Crossed Intralaminar Screws for Fusion of the Cervicothoracic Junction and the Thoracic Spine: The Experience in an Iberic Service with Case Series and Review of the Current Literature with Technique Description

The treatment of pathologies in the thoracic spine is a challenge. The periodic failure of pedicle screw insertion and anatomical variations make the search for an alternative to pedicle screws in thoracic spine surgery necessary. The interlaminar crossed screws is a well-known and secure method for fusion in cervical spine, and in thoracic spine there used to be insufficient clinical data to support this technique, until now. We demonstrate in an initial series of 10 cases treated with interlaminar fusion in association of other fusion techniques in the thoracic spine with good results. Objective: Intralaminar screws have been shown to be a biomechanical salvage technique in the thoracic spine, especially in long cervicothoracic, thoracic and thoracolumbar fixation. The goals of this article are to demonstrate our initial experience and the range of indications for thoracic crossed intralaminar screws. Methods: In this article we describe our initial series performed at S&#227o Teot&#243nio Hospital in Viseu, Portugal, and our results, and also provide a comprehensive review of the recent literature in the use of intralaminar crossed fixation.

Bohlman Technique Using Rialto Sacroiliac Fusion Implant for Treating L5-S1 High Grade Spondylolisthesis. Report of Two Cases

The article begins with a brief biography of H. Bohlman, a great orthopedist and person with strong impact on modern Medicine and Spine surgery. Using original Bohlamn technique with small modifications (instead of fibula graft used Rialto implant and performed posterior fixation L4-S2) we treated surgically two young females with L5 listhesis with success. Methods: Both patients were followed up during 1 year and 9 months and 1 year and 7 months. Results: Two young females of 18 years old with isthmic listhesis L5 were submitted to fixation L4-S2 and transsacral, transdical fusion with Rialto implant by Bohlman technique with partial reduction of listhesis. Both had resolution of the pain and have maintained a good clinical outcome at 1 year and 9 months and another one at 1 year and 7 months follow up. .

Lumbar Synovial Cyst, Literature Review: Challenges of the Surgical Management, the Role of Minimal Invasive Techniques and Endoscopy

The management of symptomatic lumbar synovial cysts is still a challenge and a matter of debate with no existing strong consensus. There are different treatment techniques and strategies, the most debated matter is to fuse or not to fuse, efficiency of less invasive techniques. One of our purposes was to provide an updated review of a literature about treatment of juxta facet synovial cysts and as standard surgical strategies are inconsistent, we present a small series of patients treated using different approaches, most of them were treated with MISS techniques, endoscopy, providing good results.

C1-C2 Goel-Harms Fixation, History of the Technique, Free Hand Technique Description

Objective: Short historical description of the evolution of C1-C2 fixation methods, anatomical tricks and free hand fixation technique description. Method: five patients were operated on using free hand technique, X-rays were only used after the positioning of the patient in the ventral position with Mayfield and at the end before locking the lateral rods. Results: no complications documented, in all the cases CT scans revealed good screw position. Conclusion: Using these landmarks and with a good preoperative planning, it is easy for experienced surgeons to perform the technique in a free hand manner, that avoids X-ray exposure for the whole team and the patient. This technique is not recommended for common use, especially for surgeons with few experiences in this field.