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Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

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World Journal of Clinical Cases 2013年第1期1卷 4-12页

作者： Marios G Lykissas Alexander Aichmair Department of Orthopaedic Surgery Spine and Scoliosis Service Hospital for Special Surgery Weill Cornell Medical College New York NY 10021 United States

Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into subcategories based on the part of the vertebral column that is addressed(anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or trans-facet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine.

关键词： Spinal arthrodesis Lumbar spine Motionsparing implants Intrebody fusion

Recurrent aneurysmal bone cyst of talus resulted in tibiotalocalcaneal arthrodesis

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World Journal of Clinical Cases 2017年第9期5卷 364-367页

作者： Amir R Vosoughi Kamran Mozaffarian Mohammad A Erfani Bone and Joint Diseases Research Center Department of Orthopedic SurgeryShiraz University of Medical Sciences

Aneurysmal bone cyst(ABC), a locally benign aggressive lytic lesion of either primary or secondary origin, seldom involves the talus. Herein, we present a 25-year-old man with recurrent ABC of the talus after curettage and bone grafting, which was managed by total resection followed by filling the defect using fibular graft and finally tibiotalocalcaneal arthrodesis due to articular surface involvement. At 18 mo postoperatively, no recurrence was detected. arthrodesis might be a good option in cases with recurrent ABC of the talus especially with articular surface involvement.

关键词： Aneurysmal bone cyst Tibiotalocalcaneal arthrodesis Bone tumor Talus

Ankle arthrodesis:A systematic approach and review of the literature

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World Journal of Orthopedics 2016年第11期7卷 700-708页

作者： Youichi Yasui Charles P Hannon Dexter Seow John G Kennedy Hospital for Special Surgery Department of Orthopaedic Surgery 2~(nd) Teikyo University School of Medicine

Ankle arthrodesis is a common treatment used for patients with end-stage ankle arthritis(ESAA). The surgical goal of ankle arthrodesis is to obtain bony union between the tibia and talus with adequate alignment [slight valgus(0°-5°)], neutral dorsiflexion, and slight external rotation positions) in order to provide a pain-free plantigrade foot for weightbearing activities. There are many variations in operative technique including deferring approaches(open or arthroscopic) and differing fixation methods(internal or external fixation). Each technique has its advantage and disadvantages. Success of ankle arthrodesis can be dependent on several factors, including patient selection, surgeons' skills, patient comorbidities, operative care, etc. However, from our experience, the majority of ESAA patients obtain successful clinical outcomes. This review aims to outline the indications and goals of arthrodesis for treatment of ESAA and discuss both open and arthroscopic ankle arthrodesis. A systematic step by step operative technique guide is presented for both the arthroscopic and open approaches including a postoperative protocol. We review the current evidence supporting each approach. The review finishes with a report of the most recent evidence of outcomes after both approaches and concerns regarding the development of hindfoot arthritis.

关键词： Ankle Osteoarthritis arthrodesis Review Ankle fusion

Arthroscopic vs open ankle arthrodesis:A prospective case series with seven years follow-up

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World Journal of Orthopedics 2021年第12期12卷 1016-1025页

作者： Federico Morelli Giorgio Princi Matteo Romano Cantagalli Marco Rossini Ludovico Caperna Daniele Mazza Andrea Ferretti Department of Trauma and Orthopaedics Sapienza University of RomeRoma 00189Italy

BACKGROUND The osteoarthritis of the ankle,although less common than other joints,is associated with severe functional *** options are ankle arthroscopic debridement,osteotomies,ankle arthrodesis and ankle *** arthroplasty is increasingly used thanks to the new implants design,but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open *** To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle *** This study enrolled 23 patients,which underwent ankle *** patients were divided into 2 groups:group A(open procedure;n=11)and group B(arthroscopic procedure,n=12),the two groups were homogeneous with regard to age and body mass index(P=0.347).The American Orthopaedic Foot and Ankle score(AOFAS),Freiburg Ankle score(FAS)and visual analogue scale for pain intensity were evaluated preoperatively,at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B(P=0.364).RESULTS Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS(group A,62.2;group B,78.5;P0.05).Hospital stay was shorter in group B than in group A(P=0.001).More complications were reported in the open group than in the arthroscopic group(P=0.459).CONCLUSION The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years ***,the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.

