scholarly journals Cotrel-Dubousset lumbar spine instrumentation

2021 ◽  
Author(s):  
Henry Knipe ◽  
Mohammad Niknejad
Keyword(s):  
Lumbar Spine ◽  
Spine Instrumentation

scholarly journals Radiographic Accuracy of Percutaneous Pedicle Screw Placement in Fluoroscopic- Versus CT Navigation-Guided Lumbar Spine Instrumentation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Guang-Ting Cong ◽  
Avani Vaishnav ◽  
Joseph Barbera ◽  
Hiroshi Kumagai ◽  
James Dowdell ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Computed Tomography ◽  
Percutaneous Pedicle Screw ◽  
Spine Instrumentation ◽  
Surgical Methods

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

scholarly journals Efficacy of Dexmedetomidine Infusion Without Loading Dose as a Potent Hypotensive Agent in Lumbar Fixation Surgery

2019 ◽  
Vol 13 (1) ◽  
pp. 68-74
Author(s):  
Assem Adel Moharram ◽  
Raham Hasan Mostafa
Keyword(s):  
Lumbar Spine ◽  
Rescue Therapy ◽  
Control Group ◽  
Double Blind Study ◽  
Loading Dose ◽  
Controlled Hypotension ◽  
Hypotensive Agent ◽  
Spine Instrumentation ◽  
Study Results ◽  
Dexmedetomidine Infusion

Background: Dexmedetomidine on the basis of the previous literature can be considered a safe agent for controlled hypotension through its central and peripheral sympatholytic action. Its easy administration and absence of fatal side effect make it a near-ideal hypotensive agent. This study was intended to evaluate the efficacy of dexmedetomidine infusion “without loading dose” as an effective hypotensive agent in lumbar fixation surgery. Methods: In a double-blind study, a total of 60 patients aged 18-65 years, of both genders, belonging to the American Society of Anesthesiologist (ASA) class I - II scheduled for elective lumbar spine instrumentation were included and divided into: Control group (Group C) who received placebo and Dexmedetomidine group (Group D) who received Intravenous (IV) dexmedetomidine. The patients were compared primarily for intraoperative hemodynamics. Results: The study results showed that dexmedetomidine had successfully maintained target mean blood pressure of 65-70 mmHg and only 2 patients out of 30 required rescue therapy (both of propofol and NG). Also, dexmedetomidine had maintained heart rate stability than the control group from the 15th minute after positioning till the end of surgery (P-value < 0.001). Intraoperative fentanyl consumption was significantly low in Dexmedetomidine group 75 ± 25.43 µg versus 169.64 ± 34.26 µg in Control group (P-value < 0.001). Finally, more post-operative sedation was noticed during the 1st postoperative hour in dexmedetomidine group when compared to the control group (P-value < 0.001). Conclusion: Dexmedetomidine infusion without loading dose could be an effective and safe agent in achieving controlled hypotension in adults undergoing elective lumbar spine instrumentation surgery with limited side effects together with intraoperative opioid-sparing effect.

scholarly journals A comparative study between intraoperativelow-dose ketamine and dexmedetomidine, as an anaesthetic adjuvant in lumbar spine instrumentation surgery for the post-operative analgesic requirement

2017 ◽  
Vol 04 (02) ◽  
pp. 091-098 ◽  
Author(s):  
Ranadhir Mitra ◽  
Hemanshu Prabhakar ◽  
Girija Rath ◽  
Parmod Bithal ◽  
Ankur Khandelwal
Keyword(s):  
Lumbar Spine ◽  
Hospital Stay ◽  
Spinal Instrumentation ◽  
Visual Analog Scale Score ◽  
Analgesic Requirement ◽  
Comparable Group ◽  
Treatment Regimens ◽  
Spine Instrumentation ◽  
Inhalational Agent ◽  
Group D

Abstract Background: Spinal instrumentation and fusion surgery presents the anaesthesiologist with multiple issues like intraoperative blood loss, hemodynamic changes, prolonged surgery etc, but the most probing aspect is analgesia. While both ketamine and dexmedetomidine as adjuvants have shown to decrease intraoperative anaesthetics and post operative analgesic consumption but there are no comparative studies. The primary aim of this study was comparison of post-operative analgesic requirements for 1st 24 hours after surgery when either of the drugs was used as adjuvants. Methods: Adult patients aged 18-60 years, of either sex, and ASA status I or II scheduled for elective lumbar spine instrumentation (of 2 or more spinal levels) surgery were enrolled for the study. Patients were randomised into one of the 3 treatment regimens ketamine/group K (0.5mg/kg bolus followed by 250 mcg/kg/h infusion), dexmedetomidine/ group D (0.5mcg/kg bolus followed by 0.5 mcg/kg/h infusion) or the placebo/ group S (saline/placebo). The study drugs were started after turning the patient prone. Data were recorded for intraoperative hemodynamics, anesthetic consumption (inhalational agent and opioids), emergence through RAS scale (Riker sedation agitation scale), PCA (patient controlled analgesia)-fentanyl use and VAS (visual analog scale) score in the 1st 24 hours after surgery. Appropriate statistical analysis was done. Results: A total of 42 patients (14 in each group) were enrolled. The total PCA fentanyl consumed in first 24 hours of surgery was maximum with the group-S (1366.6±382.6 mcg) in compared with group- D (1035.4±391.8 mcg) and group- K (1164.9±503.6 mcg) (P=0.13). The post extubation RAS score was lower in group-K (3.7±0.6) when compared with group-D (4±0.4) and group-S (4.5±0.9) (P=.009). Total intraoperative sevoflurane and fentanyl consumption showed no difference (P=0.19 and P=0.28). VAS score at rest was higher at baseline with group-S (P=0.009). The ICU stay was comparable (group-D: 1.4±0.5 d, group-K: 1.5±0.5 d, group-S: 1.9±0.5 d) among the groups. Hospital stay was also comparable (P=0.09). Conclusion: In patients undergoing lumbar instrumentation surgery, opioid consumption, VAS scores, PCA pump bad demands, inhalational agent consumption, hospital stay were comparable when either ketamine or dexmedetomidine was used as intraoperative anesthetic adjuvants.

