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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The clinical impact of the coexistence of compressive cervical myelopathy (CM) and/or lumbar spinal canal stenosis (LCS) with compressive thoracic myelopathy (TM) remains unknown. The purpose of this study was to examine the incidence, clinical pictures, and surgical outcomes of patients with compressive TM and the coexistence of compressive CM and/or LCS. ⋯ About 70 % of patients who underwent surgery for TM had concurrent CM and/or LCS, and they were initially diagnosed with CM or LCS. Single-stage multilevel decompression surgery for TM with concurrent CM and/or LCS is comparable to thoracic only surgery with regard to complications and surgical results, and it is well tolerated in elderly patients.
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To determine the presence of a consistent osseous corridor through S1 and S2 and fluoroscopic landmarks thereof, which could be used for safe trans ilio-sacroiliac screw fixation of posterior pelvic ring disorders. ⋯ Two-thirds of males and females have a complete osseous corridor to pass a trans-sacroiliac S1 screw of 8 mm diameter. The S2 corridor was present in all males but only in 87 % of females. Preoperative review of the axial CT slices at the midpoint of the S1 or S2 vertebral body allows the presence of a trans-sacroiliac osseous corridor to be determined by assessing the passage at the narrowest point of the corridor at the junction of the sacral ala to the vertebral body.
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To characterize the distribution of nerves within a single S1 vertebral body, with particular emphasis on the superior endplate that interfaces with the L5/S1 disc. ⋯ Our results demonstrate that the S1 body and endplate are densely innervated and the peak in nerve density at the vertebral center coincides with vasculature patterns previously described in lumbar vertebral bodies. In the sacrum, however, there is no posterior nutrient foramen that facilitates nerve penetration through the vertebral cortex. Rather, our data indicate that nerves penetrate the S1 via the lateral aspects, consistent with being branches of the anterior sacral nerve. Since PGP 9.5 is a ubiquitous neural marker these identified nerves are likely composed of a mixed population of nociceptive and autonomic fibers.
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Although a C2 pedicle screw and a C1-2 transarticular screw are the most rigid anchors, these screws cannot be used in cases with bilateral high-riding vertebral arteries. The authors describe their recent experience using a novel method of C2-3 transuncovertebral joint screw placement for occipitocervical fixation. ⋯ This is the first report to describe the technique of transuncovertebral joint screw. Using a C2-3 transuncovertebral joint screw, a long screw could be used, and it provided an anchor at C3 and C2 from a posterior approach.
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Image-based navigational patient-specific templates (PSTs) for pedicle screw (PS) placement have been described. With recent advances in three-dimensional computer-aided designs and additive manufacturing technology, various PST designs have been reported, although the template designs were not optimized. We have developed a novel PST design that reduces the contact area without sacrificing stability. It avoids susceptibility to intervening soft tissue, template geometric inaccuracy, and difficulty during template fitting. ⋯ This study provides a useful design concept for the development and introduction of patient-specific navigational templates for placing PSs.