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Current trend in kyphoplasty for osteoporotic vertebral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Kalliopi Alpantaki, Georgios Vastardis, Alexander G. Hadjipavlou
In the presence of pseudarthrosis, the patients may develop neurological deficit either immediately (in less than 24 hours) or gradually, with an average delay of 37.1 days (range, 3–112 days) postoperatively. Most of these patients required revision by open surgical intervention for treatment of their neurological injury (200). According to a systematic review (66), the reported incidence of neurological deficit ranges from 0, 4% to 23% for PVP, and 1%–5% for PBK.
Orthopaedics and Fractures
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Symptoms are unusual in childhood but become more noticeable with time. Operative treatments are designed at reducing the ‘fracture’ and obtaining fixation across the pseudarthrosis so that it is encouraged to heal. Cosmetic concerns may also lead to surgery.
Cervical Spine Fusion in Rheumatoid Arthritis
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Andrew H. Milby, Harvey E. Smith
The authors offer a detailed description of complications following these complex procedures in a challenging patient population. In total, they report three deaths in the immediate postoperative period, and another six within 2 years postoperatively for an overall mortality of 27% within the study period. They note a 20% (5/25) rate of pseudarthrosis among patients with sufficient long-term follow-up. Difficulties with management of pressure sores, and pin tract drainage in patients with halo immobilization are also discussed. The authors generally conclude that anterior fusions were less successful than posterior procedures, that intraoperative construct stability seemed to correlate with achievement of successful fusion, and that relief of pain was more predictable than improvement in neurologic or functional status. They propose that the largely irreversible nature of the myelopathy observed in this population may prompt a more aggressive approach to surgical stabilization in the presence of radiographic instability.
Lower extremity fractures in patients with spinal cord injury characteristics, outcome and risk factors for non-unions
Published in The Journal of Spinal Cord Medicine, 2018
Lukas Grassner, Barbara Klein, Doris Maier, Volker Bühren, Matthias Vogel
Based on patient characteristics and the univariate analyses, variables (age at time of fracture, sex, SCI level, AIS grade, duration of SCI, time until hospitalization, fracture classification, fracture localization and management) were tested as potential predictors of pseudarthrosis. Significant predictor variables (P > 0.05) were added stepwise to the logistic regression model based on the likelihood quotient. The best model for predicting pseudarthrosis (Nagelkerke R2: 0.537 P < 5.46*10−9) contained the fracture localization (P < 0.0002), fracture classification (P < 0.056), and fracture management (P < 0.036) as independent predictors (Table 4). The model showed significantly increased odds (OR=64.87, P < 0.00006) for pseudarthrosis in patients who sustained a fracture of the proximal femur compared to patients whose fracture was located at the tibia. Regarding fracture classification, the odds ratio for pseudarthrosis was significantly increased for patients with a fracture class B in comparison to class A according to the AO/OTA classification system (OR=5.23, P < 0.028). Additionally, fracture management was a significant predictor of pseudarthrosis with a higher risk for conservatively treated patients (P < 0.036, OR=5.68).
Influence of plate fixation on cervical height and alignment after one- or two-level anterior cervical discectomy and fusion
Published in British Journal of Neurosurgery, 2018
Jaecheon Yu, Yoon Ha, Jun Jae Shin, Jae Keun Oh, Chang Kyu Lee, Keung Nyun Kim, Do Heum Yoon
Pseudarthrosis, defined by non-fusion at 24 months postoperatively, developed in 2.63% of cases (2/76 patients) in group A, 3.66% (3/82 patients) in group B and 2.25% (2/89 patients) in group C. In one patient (group C) with pseudarthrosis, we performed additional posterior screw fixation. For the other 6 patients with pseudarthrosis, we did not perform additional surgery because their neck pain was tolerable. There were four cases of donor-site pain or dysesthesia persisting for more than 1 month, with the pain and numbness subsiding within 4 months. There was no incidence of operative- or donor-site infection. There were two cases of plate-related complications, including plate bending and slight screw dislodgement. Revision surgery was not performed because the displaced screws were integrated into the body of the vertebra by the final follow-up.
Combined massive allograft and intramedullary vascularized fibula transfer: the Capanna technique for treatment of congenital pseudarthrosis of the tibia
Published in Acta Orthopaedica, 2020
Stefanie C M Van Den Heuvel, Hay A H Winters, Klaas H Ultee, Nienke Zijlstra-Koenrades, Ralph J B Sakkers
In order to avoid the drawbacks and discomfort of bone transport or vascularized fibula transfer without adding initial additional stability, we introduced this technique for the treatment of pseudarthrosis in CPT. Paley (2019) recently published the outcomes of his cross-union concept, reporting union in all 17 treated patients without refracturing with his latest technique, with follow-up to 11 years. If these outcomes prove to be reproducible, this will probably make the cross-union technique the gold standard for treating CPT. We report a retrospective case series on the Capanna technique in patients with CPT as reference for future strategies in this disease.