posterior transdiscal fixation was proposed in 1994 for HGS, and the use of spine navigation could make this technique more accessible and reduce the morbidity associated with the procedure. The purpose of this study was to present a case series involving adult patients with HGS and correct spinal alignment who were treated with transdiscal pedicle screw placement guided with neuronavigation and compare the results to those achieved previously without image guidance.METHODSThe authors reviewed all cases in which adult patients with correct spinal alignment were treated for HGS with posterior transdiscal instrumentation placement guided with navigation between 2014 and 2016 at their institution. The authors compared preoperative and postoperative spinopelvic parameters on standing radiographs as well as Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for low-back pain. Follow-up CT and MRI studies and postoperative radiographs were evaluated to identify any screw malplacement or instrumentation failure. Any other intraoperative or postoperative complications were also recorded.RESULTSEight patients underwent posterior transdiscal navigated instrumentation placement during this period, with a mean duration of follow-up of 16 months (range 9–24 months). Six of the patients presented with Meyerding grade III spondylolisthesis and 2 with Meyerding grade IV. In 5 cases, L4–S1 instrumentation was placed, while in the other 3 cases, surgery consisted of transdiscal L5–S1 fixation. There was no significant difference between preoperative and postoperative spinopelvic parameters. However, there was a statistically significant improvement in the mean VAS score for low-back pain (6.5 ± 1.5 vs 4 ± 1.7) and the mean ODI score (49.2 ± 19.4 vs 37.7 ± 22) (p = 0.01 and p = 0.012, respectively). Six patients reduced their use of pain medication. There were no intraoperative or postoperative complications during the hospital stay, and as of the most recent follow-up, no complications related to pseudarthrosis or hardware failure had been observed.CONCLUSIONSTreatment with posterior transdiscal pedicle screws with in situ fusion achieved good clinical and radiological outcomes in patients with HGS and good sagittal spinal balance. The use of navigation and image guidance was associated with improved results in this technique, including a reduction in postoperative and intraoperative complications related to screw malplacement, pseudarthrosis, and instrumentation failure.

show abstract

Section: Discussionmentioning

confidence: 99%

Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Delgado-Fernández¹,

Pulido²,

García-Pallero³

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…There is adequate literature support to show the strength of lumbosacral fixation in presence of highgrade listhesis. 16,17 These screws are as strong as classical 360° circumferential techniques with the additional advantage of them being simple and fast. 12 In addition, the neurological complications associated with partial or total reduction 18 of listhesis are reduced drastically in this method.…”

Section: Discussionmentioning

confidence: 99%

Delta Fixation vs Interbody Fusion in Cases of High-grade Spondylolisthesis

Sancheti¹,

Hadgaonkar²,

Khurjekar³

et al. 2017

The Journal of Spinal Surgery

View full text Add to dashboard Cite

High-grade spondylolisthesis is better dealt with surgical methods. There are various methods to achieve solid fusion and decompression in the presence of symptomatic spinal stenosis. In our case report, we have compared delta fixation with interbody fusion methods, especially in high-risk patients (American Society of Anesthesiologists grade III) with its various merits and demerits, and we have attempted to discuss it with respect to the literature available.

show abstract

“…1,7 The transdiscal screw relies on the cortical bone of the pedicle and both adjacent endplates to form the anchorage; therefore, it provides additional benefit in comparison with the traditional pedicle screw. Nottmeier and Pirris described transdiscal screw placement for patients with osteoporosis to improve the screw purchase in the thoracic spine by using spinal navigation.…”

Section: Discussionmentioning

confidence: 99%

“…1,7 In 2004, Mehdizade et al reported percutaneous vertebroplasty via a transdiscal route following transpedicular instrumentation in the lumbar spine. 6 For the thoracic spine, such a procedure has not yet been described.…”

mentioning

confidence: 99%

Transdiscal mid- and upper thoracic vertebroplasty: first description of 2 exemplary cases

Filis

Aghayev

Schaller

et al. 2016

SPI

View full text Add to dashboard Cite

Kyphoplasty and vertebroplasty are established treatment methods to reinforce fractured vertebral bodies. In cases of previous pedicle screw instrumentation, vertebral body cannulation may be challenging. The authors describe, for the first time, an approach through the adjacent inferior vertebra and disc space in the thoracic spine for cement augmentation. A 78-year-old woman underwent posterior fusion with pedicle screws after vertebrectomy and reconstruction with cement and Steinmann pins for a pathological T-7 fracture. Two months later she developed a compression fracture of the vertebral body at the lower part of the construct, and a vertebroplasty was performed. Because a standard transpedicular route was not available, an inferior transdiscal trajectory was used for the cement injection. A 73-year-old man with a history of rheumatoid arthritis underwent cervicothoracic fusion posteriorly for subluxation. He developed pain in the upper thoracic area, and the authors performed a transdiscal vertebroplasty at T-2. The standard transpedicular route was not possible. The vertebral body was satisfactorily filled up with cement. Clinically both patients benefited significantly in terms of back pain and showed an uneventful follow-up of 3 months. Transdiscal vertebroplasty can achieve good results in the mid- and upper thoracic spine when a standard transpedicular trajectory is not possible, and can therefore be a good alternative in select cases.

show abstract

Transdiscal L5–S1 Screws for the Fixation of Isthmic Spondylolisthesis: A Biomechanical Evaluation

Cited by 64 publications

References 16 publications

Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Image guidance in transdiscal fixation for high-grade spondylolisthesis in adults with correct spinal balance

Delta Fixation vs Interbody Fusion in Cases of High-grade Spondylolisthesis

Transdiscal mid- and upper thoracic vertebroplasty: first description of 2 exemplary cases

Contact Info

Product

Resources

About