Is it safer to place pedicle screws in the lower thoracic spine than in the upper lumbar spine?

Study Design: An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine and the upper lumbar spine using magnetic resonance imaging.

Objectives: To compare the lower thoracic pedicles and upper lumbar pedicles in nondeformity patients as a surrogate measure of safety of pedicle screw use.

Summary Of Background Data: Pedicle isthmic width is the significant limiting factor in the safety and proper placement of transpedicular screws.

A review of quality of life and psychosocial issues in scoliosis.

Study Design: Recent literature regarding the psychological impact of scoliosis was reviewed.

Objective: To determine the impact of scoliosis on health-related quality of life (HRQL), psychosocial functioning, and body image to improve patient outcomes.

Summary Of Background Data: Adolescents and adults with adolescent idiopathic scoliosis have been known to score lower than healthy controls on HRQL measures.

Comparison of the lowest instrumented, stable, and lower end vertebrae in "single overhang" thoracic adolescent idiopathic scoliosis: anterior versus posterior spinal fusion.

Study Design: A retrospective multicenter study.

Objective: To investigate the relationship between the lowest instrumented, stable, and lower end vertebrae in patients with "single overhang" thoracic (main thoracic) curves treated with anterior or posterior spinal fusion.

Summary Of Background Data: Previous studies have shown "saving" fusion levels with anterior spinal fusion, as opposed to posterior spinal fusion; however, to our knowledge, none of these studies evaluated the relative position to the lower end vertebra to compare study groups accurately.

Analysis of iliac crest bone grafting process measures.

Autogenous iliac crest bone graft (ICBG) is the gold standard of materials for spinal fusion. We conducted a prospective observational study of posterior autogenous ICBG harvesting and used process measures to establish a normative database of bone harvesting for future comparative studies and analyses of bone graft substitutes. Between August 2000 and March 2002, we obtained posterior autogenous ICBG from 36 consecutive patients (29 men, 7 women).

Use of fluoroscopy to evaluate iliac screw position.

Iliac screw fixation is often used for long fusions to the sacropelvis. Maximum iliac screw purchase is obtained both by placing the screws within 1.5 cm of the greater sciatic notch and by extending them anterior to the axis of rotation in flexion-extension.

MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience.

Background Context: Patient-based quality of life scales have become a critical element of post-op assessment for lumbar fusion surgery. The most extensive outcomes data have been generated through FDA-regulated IDE trials for new technologies, which produce excellent data but are constrained by strict enrollment criteria and limited indications. This raises a question as to whether the excellent results seen in these IDE trials can be reproduced in standard clinical practice.

Pedicle screw fixation of the thoracic spine: an in vitro biomechanical study on different configurations.

Study Design: An in vitro biomechanical study of different pedicle screw configuration usage on the thoracic spine using a cadaveric model.

Objectives: To investigate the degree of motion afforded different pedicle screw configurations in the thoracic spine using a cadaveric model with 2 different degrees of intrinsic stability.

Summary Of Background Data: Recently, thoracic pedicle screws have become an alternative to hook and wire fixation, and have gained popularity.

Backfill for iliac-crest donor sites: a prospective, randomized study of coralline hydroxyapatite.

We report on a prospective randomized study of coralline hydroxyapatite (CH) used as backfill for iliac-crest donor sites. Autogenous iliac-crest bone graft is routinely harvested for spinal fusion. Donor-site morbidity is underappreciated; the presumption is that donor sites regenerate.

Monaxial versus multiaxial thoracic pedicle screws in the correction of adolescent idiopathic scoliosis.

Study Design: Radiographic outcome analysis following thoracic fusion of Lenke Type I adolescent idiopathic scoliosis (AIS) curves with segmental pedicle screw fixation.

Objective: To compare the correctional capacity of monaxial versus multiaxial pedicle screws in a matched cohort of AIS patients.

Summary Of Background Data: Thoracic pedicle screws provide improved curve correction over hook and wire or hybrid constructs for AIS.

Surgical treatment for the painful motion segment: matching technology with the indications: posterior lumbar fusion.

Study Design: A convenience literature-based review of the different techniques of posterior lumbar fusion.

Objective: To describe the history, specific techniques, and outcomes of different methods of posterior lumbar fusion. The specific methods that were described include 1) uninstrumented posterior, posterolateral, and facet fusion, and 2) instrumented fusion using pedicle screws or facet screws.

