Iulian Popa

Utility of the pedicle subtraction osteotomy for the correction of sagittal spine imbalance.

IntroductionPedicle substraction osteotomy (PSO) in the lumbar spine is indicated in the treatment of large sagittal deformities of the lumbar spine. Substantial complications associated with PSOs include pseudarthrosis and mechanical failure. The purpose of the present study was to assess the complications of this procedure and the causes of mechanical complications.Material and methodsFifteen patients aged between 38 and 79 years (mean age 63.8±12.82) were operated on between June 2011 and September 2014 for sagittal imbalance by means of one-level PSO. Pre-operative and post-operative values of radiological spino-pelvic sagittal parameters were measured. Clinical and radiological evaluations were conducted pre-operatively and post-operatively at six months and one year. Clinical evaluation included intra- and post-operative complications.ResultsMean pelvic incidence was 54.86 ± 11.82°. Lumbar lordosis (LL) was measured to be 12.26 ± 18.48° pre-operatively and increased to 42.73 ± 14.05° post-operatively (p< 0.05). Mean gain of lordosis after PSO at index level was calculated to be 28 ± 11° (range, 14–41). SVA decreased post-operatively from 93.46 ± 36.69 mm to 61.73 ±38.68 mm (p< 0.05). Several complications (n = 8), including two minor (one dural tear with no clinical consequences and one transient radicular deficit) and six major with re-intervention, were observed in our series.DiscussionsOptimal post-operative correction in the sagittal plane: SVA <50 mm, LL= –(PI+10°) is an important parameter to reduce the risk of developing sagittal decompensation which is a common condition after PSO. Rate of complications after PSO is not negligible in the literature up to 45%.ConclusionsThe main cause of mechanical complications was insufficient sagittal correction. To limit the risk of mechanical complications and to achieve a good sagittal balance, PSO must be associated with additional SPOs or a second corrective surgery to obtain a solid anterior fusion.

Cement Filling of Contained Defects from Bone Tumor Resections

The management of bone defects of the extremities has important particularities. Patients prefer limited procedures when facing with complex reconstructions and each filling option has benefits and disadvantages. We aimed to present our short and long term results with small contained bone defects after tumoral resections filled with different types of cement. Over a period of five years we identified ten cases that were operated in our service and met the inclusion criteria: contained bony defects following intralesional or marginal tumoral resections of the lower limb (weight bearing extremity skeleton) with a minimum of one year of follow-up. The most important finding of our study is that polymethylmethacrylate cement filling of contained bony defects after tumoral resections is the only one that allowed for immediate postoperative weight bearing. In addition, the bone cement interface proved stable as far as two years after the surgery. The cases described can contribute to a greater understanding when searching for solutions targeted on filling contained bone defects after intralesional resections. Polymethylmethacrylate cement proves to be a validated, versatile and safe procedure but future perspectives already show good outcomes with new osteoinductive components.

Intraoperative conjoined lumbosacral nerve roots associated with spondylolisthesis

Lumbosacral nerve roots anomalies may produce low back pain. These anomalies are reported to be a cause for failed back surgery. They are usually left undiagnosed, especially in endoscopic discectomy techniques. Any surgery for entrapment disorders, performed on a patient with undiagnosed lumbosacral nerve roots anomaly, may lead to serious neural injuries because of an improper surgical technique or decompression. In this report, we describe our experience with a case of L5–S1 spondylolisthesis and associated congenital lumbosacral nerve root anomalies discovered during the surgical intervention, and the difficulties raised by such a discovery. Careful examination of coronal and axial views obtained through high-quality Magnetic Resonance Imaging may lead to a proper diagnosis of this condition leading to an adequate surgical planning, minimizing the intraoperatory complications.

Percutaneous Transpedicular Vertebroplasty versus Conservative Management in Osteoporotic Vertebral Fractures

Osteoporotic vertebral fractures can lead to late collapse which often cause kyphotic spinal deformity, persistent back pain, decreased lung capacity, increased fracture risk and increased mortality. The purpose of our study is to compare the efficacy and safety of vertebroplasty against conservative management of osteoporotic vertebral fractures without neurologic symptoms. A total of 66 patients with recent OVF on MRI examination were included in the study. All patients were admitted from September 2009 to September 2012. The cohort was divided in two groups: first study group consisted of 33 prospectively followed consecutive patients who suffered 40 vertebral osteoporotic fractures treated by percutaneous vertebroplasty (Group 1), and the control group consisted of 33 patients who suffered 41 vertebral osteoporotic fractures treated conservatory because they reffused vertebroplasty (Group 2). Vertebroplasty with PMMA was performed in 30 patients on 39 VBs, including four thoracic vertebras, 27 vertebras of the thoracolumbar jonction and 8 lumbar vertebras. In the Group 2 were included 30 patients with 39 OVFs (four thoracic vertebras, 23 vertebras of the thoracolumbar junction and 11 lumbar vertebras). In our study on OVF, vertebroplasty delivered superior clinical and radiological outcomes over the first year from intervention when compared to consevative treatment of patients with osteoporotic compression fractures without neurological deficit.

New Surgical Option in Correction of Scoliotic Seformity – LSZ System

Introduction Between 2004-2006 in Moscow at the Russian University of People’s Friendship Department of Orthopaedic and Traumatology under the lead of Alexandr Laka, there have been created more new instruments, which allowed individualised treatment for each scoliotic patient.Case outline The case that we bring to your attention belongs to the patients group to which the deformation practically reached it’s final form. The patient is known with dextroconvex thoraco-lumbar idiopathic scoliosis that set out at the age of 11 years. Despite a long physical treatment, the deformity progressed reaching by the time she addressed to us, a critical stage with a 90º Cobb angle and 45º rotation at T9 apical vertebrae. Surgery was performed by using LSZ implant for correction of scoliotic deformity. The surgical technique is described step by step and the final result was a good tridimensional correction. Postoperatory X-Ray demonstrates 50% correction, with Cobb angle of 45º and 15% torsion correction.Conclusion The good result obtained in the case described, as well as in the studies published in literature, demonstrates that this technique is efficient for correction of scoliotic deformities both in frontal and sagittal plane, easy to perform and associated with a minimal risk for complications and encourage us to recommend this technique to other spine surgery departments.

Circumferential Decompression with Posterior Instrumentation and Fusion by Lateral Extracavitary Approach – Effective Solution Aiding the Treatment of Infectious Spondylodiscitis

The goal of this study is to assess the efficacy of one-stage surgical management for infectious spondylodiscitis by circumferential decompression with posterior instrumentation and fusion by lateral extracavitary approach. Between March 2010 and June 2012, 7 cases with bacterial spondylodiscitis were treated with one-stage circumferential decompression with posterior instrumentation and fusion. All cases were followed-up for an average of 11.3 months (range 6-18 months). The average preoperative kyphosis was 13° (range 9-29°), and the average postoperative kyphosis was 8° (range 3-18°). At final follow-up, minimal progression of kyphosis was seen, with an average kyphosis of 12° (range 4-22°). An average loss of correction of 4° was seen at final follow-up. One-stage surgical management for spondylodiscitis by circumferential decompression with posterior instrumentation and fusion was feasible and effective.