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1

Manek, Filip, Petr Marcián, Zdeněk Florian, Jiří Valášek, and Veronika Ebringerová. "Biomechanical Study of Lumbar Spinal Fixation Device." Applied Mechanics and Materials 232 (November 2012): 142–46. http://dx.doi.org/10.4028/www.scientific.net/amm.232.142.

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This article is focused on computational modeling of an interaction of malleable lumbar spine fixation device with ambient bone tissue focusing on solving problems of clinical practise. It describes creation of computational model including model of geometry, materials, loads and constraints. There is a comparative stress strain analysis of spinal segment after fixation device application with its physiological state. Computations are performed with use of FEM method. To simulate natural way of loading we used the compression of motional spinal segment. Results show the difference between the system including intervertebral disc in between vertebras and the system with applied lumbar spinal fixation device.
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2

Perrin, Richard G., and Robert J. McBroom. "Spinal Fixation after Anterior Decompression for Symptomatic Spinal Metastasis." Neurosurgery 22, no. 2 (1988): 324–27. http://dx.doi.org/10.1227/00006123-198802000-00008.

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Abstract Surgical strategies for the treatment of symptomatic spinal metastases must take into account both decompression of the spinal cord and stabilization of the spinal column. A method is described for securing spinal stabilization in patients who have undergone surgical decompression for symptomatic spinal metastases by an anterior approach. The fixation device used is a tailor-made prosthesis consisting of a U-shaped stainless steel plate permitting screw fixation to secure axial and rotational stability with an interposed methyl methacrylate strut to provide axial strength and support. The device has been used successfully in 51 patients who have undergone anterior decompression procedures for symptomatic spinal metastases. (Neurosurgery 22:324-327, 1988)
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3

Mohanty, Mira, Sulekha Baby, and K. V. Menon. "Spinal Fixation Device: A 6-Year Postimplantation Study." Journal of Biomaterials Applications 18, no. 2 (2003): 109–21. http://dx.doi.org/10.1177/088532803034746.

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4

Rohlmann, Antonius, Georg Bergmann, and Friedmar Graichen. "Loads on an internal spinal fixation device during walking." Journal of Biomechanics 30, no. 1 (1997): 41–47. http://dx.doi.org/10.1016/s0021-9290(96)00103-0.

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5

Rohlmann, Antonius, Ulrike Arntz, Friedmar Graichen, and Georg Bergmann. "Loads on an internal spinal fixation device during sitting." Journal of Biomechanics 34, no. 8 (2001): 989–93. http://dx.doi.org/10.1016/s0021-9290(01)00073-2.

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6

Rohlmann, A., G. Bergmann, and F. Graichen. "An instrumented spinal skeletal fixation device for load measurements." Journal of Biomechanics 24, no. 6 (1991): 478. http://dx.doi.org/10.1016/0021-9290(91)90120-c.

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7

Rohlmann, A., G. Bergmann, and F. Graichen. "A spinal fixation device for in vivo load measurement." Journal of Biomechanics 27, no. 7 (1994): 961–67. http://dx.doi.org/10.1016/0021-9290(94)90268-2.

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8

Rohlmann, Antonius, Friedmar Graichen, and Georg Bergmann. "Loads on an Internal Spinal Fixation Device During Physical Therapy." Physical Therapy 82, no. 1 (2002): 44–52. http://dx.doi.org/10.1093/ptj/82.1.44.

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Abstract Background and Purpose. Modified internal spinal fixation devices allow the measurement of the forces and moments acting on the implants. The aim of this study was to measure the loads on internal fixation devices for selected body positions and movements during physical therapy. Subjects and Methods. Loads on an internal spinal fixation device were measured in 10 patients with degenerative instability or compression fractures using a telemeterized implant. Results. Relatively low implant loads were found in the recumbent body positions. Most exercises performed in a lying position caused implant loads less than that measured for standing and are therefore not likely to increase the risk of screw breakage. Fixation device loads were lower for sitting relaxed than for standing. The highest implant loads (128% of the value for standing) were measured during walking. Standing up, sitting down, and lateral bending and axial rotation of the upper body while standing led to fixation device loads between 111% and 120% related to the value for standing. Even higher fixation device loads were measured for ventral flexion and extension of the upper body while standing. Kneeling on hands and knees, and flexing and extending the back in this position, caused implant loads that were lower than for standing. Discussion and Conclusion. Standing up, sitting down, and lateral bending and axial rotation of the upper body while standing may slightly increase the risk of pedicle screw breakage, whereas ventral flexion and extension of the upper body while standing may increase this risk considerably if the region bridged by the implant is distracted (the distance between upper and lower screws was increased) during surgery. However, walking is the exercise that plays the major role concerning pedicle screw breakage because it causes the highest bending moments of all exercises studied and it loads the fixation devices most frequently.
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9

Liu, Chong, Zide Zhang, Yuan Ma, et al. "Predicting the Failure Risk of Internal Fixation Devices in Chinese Patients Undergoing Spinal Internal Fixation Surgery: Development and Assessment of a New Predictive Nomogram." BioMed Research International 2021 (January 26, 2021): 1–13. http://dx.doi.org/10.1155/2021/8840107.

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The current study is aimed at developing and validating a nomogram of the risk of failure of internal fixation devices in Chinese patients undergoing spinal internal fixation. We collected data from a total of 1139 patients admitted for spinal internal fixation surgery at the First Affiliated Hospital of Guangxi Medical University from May 2012 to February 2019. Of these, 1050 patients were included in the spinal internal fixation group and 89 patients in the spinal internal fixation device failure group. Patients were divided into training and validation tests. The risk assessment of the failure of the spinal internal fixation device used 14 characteristics. In the training test, the feature selection of the failure model of the spinal internal fixation device was optimized using the least absolute shrinkage and selection operator (LASSO) regression model. Based on the characteristics selected in the LASSO regression model, multivariate logistic regression analysis was used for constructing the model. Identification, calibration, and clinical usefulness of predictive models were assessed using C-index, calibration curve, and decision curve analysis. A validation test was used to validate the constructed model. In the training test, the risk prediction nomogram included gender, age, presence or absence of scoliosis, and unilateral or bilateral fixation. The model demonstrated moderate predictive power with a C-index of 0.722 (95% confidence interval: 0.644–0.800) and the area under the curve (AUC) of 0.722. Decision curve analysis depicted that the failure risk nomogram was clinically useful when the probability threshold for internal fixation device failure was 3%. The C-index of the validation test was 0.761. This novel nomogram of failure risk for spinal instrumentation includes gender, age, presence or absence of scoliosis, and unilateral or bilateral fixation. It can be used for evaluating the risk of instrumentation failure in patients undergoing spinal instrumentation surgery.
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10

Shahrokni, M., Q. Zhu, J. Liu, W. Tetzlaff, and T. R. Oxland. "Design and biomechanical evaluation of a rodent spinal fixation device." Spinal Cord 50, no. 7 (2012): 543–47. http://dx.doi.org/10.1038/sc.2011.185.

