The spine journal : official journal of the North American Spine Society
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Comparative Study
Less invasive posterior fixation method following transforaminal lumbar interbody fusion: a biomechanical analysis.
Current surgical trends increasingly emphasize the minimization of surgical exposure and tissue morbidity. Previous research questioned the ability of unilateral pedicle screw instrumentation to adequately stabilize posterior fusion constructs. No study to date has addressed the effects of reduced posterior instrumentation mass on interbody construct techniques. Unilateral surgical exposure for transforaminal lumbar interbody fusion (TLIF) allows ipsilateral pedicle screw placement. Theoretically, percutanous contralateral facet screw placement could provide supplemental construct support without additional surgical exposure. ⋯ All tested TLIF constructs with posterior instrumentation decreased segmental range of motion and increased segmental stiffness. While placing unilateral posterior instrumentation decreases overall implant bulk and dissection, it allows for significantly increased segmental range of motion, less stiffness, and produces off-axis movement. The technique of contralateral facet screw placement provides the surgical advantages of unilateral pedicle screw placement with stability comparable to TLIF with bilateral pedicle screws.
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Posterior spinal procedures through tubular exposures have been described. However, tubes restrain visibility and require co-axial instrument manipulation, increasing difficulty and potentially compromising surgical results. An independent-blade retractor system overcomes the obstacles of working through a tube and has been used to perform minimally-disruptive decompression and instrumented tranforaminal lumbar interbody fusion (TLIF). ⋯ Minimally-disruptive decompression and instrumented TLIF can be performed in a safe and effective manner using an independent-blade retractor system. Relative to traditional-open techniques, surgical goals can be accomplished, but with the benefits of minimally-disruptive surgery.
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Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. ⋯ Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.