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- 저자 : Ruparel Sameer (검색결과 2 건)
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Assessment of Great Vessels for Anterior Access of L5/S1 Using Patient Positioning
Choi John,Rhee Isaac,Ruparel Sameer 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4
Study Design: This was a prospective cross-sectional study.Purpose: The aim was to describe the effect of patient positioning, from supine to lateral decubitus position, on the width of the L5/S1 anterior disk space defined by the great vessels.Overview of Literature: The application of the lateral decubitus position interbody fusion has been rapidly increasing; however, there are concerns regarding the access to the lumbosacral region due to the great vessels, which necessitates further morphometric data.Methods: A total of 20 consecutive live patients awaiting lumbar surgery were subjected to two magnetic resonance imaging scans on the same day in both supine and lateral decubitus positions at a single center to investigate the anterior L5/S1 disk space.Results: The bare anterior L5/S1 disk window was present in all patients of this study population, and the mean width was 27 mm in the supine and 22 mm in the lateral decubitus position, with a mean reduction of 5.2 mm between the positions. The oblique corridor angle was measured at a mean of 33°.Conclusions: The bare window of L5/S1 disk space was present within this population group, and it was found to be mobile and changed significantly with patient positioning. Therefore, the spine surgeon or the access surgeon must consider the increased potential vascular risk during disk access in lateral decubitus anterior lumbar interbody spinal fusion surgery.
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Sarkar Mehul,Maalouly Joseph,Ruparel Sameer,Choi John 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.6
Study Design: This study adopted a retrospective study design.Purpose: This study was designed to describe the fusion rate and technique and patient subjective improvement after sacroiliac (SI) joint fusion using a minimally invasive surgical (MIS) approach.Overview of Literature: The SI joint can mimic radicular or discogenic pain localized to the lower back, gluteal region, or sacral region, posing a challenge in the diagnosis and treatment. This study determines the radiological fusion rate and patient reported subjective clinical outcomes of SI joint fusion using an MIS approach, comparing the use of the Rialto SI joint fusion system (Medtronic, Minneapolis, MN, USA) with the help of the Stealth Navigation System with the use of ExcelsiusGPS Robotic Navigation Platform (Globus Medical Inc., Audubon, PA, USA) using SI-LOK screws (Globus Medical Inc.).Methods: In this retrospective study, 43 consecutive patients who underwent SI joint fusion between August 2017 and February 2020 were enrolled; 60 SI joints were fused. The patients’ fusion was documented on computed tomography or X-rays, and Visual Analog Scale (VAS) scores were used to determine patient subjective clinical outcomes.Results: A total of 60 joints were fused, including 26 joints fused using robotic guidance and 34 joints fused using the Stealth Navigation System. Student <i>t</i>-test was used to compare the mean preoperative VAS score (7.52±1.3) with the mean postoperative VAS score at the 12-month follow-up (1.43±1.22) (<i>p</i><0.05). The SI joint fusion rate using this technique was 61% at 6 months, 96.4% at 12 months, and 100% at 18 months.Conclusions: The use of navigation guidance or robotic assistance enables accurate percutaneous screw placement across the SI joint. The use of bone morphogenetic protein in the screw bore hastens fusion across the joint, improving patient-perceived pain.
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