Reliability of end, neutral, and stable vertebrae identification in adolescent idiopathic scoliosis.

Study Design: Analysis of radiographic interpretation and vertebral level identification.

Objectives: To assess the intra- and interobserver reliability by observer training level used for selecting the end vertebra (EV), neutral vertebra (NV), and stable vertebra (SV) in adolescent idiopathic scoliosis patients.

Summary Of Background Data: Various radiographic and clinical factors are important in surgical planning.

Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients.

Objective: We retrospectively reviewed the results of 100 consecutive transforaminal lumbar interbody fusions (TLIFs) performed at one institution. The preoperative diagnoses included degenerative disk disease (55), spondylolisthesis (41; 22 isthmic, 19 degenerative), and degenerative adult scoliosis (4). There were 64 single-level, 33 two-level, 2 three-level, and 1 four-level TLIF (140 levels).

Comparison of sagittal contour and posterior disc height following interbody fusion: threaded cylindrical cages versus structural allograft versus vertical cages.

Objective: Segmental restoration of sagittal contour is recognized as critical for improved long-term success following instrumented lumbar fusions. As such, the use of wedged implants has become more popular. Few studies exist to assess the postoperative lordotic and disc height changes following these varied techniques in spinal fusion.

Reliability analysis for digital adolescent idiopathic scoliosis measurements.

Objective: Analysis of adolescent idiopathic scoliosis (AIS) requires a thorough clinical and radiographic evaluation to completely assess the three-dimensional deformity. Recently, these radiographic parameters have been analyzed for reliability and reproducibility following manual measurements; however, most of these parameters have not been analyzed with regard to digital measurements. The purpose of this study is to determine the intra- and interobserver reliability of common scoliosis radiographic parameters using a digital software measurement program.

Thoracic pedicle screw fixation for spinal deformity.

Techniques to improve segmental fixation have advanced the ability to correct complex spinal deformity. The purpose of instrumentation is to correct spinal deformity or to stabilize the spine to enhance the long-term biological fusion. The ultimate goal of spinal deformity surgery is the creation of a stable, balanced, pain-free spine centered over the pelvis in the coronal and sagittal planes.

Thoracic hemivertebra excision in adults via a posterior-only approach. Report of two cases.

Hemivertebrae are a common cause of congenital scoliosis. Depending on their location and the magnitude of the resultant deformity, they may be asymptomatic or require treatment. In the past, treatment has focused on prevention of deformity progression in growing children.

Reliability analysis for manual adolescent idiopathic scoliosis measurements.

Study Design: Manual radiographic measurement analysis.

Objectives: To determine the intraobserver and interobserver reliability of numerous radiographic process measures used in the assessment of adolescent idiopathic scoliosis.

Summary Of Background Data: Analysis of scoliosis requires a thorough radiographic evaluation to completely assess the deformity.

Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees.

Study Design: Retrospective study of large-magnitude thoracic curves (> or =90 degrees ) treated with pedicle screw constructs.

Objective: To evaluate the results of pedicle screw constructs for thoracic curves > or = 90 degrees in terms of sagittal and coronal correction/efficacy, as well as accuracy and safety of thoracic pedicle screw placement.

Summary Of Background Data: Thoracic pedicle screw constructs continue to become increasingly more common; however, the debate continues about the safety and efficacy of these constructs because of their perceived increased risk of neurologic injury and the increased cost of spinal instrumentation.

Advanced medical care for soldiers injured in Iraq and Afghanistan.

War inevitably advances medical knowledge, particularly in the area of orthopedic surgery. This article presents an overview of the types of injuries emerging from the current conflicts in Iraq and Afghanistan, the majority of which are extremity injuries, and the care soldiers are receiving on the battlefield, while being evacuated, and at Walter Reed Army Medical Center. It highlights the Army's use of new therapeutic approaches such as use of methyl methacrylate antibiotic beads, vacuum-assisted closure devices, and new prosthetic technologies.

Disc arthroplasty: lessons learned from total joint arthroplasty.

Background Context: With the rapid emergence of new disc arthroplasty designs and ongoing clinical trials, there is great anticipation among clinicians. Inevitably there will be challenges associated with adoption of this new technology. Potential lessons learned from the extensive experience with extremity arthroplasty may predict some of the perils and pitfalls associated with motion-preserving devices in spinal applications.