Orthopedic Care and Consultation
Follwing xrays are of thoracolumbar spine of patient with spinal injury. The patient has fracture of D12 vertebra and dislocation of D11 over D12 vertebra.
Here is the AP view
Fracture of D12 Vertebra With Dislocation of D11-D12 AP View
Here is lateral view [Read more...]
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Anterior Instrumentation
Anterior instrumentation and fusion is used in thoracolumbar and lumbar curves. It provides excellent derotation and correction of the curve in the coronal plane.
At some occasions, the deformity correction requires lesser number of motion segments to be fused than if done posteriorly.
For treatment to be effective the thoracolumbar or lumbar curve should be flexible. The thoracic curve should be nonstructural and reducible to 25 degrees or less on the bending films.
The child should be around 9 years of age.
Anterior instrumentation and fusion in thoracic curves is controversial.
In case of thoracolumbar curve, a thoracoabdominal approach is required. However in lumbar curves, a lumbar extraperitoneal approach can be used. Pedicle screws are used to instrument the spine. [Read more...]
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Posterior thoracoplasty is a surgery for correction of rib hump in scoliosis though with newer surgical techniques and newer instrumentation, it is now done rarely.
The procedure is performed in prone position and the approach used is midline posterior. YThe procedure involves cutting of the ribs at the site of deformity.
After the surgery, a a protective plaster shell is applied over the rib resection area to help prevent a postoperative flail chest. This protective shell also helps to minimize pleural effusion by reducing motion of the ribs.
If at two days, there is no evidence of a flail chest and the rib resection gap measures less than the width of the palm of the hand, no prolonged postoperative immobilization is needed. If there is a larger gap or a flail chest, a postoperative rib protector, such as the posterolateral half of a TLSO, is worn for 3 months.
Anterior thoracoplasty also aims at same correction.
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Artificial collagen/hydrogel disc resembles the natural discs more closely as compared to artificial discs available now. Modern artificial spinal discs are commonly made of rigid materials such as metal and plastic, but natural discs are more like a stiff gel, and softer and bouncy.
Cornell researchers have successfully tested artificial discs in a mouse model that are made of collagen and a hydrogel called alginate. The discs were populated with mice’s own cells and the implants actually improved over time as new cells grew within the implant’s matrix. After six months of living with the new discs, the mice retained 80-90% of their implants’ initial height. [Read more...]
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Xray and MRI pictures of dislocation of C4 vertebra over C5. Here is the lateral view of injured spine on xray
Xray showing Cervical Diislocation C4 Over C5 Vertebra
MRI shows the dislocation and a disc compressing on the cord as well. [Read more...]
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Non operative treatment in congenital kyphosis is not effective. The operative treatment depends on the
Type I Deformities
In children less than five years of age and deformity less than 50 degrees a posterior fusion is appropriate. Autogenous bone grafts are preferable but if sufficient graft is not present, allograft bone can be used. [Read more...]
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Damage to spinal cord and subsequent neurological deficit may occur during surgery of spinal cord. Stagnara wake up test aims at recognizing early intraoperative warning of potential damage.
If the injury is recognized, steps can be taken to undo the process that might have caused it. For example if spinal injury signs are found following correction of the curves by distraction of instrumentation rods, the distraction can be reduced.
The Test
This test involves waking the patient during the surgery and asking them to move their feet. [Read more...]
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