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11

Rohlmann, A., L. H. Riley, G. Bergmann, and F. Graichen. "In vitro load measurement using an instrumented spinal fixation device." Medical Engineering & Physics 18, no. 6 (1996): 485–88. http://dx.doi.org/10.1016/1350-4533(95)00087-9.

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12

Shevtsov, Vladimir Ivanovich, Aleksandr Timofeyevich Khudyaev, Sergey Vladimirovich Lyulin, and Oleg Sergeyevich Rossik. "TREATMENT OF SPONDYLOLISTHESIS WITH A DEVICE FOR EXTERNAL TRANSPEDICULAR SPINAL FIXATION." Hirurgiâ pozvonočnika, no. 3 (August 23, 2005): 097–100. http://dx.doi.org/10.14531/ss2005.3.97-100.

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Objectives. To analyze issues of surgical treatment of complicated spondylolisthesis in the lumbar spine. Materials and Methods. Forty-five patients at the age of 14 to 62 years were operated on with a device for external transpedicular fixation. All patients underwent clinical, radiological and physiologic examinations. To characterize the degree of spondylolisthesis the Meyerding classification was used. Grade I and II dislocations were treated by laminectomy of a displaced vertebra, excision of scars and mobilization of a dural sack, discectomy at a pathologic level involving both end plates of the adjacent vertebral bodies, impacting of 2 autografts (of the bone excised during laminectomy) into a disc space, and placement of a device for external transpedicular fixation. For Grade III and IV the second stage was performed after instrumentation and maximum possible reduction of dislocation. The procedure included anterior fusion of displaced and adjacent vertebrae in the achieved position either with autografts of the illiac crest or with porous nickel titanium implants through trans- or extraperitoneal approach. Results. Achieved results of application of the device for external transpedicular fixation in patients with spondylolisthesis enable to consider clinically justified a partial or total reduction of a displaced vertebra followed by neurologic status monitoring and radiological control during the post-operative period. Use of porous nickel titanium implant accelerates the formation of a bony block and decreases the time of surgery, as there is no need for autograft preparation.
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13

SlMSA, J. "Use of 29-gauge spinal needles and a fixation device with combined spinal epidural technique." Acta Anaesthesiologica Scandinavica 38, no. 5 (1994): 439–41. http://dx.doi.org/10.1111/j.1399-6576.1994.tb03925.x.

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14

Kalfas, Iain H., Donald W. Kormos, Michael A. Murphy, et al. "Application of frameless stereotaxy to pedicle screw fixation of the spine." Journal of Neurosurgery 83, no. 4 (1995): 641–47. http://dx.doi.org/10.3171/jns.1995.83.4.0641.

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✓ Interactive frameless stereotaxy has been successfully applied to intracranial surgery. It has contributed to the improved localization of deep-seated brain lesions and has demonstrated a potential for reducing both operative time and morbidity. However, it has not been as effectively applied to spinal surgery. The authors describe the application of frameless stereotactic techniques to spinal surgery, specifically pedicle screw fixation of the lumbosacral spine. Preoperative axial computerized tomography (CT) images of the appropriate spinal segments are obtained and loaded onto a high-speed graphics supercomputer workstation. Intraoperatively, these images can be linked to the appropriate spinal anatomy by a sonic localization digitizer device that is interfaced with the computer workstation. This permits the surgeon to place a pointing device (sonic wand) on any exposed spinal bone landmark in the operative field and obtain multiplanar reconstructed CT images projected in near-real time on the workstation screen. The images can be manipulated to assist the surgeon in determining the proper entry point for a pedicle screw as well as defining the appropriate trajectory in the axial and sagittal planes. It can also define the correct screw length and diameter for each pedicle to be instrumented. The authors applied this device to the insertion of 150 screws into the lumbosacral spines of 30 patients. One hundred forty-nine screws were assessed to be satisfactorily placed by postoperative CT and plain film radiography. In this report the authors discuss their use of this device in the clinical setting and review their preliminary results of frameless stereotaxy applied to spinal surgery. On the basis of their findings, the authors conclude that frameless stereotactic technology can be successfully applied to spinal surgery.
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15

Rohlmann, A., G. Bergmann, and F. Graichen. "Loads on an internal spinal fixation device in the postoperative temporal course." Journal of Biomechanics 31 (July 1998): 53. http://dx.doi.org/10.1016/s0021-9290(98)80109-7.

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16

Rohlmann, Antonius, Friedmar Graichen, Ulrich Weber, and Georg Bergmann. "Monitoring In Vivo Implant Loads With a Telemeterized Internal Spinal Fixation Device." Spine 25, no. 23 (2000): 2981–86. http://dx.doi.org/10.1097/00007632-200012010-00004.

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17

Balabaud, Laurent, Emeric Gallard, Wafa Skalli, et al. "Biomechanical evaluation of a bipedicular spinal fixation device: three different strength tests." European Spine Journal 12, no. 5 (2003): 480–86. http://dx.doi.org/10.1007/s00586-002-0520-9.

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18

Sergeev, Konstantin S., Roman V. Pas’kov, and Valery V. Piven. "External Dynamic Apparatus Correction in Rigid Posttraumatic Spinal De-formations Engineering and Clinical Aspects." Revista Gestão Inovação e Tecnologias 11, no. 2 (2021): 29–38. http://dx.doi.org/10.47059/revistageintec.v11i2.1641.

