Surgical treatment of spinal deformities in Marfan syndrome: Long-term follow-up results using different instrumentations

Palmisani, M.; Dema, Eugenio; Rava, Alessandro; Palmisani, Rosa; Girardo, Massimo; Cervellati, S.

doi:10.4103/jcvjs.jcvjs_68_19

Cited by 8 publications

(2 citation statements)

References 25 publications

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“…The latest is nowadays the principal strategy for osteoporotic bone management; numerous studies demonstrate that augmentation can increase the screws' pull out strength in osteoporotic and normal vertebrae in several spine pathologies. [ 5 16 17 18 19 20 ]…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and reliability of cannulated fenestrated screws augmented with polymethylmethacrylate cement in the surgical treatment of osteoporotic vertebral fractures

Coniglio

Rava

Fusini

et al. 2021

Journal of Craniovertebral Junction and Spine

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Background: Implants' stability, especially in osteoporosis patients, is a challenging matter. Nowadays, the adoption of cannulated fenestrated screws augmented with polymethylmethacrylate cement (PMMA CSF) is described by some authors. This single-center, retrospective observational study aims to evaluate the long-term effectiveness, reliability, and mechanical performances of this type of screws in osteoporotic fractures. Materials and Methods: All the patients surgically treated from January 2009 to December 2019 with PMMA CSF were evaluated and submitted to the inclusion and exclusion criteria. Clinical and radiological evaluations were performed at pre- and post-surgery time and at the follow-up (FU). Loss of correction in the sagittal plane (bisegmental Cobb angle), kyphosis angle of the fracture (fractured vertebral angle), loosening of pedicle screws (screw's apex vertebral body's anterior cortex mean gap called SAAC gap and screw's apex vertebral body's superior endplate mean gap called SASE gap), visual analog scale, and Oswestry disability index scores were evaluated. Results: One hundred and sixty-three patients (58 males and 105 females) aged over 65 years affected by vertebral osteoporotic fractures were included in the study. At FU, we do not found significant differences in radiological items in respect to the postoperative period. Only one case of loosening and 18 cases of cement leaking (without neurological impairments) were found. Clinical scores improvement was significant in the interval between preoperative and FU. Conclusions: PMMA CSF seems to can guarantee good efficacy and effectiveness in the surgical treatment of vertebral fractures in osteoporosis.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and reliability of cannulated fenestrated screws augmented with polymethylmethacrylate cement in the surgical treatment of osteoporotic vertebral fractures

Coniglio

Rava

Fusini

et al. 2021

Journal of Craniovertebral Junction and Spine

Self Cite

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“…In addition, hypoplastic pedicles are more frequently sclerotic and the pedicle canal is, therefore, often occluded. In such cases, other fixation methods such as hooks, laminar polyester bands or sublaminar wires are used in place of pedicle screws [ 1 , 16 – 18 ]. Pedicle screws, however, seem to be advantageous in achieving superior curve correction and curve maintenance, illustrating their importance in posterior spinal instrumentation [ 1 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Instrumentation of hypoplastic pedicles with patient-specific guides

Farshad,

Zindel,

Safa

et al. 2024

Spine Deform

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Purpose Hypoplastic pedicles of the thoracolumbar spine (<5 mm diameter) are often found in syndromic deformities of the spine and pose a challenge in pedicle screw instrumentation. 3D-printed patient-specific guides might help overcome anatomical difficulties when instrumenting pedicles with screws, thereby reducing the necessity for less effective fixation methods such as hooks or sublaminar wires. In this study, the surgical feasibility and clinical outcome of patients with hypoplastic pedicles following pedicle screw instrumentation with 3D-printed patient-specific guides were assessed. Methods Hypoplastic pedicles were identified on preoperative computed tomography (CT) scans in six patients undergoing posterior spinal fusion surgery between 2017 and 2020. Based on these preoperative CT scans, patient-specific guides were produced to help with screw instrumentation of these thin pedicles. Postoperatively, pedicle-screw-related complications or revisions were analyzed. Results 93/105 (88.6%) pedicle screws placed with patient-specific guides were instrumented. 62/93 (66.7%) of these instrumented pedicles were defined as hypoplastic with a mean width of 3.07 mm (SD ±0.98 mm, 95% CI [2.82–3.32]). Overall, 6 complications in the 62 hypoplastic pedicles (9.7%) were observed and included intraoperatively managed 4 cerebrospinal fluid leaks, 1 pneumothorax and 1 delayed revision due to 2 lumbar screws (2/62, 3.3%) impinging the L3 nerve root causing a painful radiculopathy. The mean follow-up time was 26.7 (SD ±11.7) months. Complications were only noted when the pedicle-width-to-screw-diameter ratio measured less than 0.62. Conclusion Patient-specific 3D-printed guides can aid in challenging instrumentation of hypoplastic pedicles in the thoracolumbar spine, especially if the pedicle-width-to-screw-diameter ratio is greater than 0.62.

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