Injury
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Retrospective review of a series of patients who underwent spinal surgery at a single spine unit during a 1 year period. ⋯ Incidental durotomy is a common complication of spine surgery. All incidental durotomies must be repaired primarily. Dural tears that were immediately recognised and treated accordingly did not lead to any significant sequelae at a mean follow-up of 37 months. However, long-term follow-up studies will be needed to confirm this finding. The risks associated with dural tears and cerebrospinal fluid leaks are serious and should be discussed with any patients undergoing spine surgery.
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Randomized Controlled Trial
The application of a computer-assisted thermoplastic membrane navigation system in screw fixation of the sacroiliac joint--a clinical study.
We inserted iliosacral screws with the aid of a computer-assisted thermoplastic membrane navigation (CATMN) system which is widely used for the accurate and repeatable location tumour in radiation therapy. We hypothesised that application of the CATMN system on IS screws' insertion will provide a superior result to conventional fluoroscopic imaging with less operative time, more accuracy and lower complication rates. ⋯ Application of CATMN system has high accuracy in treating sacroiliac joint dislocations and provides a new alternative method for guidance of the IS screw placement.
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Comparative Study
Combined posteroanterior fusion versus transforaminal lumbar interbody fusion (TLIF) in thoracolumbar burst fractures.
The optimal treatment strategy for burst fractures of the thoracolumbar junction is discussed controversially in the literature. Whilst 360° fusion has shown to result in better radiological outcome, recent studies have failed to show its superiority concerning clinical outcome. The morbidity associated with the additional anterior approach may account for these findings. The aim of this prospective observational study was therefore to compare two different techniques for 360° fusion in thoracolumbar burst fractures using either thoracoscopy or a transforaminal approach (transforaminal lumbar interbody fusion (TLIF)) to support the anterior column. ⋯ The smaller donor-site morbidity in the posteroanterior group is counterbalanced by an additional morbidity associated with the anterior approach resulting in similar clinical outcome. Mastering both techniques will allow the spine surgeon to be more flexible in specific situations, for example, in patients with neurological deficits or severe concomitant thoracic trauma.
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Traumatic spinopelvic dissociation is a rare high-energy injury pattern, characterised by a transverse sacral fracture in conjunction with bilateral sacral fracture-dislocations. It has a high incidence of neurological complications. The true nature of the injury is easily missed and diagnosis is delayed because it commonly presents in patients with severe associated injuries. ⋯ There is no single treatment paradigm and various surgical strategies have been described in the literature. Lumbopelvic fixation or triangular osteosynthesis has recently been recommended by several authors to restore stability at the lumbosacral junction. This article presents a review of the incidence, clinical evaluation, treatment methods and outcomes of this injury pattern.