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Study design: The authors define most dangerous sections and calculate the stresses arising in the parts of the external fixation device. They configure external fixation devices taking into account the obtained results and use them in medical practice. Objective: the development of an apparatus correction technique for the treatment of spinal deformations. Summary of background data: standard methods of rigid deformation correction are technically complicated and high-costly; there are also possible formidable intraoperative complications. Authors consider a variant of apparatus external correction as an alternative to the known methods, which is devoid of the aforementioned disadvantages. Methods: The authors use theoretical and experimental research methods. The theoretical deductions are confirmed experimentally during clinical trials. Clinical studies were evaluated using ray-based diagnostic procedures, computed tomography, and patient interviewing using the Oswestry Disability Index and visual analogue scale. Results: The calculations showed that in case of one-sided point load, the stresses arising in the dangerous section of screws-rods from that load can reach 60 – 70% of the total stresses in the device nodes. During clinical testing it was established that external apparatus correction leads to normalization of anatomical relationships in the area of damaged segments, normalization of the spinal column axis, and reduction of pain; it does not preclude the use of dorsal internal puncture fixation. Conclusions: It is advisable to load the structural element of the external spinal fixation device in a skew-symmetric pattern, applying distraction and compression forces to the transverse plate on both sides along parallel straight lines in opposite directions. Apparatus external fixation makes it possible to perform a complete correction of rigid deformations without releasing the supporting structures, to control the level of neurological dis-orders, to simplify the technique of internal fixation operations, to use the minimally invasive procedure for the installation of the internal pedicle fixator.
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Biswas, Jayanta Kumar, Sandipan Roy, Masud Rana, and Subhasish Halder. "A comparison of rigid, semi-rigid and flexible spinal stabilization devices: A finite element study." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 233, no. 12 (2019): 1292–98. http://dx.doi.org/10.1177/0954411919880694.

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Pedicle-screw-based spinal fixation system has shown its success for treating degenerative disc disease-related back pain and spinal instability. In the last few decades, several non-fusion implants ( ‘flexible’ or ‘dynamic’ fixation) are developed for treating slight degenerate disc disease. The aim of this study is to characterize and compare the biomechanical responses of pedicle-screw-based fusion with various rod materials and a flexible spinal stabilization device on the lumbar spine (L3L5). Computed tomography scan-based finite element model and pedicle screw fixation with rigid rod material stainless steel rod, semi-rigid rod material poly-ether-ether-ketone and flexible rod device made of stainless steel are used in this study. Intact model of the lumbar spine and treated with all the different implants are simulated under typical physiological loading conditions. Compared with the intact model, pedicle screw with the stainless steel rod fixation system is found to offer very less range of motion. Poly-ether-ether-ketone rod system increased range of motion 3.8, 7 and 1.8 times for axial rotation, lateral bending and flexion–extension, respectively, compared to the stainless steel rod system. The flexible rod device rod system is found to reduce stress on vertebral body, carrying out more loads as compared to poly-ether-ether-ketone rods. In the case of stainless steel rods, range of motion is almost restricted on the fusion zone, which is overcome by the poly-ether-ether-ketone rod system to some extent and farther improved by the flexible rod device rod system. So, the poly-ether-ether-ketone rod and flexible rod device rod systems may be implemented for better clinical results after succeeding experimental validation and clinical trial.
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20

ACAR, Leyla Nesrin, Göktürk FINDIK, Erkmen GÜLHAN, et al. "An Interesting Case of Hemoptysis: Aorta-Bronchial Fistula Caused by Spinal Fixation Device." Turkiye Klinikleri Archives of Lung 16, no. 1 (2015): 22–26. http://dx.doi.org/10.5336/archlung.2014-41371.

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21

YUAN, HANSEN A., KENNETH A. MANN, ERNEST M. FOUND, et al. "Early Clinical Experience with the Syracuse I-Plate: An Anterior Spinal Fixation Device." Spine 13, no. 3 (1988): 278–85. http://dx.doi.org/10.1097/00007632-198803000-00010.

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22

Zhang, Y., Y. B. Tan та S. Xiang. "Effect of ω phase transition mechanism on biomechanical properties of spinal fixation device". MRS Communications 11, № 3 (2021): 349–55. http://dx.doi.org/10.1557/s43579-021-00031-1.

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23

Baldwin, Nevan G., and Edward C. Benzel. "Sacral fixation using iliac instrumentation and a variable-angle screw device." Journal of Neurosurgery 81, no. 2 (1994): 313–16. http://dx.doi.org/10.3171/jns.1994.81.2.0313.

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✓ Secure fixation of the sacrum is technically challenging. The bone of the dorsal sacral surface is often thin, making hook fixation tenuous. The use of bone screws in the sacral pedicles has gained popularity, but rigidity is often not achieved and screw pullout is common. Solid constructs have been achieved using angled rods to stabilize the ilium, but these methods are technically difficult and time-consuming to perform. A technique is described that achieves rigid sacral fixation by adding a bone screw placed through both cortical surfaces of the ilium. This bone screw is a new type that allows attachment to a rod at variable angles. It permits easy attachment to an appropriately contoured rod, which is affixed to sacral hooks or screws. The resulting configuration of the bone-metal interface creates a tripod for load distribution. Additionally, the splayed geometry of these purchase sites provides a significant biomechanical advantage preventing the instrument from being pulled out. The technique for this fixation method, particularly for patients with complex spinal disorders, is described. Use of this new technique provides significant advantages to the spine surgeon in situations in which substantial sacral fixation integrity is necessary.
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Tüfrkmen, Cengiz S., Ibrahim M. Ziyal, Alper R. Kaya, and Yunus Aydin. "A new spinal stabilization system: Anterior intercorporal fixation with the türkmen device. Cadaver study." Clinical Neurology and Neurosurgery 99 (July 1997): S218—S219. http://dx.doi.org/10.1016/s0303-8467(97)82283-4.

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Bowman, Richard G., David Caraway, and Ishmael Bentley. "Comparison of a Novel Fixation Device With Standard Suturing Methods for Spinal Cord Stimulators." Neuromodulation: Technology at the Neural Interface 16, no. 5 (2012): 454–58. http://dx.doi.org/10.1111/j.1525-1403.2012.00480.x.

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26

van Laar, Wilbert, Rinse J. Meester, Theo H. Smit, and Barend J. van Royen. "A biomechanical analysis of the self-retaining pedicle hook device in posterior spinal fixation." European Spine Journal 16, no. 8 (2007): 1209–14. http://dx.doi.org/10.1007/s00586-006-0288-4.

