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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We intended to prospectively evaluate the clinical and radiological results of lumbo-sacral fusion achieved by a combined approach, anterior then posterior. ⋯ The combined procedure meets the requested criteria for a lumbar fusion in terms of clinical results, functional outcomes, fusion rates while restoring segmental lordosis and disc height. It cumulates the advantages of the anterior and posterior approach performed alone, especially for L5-S1.
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Observational Study
Failures and revisions in surgery for sagittal imbalance: analysis of factors influencing failure.
Sagittal imbalance is an important risk factor for spinal disability, pain and loss of health related quality of life. Its correction has a positive impact on these outcomes. Still, it is a very aggressive surgery, with a high revision rate. The aim of this study is to analyze the most important causes of failure of surgery for correction of sagittal imbalance. ⋯ Causes of failure were insufficient correction, junctional kyphosis, screw loosening and pseudoarthrosis with rod breakage. In every case, patients presented a new onset or a worsening of sagittal imbalance and pain.
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Spondylolisthesis surgical treatment is often difficult with higher degree of slip and related techniques still debated. We have taken into consideration double thread recoil Schanz screws. This system should allow the best reduction of the slip, treating only the affected vertebrae. ⋯ Fixation system with Schanz screws seems to be effective in reducing the slip, treating only the affected level, in high grade of spondylolisthesis.
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Obesity and osteoporosis share many features and recent studies have identified many similarities suggesting common pathophysiological mechanisms. Obesity is associated with a higher risk of non-traumatic fractures despite bone mineral density (BMD) being normal or even increased. ⋯ The objective of this study was to assess in obese patients levels of 25OH vitamin D, parathyroid hormone, serum and urinary calcium (Ca) and phosphorus (P), BMD, and SDI. 87.5 % of the obese subjects present nontraumatic vertebral fractures and reduced bone quality as measured by SDI.
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Posterior-only approach arthrodesis by all-pedicle screw instrumentation has a correction rate similar to correction obtained by traditional combined anterior/posterior approach surgery and avoids the complications associated with the thoracic approach. ⋯ Posterior spinal fusion with pedicle screw-only instrumentation obtains a good and stable correction of severe scoliosis; compared to hybrid instrumentation, it allows a greater coronal correction of the deformity and less correction loss at the follow-up.