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Spinopelvic reconstruction

Amrit S Khalsa, Gregory M Mundis, Mitsuru Yagi, Richard Fessler, Shay Bess, Naobumi Hosogane, Paul Park, Khoi Than, Alan Daniels, Justin Iorio, Justin Ledesma, Stacie Tran, Robert K Eastlack
STUDY DESIGN: Prospectively-collected survey study OBJECTIVE.: To determine the consistency with which spino-pelvic parameters (SPP) are determined in patients with lumbosacral transitional vertebrae (LSTV). SUMMARY OF BACKGROUND DATA: The incidence of LSTV in the general population is as high as 35.6%. The often fixed nature of LSTV relative to the pelvis, but lumbar-type appearance, may lead to differential use of the S1 endplate when performing SPP assessment...
October 3, 2017: Spine
João Antonio Matheus Guimarães, Vinícius Magno da Rocha, André Luiz Loyelo Barcellos
Pelvic ring fractures occur in association with potentially fatal lesions, whose treatment is a priority in the polytrauma setting. As consequence, the definitive orthopedic approach may be postponed, leading patients to chronic and potentially disabling deformities. The treatment of these deformities is a challenge, requiring highly complex and staged surgical reconstructions. The ilioinguinal approach has been widely used in these surgeries, because it allows the release and mobilization of the hemipelvis and, in some cases, anterior fixation of the sacroiliac joint...
2017: Revista Brasileira de Ortopedia
Arnaud Dubory, Houssam Bouloussa, Guillaume Riouallon, Stéphane Wolff
PURPOSE: Widely used in traumatic pelvic ring fractures, the iliosacral (IS) screw technique for spino-pelvic fixation remains anecdotal in adult spinal deformity. The objective of this study was to assess anatomical variability of the adult upper sacrum and to provide a user guide of spino-pelvic fixation with IS screws in adult spinal deformity. METHODS: Anatomical variability of the upper sacrum according to age, gender, height and weight was sought on 30 consecutive pelvic CT-scans...
December 2017: International Orthopaedics
Muhammed Yaser Hasan, Gabriel Liu
The management of lumbosacral neoplastic disease can be demanding, often requiring complex reconstruction. In the context of extensive sacral involvement, the risk of iliac screw breakage is greater. Few studies advocate the use of dual iliac screw techniques to reduce implant failure. In this report, the authors have described the first case of percutaneous dual iliac screw, dual rod insertion as part of a minimally invasive spinopelvic stabilization in a patient with a sacral fracture from a paraganglionoma...
September 2017: Journal of Neurosurgery. Spine
Matthew T Houdek, Peter S Rose, Karim Bakri, Eric R Wagner, Michael J Yaszemski, Franklin H Sim, Steven L Moran
BACKGROUND: Following resection of malignant tumors of the spine and pelvis, reconstructive surgeons often face large structural defects. Unlike reconstruction in the extremities, wherein a free vascularized fibular graft (FVFG) is a highly utilized option for segmental osseous reconstruction, there are limited data on the use of an FVFG in the spine and pelvis. The aim of this study was to review our institution's experience with reconstruction with use of an FVFG following oncological resection in the spine and pelvis...
July 5, 2017: Journal of Bone and Joint Surgery. American Volume
Emmanuelle Ferrero, Renaud Lafage, Bassel G Diebo, Vincent Challier, Brice Illharreborde, Frank Schwab, Wafa Skalli, Pierre Guigui, Virginie Lafage
STUDY DESIGN: Retrospective single-center. OBJECTIVE: To investigate rotatory subluxation (RS) in adult spinal deformity (ASD) with three-dimensional (3D) stereoradiographic images and analyze relationships between RS, transverse plane parameters, spinopelvic parameters, and clinical outcomes. BACKGROUND: Recent research has demonstrated that sagittal plane malalignment and listhesis correlate with ASD patient-reported outcomes. However, there is still a lack of knowledge regarding the clinical impact of 3D evaluation and rotatory subluxation...
July 2017: Spine Deformity
V S Klimov, I I Vasilenko, A V Evsyukov, E V Amelina
INTRODUCTION: As the life span and proportion of people over 65 years increase, the incidence of degenerative lumbar spine stenosis grows proportionally. Various parameters of the spinopelvic relationships are used to predict surgical treatment outcomes in patients with degenerative spine diseases. There are no unified protocols for evaluation, in terms of the sagittal balance, of surgical treatment outcomes in elderly patients. PURPOSE: To study the impact of sagittal balance parameters on the life quality of elderly and senile patients after surgery for degenerative stenosis of the lumbar spine...
2017: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
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...
August 2017: 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...
August 2017: 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...
April 2017: 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
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