The Preemptive Analgesic Effect of Intravenous Ketamine after Lumbar Spine Instrumentation

2000 ◽  
Vol 39 (2) ◽  
pp. 206
Author(s):  
In Ho Lee ◽  
Il Ok Lee ◽  
Tae Hyung Cho ◽  
Myoung Hoon Kong ◽  
Mi Kyoung Lee ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Analgesic Effect ◽  
Spine Instrumentation ◽  
Intravenous Ketamine

Short-segment compression instrumentation for selected thoracic and lumbar spine fractures: the short-rod/two-claw technique

1993 ◽  
Vol 79 (3) ◽  
pp. 335-340 ◽  
Author(s):  
Edward C. Benzel
Keyword(s):  
Lumbar Spine ◽  
Fracture Site ◽  
Spine Fractures ◽  
Short Segment ◽  
Content Type ◽  
Scoliotic Deformity ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine ◽  
Fine Print

✓ The short-rod/two-claw (SRTC) technique of spine instrumentation was recently introduced for the treatment of thoracic and lumbar spine fractures. The use of this technique in 10 patients harboring wedge compression or burst fractures of the thoracic or lumbar spine is described. Of three patients treated with the construct placed in a distraction mode, the average follow-up loss of angle (the difference between the immediate postoperative and follow-up midsagittal angle as measured on x-ray films) was 18.3°. Of the seven patients in whom the instrumentation was placed in a compression mode, the average observed loss of angle at follow-up examination was 1.6°. Two patients had a preoperative scoliotic deformity at the fracture site. and both deformities were exaggerated by the placement of the SRTC technique in compression. Although no patient experienced an adverse outcome and all achieved a solid fusion, the application of the SRTC technique of universal spine instrumentation in distraction was associated with an exaggerated loss of angle. Loss of angle and deformity exaggeration are not desirable and are preventable by strict patient selection and by applying the construct in a compression mode. It is emphasized that few patients are candidates for this form of instrumentation. When applicable. however, the advantages of decreased pain and stiffness and the elimination of the need for instrumentation removal make the SRTC and related short-segment techniques desirable alternatives to traditional methods of spinal fixation.

Spinal motion and intradiscal pressure measurements before and after lumbar spine instrumentation with titanium or PEEK rods

2014 ◽  
Vol 21 (4) ◽  
pp. 651-655 ◽  
Author(s):  
Kingsley Abode-Iyamah ◽  
Sam Byeong Kim ◽  
Nicole Grosland ◽  
Rajinder Kumar ◽  
Muhittin Belirgen ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Intradiscal Pressure ◽  
Pressure Measurements ◽  
Spinal Motion ◽  
Peek Rods ◽  
Spine Instrumentation ◽  
Before And After

Thoracic and lumbar spine instrumentation

2012 ◽  
pp. 206-213
Author(s):  
Edward A. Smirnov ◽  
D. Greg Anderson ◽  
Vincent J. Devlin
Keyword(s):  
Lumbar Spine ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine

The sequential hook insertion technique for universal spine instrumentation application

1993 ◽  
Vol 79 (4) ◽  
pp. 608-611 ◽  
Author(s):  
Edward C. Benzel ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
Erich P. Marchand
Keyword(s):  
Lumbar Spine ◽  
Operative Time ◽  
Deformity Correction ◽  
Insertion Technique ◽  
Content Type ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine ◽  
A New Technique ◽  
Texas Scottish Rite Hospital ◽  
Fine Print

✓ A new technique of universal spine instrumentation insertion for the management of thoracic and lumbar spine instability is presented and the results in 10 patients are described. The technique involves the sequential insertion of Texas Scottish Rite Hospital (TSRH) central-post hooks, followed by hook fixation to the rod; force is then applied with correction of deformity, if needed. This allows for methodical, safe, and rapid instrumentation insertion. The new TSRH central-post hook configuration permits manipulation of the hook/rod relationships to the advantage of the surgeon (and patient) by providing more room for both hook insertion and hook/rod fixation. This technique has reduced operative time, facilitated case of deformity correction, and provided uniformly acceptable early postsurgical results.

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