While management of appendicular fractures has been well described in the setting of osteopetrosis, there is limited information on managing fractures of the axial spine. Here we present an osteopetrotic patient with ...While management of appendicular fractures has been well described in the setting of osteopetrosis, there is limited information on managing fractures of the axial spine. Here we present an osteopetrotic patient with multiple traumatic multiple, comminuted, unstable cervical spinal fractures managed with non-operative stabilization, and provide a review of the pathophysiology, genetic characteristics, and special considerations that must be explored when determining operative versus non-operative management of spinal injury in osteopetrosis. A PubMed query was performed for English articles in the literature published up to June 2016, and used the following search terms alone and in combination: "osteopetrosis", "spine", "fractures", "osteoclasts", and "operative management". Within four months after initial injury, treatment with halo vest allowed for adequate healing. The patient was asymptomatic with cervical spine dynamic radiographs confirming stability at four months. On four-year follow up examination, the patient remained without neck pain, and CT scan demonstrated partially sclerotic fracture lines with appropriate anatomical alignment. In conclusion, external halo stabilization may be an effective option for treatment of multiple unstable acute traumatic cervical spine fractures in patients with osteopetrosis. Given the challenge of surgical stabilization in osteopetrosis, further research is necessary to elucidate the optimal form of treatment in this select patient population.展开更多
Arthrodesis of the sacroiliac joint(SIJ) for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoros...Arthrodesis of the sacroiliac joint(SIJ) for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^(?)multidimensional surgical imaging with StealthStation^(?)navigation(Medtronic,Inc.Minneapolis,MN).Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^(?) integrated with StealthStation^(?) allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage(s) packed with autograft and/or allograft were then placed.O-arm^(?) image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.展开更多
In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were ...In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.展开更多
文摘While management of appendicular fractures has been well described in the setting of osteopetrosis, there is limited information on managing fractures of the axial spine. Here we present an osteopetrotic patient with multiple traumatic multiple, comminuted, unstable cervical spinal fractures managed with non-operative stabilization, and provide a review of the pathophysiology, genetic characteristics, and special considerations that must be explored when determining operative versus non-operative management of spinal injury in osteopetrosis. A PubMed query was performed for English articles in the literature published up to June 2016, and used the following search terms alone and in combination: "osteopetrosis", "spine", "fractures", "osteoclasts", and "operative management". Within four months after initial injury, treatment with halo vest allowed for adequate healing. The patient was asymptomatic with cervical spine dynamic radiographs confirming stability at four months. On four-year follow up examination, the patient remained without neck pain, and CT scan demonstrated partially sclerotic fracture lines with appropriate anatomical alignment. In conclusion, external halo stabilization may be an effective option for treatment of multiple unstable acute traumatic cervical spine fractures in patients with osteopetrosis. Given the challenge of surgical stabilization in osteopetrosis, further research is necessary to elucidate the optimal form of treatment in this select patient population.
文摘Arthrodesis of the sacroiliac joint(SIJ) for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^(?)multidimensional surgical imaging with StealthStation^(?)navigation(Medtronic,Inc.Minneapolis,MN).Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^(?) integrated with StealthStation^(?) allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage(s) packed with autograft and/or allograft were then placed.O-arm^(?) image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.
文摘In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.
