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Surgical Technology International XXII contains 46 articles with color illustrations.
Universal Medical Press, Inc.
San Francisco, December, 2012
ISBN: 1-890131-18-0
»
Orthopaedic Surgery
Bicruciate Retaining Arthroplasty
Michael A. Mont, MD, Co-Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, Mario John, MD, Howard University Department of Orthopaedic Surgery Washington DC Department of Orthopaedics Howard University Hospital Washington District of Columbia
Aaron J Johnson, MD, Orthopaedic Research Fellow, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
PMID: 22915498
Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures with 10 to 20 year survivorships from multiple studies of greater than 95% [1-3]. These success rates typically apply to patients over 70 years of age who may only want to return to activities of daily living. However, recently there is a demand by both senior citizens as well as young patients to have TKAs that return them to high activity levels and occasionally high performance sports. In this review, we will describe bicruciate retaining prostheses, including knowledge of their kinematics from fluoroscopic and gait studies, results of clinical studies, a summary of their potential advantages and disadvantages, anterior cruciate ligament viability at time of arthroplasty, considerations for implantation of these devices, and their role in the future of total knee arthroplasty.
New Technologies in Knee Arthroplasty
Qais Naziri, MD, Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, MD, Robert Pivec, MD, Fellow,
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement
Sinai Hospital of Baltimore, Baltimore, MD, Steven F. Harwin, MD, FACS, Chief of Adult Reconstructive Surgery and Total Joint, Replacement, The Center for Reconstructive Joint Surgery, Beth Israel Medical Center, New York, NY, Christopher R. Costa, MD, Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Aaron J. Johnson, MD, Fellow, Rubin Institute for Advanced Orthopedics Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Peter M. Bonutti, MD, Director, Bonutti Clinic, Effingham, IL, Michael A. Mont, MD, Co-Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
PMID: 22915499
Advances in surgical technique and implant design have increased the treatment options available to joint reconstruction surgeons. New technologies for component alignment such as custom cutting blocks and disposable cutting blocks hold the potential for more anatomic component positioning and less instrument turnover which may decrease infection rates. Improved component alignment may also be obtained with the use of computer-assisted surgery. Utilization of bone-sparing designs such as patellofemoral, unicompartmental, and bicompartmental knee arthroplasty allow for the surgeon to customize treatment based on patient symptoms by addressing each compartment individually. Gender-specific designs may be useful in the setting of populations which deviate from standard dimensions that are available in traditional unisex designs. New higher-conforming bearing designs such as rotating platform bearings allow for more natural knee kinematics, while also limiting polyethylene wear by decreasing contact stress. Newer interfaces for cementless fixation utilizing porous coated surfaces allows for biologic component fixation which has the potential to increase interface durability and implant survivorship. These new materials, designs, and techniques are challenging the traditional "gold standard" cemented total knee arthroplasty and have the potential for developing a more durable and naturally feeling prosthetic knee. Further study is required to identify which patients are most appropriate for each new technology.
Procedure Simplification: The Role of Single-Use Instruments in Total Knee Arthroplasty
Arup K. Bhadra, MD, MRCS, Orthopaedic Surgeon, Rockland Orthopedics & Sports Medicine, P.C., Grzegorz J. Kwiecien, BA, Research Fellow, University of Louiville, KY, Steven F. Harwin, MD, FACS, Chief of Adult Reconstructive Surgery and Total Joint Replacement, The Center for Reconstructive Joint Surgery Beth Israel Medical Center, New York, NY, Aaron J. Johnson M.D., Research Fellow, Rubin Institute for Advanced Orthopedics Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Michael A. Mont, M.D., Co-Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Arthur L. Malkani, MD, Chief of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, University of Louiville, KY
PMID: 23023576
In orthopaedic surgery, surgical site contamination leading to periprosthetic infections is a major concern with important morbidity, financial and emotional burden. Single-use instruments developed for total knee arthroplasties are intended to simplify the surgical procedure, decrease the number of surgical trays that require sterilization and reprocessing, decrease the incidence of possible contamination through breaks in surgical wraps, and improve operating room efficiency. As the demand for total knee arthroplasty continues to rise, a greater burden on the healthcare system may be created. The use of single-use instruments, cutting guides, and trials will play an increasing role in total knee arthroplasty through improved operating room efficiency.
