conclusions V. Rossmanov, S. Todorov, I. Palev University of Medicine - PLEVEN Spine Expert Group Meeting – SOFIA 2008 Anterior reconstructive.

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Presentation transcript:

conclusions

V. Rossmanov, S. Todorov, I. Palev University of Medicine - PLEVEN Spine Expert Group Meeting – SOFIA 2008 Anterior reconstructive corporodesis for the treatment of posttraumatic toracolumbar kyphosis V. Rossmanov, S. Todorov, I. Palev University of Medicine - PLEVEN

I N D I C A T I O N S 1. “Burst “ Fx with posterior displacement of fragment in the spine canal. 2. More than 15 days from the incident. 3. Post laminectomy destabilization. 4. Deficient anterior bone stock in burst Fx. 5. Late kyphotic deformity with Sagital index > 25°. 6. After conservative treatment of old Fx of the posterior wall (on AP X-ray there is lateral tilt of the subchondral plate) and prominent vertebral syndrom.

APPROACHES /Levels: L2,L3,L4/ THORACO-PHRENO- /Levels: Th11- L1/ LUMBOTOMIES /Levels: L2,L3,L4/ THORACO-PHRENO- /Levels: Th11- L1/ THORACOTOMIES / Proximal to Th11/

MATERIAL AND METHODS Study period 1992 - 2008: 86 anterior corporodesis were performed including 46 thoracophrenolumbotomies (Th11-L1). 26 patient are included in the study. Average follow-up is 9.4 years (min. 1 y – max. 16 y). Mean age at surgery was 38 years. Male /Female ratio – ♂ 59 (69%) : ♀ 27 (31%). All corporodesis included only one level (monosegmental). In 9 cases simultaneous anterior and posterior surgery was performed.

MATERIAL AND METHODS Standard prophylaxis for DVT. Preoperative antibiotic prophylaxis. Standard prophylaxis for DVT. Mean intraoperative blood loss – 130 ml. Average surgical time – 1. 45 h. Average postoperative stay – 7 days. Average stay in reanimation unit (thoracic drain) – 60 h.

MATERIAL AND METHODS and experienced scrub nurses. The operative team – ortopaedic surgeons, anesthesiologist and experienced scrub nurses. Neurological evaluation – according to Frankel. Procedure – revision, decompression, reduction, stabilization, ostheoplasty with tricortical graft from crista iliaca and from resected rib.

POSITIONING OF THE PATIENT OPERATIVE TECHNIQUE POSITIONING OF THE PATIENT PRONE POSITION

APPROACHES /Levels: L2,L3,L4/ THORACO-PHRENO- /Levels: Th11- L1/ LUMBOTOMIES /Levels: L2,L3,L4/ THORACO-PHRENO- /Levels: Th11- L1/ THORACOTOMIES / Proximal to Th11/

I M P L A N T S Cotrel – Dubousset CD dorsal instrumentation /from 1991 till 1998/ 26.09.1996

I M P L A N T S SPINAL Instrumentation “NERO” /from 2002 till 2008/

I M P L A N T S XIA ANTERIOR SYSTEM /STRYKER/