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27

Bucholz, Richard D., and K. Charles Cheung. "Halo vest versus spinal fusion for cervical injury: evidence from an outcome study." Journal of Neurosurgery 70, no. 6 (1989): 884–92. http://dx.doi.org/10.3171/jns.1989.70.6.0884.

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✓ The indications for surgical fusion, as opposed to halo fixation, in the management of cervical spine injury are still unclear. At St. Louis University Medical Center a conservative protocol has been adopted to treat almost all cervical spine fractures with halo fixation. To determine what factors have contributed to failure of halo fixation, the records and radiographs of all patients with cervical spine injuries who were treated at that institution between 1984 and 1986 were reviewed. During this interval, 124 patients were treated, consisting of 93 men and 31 women between 6 and 94 years old. Of these, 15 (12%) had cervical fusion without preoperative halo device application. This group included eight patients with old injuries and delayed diagnosis, three with nonreducible locked facets, and four with miscellaneous indications. The remaining 109 patients were treated with halo vests. Four died before completing the 3-month standard treatment. Of those completing the treatment, 48 had C1–2 level injuries and 57 had C3–T1 level injuries. Sixteen patients (15%) failed their halo treatments and required surgical fusion: eight while still in halo fixation and eight after they had completed treatment with a halo device. Failure of halo treatment was indicated by recurrent dislocation in 13 patients and increased neurological deficit in three. Thirteen of the patients who failed treatment had C3–T1 injuries and three had C1–2 injuries. Of 27 patients with odontoid fractures, only two (7.4%) failed halo fixation. There were no failures in 11 patients with hangman's fractures. Of the 57 patients with C3–T1 injuries, 13 (23%) failed treatment, nine of whom had locked or “perched” facets. The factors causing failure of halo fixation were analyzed. The overall success rate was 85%, suggesting that the halo vest can be used to treat most patients with cervical spine injuries. Under certain circumstances (in the presence of old injuries, difficult reduction, or locked or “perched” facets), surgery may be indicated to avoid unnecessary delay in definitive management.
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Niazi, Toba, Alfredo Quinoñes-Hinojosa, and Meic H. Schmidt. "Management of brain abscesses associated with halo fixation." Neurosurgical Focus 24, no. 6 (2008): E14. http://dx.doi.org/10.3171/foc/2008/24/6/e14.

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✓ Halo orthoses are commonly used in the management of a variety of cervical spinal pathological conditions. Although placement of the cranial pins was initially believed to be safe with minimal complications, minor complications related to the cranial pins have the potential to create a setting for formation of cerebral abscesses. The risk of death due to cerebral abscesses has declined in the modern antibiotic era, but cerebral abscesses are associated with long-standing neurological morbidity that should not be considered negligible. Prevention by careful pin placement and hygiene and appropriate early management are crucial to prevent more serious complications. The authors report the case of a patient treated with a halo orthosis after incurring cervical spinal trauma who developed a cerebral abscess as a complication related to the cranial pins of the halo fixation device. They review the literature in an attempt to formulate a standardized treatment algorithm to prevent this disease process and to treat an abscess if it should form.
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Justiz, Rafael, and Ishmael Bentley. "A Case Series Review of Spinal Cord Stimulation Migration Rates With a Novel Fixation Device." Neuromodulation: Technology at the Neural Interface 17, no. 1 (2013): 37–41. http://dx.doi.org/10.1111/ner.12014.

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30

Lim, Tae-Hong, Vijay K. Goel, John M. Winterbottom, et al. "A Comparison of Stress-Induced Porosity Due to Conventional and a Modified Spinal Fixation Device." Journal of Spinal Disorders 7, no. 1 (1994): 1–11. http://dx.doi.org/10.1097/00002517-199407010-00001.

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31

Suezawa, Y., and H. A. C. Jacob. "Lumbar and thoracic spinal fusion with transpedicular fixation (Including a novel distraction and compression device)." Archives of Orthopaedic and Traumatic Surgery 105, no. 2 (1986): 126–29. http://dx.doi.org/10.1007/bf00455847.

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Foley, Kevin T., Sanjay K. Gupta, Jeff R. Justis, and Michael C. Sherman. "Percutaneous pedicle screw fixation of the lumbar spine." Neurosurgical Focus 10, no. 4 (2001): 1–9. http://dx.doi.org/10.3171/foc.2001.10.4.11.

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Object Standard techniques for lumbar pedicle screw fixation involve open exposures and extensive muscle dissection. The purpose of this study was to report the initial clinical experience with a novel device for percutaneous posterior fixation of the lumbar spine. Methods An existing multiaxial lumbar pedicle screw system was modified so that screws could be placed percutaneously by using an extension sleeve that would allow for remote manipulation of the polyaxial screw heads and remote engagement of the screw locking mechanism. A unique rod insertion device was developed that linked to the screw extension sleeves, allowing for a precut, precontoured rod to be placed through a small stab wound. Because the insertion device relies on geometrical constraint of the rod pathway through the screw heads, rods can be placed in a standard submuscular position with minimal manipulation, essentially no muscle dissection, and without the need for direct visual feedback. Twelve patients (six men and six women who ranged in age from 23–68 years) underwent pedicle screw fixation in which the rod insertion device was used. Spondylolisthesis was present in 10 patients and nonunion of a prior interbody fusion was present in two. All patients underwent successful percutaneous fixation. Ten patients underwent single-level fusions (six at L5–S1, three at L4–5, and one at L2–3), and two underwent two-level fusions (one from L–3 to L–5 and the other from L–4 to S–1). The follow-up period ranged from 3 to 12 months (mean 6.8 months). Conclusions Although percutaneous lumbar pedicle screw placement has been described previously, longitudinal connector (rod or plate) insertion has been more problematic. The device used in this study allows for straightforward placement of lumbar pedicle screws and rods through percutaneous stab wounds. Paraspinous tissue trauma is minimized without compromising the quality of spinal fixation. Preliminary experience with this device has been promising.
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Bonthius, Daniel. "4273 An innovative rib construct for treatment of pediatric spinal deformity." Journal of Clinical and Translational Science 4, s1 (2020): 41. http://dx.doi.org/10.1017/cts.2020.156.