Can TKA be Avoided? Alternate Strategies.
Youssef Sabry, MD, Research Fellow, Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, Tennison Malcolm, BA, Medical Student, Cleveland Clinic, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, Caleb R. Szubski, BA, Research Coordinator, Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, Wael K. Barsoum, MD, Chairman, Surgical Operations, Staff, Orthopaedic Surgery Cleveland Clinic, Cleveland, Ohio
PMID: 23023575
In the properly selected patient, alternative options to total knee arthroplasty exist for the surgical treatment of knee joint disease. These procedures involve reestablishing healthy cartilage (i.e., bone marrow stimulation, grafting, autologous chondrocyte implantation), mechanical axis correction (i.e., osteotomy), and/or replacing pathologic knee compartments with prosthetic devices (i.e., unicompartmental and bicompartmental knee arthroplasty). Treatment modality selection varies based on a number of factors, including but not limited to age, activity level, treatment history, and lesion size, location, severity, and etiology. Reestablishing healthy cartilage in pathologic knees is dependent on the recipient's capacity and propensity to heal and regenerate new cartilage. Therefore, this technique is typically conducted in young patients, with small- to medium-sized focal chondral or osteochondral lesions. Osteotomy, unicompartmental knee arthroplasty, and bicompartmental knee arthroplasty do not have the same restrictions and are used for patients with larger, isolated knee lesions. This article reviews indications, efficacy, and advancements of existing surgical techniques for the repair or restoration of knee lesion injuries.
Computer-based Assessment and Classification of Periacetabular Osteolytic Lesions: A New Method
Michele F. Surace, MD., Associate Professor, Department of Reconstructive Sciences and advanced Technology, University of Insubria, Varese, Italy, Alessandro Fagetti, MD, Resident, Department of Reconstructive Sciences and Advanced Technology, University of Insubria, Varese, Italy, Luca Monestier, MD, Resident, Department of Reconstructive Sciences and Advanced Technology, University of Insubria, Varese, Italy, Mario Ronga, MD, Assistant Professor, Department of Reconstructive Sciences and Advanced Technology,University of Insubria, Varese, Italy, Paolo Cherubino, MD, Professor and Chief, Orthopedics Clinic and Department of Reconstructive Sciences and Advanced Technology, University of Insubria, Varese, Italy
PMID:23065802
Although it is currently the gold standard for the treatment of primary and secondary coxarthrosis, total hip arthroplasty is associated with long-time complications, primarily, polyethylene liner wear, and production of debris that lead to peri-prosthetic osteolysis and resultant aseptic mobilization. (The definition of these osteolytic areas is based on a radiographic classification first described by DeLee and Charnley in 1976.) We introduce a new radiographic classification method, based on the well-known measuring software Roman® v.170 (Cook e Poullain [2002-2005, Institute of Orthopaedics, Oswestry, U.K.]) that is designed to quantify radiologic parameters. Two case studies are also described. This original method can be easily employed, and returns a precise angular classification of the position of the osteolytic area and a computerized calculation of the extent of the osteolytic lesion.
Managing Massive Bone Loss after Infected Total Knee Arthroplasty with a Custom-made Spacer
Atul F. Kamath, MD, Clinical Instructor, University of Pennsylvania Department of Orthopaedic Surgery Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, F. Omoleye Roberts, BS, MD Candidate, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Jonathan P. Garino, MD, Attending Surgeon, Department of Orthopaedic Surgery, Pennsylvania Orthopaedic Center, Malvern, Pennsylvania
PMID: 23292671
Periprosthetic infection is an increasingly prevalent and challenging problem in joint reconstruction. We present a technical report of a custom spacer for management of an infected total knee arthroplasty (TKA) and concomitant severe bone loss. The spacer was designed to provide sufficient leg length, soft tissue tension, and limb stability in preparation for ultimate limb reconstruction. This technique and custom spacer serve as an alternative for managing significant bone loss in infected knee arthroplasty.
