Orthopaedic surgery
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Orthopaedic surgery · Feb 2014
Does spinal alignment influence acetabular orientation: a study of spinopelvic variables and sagittal acetabular version.
Although hip alignment and spinal alignment have been studied individually, there is little information concerning the relationship between them. The questions addressed in this study are: (i) Is there a reproducible measure of sagittal plane acetabular orientation; (ii) Is sagittal plane acetabular orientation determined more by pelvic incidence (PI) or acetabular wall coverage? ⋯ Sagittal acetabular orientation is related to spino-pelvic balance and morphological characteristics. Increased PI or posterior wall coverage corresponds to a more vertical acetabular orientation. Sagittal plane acetabular alignment may be an important variable in achieving favorable results after reconstruction.
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Orthopaedic surgery · Feb 2014
The "TFP" fusion technique for posterior 360° lumbar fusion: a combination of open decompression, transforaminal lumbar interbody fusion, and facet fusion with percutaneous pedicle screw fixation.
Because degenerative spondylolithesis is prevalent in the elderly with associated osteoporosis, the rate of failure of pedicle screws is high; this leads to pseudoarthrosis and potentially requires reoperation. The burden of recurrent symptoms and reoperation is sufficiently significant to warrant prevention. We here describe a hybrid technique that involves a combination of a unilateral approach to bilateral decompression via a midline incision, transforaminal lumbar interbody fusion (TLIF), contralateral facet fusion, and percutaneously placed pedicle screws without compromising operative time and visualization. ⋯ Percutaneous pedicle screws are inserted under stereotactic guidance with reduction of the deformity using a pedicle screws construct. Rods are inserted percutaneously to link the pedicle screws. Image intensification is used to confirmed satisfactory screw placement and reduction of the spondylolisthesis.