Istvan Hovorka

Percutaneous Facet Screw Fixation of Lumbar Spine with CT and Fluoroscopic Guidance: A Feasibility Study

PURPOSE To assess the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous facet screw fixation following anterior lumbar interbody fusion (ALIF) or anterior pseudarthrosis in adults. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this study. One hundred seven consecutive adult patients (46 men, 61 women; mean age ± standard deviation: 56.3 years ± 12.9) with ALIF (n = 79) or anterior pseudarthrosis (n = 28) were prospectively treated by means of percutaneous facet screw fixation with CT and fluoroscopic guidance. Two 4.0-mm cannulated screws were placed per level to fix facet joints by using either a translaminar facet or transfacet pedicle pathway. Only local anesthesia was used during these procedures. Procedural time was noted for each patient. Postoperative follow-up ranging from 1 year to 3 years was assessed by using Macnab and radiologic criteria. RESULTS The mean procedure times for a lumbar single-level and a double-level fusion ranged from 15 to 25 minutes and from 40 to 50 minutes, respectively. All the transfacet pedicle (n = 182) and translaminar facet (n = 56) screws were successfully placed in one attempt. Radiographic fusion was observed within the year following posterior fixation in all patients despite one translaminar screw failure. According to the Macnab criteria, the clinical results were classified as excellent in 92 (86%) and good in 15 (14%) of 107 patients at the time of their last follow-up examination. CONCLUSION This feasibility study showed that CT- and fluoroscopy-guided percutaneous facet screw fixation is a rapid, safe, and effective method.

Foreign body extraction from soft tissue by using CT and fluoroscopic guidance: a new technique

We report on a new minimally invasive technique for the retrieval of a surgical pin fragment after accidental migration into the soft tissue of the shoulder in two patients. The technique is performed under local anaesthesia and uses combined CT and fluoroscopic guidance. The materials used were simple, combining a bone biopsy needle and an endoscopy clamp. Pin displacement was confirmed under fluoroscopic guidance and the clamp was used to withdraw the pin to the cutaneous entry point under CT (step-by-step) guidance. The CT slices provide perfect visualisation of the vascular or nervous structures as well as perfect positioning of the extremity of the trocar relative to the material to be removed. This intervention avoids a second surgical intervention with a longer incision and avoided repeated general anaesthesia.

Peut-on prévoir, avant l'intervention, l'intensité de la douleur postopératoire ?

Resume Cette etude a porte sur l’observation de 86 patients de plus de 18 ans operes d’une epaule dans le service de janvier a septembre 2004 : 23 tenodeses ou ablations de calcification sous arthroscopie, 21 reparations de la coiffe des rotateurs sous arthroscopie, 18 Bankart sous arthroscopie, 17 butees et 7 protheses d’epaule. A l’arrivee en salle de reveil (H0), l’intensite postoperatoire de la douleur, a l’EVA moyenne (de 0 a 100), etait de 44/100 et 1 heure plus tard (H1) de 28/100. Les interventions pour instabilite de type Bankart et les protheses d’epaule etaient les plus douloureuses. A 1 mois, L’EVA moyenne etait encore a 16/100 et 37 % des patients prenaient toujours des antalgiques. A chaque etape, les patients etaient separes en 2 groupes selon le niveau de la douleur postoperatoire forte ou faible. Les donnees etaient saisies et analysees sur le logiciel Statview ® 5.0. Une douleur importante en postoperatoire etait correlee a l’existence d’antecedents chirurgicaux douloureux, a l’anciennete de la douleur, a l’intensite de la douleur preoperatoire, et a un etat depressif.