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OBJECTIVES/GOALS: The rib construct is a novel device for treating childhood hyperkyphosis and kyphoscoliosis. The purpose of this study was to investigate the biomechanics, mechanism, and clinical outcomes of this device. The overarching hypothesis was that the rib construct is safe and effective for correcting hyperkyphotic spinal deformity. METHODS/STUDY POPULATION: Biomechanical evaluation: An ex vivo porcine spine biomechanical study compared traditional pedicle screw proximal fixation to the rib construct in terms of proximal fixation strength and construct stiffness. Porcine model hyperkyphosis correction with rib construct: An in vivo hyperkyphotic porcine model was used to study the ability of the rib construct to correct hyperkyphosis in the developing porcine spine. Human hyperkyphotic correction with rib construct: A retrospective study was conducted to examine the radiographic outcomes, complication rates, procedure times, and blood losses experienced by human patients that received rib construct surgery. RESULTS/ANTICIPATED RESULTS: Biomechanical evaluation: The rib construct was significantly less prone to proximal fixation failure and less stiff compared to pedicle screws. Porcine model hyperkyphosis correction with rib construct: The average T6-T14 thoracic kyphosis was 35.8 ± 3.2° at the time of hyperkyphosis creation surgery. In response to corrective surgery with the rib-hook construct, T6-T14 thoracic hyperkyphosis decreased immediately post-op to 11.3 ± 7.8° and continued to decrease to 7.8 ± 7.6° until final follow-up 8 weeks post-op (n = 3). Human hyperkyphosis correction with rib construct: Pre-op sagittal Cobb angle was 81 ± 31° and fell to 43 ± 24° post-op and to 38 ± 24° at final follow-up; indicating ~100% correction (normal thoracic kyphosis is 40°). DISCUSSION/SIGNIFICANCE OF IMPACT: The results suggest that the rib construct is a highly effective technique and superior to existing methods.
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Jang, Jee Soo, Sang Ho Lee, and Sang Rak Lim. "Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion." Journal of Neurosurgery: Spine 98, no. 1 (2003): 100–103. http://dx.doi.org/10.3171/spi.2003.98.1.0100.

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Because the degree of immediate stabilization provided by cage-assisted anterior lumbar interbody fusion (ALIF) has been shown by several studies to be inadequate, supplementary posterior fixation, such as that created by translaminar or transpedicle screw fixation, is necessary. In this study, the authors studied the ALIF-augmentation procedure in which a special guide device is used to place percutaneously translaminar facet screws in 18 patients with degenerative lumbar disease. The minimum follow-up period was 1 month (mean 6 months, range 1–13 months). Degenerative spondylolisthesis with foraminal stenosis was diagnosed in nine patients, associated degenerative disc disease alone or combined with foraminal stenosis in eight, and recurrent disc herniation in one. Following screw placement, computerized tomography scanning was conducted to evaluate the accuracy of the facet screw positioning. All screws were properly placed. No screw penetrated the spinal canal or injured the neural structures. Excellent or good clinical outcomes were demonstrated in all patients at the last follow up. The use of this guide device for post—ALIF percutaneous translaminar facet screw fixation represents a safe, accurate, and minimally invasive modality with which to achieve immediate solid fixation in the lumbar spine.
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Geisler, Fred H., Leslie N. Sutton, Stuart E. Mirvis, Hafez Zrebeet, and John N. Joslyn. "Titanium Wire Internal Fixation for Stabilization of Injury of the Cervical Spine: Clinical Results and Postoperative Magnetic Resonance Imaging of the Spinal Cord." Neurosurgery 25, no. 3 (1989): 356–62. http://dx.doi.org/10.1227/00006123-198909000-00006.

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Abstract Nine patients with dislocation of the cervical spinal with posterior ligamentous damage were treated with posterior internal fixation using a twisted pair of 22-gauge titanium wires and iliac crest bone fusion. Fixation using the titanium wire was compared with fixation using stainless steel wire for differences in surgical insertion, long term stability of bony fusion, and postoperative magnetic resonance imaging (MRI) artifacts near the implanted wire. MRI of the cervical spine is valuable for diagnosing the acute and chronic consequences of traumatic cervical spinal injury by providing anatomic evaluation of both the spinal cord and the supporting bony/ligamentous structures in the neck. Because MRI is an accurate and sensitive noninvasive test, it is especially useful for the long-term serial assessment of the region near the cervical dislocation site to detect the sequelae of spinal cord injury, including syrinx, arachnoid cyst, cord tethering, and persistent mechanical impingement on the spinal cord or spinal roots. Previous attempts at our institution to obtain useful MRI scans of the cervical region adjacent to stainless steel wires after posterior wire fixation have failed due to marked imaging artifacts arising from the ferromagnetic properties of these wires. Our substitution of biocompatible titanium wire (Titanium 6 A1-4V ELI alloy, Specialty Steel and Forge, Leonia, New Jersey) for stainless steel wire produced identical immediate stabilization and ultimate bony fusion of the fracture and yielded minimal MRI artifacts overlying the immediately adjacent spinal cord and neural canal; however, the installation was technically more difficult, because of the titanium wire's greater stiffness. We believe that the implantation of a permancent fixation device in these patients should be made of an MRI-compatible material, such as titanium wire, to allow serial imaging with MRI in their lifelong medical care.
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Lim, Tae-Hong, and Vijay K. Goel. "Load Sharing Characteristics in the Stabilized Lumbar Motion Segment: A Finite Element Study." Journal of Musculoskeletal Research 02, no. 01 (1998): 55–64. http://dx.doi.org/10.1142/s0218957798000081.

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The effects of intervertebral joint stiffness as well as implant stiffness on the load sharing characteristics across the stabilized motion segment were investigated using the finite element technique. Intervertebral joint stiffness variations were modeled by using various Young's modulus ( Edisc ) values of the ground substance that had replaced the nucleus pulposus. Variations in the implant stiffness were made by simulating the use of three different pedicle screw-plate instrumentation constructs: 1) bilateral fixation using stainless steel (ST) plates; 2) unilateral fixation using one stainless steel plate; and 3) bilateral fixation using Plexiglas (PL) plates. For the case of constant fixation device stiffness, the axial force across the VSP plate changed in a step-wise manner with the changes in the "disc" stiffness. The axial force carried by the plates was about 10% of the applied compression for Edisc ≥ 1000 MPa. The plates carried about 40% of the applied compression in the intact and degenerated disc ( Edisc = 4.2 and 8.2 MPa) models, as compared to 100% load by the plates for the totally denucleated case. For the case of constant disc stiffness ( Edisc = 8.4 MPa), ST and PL plates were predicted to take over 38% and 18% of the applied compression load, respectively, while for the uniaxial fixation this value was 24%. The load borne by the plates decreased with a decrease in the stiffness of the device. Larger average stresses were predicted in all spinal components when a less rigid VSP system was used, although still lower than the intact stress values. By contrast, the stresses in the device components were predicted to decrease by a considerable amount due to the use of PL plates. These results clearly demonstrate that both the spinal segment and fixation devices are important load supporting components. However, further studies are required to determine an optimum range of stiffness of the unstable spine-graft-implant construct for fast and solid fusion to occur.
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Kolesov, S. V., A. N. Baklanov, and I. A. Shavyrin. "SURGICAL TREATMENT OF PATIENTS WITH SPINAL DEFORMITIES WITH SHORTENING OF THE LOWER LIMB." Annals of the Russian academy of medical sciences 68, no. 10 (2013): 41–45. http://dx.doi.org/10.15690/vramn.v68i10.787.

