Dataset Information

One-Stage Anterior Approach with Arch Plate to Treat Lumbosacral Tuberculosis.

ABSTRACT: This article describes the arch plate technique for treating lumbosacral tuberculosis. Lumbosacral tuberculosis often leads to the destruction of anterior vertebral columns and presacral or iliopsoas abscess, which requires an anterior approach to achieve thorough debridement. Due to the complexity of the anatomical structure of lumbosacral spine and the high requirement of fixation stability, a combined posterior approach to perform internal fixation is necessary, which is rather traumatic. On the other hand, most of the current anterior lumbosacral internal fixation systems cannot be applied to spinal tuberculosis patients who have irregular bony endplate destruction. The arch plate was designed as a cephalic narrow and caudal wide trapezoid or triangle outline according to the preliminary anatomic research. In terms of the endplate bony destruction, a multidirectional technique was introduced in the arch screws, which enables surgeons to arbitrarily change the direction of the screw in the range of 5°-20°, which increases the length and the inclination angles in the sagittal plane of the implant screw and makes sure that the autologous iliac bone graft fits the irregular bone destruction for maximum stability. This study demonstrated the effectiveness of one-stage anterior debridement, bone grafting, and arch plate fixation to treat lumbosacral tuberculosis. The risk of intraoperative and postoperative complications, such as injury to major vessels, could be minimized. This surgical procedure had many advantages, including a shorter operation time, less blood loss, and better functional recovery over the conventional combined anterior and posterior approach.

SUBMITTER: Luo F

PROVIDER: S-EPMC6583719 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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One-Stage Anterior Approach with Arch Plate to Treat Lumbosacral Tuberculosis.

Luo Fei F Zhang Ze-hua ZH Sun Dong D Xu Jian-zhong JZ

Orthopaedic surgery 20151101 4

This article describes the arch plate technique for treating lumbosacral tuberculosis. Lumbosacral tuberculosis often leads to the destruction of anterior vertebral columns and presacral or iliopsoas abscess, which requires an anterior approach to achieve thorough debridement. Due to the complexity of the anatomical structure of lumbosacral spine and the high requirement of fixation stability, a combined posterior approach to perform internal fixation is necessary, which is rather traumatic. On ...[more]

PMID: 26791434

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Project description:BackgroundAnterior plate fusion is an effective procedure for the treatment of cervical spinal diseases but is accompanied by a high incidence of postoperative dysphagia. A zero profile (Zero-P) spacer is increasingly being used to reduce postoperative dysphagia and other potential complications associated with surgical intervention. Studies comparing the Zero-P spacer and anterior plate have reported conflicting results.MethodologyA meta-analysis was conducted to compare the safety, efficacy, radiological outcomes and complications associated with the use of a Zero-P spacer versus an anterior plate in anterior cervical spine fusion for the treatment of cervical spinal disease. We comprehensively searched PubMed, Embase, the Cochrane Library and other databases and performed a meta-analysis of all randomized controlled trials (RCTs) and prospective or retrospective comparative studies assessing the two techniques.ResultsTen studies enrolling 719 cervical spondylosis patients were included. The pooled data showed significant differences in the operation time [SMD = -0.58 (95% CI = -0.77 to 0.40, p < 0.01)] and blood loss [SMD = -0.40, 95% CI (-0.59 to -0.21), p < 0.01] between the two groups. Compared to the anterior plate group, the Zero-P group exhibited a significantly improved JOA score and reduced NDI and VAS. However, anterior plate fusion had greater postoperative segmental and cervical Cobb's angles than the Zero-P group at the last follow-up. The fusion rate in the two groups was similar. More importantly, the Zero-P group had a lower incidence of earlier and later postoperative dysphagia.ConclusionsCompared to anterior plate fusion, Zero-P is a safer and effective procedure, with a similar fusion rate and lower incidence of earlier and later postoperative dysphagia. However, the results of this meta-analysis should be accepted with caution due to the limitations of the study. Further evaluation and large-sample RCTs are required to confirm and update the results of this study.

Project description:Fractures of the clavicle present very common injuries with a peak of incidence in young active patients. Recently published randomized clinical trials demonstrated an improved functional outcome and a lower rate of nonunions in comparison to non-operative treatment. Anterior chest wall numbness due to injury of the supraclavicular nerve and postoperative pain constitute common surgery related complications in plate fixation of displaced clavicle fractures. We recently developed a technique for mini open plating (MOP) of the clavicle to reduce postoperative numbness and pain. The purpose of this study was to analyze the size of anterior chest wall numbness and the intensity of postoperative pain in MOP in comparison to conventional open plating (COP) of clavicle fractures.24 patients (mean age 38.2 ± 14.2 yrs.) with a displaced fracture of the clavicle (Orthopaedic Trauma Association B1.2-C1.2) surgically treated using a locking compression plate (LCP) were enrolled. 12 patients underwent MOP and another 12 patients COP. Anterior chest wall numbness was measured with a transparency grid on the second postoperative day and at the six months follow-up. Postoperative pain was evaluated using the Visual Analog Scale (VAS).Mean ratio of skin incision length to plate length was 0.61 ± 0.04 in the MOP group and 0.85 ± 0.06 in the COP group (p < 0.05). Mean ratio of the area of anterior chest wall numbness to plate length was postoperative 7.6 ± 5.9 (six months follow-up 4.7 ± 3.9) in the MOP group and 22.1 ± 19.1 (16.9 ± 14.1) in the COP group (p < 0.05). Mean VAS was 2.6 ± 1.4 points in the MOP group and 3.4 ± 1.6 points in the COP group (p = 0.20).In our study, MOP significantly reduced anterior chest wall numbness in comparison to a conventional open approach postoperative as well as at the six months follow-up. Postoperative pain tended to be lower in the MOP group, however this difference was not statistically significant.ClinicalTrials.gov NCT02247778 . Registered 21 September 2014.

Dataset Information

One-Stage Anterior Approach with Arch Plate to Treat Lumbosacral Tuberculosis.

Publications

One-Stage Anterior Approach with Arch Plate to Treat Lumbosacral Tuberculosis.

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