Is Proximal Triangular Fixation Better than the Conventional Method in Adult Spinal Deformity Surgery?

In adult spinal deformity (ASD) surgery, one of the key factors working to prevent proximal junctional kyphosis is the proximal anchor. The aim of this study was to compare clinical and radiographic outcomes of triangular fixation with conventional fixation as proximal anchoring techniques in ASD surgery. We retrospectively evaluated 54 patients who underwent corrective spinal fusion for ASD. Fourteen patients underwent proximal triangular fixation (Group T; average 74.6 years), and 40 patients underwent the conventional method (Group C; average 70.5 years). Clinical and radiographic outcomes were assessed using visual analogue scale (VAS) values for back pain and the Oswestry disability index (ODI). Radiographic evaluation was also collected preoperatively and postoperatively. Surgical times and intraoperative blood loss of the two groups were not significantly different (493 vs 490 min, 1,260 vs 1,173 mL). Clinical outcomes such as VAS and ODI were comparable in the two groups. Proximal junctional kyphosis in group T was slightly lower than that of group C (28.5% vs 47.5%, p=0.491). However, based on radiology, proximal screw pullout occurred significantly less frequently in the triangular fixation group than the conventional group (0.0% vs 22.5%, p=0.049). Clinical outcomes in the two groups were not significantly different

Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note

Study design: Technical note. Objectives: To present a novel C-arm-free technique guided by navigation to insert and place a C1 lateral mass screw. Background and Objectives: Atlantoaxial subluxation (AAS) is a relatively common sequelae in patients with rheumatoid arthritis (RA) and upper cervical trauma. If they present with severe symptoms, surgical intervention such as posterior fusion is indicated. The established treatment for AAS is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique) to achieve bony fusion. However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation, we present here a novel C-arm-free C1 lateral mass screw insertion technique for AAS. Materials and Methods: A 67-year-old man was referred to our hospital with neck pain, quadriparesis, and clumsiness and numbness of both upper and lower limbs. He had undergone C3–6 posterior fusion previously in another hospital. In physical examination, he had severe muscle weakness of bilateral upper limbs and hypoesthesia of all four limbs. He had hyper-reflexia of bilateral lower limbs and pollakiuria. His Japanese orthopedic score was 8 points out of 17. Preoperative radiograms showed AAS with an atlantodental interval (ADI) of 7 mm. MRI indicated retro-odontoid pseudotumor and severe spinal cord compression at the C1–2 level. The patient underwent posterior atlantoaxial fixation under navigation guidance. To prevent epidural bleeding during the insertion and placement of a C1 lateral mass screw, we have here defined a novel screw insertion technique. Results: The surgical time was clocked as 127 min and blood loss was 100 mL. There were no complications per-operatively or in the postoperative period. The patient showed almost full recovery (JOA 16/17) at two months follow-up and a solid bony fusion was noticed in the radiograms at one year follow-up. Conclusions: This novel surgical procedure and C1 lateral mas screw placement technique is a practical and safe method in recent advances of AAS treatment. Procedurally, the technique helps prevent epidural bleeding from the screw entry point and also allows for proper C1 screw insertion under navigation guidance without exposing surgeons and staff to the risk of fluoroscopic radiation

Effect of an Adjustable Hinged Carbon Fiber Operating Table on Sagittal Alignment of the Lumbar Spine

This is a prospective study that has been done to assess the lumbar sagittal alignment of patients positioned prone over an adjustable hinged carbon fiber operating table. The following three variations of table position have been considered: neutral, 20° convex, and 20° concave bending. A total of 33 patients who underwent lumbar disc herniation and lumbar canal stenosis surgery were enrolled. Patients who presented with spinal deformity akin to lumbar scoliosis or spondylolisthesis were excluded. For the surgical procedure, following the induction of endotracheal general anesthesia, patients were positioned prone on the adjustable hinged carbon fiber operating table. Radiographs of the lateral view of the lumbar spine were acquired for the three table positions, i.e., neutral, 20° convex, and 20° concave. The lumbar lordosis was measured on radiographs. The lumbar lordosis presented divergently in all three variations of the table (p < 0.01): 45.2 ± 11.0° in neutral; 52.0 ± 10.7° in 20° lumbar extension bending; and 35.9 ± 10.8° in 20° lumbar flexion bending. The efficacy of table bending was 46.5% in convex and 34.0% in concave bending. In conclusion, the lumbar lordosis in three different table positions were 35.9° in 20° convex bending, 45.2° in neutral, and 52.0° in concave bending. The efficacy of table bending was 46.5% in convex and 34.0% in concave bending