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Aim. Determination of the optimal diagnostic and treatment strategy in patients with scoliosis and having an anatomic shortening of the lower limb. Patients and methods. Surgical correction of scoliosis held 8 to patients with lower limb shortening caused by congenital dislocation of the hip (n = 3), anatomic shortening of the lower extremities due to the hip (n = 1), the shin bone (n = 4). Shortening before correction and fixation of scoliosis ranged from 6 to 14 cm, after surgery on the spine has been reduced by 2-4 cm achieved reduction or removal of pelvic obliquity . The second stage, after 8-12 months, performed surgery to address shortening of the lower extremity. Osteotomy of the femur with the imposition of a spoke - rod device held 4 tibial osteotomy with the imposition of external fixation device Spoke - and 4 patients and in the subsequent limb lengthening was performed by compression-distraction osteosynthesis. Results. After the dorsal stabilization and fixation of the spine scoliosis correction averaged 64% (from 76 to 27 °), the value of breast / thoracolumbar kyphosis after surgery failed to bring to the physiological (average 43 °). Misalignment of the pelvis is reduced by 67 % (from 24 to 8 °), which reduced the shortening of the lower limb by an average of 3 cm (compensation relative shortening by reducing or eliminating the distortion of the pelvis). Further compensation shortening held on the second stage of treatment, representing an osteotomy and subsequent elongation of the femur or tibia bones by transosseous compression-distraction osteosynthesis by Ilizarov. Conclusions. Multi-stage treatment reduced the degree of spinal deformity, to normalize the balance of the body, restore the function of distance without the use of orthotic devices and means of support.
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Mohamed, Ahmed S., Jung Yoo, Robert Hart, et al. "Posterior fixation without debridement for vertebral body osteomyelitis and discitis." Neurosurgical Focus 37, no. 2 (2014): E6. http://dx.doi.org/10.3171/2014.6.focus14142.

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Object The authors evaluated the efficacy of posterior instrumentation for the management of spontaneous spinal infections. Standard surgical management of spontaneous spinal infection is based on debridement of the infected tissue. However, this can be very challenging as most of these patients are medically debilitated and the surgical debridement requires a more aggressive approach to the spine either anteriorly or via an expanded posterior approach. The authors present their results using an alternative treatment method of posterior-only neuro-decompression and stabilization without formal debridement of anterior tissue for treating spontaneous spinal infection. Methods Fifteen consecutive patients were treated surgically by 2 of the authors. All patients had osteomyelitis and discitis and were treated postoperatively with intravenous antibiotics for at least 6 weeks. The indications for surgery were failed medical management, progressive deformity with ongoing persistent spinal infection, or neurological deficit. Patients with simple epidural abscess without bony instability were treated with laminectomy and were not included in this series. Fourteen patients were treated with posterior-only decompression and long-segment rigid fixation, without formal debridement of the infected area. One patient was treated with staged anterior and posterior surgery due to delay in treatment related to medical comorbidities. The authors examined as their outcome the ambulatory status and recurrence of deep infection requiring additional surgery or medical treatment. Results Of the initial 15 patients, 10 (66%) had a minimum 2-year follow-up and 14 patients had at least 1 year of followup. There were no recurrent spinal infections. There were 3 unplanned reoperations (1 for loss of fixation, 1 for early superficial wound infection, and 1 for epidural hematoma). Nine (60%) of 15 patients were nonambulatory at presentation. At final followup, 8 of 15 patients were independently ambulatory, 6 required an assistive device, and 1 remained nonambulatory. Conclusions Long-segment fixation, without formal debridement, resulted in resolution of spinal infection in all cases and in significant neurological recovery in almost all cases. This surgical technique, when combined with aggressive antibiotic therapy and a multidisciplinary team approach, is an effective way of managing serious spinal infections in a challenging patient population.
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Tuite, Gerald F., Robert Veres, H. Alan Crockard, David Peterson, and Richard D. Hayward. "Use of an adjustable, transportable, radiolucent spinal immobilization device in the comprehensive management of cervical spine instability." Journal of Neurosurgery 85, no. 6 (1996): 1177–80. http://dx.doi.org/10.3171/jns.1996.85.6.1177.

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✓ In this report the authors describe a device that consists of a transportable, radiolucent board that couples to a standard halo head ring. The board provides continuous cervical spine immobilization during all phases of acute medical treatment of cervical spine instability, including closed reduction, transport, radiographic imaging, and operative procedures. By combining the advantages of several existing systems, this immobilization device facilitates and improves the safety of comprehensive acute management of cervical spinal instability by eliminating the need for patient transfer from stretcher to radiography machine to operating table. Its radiolucent construction and its compatibility with standard operating tables allow unencumbered surgical access and ample room for biplanar fluoroscopy, thereby also facilitating operative procedures, particularly the placement of internal spinal fixation.
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Goto, Takeo, Kenji Ohata, Toshihiro Takami, et al. "Hydroxyapatite laminar spacers and titanium miniplates in cervical laminoplasty." Journal of Neurosurgery: Spine 97, no. 3 (2002): 323–29. http://dx.doi.org/10.3171/spi.2002.97.3.0323.