Treatment of Severe Post-traumatic Bone Defects With Autologous Stem Cells Loaded on Allogeneic Scaffolds
Ettore Vulcano, MD, Orthopedic Surgery Resident, Department of Trauma and Orthopaedic Surgery, Daniele A. Falvo, MD, Orthopedic Surgery Resident, Department of Trauma and Orthopaedic Surgery, Luigi Murena, MD, Assistant Professor of Orthopedics,Department of Trauma And Orthopaedic Surgery, Antonio Rossi, MD, PhD, Microbiologist, The Laboratory of Medical Microbiology, Paolo Cherubino, MD, Chief And Professor of Orthopedics Department of Trauma And Orthopaedic Surgery, Andreina Baj, PhD, Microbiologist, The Laboratory of Medical Microbiology Antonio Toniolo, MD, Chief and Professor of Medical Microbiology University of Insubria Medical School and Ospedale di Circolo E Fondazione Macchi, Varese, Italy
PMID: 23065806
Mesenchymal stem cells may differentiate into angiogenic and osteoprogenitor cells. the effectiveness of autologous pluripotent mesenchymal cells for treating bone defects has not been investigated in humans. We present a case series to evaluate the rationale of using nucleated cells from autologous bone marrow aspirates in the treatment of severe bone defects that failed to respond to traditional treatments.
Ten adult patients (mean age, 49.6-years-old) with severe bone defects were included in this study. lower limb bone defects were ≥5 cm3 in size, and upper limb defects ≥2 cm.3 before surgery, patients were tested for antibodies to common pathogens. treatment consisted of bone allogeneic scaffold enriched with bone marrow nucleated cells harvested from the iliac crest and concentrated using an FDA-approved device. postsurgery clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months. to assess viability, morphology, and immunophenotype, bone marrow nucleated cells were cultured in vitro, tested for sterility, and assayed for the possible replication of adventitious (contaminating) viruses.
In 9 of 10 patients, both clinical and radiographic healing of the bone defect along with bone graft integration were observed (mean time, 5.6 months); one patient failed to respond. no post-operative complications were observed. bone marrow nucleated cells were enriched 4.49-fold by a single concentration step, and these enriched cells were free of microbial contamination. the immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. We detected the replication of Epstein-barr virus in 2/10 bone marrow cell cultures tested. hepatitis b virus, cytomegalovirus, parvovirus b19, and endogenous retrovirus hErV-K replication were not detected. overall, 470 to 1,150 million nucleated cells were grafted into each patient. this case series, with a mean follow-up of almost 2 years, demonstrates that an allogeneic bone scaffold enriched with concentrated autologous bone marrow cells obtained from the iliac crest provides orthopedic surgeons a novel option for treating important bone defects that are unresponsive to traditional therapies.
Prevention and Management of Venous Thromboembolic Disease Following Lower Extremity Total Joint Arthroplasty
Bhaveen H. Kapadia, MD, Orthopedic Research Fellow, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, Kimona Issa, MD, Orthopedic Research Fellow, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, Robert Pivec, MD, Orthopedic Research Fellow, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland Michael A. Mont, MD , Co-Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Associate Professor, Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
PMID: 23292672
Venous thromboembolic disease remains a serious complication following lower extremity total joint arthroplasty. Postoperative thromboembolic complications, which include symptomatic deep vein thrombosis, bleeding, and pulmonary embolus, are recognized causes of patient morbidity, mortality, increased length of stay, and higher healthcare costs. Various thromboprophylaxis guidelines have been recommended to prevent and thereby reduce the incidence of such events. However, despite various studies exploring prophylaxis measures, the incidence of venous thromboembolic events has remained relatively unchanged over the past 10 years. We therefore aimed to: (1) evaluate the current 2011 American Academy of Orthopaedic Surgeons (AAOS) and the 2012 American College of Chest Physicians (ACCP) recommendations concerning venous thromboembolic disease after lower extremity joint arthroplasty; and (2) report on different modalities of prophylaxis, specifically, pharmacological agents, mechanical compression devices, and inferior vena cava filters. Both AAOS and ACCP guidelines recommend a combined approach with mechanical compression devices and pharmacological prophylaxis. A major difference is that the AAOS work group does not recommend specific pharmacological agents, whereas the ACCP guidelines give specific recommendations. Additionally, routine primary thromboprophylaxis with inferior vena cava filters is only recommended when there are contraindications to anticoagulation therapy.
