Introduction
Pedicle screw augmentation of the posterior lumbosacral spine has long been considered the gold standard for rigid three-column fixation. Since the pioneering work of Roy-Camille and colleagues[1], several novel instruments and techniques have emerged which aid in a more reliable construct less tissue destruction and ultimately greater patient satisfaction.
Modern advances in spine surgery in conjunction with a growing desire for less invasive procedures are rapidly propelling the design of instruments and implants to achieve greater posterior spinal fixation, with decreased tissue destruction and higher safety margins [2]. The focus of this paper is to discuss the surgical technique, advantages and disadvantages of
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Incision length was measured at 1.5 inch (Figure 6).
Discharge and follow up
All patients were discharged within hours of completing surgery after being deemed oriented and neurologically intact by the anesthesiologist and operating surgeon. Outpatient postoperative instructions were discussed with all patients and caregivers with written copies provided (Figure 7). Postoperative radiographs done at three weeks demonstrated satisfactory position of the cortical pedicle screw and rod constructs (PSRC) (Figure 8A/B).
Tips and tricks
1. When establishing the starting point, the high speed burr or drill provides more accurate starting points than an awl. Due to the angle of the screw trajectory and the lordotic nature of the lumbar spine, the awl will tend to walk and cause the starting point to be more cephalad than intended. In a patient with aggressive hemilaminotomy or narrow pars, the awl can cause a fracture.
2. For the first few cases, we recommend advancing the drill on oscillate. This allows for increased tactile feedback and reassures the surgeon as the neural elements can not become wrapped around the drill
The clip that was particularly memorable was the story of both Katie Worrick and Michael Rehbein’s hemispherectomy. From a neurological perspective, it was astounding to watch both these children survive and function without a part of their brain and if that wasn’t enough they were functioning remarkably well from a cognitive point of reference. I did wonder at first why Katie was still not speaking, but realized that her surgery was still recent when the documentary was made. Just like Michael, who took about 2 years after surgery to regain some of his speech after persistently working on it, Katie too could hope for the same. Having said that, I am also aware of Neuroscientist Dana Boatman’s conclusion that results and recovery times vary from child to child. I did try to find out more about the two children featured in this documentary to see how much life had improved, but could not find any documented information except for an answer to a blog about hemispherectomy by Katie’s mom that said, “My name is Janie Warrick and I live in Richmond, VA. My daughter, Katie who is now 17, had a left hemispherectomy Aug. 8, 2000 in Baltimore, Maryland at Johns Hopkins
Dr. Tagge, the lead surgeon, finally updated the family over two and a half hours later stating that Lewis did well even though he had to reposition the metal bar four times for correct placement (Kumar, 2008; Monk, 2002). Helen reported wondering if Dr. Tagge had realized how much Lewis’ chest depression had deepened since he last saw him a year ago in the office, especially considering he did not lay eyes on Lewis until he was under anesthesia the day of surgery (Kumar, 2008). In the recovery room, Lewis was conscious and alert with good vital signs, listing his pain as a three out of ten (Monk, 2002). Nurses and doctors in the recovery area charted that he had not produced any urine in his catheter despite intravenous hydration (Kumar, 2008; Monk, 2002). Epidural opioid analgesia was administered post-operatively for pain control, but was supplemented every six hours by intravenous Toradol (Ketorolac) (Kumar, 2008; Solidline Media,
What needs to be assessed is how these full body scans are produced. It is produced through radiation through computed tomography. And, is the amount of radiation that a patient is receiving necessary. Radiation exposure is harmful. According to the FDA website
26-Noble S, Asgar A, Cartier R, Virmani R, Bonan R. Anatomopathological analysis after CoreValve ReValving system implantation.EuroIntervention 2009;5:78–85.
Lantada, Andres Diaz, Pilar Lafont Morgado, Julio Munoz-Garcia, Juan Manuel Munoz-Guijosa, Javier Echavarri Otero, Jose Luis Munoz Sanz, and Raquel Del Valle-Fernandez. “Development of Personalized Annuloplasty Rings: Combination of CT Images and CAD-CAM Tools.” Annals of Biomedical Engineering 38, 2009. 28 March 2011: 280-290.
With ABC recipient site classification surgeons gain some insight in to regenerative potential of the surgical bed and can consider some modifications to help increasing of success rate of bone healing and decreasing morbidities of donor sites.
Moreover, I will let the patient become familiar with any instruments such as a speculum, and demonstrate the tools that will be used to obtain tissue samples that would be used during the examination. Explaining the procedure is also a significant step; this will allow the patient have a sense of control during the examination as we ask and answer questions about their current state, that would help disseminate any concern they may have. Meanwhile, they can learn about what may happen, related to any body sensations or feelings they can experience during the procedure, all while the provider continues to develop rapport and patient’s trust
Potter, J. E., White, K., Hopkins, K., Amastae, J., & Grossman, D. (2010). Clinic Versus Over-
The first projection, an AP projection, was done with the patient’s back against the wall bucky and the
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
...he site of destruction and regrow those damaged cells. This could be a medical breakthrough for many patients because this could mean limited hospital stay; Fewer treatments from reoccurring illness caused by damaged tissue and saving them money by decreasing the need for multiple hospital visits.
An unacceptable reduction and loss reduction were defined as excessive rotation or transla¬tion of bone fragment. Rotational mal-alignment was defined on a lateral radiograph as a 3-mm difference existed in the width of the bone at the fracture site between the proximal and distal fragments (Figure 1). Translational mal-alignment was defined on a lateral radiograph as less than 50% cortical contact existed between the proximal and distal fragments (Figure 2). 8
An edosteal implant is surgically placed in the bone can be used to replace a single or
McIntyre J, Lee J, Trope M, Vann WJ, Permanent tooth replantation following avulsion: Using a decision tree to achieve the best outcome. Pediatr Dent 2009;31(2):137-44.
Marginal integrity has been chosen as the primary outcome measure. Defects and/or gaps at the restoration margins signify poor marginal integrity. The outcome will be measured by modified USPHS (US Public Health Service Guidelines) criteria for direct clinical evaluation [Table 1]. By this the marginal integrity will be scored as Alpha (A), Bravo (B) or Charlie (C) depending on the clinical outcome at baseline followed by every six months for a period of 5 years. The scoring can be done by visual examination along with running an explorer along restoration