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Object. The authors describe a new surgical technique for cervical laminoplasty that was performed in 25 patients. The posterior elements along with the various ligaments are removed en bloc and are stabilized in a lift-up position by placing hydroxyapatite (HA) laminar spacers and titanium miniplates and screws. The procedure and clinical results are discussed. Methods. The posterior spinal elements, including the lamina(e), spinous process(es), and various attached ligaments, are removed en bloc by incising the lamina in its lateral aspect. Trapezoid-shaped HA spacers are placed between the cut ends of the laminae or between the laminae and lateral masses bilaterally at each level. Malleable titanium miniplates and screws are used for fixation of the spacers. The fixation of transected laminae was judged to be successful. Postoperative care included application of a soft neck collar for 1 week but no further restriction of activity. Surgery-related outcome was assessed in the 21 patients who attended more than 6 months of follow up after laminoplasty. There were 18 men and three women who ranged in age from 27 to 81 years. Cervical stenotic myelopathy was demonstrated in 15 patients who underwent decompressive and expansive laminoplasty, and spinal tumors were documented in six patients who underwent a nonexpansive laminoplasty. Postoperative and follow-up computerized tomography scans demonstrated no hardware failure. Bone formation around the spacers was observed either at 6- or at 9-month follow-up examination in all 21 patients. Fusion of the reconstructed laminae was found to be completed at 12 months in all 18 patients able to attend follow up for this duration. Spinal alignment and the range of motion of the cervical spine were well preserved. In patients with stenotic cervical myelopathy, neurological and anatomical outcome of canal expansion were satisfactory. Conclusions. This technique enables rigid laminoplasty while maintaining anatomical and biomechanical integrity of posterior elements of cervical spine. Expansive and nonexpansive laminoplasty procedures are possible.
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Li, Qiaochu, Xiaohua Min, Pengfei Bai, et al. "Microstructure, mechanical properties and springback behaviour of Ti‑6Al‑4V alloy connection rod for spinal fixation device." Materials Science and Engineering: C 94 (January 2019): 811–20. http://dx.doi.org/10.1016/j.msec.2018.10.030.

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42

Foley, Kevin T., and Sanjay K. Gupta. "Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results." Journal of Neurosurgery: Spine 97, no. 1 (2002): 7–12. http://dx.doi.org/10.3171/spi.2002.97.1.0007.

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Object. Standard techniques for pedicle screw fixation of the lumbar spine involve open exposures and extensive muscle dissection. The purpose of this study was to report the initial clinical experience with a novel device for percutaneous posterior fixation of the lumbar spine. Methods. An existing multiaxial lumbar pedicle screw system was modified to allow screws to be placed percutaneously by using an extension sleeve that permits remote manipulation of the polyaxial screw heads and remote engagement of the screw-locking mechanism. A unique rod-insertion device was developed that linked to the screw extension sleeves, allowing for a precut and -contoured rod to be placed through a small stab wound. Because the insertion device relies on the geometrical constraint of the rod pathway through the screw heads, minimal manipulation is required to place the rods in a standard submuscular position, there is essentially no muscle dissection, and the need for direct visual feedback is avoided. Twelve patients (six men and six women) who ranged in age from 23 to 68 years underwent pedicle screw fixation in which the rod-insertion device was used. Spondylolisthesis was present in 10 patients and osseous nonunion of a prior interbody fusion was present in two. All patients underwent successful percutaneous fixation. Ten patients underwent single-level fusions (six at L5—S1, three at L4–5, and one at L2–3), and two underwent two-level fusions (one from L3–5 and the other from L4—S1). The follow-up period ranged from 10 to 19 months (mean 13.8 months). Conclusions. Although percutaneous lumbar pedicle screw placement has been described previously, longitudinal connector (rod or plate) insertion has been more problematic. The device used in this study allows for straightforward placement of lumbar pedicle screws and rods through percutaneous stab wounds. Paraspinous tissue trauma is minimized without compromising the quality of spinal fixation. Preliminary experience involving the use of this device has been promising.
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Mochida, Yuichi, Thomas W. Bauer, Hironori Nitto, Helen E. Kambic, and George F. Muschler. "Influence of stability and mechanical properties of a spinal fixation device on production of wear debris particlesIn Vivo." Journal of Biomedical Materials Research 53, no. 3 (2000): 193–98. http://dx.doi.org/10.1002/(sici)1097-4636(2000)53:3<193::aid-jbm1>3.0.co;2-3.

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Gushcha, A. O., S. V. Kolesov, Ekaterina N. Poltorako, D. A. Kolbovskiy, and A. I. Kaz’min. "Surgical treatment of multilevel lumbar vertebral canal stenosis using dynamic stabilization. Multicenter study." N.N. Priorov Journal of Traumatology and Orthopedics 24, no. 4 (2017): 11–17. http://dx.doi.org/10.17816/vto201724411-17.

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Purpose: to compare the results of surgical treatment of patients with multilevel lumbar vertebral canal stenosis. Patients and methods. Prospective randomized multicenter study included 71 patients aged 41 - 79 years. In the 1st group of patients (n=38) a standard wide decompression of the spinal canal, transpedicular fixation of one clinically and roentgenologically significant spinal motion segment using rigid stabilization and interbody fusion was performed. In the 2nd group (n=33) microdecompression of the spinal canal, transpedicular fixation of one clinically and roentgenologically significant segment using the rods of nitinol transpedicular device. The results were assessed by the pain VAS, ODI and SF-36 questionnaires, roentgenologic, CT and MRI data. Results. Mean follow up made up 1.5 years, the maximum one - 3.0 years. Significant pain relief and im- provement in the quality of life as compared with the preoperative level was reported for both groups. No sig- nificant difference between the groups was observed. Functional roentgenograms showed within 5° (4.2 - 6.5°) preservation of motion in the stabilized segment only in patients from the 2nd group. Adjacent segment pathology in 12 months after operation was diagnosed only in 1 patient from the 1st group. Conclusion. Preliminary results allow considering the dynamic transpedicular fixation using nitinol rods as an effective surgical technique for the treatment of degenerative lumbar spine pathology.
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Missori, Paolo, Alessandro Ramieri, Giuseppe Costanzo, et al. "Late vertebral body fracture after lumbar transpedicular fixation." Journal of Neurosurgery: Spine 3, no. 1 (2005): 57–60. http://dx.doi.org/10.3171/spi.2005.3.1.0057.