Single-use Cutting Blocks and Trials Lower Costs in Primary Total Knee Arthroplasty
Michael A. Mont, MD, Co-Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Robert Pivec, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Aaron J. Johnson, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Kimona Issa, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
PMID: 23109073
Because total knee arthroplasty is one of the most common orthopaedic procedures, it is important that the medical community continually strive for cost reductions. This prospective controlled trial aimed to determine if cost decreases could be achieved in non-navigated and navigated procedures by replacing traditional saws, cutting blocks, and trials with a specialized single-use system. Costs were lowered by an estimated $140.00-220.00 per surgery as a result of fewer instrument trays being reprocessed, and an estimated $75.00-330.00 per instrument case due to a 10-24-minute time savings during tray rewrapping. This study has positive financial implications for patients, hospitals, institutions, and third-party carriers.
Review: Biomechanical Issues in Total Hip Replacement
Kevin L. Ong, Ph.D., PE, Senior Managing Engineer, Exponent, Inc., Philadelphia, PA, Michael T. Manley, FRSA, PhD, Academic Director, Homer Stryker Center for Orthopaedic Education Mahwah, NJ, Visiting Professor, Department of Biomechanics, University of Bath, Bath, UK, James Nevelos, PhD, Director, Hip Research, Stryker Orthopaedics Mahwah, NJ, Kenneth Greene MD, Professor of Orthopaedic Surgery, Cleveland Clinic Foundation, Akron, OH
PMID: 23023572
During total hip arthroplasty, the biomechanics of the joint may be altered by removal of bone and by a change in the center of rotation of the joint. Joint pathologies existing at the time of reconstruction may also affect post-operative joint motion. In order to achieve optimized biomechanics of the replaced joint, it is important to understand the muscle actions that are involved in joint movement and the forces that are imposed on the construct by patient activity. To ensure survivorship of the replacement, intraoperative and long-term stability of the components making up the joint within host bone must be achieved. The patients receiving total hip replacements in the twenty first century tend to be younger, heavier, more active and longer lived than the patients who first received hip implants. Thus, biomechanical decisions are becoming even more important for long-term survivorship of the reconstruction.
A Simple Tool for the Adjustment of the Guide Wire Position in Hip Resurfacing
Michael Nogler, M.D., M.A., M.Sc., Professor, Department of Orthopaedic Surgery, Unit of Experimental Orthopaedics, Medical University Innsbruck, Austria, David Putzer, M.A., Department of Orthopaedic Surgery, Unit of Experimental Orthopaedics, Medical University Innsbruck, Austria, Eckart Mayr, M.D. Professor, Department of Orthopaedic Surgery Medical University of Innsbruck, Austria
PMID: 23065803
Hip resurfacing is a popular procedure among patients and surgeons. The principal concepts of hip resurfacing are simple, yet demanding, as the procedure has limited tolerance to placement errors, especially for the femoral component. In current technical manuals, the placement of a guide wire seated in the neck is crucial. This guide wire is usually applied by the use of jigs that are intended to align to the neck axis. After evaluating the position of the guide wire, it is necessary to reposition it in many cases. We propose the use of a specially designed readjustment jig that takes advantage of the first guide wire, and gives defined offset and angulations for the placement of a second guide wire. A simple set of disks with different offsets and angulations in relation to a central hole has been developed to serve as a tool to readjust the positioning of the central guide wire in hip resurfacing.
