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Spinopelvic reconstruction

Emmanuelle Ferrero, Renaud Lafage, Shaleen Vira, Pierre-Yves Rohan, Jonathan Oren, Edward Delsole, Pierre Guigui, Frank Schwab, Virginie Lafage, Wafa Skalli
PURPOSE: In addition to the sagittal alignment, impact of transverse plane parameters (TPP) and rotatory subluxation on patients reported outcomes were highlighted. One of the hypotheses for genesis of degenerative scoliosis is disc degeneration with increased axial vertebral (AVR) and intervertebral rotation (AIR). Therefore, TPP analysis at early stage of the scoliosis seems of particular interest. This study aims at assessing reliability of tridimensional (3D) reconstructions of adult spinal deformity (ASD) patients...
November 5, 2016: European Spine Journal
Hai-Ming Jin, Dao-Liang Xu, Jun Xuan, Jiao-Xiang Chen, Kai Chen, Amit Goswami, Yu Chen, Qiu-Yan Kong, Xiang-Yang Wang
STUDY DESIGN: Digitally reconstructed radiograph-based study. OBJECTIVE: Using a computer-based method to determine what degree of pelvic rotation is acceptable for measuring the pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). The effectiveness of a geometrical formula used to calculate the angle of pelvic rotation proposed in a previous article was assessed. SUMMARY OF BACKGROUND DATA: It is unclear whether PI, PT, and SS are valid with pelvic rotation while acquiring a radiograph...
September 16, 2016: Clinical Spine Surgery
Celia Amabile, Bertrand Moal, Oussama Arous Chtara, Helene Pillet, Jose G Raya, Antoine Iannessi, Wafa Skalli, Virginie Lafage, Nicolas Bronsard
PURPOSE: Muscles have been proved to be a major component in postural regulation during pathological evolution or aging. Particularly, spinopelvic muscles are recruited for compensatory mechanisms such as pelvic retroversion, or knee flexion. Change in muscles' volume could, therefore, be a marker of greater postural degradation. Yet, it is difficult to interpret spinopelvic muscular degradation as there are few reported values for young asymptomatic adults to compare to. The objective was to provide such reference values on spinopelvic muscles...
September 16, 2016: Surgical and Radiologic Anatomy: SRA
Man Kyu Choi, Dae Jean Jo, Sung Bum Kim
BACKGROUND: Spinopelvic reconstruction after sacrectomy for a sacropelvic tumor can result in various complications and requires a highly complicated surgical technique. We report 2 cases of pelvic reconstruction surgery using diverse U-shaped rods (USRs) after partial sacrectomy. CASE DESCRIPTION: A partial sacrectomy was performed for 2 different cases: one case was a metastatic sacral tumor and the other was a chordoma. In the first case, reconstruction was completed with an inner straight rod and an outer USR...
November 2016: World Neurosurgery
Charles A Sansur, Nicholas M Caffes, David M Ibrahimi, Nathan L Pratt, Evan M Lewis, Ashley A Murgatroyd, Bryan W Cunningham
OBJECTIVE Optimal strategies for fixation in the osteoporotic lumbar spine remain a clinical issue. Classic transpedicular fixation in the osteoporotic spine is frequently plagued with construct instability, often due to inadequate cortical screw-bone purchase. A cortical bone trajectory maximizes bony purchase and has been reported to provide increased screw pullout strength. The aim of the current investigation was to evaluate the biomechanical efficacy of cortical spinal fixation as a surgical alternative to transpedicular fixation in the osteoporotic lumbar spine under physiological loading...
October 2016: Journal of Neurosurgery. Spine
Piya Kiatisevi, Chaiwat Piyaskulkaew, Sombat Kunakornsawat, Bhasanan Sukunthanak
BACKGROUND: After total sacrectomy, many types of spinopelvic reconstruction have been described with good functional results. However, complications associated with reconstruction are not uncommon and usually result in further surgical interventions. Moreover, less is known about patient function after total sacrectomy without spinopelvic reconstruction, which may be indicated when malignant or aggressive benign bone and soft tissue tumors involved the entire sacrum. QUESTIONS/PURPOSES: (1) What is the functional outcome and ambulatory status of patients after total sacrectomy without spinopelvic reconstruction? (2) What is the walking ability and ambulatory status of patients when categorized by the location of the iliosacral resection relative to the sacroiliac joint? (3) What complications and reoperations occur after this procedure? METHODS: Between 2008 and 2014, we performed 16 total sacrectomies without spinopelvic reconstructions for nonmetastatic oncologic indications...