关键词： Ankle Osteoarthritis arthrodesis Arthroscopy Arthroplasty Surgery

Intraosseous device for arthrodesis in foot and ankle surgery: Review of the literature and biomechanical properties

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World Journal of Orthopedics 2021年第12期12卷 1036-1044页

作者： Biju Benjamin Paul Ryan Yulia Chechelnitskaya Levent Bayam Turab Syed Efstathios Drampalos Department of Trauma and Orthopaedics Forth Valley Royal HospitalLarbert FK54WRScotlandUnited Kingdom Department of Orthopaedic Sakarya UniversitySakarya 54100Turkey

BACKGROUND arthrodesis is the surgical fusion of a diseased joint for the purposes of obtaining pain relief and *** have been numerous fixation devices described in literature for foot and ankle arthrodesis,each with their own benefits and *** To review the use of intraosseous devices in foot and ankle *** There were 9 papers included in the review(6 clinical and 3 experimental studies)all evaluating arthrodesis in the foot and ankle using the IOFIX device(Extremity Medical™,Parsippany,NJ,United States).Outcome scores,union rates,as well as complications were *** IOFIX appears to be safe and effective in achieving arthrodesis of the 1st metatarsophalangeal,and talonavicular joints with early *** comparison to plate/screw constructs there were fewer soft tissue complications and issues of metalwork *** and biomechanical studies on the use of intramedullary fixation for fusion of the tarsometatarsal and ankle joint showed decreased load to failure,cycles to failure and stiffness in comparison to traditional fusion methods using plates and screws,however IOFIX devices produced higher compressive forces at the *** We describe the reasons for which this biomechanical behavior of the intraosseous fixation may be favorable,until prospective and comparative studies with largersample size and longer follow-up confirm the effectiveness and limitations of the method.

关键词： Intra-osseous fixation Foot Ankle arthrodesis Biomechanical IOFIX

Advanced concepts in knee arthrodesis

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World Journal of Orthopedics 2015年第2期6卷 202-210页

作者： Jennifer H Wood Janet D Conway Department of Orthopaedics University of Maryland School of Medicine University of Maryland Medical System International Center for Limb Lengthening Rubin Institute for Advanced OrthopedicsSinai Hospital of Baltimore

The aim is to describe advanced strategies that can beused to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.

关键词： Arthroplasty Knee arthrodesis Nonunion Limb salvage Limb length inequality Infection Osteomyelitis Bone lengthening External fixator

Achieving high union rates after first metatarsophalangeal joint arthrodesis:Radiographic outcomes and technical pitfalls

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World Journal of Orthopedics 2023年第6期14卷 436-442页

作者： Christian von Deimling Timo Tondelli Samuel Brunner Octavian Andronic Alexander David Graf Department of Orthopedic Surgery and Traumatology Bürgerspital SolothurnSolothurn 4500Switzerland

BACKGROUND Fusion of the first metatarsophalangeal(MTP1)joint is a common surgery performed to correct hallux rigidus,hallux rigidus et valgus and other painful degenerative diseases of the *** To assess outcomes of our surgical technique including non-union rates,accuracy and aims of *** Between September 2011 and November 2020 a total 72 of MTP1 fusions were performed using a low profile,pre-contoured dorsal locking plate and a plantar compression *** and revision rates were analyzed with a minimum clinical and radiological follow up of at least 3 mo(range 3-18 mo).The following parameters were evaluated on pre-and postoperative conventional radiographs:Intermetatarsal angle,Hallux-valgus angle,dorsal extension of the proximal phalanx(P1)in relation to the floor and the angle between the Metatarsal 1 and the P1(MT1-P1 angle).Descriptive statistical analysis was *** analysis was used to assess for correlations between radiographic parameters and achievement of *** An overall union rate of 98.6%(71/72)was *** out of 72 patients did not primarily fuse with one patient suffering from a non-union,whilst the other demonstrating a radiological delayed union without clinical symptoms,with eventually complete fusion after 18 *** was no correlation between the measured radiographic parameters and the achievement of *** believe the reason for the non-union was mainly attributed to the patient’s incompliance without wearing the therapeutic shoe leading to a fracture of the ***,we didn`t find any correlation between fusion and the degree of *** With our surgical technique,high union rates(98%)can be achieved using a compression screw and a dorsal variable-angle locking plate to treat degenerative diseases of the MTP1.

