http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
Tandon Vikas,Kalidindi Kalyan Kumar Varma,Pacha Sandesh,Bhat Mohd Rafiq 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3
Study Design: Prospective case study.Purpose: Osteoporotic spine fixation by pedicle screw instrumentation is complicated by screw loosening, migration, or pullout with rates of up to 62% documented in the literature. Contemporary solutions have not adequately addressed these complications. We propose a modified surgical technique of cement augmentation with bicortical pedicle screw fixation to address the issue related to implant failure in osteoporotic spine.Overview of Literature: Zindrick and his colleagues described a “windshield wiper” effect owing to the shift of center of rotation to the distal tip of the screw in the bicortical purchase of screws. An increase in pullout strength from 119% to 250% with polymethyl methacrylate augmentation has been documented in the literature. This technique has not been described in the literature.Methods: A prospective study was conducted with 40 patients who underwent surgery by the modified technique. Intraoperative and postoperative complications directly related to the procedure were assessed. Improvement in pain and functional status were assessed. Follow-up radiographs were assessed to check for appreciable screw migration, loosening, or pullout.Results: This technique was used in inserting 364 screws in 40 patients. We did not encounter any difficulty in inserting the screws. A total of 19 screws failed to breach the anterior cortex owing to an error in measurement. There were no complications during the procedure in any of the patients, and the postoperative period was uneventful. The mean follow-up period was 18 months. There were two patients in whom proximal junctional failure with kyphosis was noted during follow-up, who were surgically managed by extension of the fixation levels.Conclusions: Bicortical fixation with cement augmentation is a technically feasible, safe, and effective technique to augment the strength of pedicle screws in osteoporotic spine fixation. It has the potential to be established as a standard of care in osteoporotic spine fixation.
Kalidindi Kalyan Kumar Varma,Bansal Kuldeep,Biswas Gourab,Gupta Anuj,Vishwakarma Gayatri,Tandon Vikas,Chhabra Harvinder Singh 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.2
Study Design: Retrospective case-control study. Purpose: This study aimed to analyze the radiological and clinical outcomes of transpedicular decompression in spinal tuberculosis (or Pott’s spine) with and without anterior reconstruction using polyetheretherketone (PEEK) or mesh cage. Overview of Literature: The outcomes of transpedicular decompression with and without global reconstruction in Pott’s spine are insufficiently investigated. Additionally, the use of PEEK cages in Pott’s spine has remained unestablished. Methods: Using the hospital records and imaging database obtained from January 2014 to January 2020, this study retrospectively analyzed patients who underwent surgery for Pott’s spine and met the eligibility criteria. Results: This study included 230 patients with a mean±standard deviation age of 47.7±18.1 years (109 males, 121 females). The Visual Analog Scale score, Oswestry Disability Index, and Cobb angle were significantly improved in these patients (p<0.001). Patients who underwent anterior reconstruction had a greater correction in Cobb angle postoperatively (p=0.042) but also had a greater blood loss (p=0.04). During the follow-up, they experienced a significant loss of correction compared with those who only underwent transpedicular decompression (p=0.026). Nevertheless, patients who underwent anterior reconstruction using mesh/PEEK cages showed no significance difference in the clinical or radiological outcomes. Conclusions: Transpedicular decompression used in the surgical management of Pott’s spine showed favorable clinical and radiological outcomes. The additional use of anterior reconstruction obtained equivalent clinical outcomes but resulted in excessive blood loss. Meanwhile, the use of mesh/PEEK cage for anterior reconstruction did not affect the clinical and radiological outcomes.