The Dual Radius Hemispherical “Trident”Cup: Results Based on 150 Consecutive Cases
Enrico Bonicoli, MD, Consultant Orthopedic Surgeon, 1st Department of Orthopaedic Surgery, Alessandro Baluganti, MD, Resident, 1st Department of Orthopaedic Surgery, Lorenzo Andreani, MD, Resident, 1st Department of Orthopaedic Surgery, Nicola Piolanti, MD,Resident, 1st Department of Orthopaedic Surgery,
Michele Lisanti, MD, Professor of Orthopaedic Surgery and Chief, 1st Department of Orthopaedic Surgery of Pisa, University of Pisa, Italy
PMID:23109072
Introduction: Initial stability with press-fit cups can be achieved in a number of ways based on the design of the cup. With line-to-line fit, screws fixation, press-fit of 1 to 2 mm which is obtained by an oversized hemispherical cup, initial stability can be achieved with the dual-radius press-fit cups, which have an equatorial diameter 1 to 2 mm greater than that of the polar diameter, to ensure a good press-fit and to provide adequate initial stability for bone ingrowth to occur reliably.
Methods: Between January 2002 and January 2008, 400 total hip replacements (THRs) were carried out. We examined the first 150 consecutive primary THRs. In all hips, the acetabular component was the dual radius Trident ™ AD shell (Stryker Orthopaedics, Mahwah, New Jersey ).
Results: The median duration of follow-up was 6,2 yrs (range, 5 to 7 yrs). The median post-operative Harris Hip Score for 150 hips was 90.5 (range, 51 to 98). At the time of the latest follow-up, there was a bony incorporation of all components; we found no definite evidence of radiographic loosening and no signs of radiolucency.
Conclusion: According to the encouraging.
Bearing Surfaces for Hip Arthroplasty- Is Metal-on-metal a Passing Fancy?
Reginald K. Lee, MS, Senior Research Engineer, Stryker Orthopaedics, Mahwah, NJ, Jim Nevelos, PhD, Research Director, Stryker Orthopaedics, Mahwah, NJ, Jonathan Vigdorchik, MD, Chief Resident, DMC-Providence Orthopaedic Surgery Residency Program Detroit, MI, David C. Markel, MD, Chairman, DMC-Providence Orthopaedic Surgery Residency Program, Chair, Orthopaedic Surgery, Providence Hospital, Detroit, MI
PMID: 23065801
Metal-on-metal bearings have had popularity that has waxed and waned over the years. The advantages realized relative to wear resistance and strength had been offset by early failures, manufacturing difficulty, and most recently by adverse soft tissue responses to the metallic debris. The bearing's history, evolution, advantages and disadvantages will be discussed in attempt to answer the question: is metal-onmetal a passing fancy?
Calcium Sulfate Cement in Contained Traumatic Metaphyseal Bone Defects
Georgios I. Drosos, MD, PhD, Assistant Professor of Orthopaedics, Democritus University of Thrace, Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece, Eleni C. Babourda, MD, Orthopaedic Surgeon, University General Hospital of Alexandroupolis Alexandroupolis, Greece, Athanasios Ververidis, MD, PhD, Lecturer of Orthopaedics,Democritus University of Thrace, Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis Alexandroupolis, Greece, Despoina Kakagia, MD, PhD, Assistant Professor of Plastic Surgery, Democritus University of Thrace, Department of Plastic and Reconstructive Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece, Dionisios-Alexandros Verettas, MD, PhD, MSc(Orth), Professor of Orthopaedics, Democritus University of Thrace, Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
PMID: 23109071
The aim of this study was to evaluate prospective patients with periarticular fractures where a metaphyseal bone defect was grafted with high compressive calcium sulfate cement. The calcium sulfate cement MIIG X3, (Wright Medical Technology, Inc, Arlington, TN) was used in 45 patients with periarticular fractures—distal radial, tibial plateau, humeral head, and calcaneal fractures—to fill the metaphyseal defect. All fractures were treated either with open or closed reduction, fracture fixation, and the cement was applied openly or closed. Radiographs were evaluated for fracture reduction, joint line gap, and step, as well as for rate of graft replacement by bone. All fractures united without an additional procedure. There were no wound infections or other complications attributed to the graft. At three-month follow-up, a complete graft replacement by bone was observed in all fractures. Joint line step was not developed in any patient, but a joint line gap of 3 mm was observed postoperatively in one patient with a tibial plateau fracture. Loss of reduction occurred in one patient with an extra-articular distal radial fracture treated with closed reduction and k-wire fixation. Cement that escaped into the joint or the surrounding soft tissues was not visible at the six-week follow-up. In conclusion, the results of this study confirm the safety and the efficacy of this cement when it is used as graft with the appropriate fixation method in traumatic metaphyseal bone defects.
