European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Patient positioning is an important step in spinal surgeries. Many surgical frames allow for lumbar lordosis modulation due to lower limb displacement, however, they do not include a feature which can modulate thoracic kyphosis. A sternum vertical displacer (SVD) prototype has been developed which can increase a subject's thoracic kyphosis relative to the neutral prone position on a surgical frame. ⋯ Sensors showed that the sternum was raised a total of 8 cm and that interface pressures were considerably higher in the raised position. The SVD provides a novel way of increasing a patient's thoracic kyphosis intra-operatively which can be used to improve access to posterior vertebral elements and improve sagittal balance. It is recommended that its use should be limited in time due to the increase in interface pressures observed.
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Thoracolumbar fractures (T11-L2) complicated by malunion often need surgery. In our hands two approaches are necessary for release and fusion. Correction is obtained by posterior bending in situ of a screw rod fixation. ⋯ When spine is rigid an anterior release with waiting bone graft is performed first followed by a second posterior reduction and stabilization. This strategy allows a real correction without the loss of correction in time. This technique is fast and safe as demonstrated in our series of 20 patients.
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Pedicle screws in the sub-axial spine are infrequently used because of concerns over their safety and difficulty in placement, despite their superior pullout strength. In the sub-axial cervical vertebrae, we have observed that the lamina appears to project at right angles to the ipsilateral pedicle axis. The aim of this investigation was to confirm the lamina orientation as a reliable landmark for pedicle screw placement. 80 digital cervical spine CT were analysed. ⋯ Average axial lamina-pedicle angle ranged from 96.6 degrees at C3 to 87.2 degrees at C7 in males, and from 95.6 degrees to 87.5 degrees in females. The angle formed by the posterior cortex of the lamina and the ipsilateral pedicle shows a high level of consistency for sub-axial cervical vertebrae ranging from 96 degrees at C3 to 87 degrees at C7. Although the angle is not exactly 90 degrees at all levels as hypothesised, the orientation of the lamina, nevertheless, forms a useful reference plane for insertion of pedicle screws in the sub-axial cervical spine.
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Retrospective study on the results of microendoscopic decompression surgery for the treatment of cervical myelopathy. The purpose of this study was to describe the microendoscopic laminoplasty (MEL) technique as the surgical method in the treatment of cervical myelopathy, and to document the clinical outcomes for MEL surgery. Endoscopic surgery poses several challenges for the aspiring endoscopic surgeons, the most critical of which is mastering hand-eye coordination. ⋯ These four patients on complications have returned to work at the final follow-up. This observation suggests that the clinical outcomes of microendoscopic surgery for cervical myelopathy were excellent or showed good results. This minimally invasive technique would be helpful in choosing a surgical method for cervical myelopathy.