Orthopedic Care and Consultation
Spondylolysis is defined as a bony defect in the pars interarticularis of a vertebral arch.
When this defect is bilateral, the anterior and posterior portion of the neural arch separate. The inferior articular
processes, lamina, and spinous process no longer remain connected to the superior articular processes, pedicles, and vertebral body.
Because of this discontinuity spondylolisthesis may result.
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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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T2 weighted MRI images of patient with dislocation of C6 over C7 vertebra.
MRI Dislocation of Cevical Spine C6 Over C7 Showing Compression Of The Cord
Associated cord injury and compression is visible.
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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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