March 2017: Clinical Orthopaedics and related Research
Murat Arıkan, Guray Togral, Askin Esen Hasturk, Fevzi Kekec, Murat Parpucu, Safak Gungor
In this retrospective study, surgical results of four patients with sacral tumors having disparate pathologic diagnoses, who were treated with partial or total sacrectomy and lumbopelvic stabilization were abstracted. Two patients were treated with partial sacral resection and two patients were treated with total sacrectomy and spinopelvic fixation. Fixation methods included spinopelvic fixation with rods and screws in two cases, reconstruction plate in one case, and fresh frozen allografts in two cases. Fibular allografts used for reconstruction accelerated bony union and enhanced the stability in two cases...
December 2015: Asian Spine Journal
Hanny A Anwar, Joseph S Butler, Tejas Yarashi, Karthig Rajakulendran, Sean Molloy
BACKGROUND CONTEXT: Lumbar lordosis (LL) correlates with pelvic morphology, and it has been demonstrated that as LL increases, the inflection point and apex of lordosis move cranially. This suggests that each segment of the lumbar spine relates to pelvic morphology in a unique way. OBJECTIVES: This study aimed to establish whether there is a direct relationship between pelvic morphology and lumbar segmental angulation in the sagittal plane. STUDY DESIGN: A retrospective analysis of 41 patient radiographs was carried out...
December 1, 2015: Spine Journal: Official Journal of the North American Spine Society
Seung-Hoon Lim, Dae-Jean Jo, Sung-Min Kim, Young-Jin Lim
Despite various complications associated with sacrectomy to remove sacral tumors, total or en bloc sacrectomy has been suggested as the most appropriate surgical treatment in such cases. The authors present the case of a 62-year-old male patient with intractable back pain and voiding difficulty whom they treated with posterior en bloc sacral hemiresection followed by reconstruction using dual U-shaped rods. They report that good spinopelvic stability was achieved without complications. The authors conclude that this technique is relatively simple compared with other sacral reconstructive techniques and can prevent complications, including herniation...
July 31, 2015: Journal of Neurosurgery. Spine
Nalli R Uvaraj, Aju Bosco, Nalli R Gopinath
Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result in a kyphosis or hypolordosis, leading to back pain, spinal instability, and neurological deficits. The conventional treatment goals of lumbosacral tuberculosis are to correct and prevent a lumbar kyphosis, treat or prevent a neurological deficit, and restore global spinal stability...
August 2015: Global Spine Journal
E Ferrero, R Lafage, V Challier, B Diebo, P Guigui, K Mazda, F Schwab, W Skalli, V Lafage
INTRODUCTION: In degenerative adult spinal deformity (ASD), sagittal malalignment and rotatory subluxation (RS) correlate with clinical symptomatology. RS is defined as axial rotation with lateral listhesis. Stereoradiography, recently developed for medical applications, provides full-body standing radiographs and 3D reconstruction of the spine, with low radiation dose. HYPOTHESIS: 3D stereoradiography improves analysis of RS and of its relations with transverse plane and spinopelvic parameters and clinical impact...
September 2015: Orthopaedics & Traumatology, Surgery & Research: OTSR
Marek Jóźwiak, Michał Rychlik, Bartosz Musielak, Brian Po-Jung Chen, Maciej Idzior, Andrzej Grzegorzewski
BACKGROUND: Two-dimensional (2D) measurements of acetabular morphology and orientation are well known; there is less information on these acetabular characteristics in three dimensions. One important reason is the lack of standardized reference planes for the pelvis, especially in relation to the spinopelvic unit; another is that no method precisely assesses the acetabulum in three-dimensional (3D) orientation based on its axis rather than on the directions of the edges of the acetabular rim...
February 25, 2015: BMC Musculoskeletal Disorders
Jay D Turner, Behrooz A Akbarnia, Robert K Eastlack, Ramin Bagheri, Stacie Nguyen, Luiz Pimenta, Rex Marco, Vedat Deviren, Juan Uribe, Gregory M Mundis
PURPOSE: Anterior column reconstruction (ACR) is a minimally invasive technique for the treatment of sagittal plane deformity. ACR uses a lateral transpsoas approach with ALL release and the application of an interbody device to achieve correction. Here, we present 1-year radiographic results from a multicenter study of adult spinal deformity (ASD) patients. METHODS: A multicenter database was queried from 2005 to 2013 for ASD patients treated with ACR. Demographics, surgical data, and radiographic measurements were collected and retrospectively analyzed...