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✓ Late-onset vertebral body (VB) fracture after lumbar transpedicular fixation has not been previously described in the literature. The authors present three cases in which VB fracture occurred several months after posterolateral fixation in patients with degenerative disease or traumatic injury. The authors suggest that postoperative osteopenia, modified load-sharing function, and intravertebral clefts were responsible for the fractures. Two women and one man were evaluated at a mean follow-up interval of 3 months. Two patients suffered recurrent lumbar pain. Radiography and magnetic resonance imaging revealed fracture of some of the instrumentation-treated VBs. These two patients underwent surgical superior or inferior extension of instrumentation. The third, an asymptomatic patient, received conservative management. The two patients who underwent reoperation made complete recoveries, and there was no evidence of further bone collapse in any case. The authors speculate that alterations in the VBs may occur following application of spinal instrumentation. In rare cases, the device can fracture and consequently lead to recurrent lumbar back pain. Recovery can be achieved by extending the instrumentation in the appropriate direction.
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Pontes, Mariana Demétrio de Sousa, Breno de Paula Faleiros Pires, Felipe de Paula Albuquerque, and Carlos Fernando Pereira da Silva Herrero. "ASSESSMENT OF THE POSTERIOR APPROACH FOR SURGICAL TREATMENT OF SPINAL METASTATIC BREAST CANCER." Acta Ortopédica Brasileira 28, no. 1 (2020): 22–25. http://dx.doi.org/10.1590/1413-785220202801223529.

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ABSTRACT Objective: To assess the clinical and radiological aspects of patients with spinal metastatic breast cancer who underwent surgical treatment by posterior approach. Methods: This is a retrospective and descriptive study. Clinical assessment included the patient’s sex, age, surgical treatment employed and complications. Radiological assessment comprised the study of the morphopathological characteristics of the lesions. Results: Data from 44 patients (93.2% female) submitted to surgical treatment of spinal metastasis were collected. The average age of diagnosis was 56.79 years. Decompression and posterior fixation with pedicle screws were performed in 43.1% of patients, while 36.3% underwent decompression and posterior fixation with pedicle screws associated with corpectomy and replacement with intersomatic device filled with bone cement. In 20.4%, kyphoplasty was the chosen procedure. Eighteen percent of patients had surgical complications, and the thoracic spine was most affected by the tumor. Conclusion: The clinical and radiological presentation of this group of patients is variable. The posterior portion of the vertebrae was more affected than the anterior. Although surgical treatment by posterior approach does not have the objective of curing the underlying disease, it can present favorable results, with higher rate of complication in major surgeries. Level of evidence IV, Therapeutic Studys.
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Afaunov, Asker Alievich, Vladimir Dmitryevich Usikov, Ali Ibragimovich Afaunov, and Igor Mikhailovich Dunaev. "OPPORTUNITIES OF TRANSPEDICULAR SPINAL INSTRUMENTATION FROM THE POSITION OF BIOMECHANICAL MODELING." Hirurgiâ pozvonočnika, no. 2 (May 26, 2005): 013–19. http://dx.doi.org/10.14531/ss2005.2.13-19.

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Objective. The authors analyze the causes of destabilization of transpedicular spinal instrumentation and prove the measures of its prevention basing on biomechanical modeling results and clinical data. Material and Methods. Experimental study included three series of 10 tests and one series of 12 tests with human spine cadaver specimens. The stability of injured spinal segments after transpedicular instrumentation was studied under mechanical load similar to that experienced by the human spine. Clinical study included the outcome analysis of transpedicular instrumentation in 107 patients with unstable thoracic and lumbar spine injuries. Results. The bone tissue mass around screws inserted in a cranial vertebra for two-segment spinal fusion proved to be the weakest place in a system consisting of a fourscrew transpedicular metal construction and spinal segments. The static mechanical strength of the injured vertebral motion segment stabilized with transpedicular device turned to be lower by 8–42 % (depending on loading conditions) than that of a corresponding intact vertebral motion segment. The identified factors negatively affecting the mechanical stability of transpedicular fixation were the following: osteoporosis, incomplete correction of deformity, motion coordination disorder due to neurological deficit, excessive weight, and postoperative regimen breach. A differentiated approach to reposition and transpedicular instrumentation for significant spinal deformities was offered allowing the restoration of anatomical interrelations and stable fixation in the spine regardless of the time of trauma.
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Rohlmann, A., O. Eick, G. Bergmann, and F. Graichen. "Belastungsmessungen mit einem instrumentierten Wirbel-Fixateur interne. Measuring Loads with the Aid of an Instrumented Internal Spinal Fixation Device." Biomedizinische Technik/Biomedical Engineering 38, no. 10 (1993): 255–60. http://dx.doi.org/10.1515/bmte.1993.38.10.255.

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NARITA, Kengo, Mitsuo NIINOMI, Masaaki NAKAI, SUYALATU, Hisashi SOYAMA, and Osamu TAKAKUWA. "G0410204 Durability of a spinal fixation device made of a low Young's modulus titanium alloy subjected to surface hardening." Proceedings of Mechanical Engineering Congress, Japan 2014 (2014): _G0410204——_G0410204—. http://dx.doi.org/10.1299/jsmemecj.2014._g0410204-.

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50

Allen, Hailey, Kirkland Davis, Kenneth Noonan, Yoshimi Endo, and Jie Nguyen. "Orthopaedic Fixation Devices Used in Children: A Radiologist's Guide." Seminars in Musculoskeletal Radiology 22, no. 01 (2018): 012–24. http://dx.doi.org/10.1055/s-0037-1609013.

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AbstractFractures are common in children with some requiring surgical reduction and fixation to maintain anatomical alignment. Although various surgical techniques and principles are shared between children and adults, certain unique considerations in children can influence the surgical approach and device selection. In particular, for skeletally immature children, it is of utmost importance to protect certain critical open growth plates because permanent injury can produce severe growth disturbances. The often robust healing response and potential limited patient compliance can also influence the treatment algorithm and decision making. Commonly encountered orthopaedic fixation devices, including screws, intramedullary devices, and plates, are reviewed with an emphasis on their mechanism and application in children. Additional miscellaneous devices that are commonly used to treat malalignment and guide bone growth including epiphysiodesis plates, proximal femur osteotomy plates, and spinal magnetic growing rods are also reviewed. The goal of this article is to provide a basic understanding of the principles and mechanisms of different types of pediatric orthopaedic devices and thereby improve the radiologist's diagnostic confidence and allow better anticipation of complications.
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