European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Recently, the sacroiliac joint (SIJ) has gained increased attention as a source of persistent or new pain after lumbar/lumbosacral fusion. The underlying pathophysiology of SIJ pain may be increased mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. ⋯ Recent articles reporting on surgical outcomes of SIJ fusion include a high percentage of patients who had lumbar/lumbosacral fusion or surgery before, although well-controlled clinical studies are necessary to assess the efficacy of surgical treatment. Taking these findings into consideration, the possibility that the SIJ is the source of pain should be considered in patients with failed back surgery syndrome after lumbar/lumbosacral fusion.
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To provide the anatomical basis for the feasibility and clinical practice of lengthened sacroiliac screw fixation, by measuring various related indicators of the safe insertion regions of S1 and S2 lengthened sacroiliac screws. ⋯ (1) There is anatomical feasibility for the placements of S1 and S2 lengthened sacroiliac screws. (2) φ 7.3-mm partial thread cannulated screw (thread length 16 mm) and φ 6.5-mm partial thread cancellous screw(thread length 16 mm) can be used as lengthened sacroiliac lag screw. (3) The safe insertion space of S1 is larger than that of S2. (4) There is safe space for placement of at least one piece of lengthened sacroiliac screw in both S1 and S2. (5) The best/safest entrance points of S1 and S2 can be approximately located with anatomical landmarks.
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The life span of cancer patients has improved due to advancements in cancer management. With long survival periods, more patients show metastatic disease. Osteolytic tumours of spine are generated by metastatic deposits or primary tumours of the spine. A prospective study was performed to evaluate the efficacy and safety of percutaneous kyphoplasty in patients with osteolytic tumours of the thoracic and lumbar spine. ⋯ Kyphoplasty is a suitable palliative treatment option for patients with advanced metastatic disease of the spine even with low Tokuhashi scores allowing rapid pain relief and mobilisation to increase the quality of life.
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Case Reports
A novel "pelvic ring augmentation construct" for lumbo-pelvic reconstruction in tumour surgery.
Reconstructing or augmenting the lumbo-pelvic junction after resection of L5 and part of the sacrum is challenging. Numerous lumbo-pelvic reconstruction methods based on posterior construct and anterior cages have been proposed for cases involving total sacrectomy and lumbar vertebrectomy. These constructs create long lever arms and generate high cantilever forces across the lumbo-sacral junction, resulting in implant failure or breakage. Biomechanical studies have shown that placing implants anterior to lumbo-sacral pivot point provides a more effective moment arm to resist flexion force and improves the ultimate strength of the construct. We present here a novel method to augment a lumbo-pelvic construction using a pelvic ring construct. ⋯ There were no intra-operative complications. At the end of 12 months, she was mobilising with a frame, with no radiological evidence of failure of the construct. However, she died due to disease progression at the end of 15 months. Experience from one clinical case shows that such a construct is feasible and adds a technical option to the difficult reconstruction of lumbo-pelvic junction after tumour surgery.
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The purpose of this study is to evaluate the effects of multilevel balloon kyphoplasty (BK) on blood pressure, blood gases and cement leakage. ⋯ BK performed under general anesthesia appears to be safe when applied in multiple levels in the same seating provided the balloons are inflated sequentially and not simultaneously and the cement is inserted slowly in a very doughy state. Close monitoring of cardiorespiratory factors is valuable. Its rare circulatory effects are unrelated to the number of levels or the cement type.