April 2015: European Spine Journal
Piya Kiatisevi, Chaiwat Piyaskulkaew, Bhasanan Sukunthanak, Voranuch Thanakit, Saraporn Bumrungchart
We report on a 58-year-old woman who underwent total sacrectomy and spinopelvic reconstruction for a low-grade malignant peripheral nerve sheath tumour involving the sacrum. One week later, she developed deep wound infection, and the entire spinopelvic reconstruction was removed. At the 36-month followup, the patient had no pain and was able to walk with a walking frame. There was no sign of recurrence or metastasis.
December 2014: Journal of Orthopaedic Surgery
Hui Liu, Sibei Li, Jiranru Wang, Taiping Wang, Hao Yang, Zemin Li, Xiang Li, Zhaomin Zheng
STUDY DESIGN: A retrospective and radiological study of degenerative spinal diseases. OBJECTIVE: To explore the changes in spinopelvic sagittal alignment after lumbar instrumentation and fusion of degenerative spinal diseases. SUMMARY OF BACKGROUND DATA: Efforts have been paid to clarify the ideal postoperative sagittal profile for degenerative spinal diseases. However, little has been published about the actual changes of sagittal alignment after lumbar lordosis reconstruction...
December 15, 2014: Spine
Jason W Savage, Alpesh A Patel
Study Design Literature review. Objective To discuss the evaluation and management of fixed sagittal plane imbalance. Methods A comprehensive literature review was performed on the preoperative evaluation of patients with sagittal plane malalignment, as well as the surgical strategies to address sagittal plane deformity. Results Sagittal plane imbalance is often caused by de novo scoliosis or iatrogenic flat back deformity. Understanding the etiology and magnitude of sagittal malalignment is crucial in realignment planning...
December 2014: Global Spine Journal
Jo Armour Smith, Alexander Tuchman, Michael Huoh, Andreas M Kaiser, Wesley G Schooler, Patrick C Hsieh
STUDY DESIGN: Biomechanical analysis of locomotion after total sacrectomy in a single patient case. OBJECTIVE: To describe the biomechanics of locomotion after successful total sacrectomy and spinopelvic reconstruction. SUMMARY OF BACKGROUND DATA: Total sacrectomy is a complex surgery that has significant consequences for mobility after surgery due to loss of lower lumbar and sacral innervation to the lower extremities, and the anatomic dissociation of the spine from the pelvis...
November 15, 2014: Spine
Jean-Charles Le Huec, Antonio Faundez, Dennis Dominguez, Pierre Hoffmeyer, Stéphane Aunoble
The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD). Fusion in the lumbar spine may result in loss of lumbar lordosis (LL), with possible compensatory mechanisms: decreased sacral slope (SS), increased pelvic tilt (PT) and decreased thoracic kyphosis (TK). An increase in PT after surgery is correlated with postoperative back pain. A decreased SS and/or abnormal sagittal vertical axis (SVA) after fusion have a higher risk of adjacent segment degeneration...
January 2015: International Orthopaedics
Christopher C Gillis, John T Street, Michael C Boyd, Charles G Fisher
A novel method of spinopelvic ring reconstruction after partial sacrectomy for a chondrosarcoma is described. Chondrosarcoma is one of the most common primary malignant bone tumors, and en bloc resection is the mainstay of treatment. Involvement of the pelvis as well as the sacrum and lumbar spine can result in a technically difficult challenge for en bloc resection and for achievement of appropriate load-bearing reconstruction. After en bloc resection in their patient, the authors achieved reconstruction with a rod and screw construct including vascularized fibula graft as the main strut from the lumbar spine to the pelvis...
October 2014: Journal of Neurosurgery. Spine
Michelle J Clarke, Patricia L Zadnik, Mari L Groves, Hormuzdiyar H Dasenbrock, Daniel M Sciubba, Wesley Hsu, Timothy F Witham, Ali Bydon, Ziya L Gokaslan, Jean-Paul Wolinsky
OBJECT: Traditionally, hemisacrectomy and internal hemipelvectomy procedures have required both an anterior and a posterior approach. A posterior-only approach has the potential to complete an en bloc tumor resection and spinopelvic reconstruction while reducing surgical morbidity. METHODS: The authors describe 3 cases in which en bloc resection of the hemisacrum and ilium and subsequent lumbopelvic and pelvic ring reconstruction were performed from a posterior-only approach...
September 2014: Journal of Neurosurgery. Spine
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