Stabilization of the Lower Thoracic and Lumbar Spine with the Internal Spinal Skeletal Fixation System

Aebi, Max; Etter, Christian; Kehl, Thomas; Thalgott, John S.

doi:10.1097/00007632-198707000-00007

Cited by 183 publications

(126 citation statements)

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“…However, the indirect reduction and transpedicular posterior instrumentation is often regarded as the best procedure, since it offers great advantages and less health costs, better quality of life in the rehabilitation T11-T12 1°decrease T12-L1 5°decrease T12-L1 2°decrease L1-L2 2°NM T12-L1 5°decrease L1-L2 7°decrease T12-L1 2°decrease L2-L3 2°NM L1-L2 1°NM T12-L1 7°N L1-L2 6°decrease L1-L2 11°N L2-L3 11°decrease L1-L2 5°decrease L2-L3 2°NM T11-T12 3°N T12-L1 7°N L1-L2 1°NM T12-L1 4°decrease L1-L2 6°decrease T12-L1 4°decrease L1-L2 1°NM L2-L3 6°Decrease T11-T12 4°N T12-L1 6°N L3-L4 13°N T12-L1 0°NM Several studies of radiological follow-up showed some degree of loss in reduction and sagittal alignment achieved with posterior instrumentations [3,15,16,19,27,36,37,38,43,47,52,53]. Due to its biomechanical characteristics, pedicular fixation maintains better reduction than the classic fixation and reduction in three points of the Harrington rods [1,19,32,35,37,52,53,56]. Specifically, the USS internal fixator has proven to be an efficient system for reduction and maintenance of sagittal alignment …”

Section: Discussionmentioning

confidence: 99%

“…Surgical management presents potential benefits including neural decompression, spinal anatomy restoration and inmediate stability, which improves the integral rehabilitation of patients and allows them a rapid return to work [1,19,27,32,34,37,38,43,47,49,52,53]. Historically, most surgical techniques solved the problem of instability by fusion of mobile segments.…”

Section: Introductionmentioning

confidence: 99%

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Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

et al. 2006

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The surgical management of thoracolumbar fractures presents potential benefits. However, the surgery solve the instability by fusion of mobile segments. We incorporate in our treatment algorithms, the use of restricted arthrodesis at injured levels, regardless of longer instrumentations, as well as the use of non-fused transitory stabilizations, based on the conviction that in non-fused segments without traumatic disc injury, mobility persists once the instrumentation is removed. The goals of this study were to compare the mobility of non-fused segments after hardware removal to a normal range of motion and to find prognostic pre-op imaging patterns. We reviewed 21 consecutive patients who underwent surgery with preservation of mobile segments (nonfused segments included in the construction) in order to recover mobility after removal of instrumentation, performed between 1995 and 2001. All patients were treated by indirect reduction with posterior transpedicular instrumentation. Clinical and radiological outcome was analyzed after an average follow-up of 46.6 months. Satisfactory subjective outcome results were obtained in 94.7%. The dynamic radiological follow-up study showed 75% (21 segments) with normal or decreased range of motion (ROM) and 25% (7 segments) without mobility. The non-fused segments with hardware removal before 10 months of evolution presented a normal or decreased mobility in 83.2% while the segments with hardware removal after 10 months showed 68.8% of mobility. The intervertebral disc (IVD)'s with normal initial MRI morphology preserved their mobility in 81.9%. Complications occurred in four patients: two superficial wound infections and two patients presented a late fracture of one USS Schanz. The results of this study prove that in thoracolumbar fractures, non-fused spinal segments included in pedicular instrumentation maintained mobility in a high percentage once the hardware is removed. 75% of the segments presented a normal or decreased ROM.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

et al. 2006

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“…The improvement in positional control of the anterior column by posterior pedicular instrumentation allows reduction of displaced, fractured vertebrae even if the posterior elements are injured [3,34,41]. The ability to restore the normal height of the fractured vertebra by distraction can lead to spinal canal clearance by ligamento-taxis, but bone remodeling with time appears to be a more important factor [51].…”

Section: Spinal Fracturesmentioning

confidence: 99%

“…The ability to restore the normal height of the fractured vertebra by distraction can lead to spinal canal clearance by ligamento-taxis, but bone remodeling with time appears to be a more important factor [51]. In thoracolumbar burst fractures, a thoraco-abdominal approach for an anterior decompression is therefore often not required [3,34,41]. Experimental and clinical studies [40,121] have indicated the requirement for an anterior buttress despite pedicle screw fixation to avoid implant failure and loss of correction.…”

Section: Spinal Fracturesmentioning

confidence: 99%

Pedicle screw fixation in spinal disorders: A European view

1997

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Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near future.

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“…1,18,19 Initially, the corpectomy defect was stabilized with a tricorticate iliac crest graft or ®bular strut allograft. Posterior instrumentation or external immobilization was still necessary to provide reliable stability.…”

Section: Introductionmentioning

confidence: 99%

Four year experience with the AO Anterior Thoracolumbar Locking Plate

Thalgott

Kabins

Timlin³

et al. 1997

Spinal Cord

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For decades spinal surgeons have attempted to design simple, single stage anterior internal ®xation systems for the thoracic and lumbar spine. Early devices presented both biomechanical and technical problems. The AO Anterior Thoracolumbar Locking Plate (ATLP) was designed to solve some of the problems encountered with early anterior instrumentation. The ATLP system is constructed in Commercially Pure titanium. It is a low pro®le device indicated for use for unstable burst fractures in the anterior column; metastatic tumor management; and degenerative diseases of the thoracolumbar spine between levels T10 and L5. Implantation of the device involves direct anterior decompression with sagittal reduction and corpectomy. This is followed by grafting reconstruction, and plate ®xation. This device has been implanted in 25 patients with an average follow-up of 38 months. There were ®ve (5) broken screws in three (3) patients, and no broken plates. Implant related postoperative complications included two misplaced screws. Preliminary results indicate that the ATLP system seems to be a safe, low pro®le, MRI/CT compatible device that provides de®nitive single stage ®xation of the anterior spinal column.

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Stabilization of the Lower Thoracic and Lumbar Spine with the Internal Spinal Skeletal Fixation System

Cited by 183 publications

References 0 publications

Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

Pedicle screw fixation in spinal disorders: A European view

Four year experience with the AO Anterior Thoracolumbar Locking Plate

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