关键词： arthrodesis First metatarsophalangeal joint Dorsal plate arthrodesis

Complex ankle arthrodesis: Review of the literature

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World Journal of Orthopedics 2015年第8期6卷 602-613页

作者： Remy V Rabinovich Amgad M Haleem S Robert Rozbruch Department of Orthopaedic Surgery Lenox Hill Hospital Department of Ortho-paedic Surgery Limb Lengthening and Complex Reconstruction Service Hospital for Special Surgery

Complex ankle arthrodesis is defined as an ankle fusion that is at high risk of delayed and nonunion secondary to patient comorbidities and/or local ankle/hindfoot factors. Risk factors that contribute to defining this group of patients can be divided into systemic factors and local factors pertaining to co-existing ankle or hindfoot pathology. Orthopaedic surgeons should be aware of these risk factors and their association with patients' outcomes after complex ankle fusions. Both external and internal fixations have demonstrated positive outcomes with regards to achieving stable fixation and minimizing infection. Recent innovations in the application of biophysical agents and devices have shown promising results as adjuncts for healing. Both osteoconductive and osteoinductive agents have been effectively utilized as biological adjuncts for bone healing with low complication rates. Devices such as pulsed electromagnetic field bone stimulators, internal direct current stimulators and low-intensity pulsed ultrasound bone stimulators have been associated with faster bone healing and improved outcomes scores when compared with controls. The aim of this review article is to present a comprehensive approach to the management of complex ankle fusions, including the use of biophysical adjuncts for healing and a proposed algorithm for their treatment.

关键词： Ankle arthrodesis Ilizarov Reconstruction Salvage

Surgical Management of Lumbar and Thoracolumbar Spinal Fractures: Indications, Surgical Technique and Evaluation on a Series of 64 Patients Treated with Percutaneous Posterior Osteosynthesis Combined with Kyphoplasty or Anterior arthrodesis

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Open Journal of Modern Neurosurgery 2018年第1期8卷 84-100页

作者： Romuald Kouitcheu Drogba Landry N’da Hermann Adonis Diallo Moussa Melot Anthony Troude Lucas Roche Pierre-Hugues Department of Neurosurgery CHU-HOPITAL NORDMarseilleFrance Department of Neurosurgery CHU-YOPOUGONAbidjanIvory Coast

Introduction: Fractures of the lumbar spine and thoracolumbar junction are common in spinal trauma. The aim of this work is to analyze the nature of the indications, the morbidity as well as the results of these treatment regimens. Patients and Methods: A retrospective, single-center study, based on a review of 64 patients with lumbar spine and thoracolumbar junction fractures (T10-L2) without neurological disorders, was collected in the neurosurgery department of the North Hospital and University Hospital (CHU), Marseille over a period of 2 years from January 2015 to December 2016. Posterior percutaneous osteosynthesis were more or less associated with kyphoplasty preceded anterior arthrodesis. Clinical and radiological endpoints were collected at least 6 months later. Results: The mean follow-up was 9.5 months (6 - 24). The clinical evaluation found a mean VAS at last follow-up at 14/100 (0 - 30) and an average Oswestry score at the last follow-up at 88%. The initial average vertebral kyphosis went from 13° to 4° at the last follow-up with a correction loss of 1°, an absolute gain of 8°. No postoperative neurological complications were noted in our series. Conclusion: The implementation of a two-step therapeutic strategy with anterior reconstruction in Magerl’s lumbar spine or A3.3 thoracolumbar junction fractures allows effective and long-lasting correction of lumbar lordosis and thoracic kyphosis, and obtaining a balanced spine in the sagittal plane. Our functional results are close to normal, with low morbidity and a low complication rate.

关键词： Anterior arthrodesis Spine Fracture Kyphoplasty Percutaneous Osteosynthe-sis