Titanium Expandable Pedicle Screw for the Treatment of Degenerative and Traumatic Spinal Diseases in Osteoporotic Patients: Preliminary Experience
Roberto Gazzeri, M.D. Consultant Neurosurgeon, Raffaelino Roperto, M.D., Consultant Neurosurgeon , Claudio Fiore, M.D., Consultant Neurosurgeon, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy
PMID:23023577
Osteoporosis is a major global health problem, with over 10 million people currently diagnosed with the disease. Although 80% of osteoporotic patients are women, a considerable number of men are also affected. Also, due to increasing life expectancy, the number of elderly patients with osteoporosis affected by degenerative and traumatic spinal diseases will increase further. Osteoporosis reduces bone quality through negative bone remodelling. Low bone quality can reduce the pull-out strength of pedicle screw, and negative bone remodelling can cause delayed bone fusion. However, pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pull-out, and fixation failure.
Our preliminary study aims to investigate the efficiency of expandable pedicle screws (OsseoScrew® -Spinal Fixation System, Alphatec Spine Inc., Carlsbad, CA) in osteoporotic spinal patients.
All osteoporotic patients with degenerative and traumatic spinal diseases admitted in our department underwent a pre-operative spinal x-Ray and MRI or CT. Pre-operative clinical assesment of patients was based on the visual analog scale (VAS) and Owestry Disability (ODI) questionnaire-a disease-specific outcome measure. Ten osteoporotic patients were treated with expandable pedicle screws (OsseoScrew). Post-operative clinical assessment of patients was based on the VAS and ODI questionnaire at 3 months and 1 year of follow-up. Post-operative radiologic follow-up was performed after 3 days (CT, x-ray); 3 months (xray); 6 months (spinal CT); and 1 year (spinal CT).
Expandable pedicle screws improved pull-out strength as compared to standard pedicle screws in osteoporotic patients with degenerative and traumatic spinal diseases.
A Simple Technique of Accessing the L5-S1 Disc Space for Transforaminal Endoscopic Spine Surgery
Hong-Fei Nie, M.D. Orthopaedic Resident
Department of Orthopaedics, West China Hospital
Sichuan University, Chengdu, China, Jian-Cheng Zeng, M.D., Ph.D. Associate Professor, Department of Orthopaedics
West China Hospital, Sichuan University, Chengdu, China
Kai-Xuan Liu, M.D., Ph.D. Chief Surgeon, Atlantic Spine Center, Edison, New Jersey
PMID: 23292677
Transforaminal endoscopic spine surgery is increasingly used to treat a range of spinal conditions. The success of the surgery requires an accurate insertion of the guide needle and a precise placement of the working cannula and endoscope. However, such a precise placement is challenging for many surgeons to achieve when the pathology is located at the L5-S1 level. On the basis of our years of experience with performing transforaminal endoscopic spine surgery, we have developed a simple technique to help surgeons safely access the L5-S1 level. The technique has been proven intuitive and easy for experienced as well as inexperienced surgeons to learn. The key steps of the technique involve identifying an appropriate entry point on the skin and choosing an accurate trajectory angle for insertion. The purpose of this chapter is to report how to easily identify the entry point and choose a trajectory angle depending on the patient's anatomic characteristics.
