摘要 :
Multilevel arthritis of the foot is a frequent problem. The arthritis does not always involve adjacent levels. A comprehensive literature search did not reveal any information about this pathology, neither about its treatment. Thi...
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Multilevel arthritis of the foot is a frequent problem. The arthritis does not always involve adjacent levels. A comprehensive literature search did not reveal any information about this pathology, neither about its treatment. This case series report presents two patients. The first patient has bilateral talonavicular and first metatarsophalangeal joint arthritis, the second has unilateral talonavicular and first tarsometatarsal joint arthritis. Conservative treatment was insufficient and operative treatment of the arthritic joints was performed using the IoFix system (Intra-Osseus Fixation Device). In all three operations arthrodesis of the talonavicular and a more distal nonadjacent joint was successfully performed. With a follow-up period up till five years postoperative, no short- nor long-term complications were observed. Multilevel arthritis with nonadjacent joints in the foot is a common pathology. Fusion of the affected joints, leaving at least one free joint in between is a surgical treatment with good results.
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Pseudarthrosis is a well-recognized complication following multi-level ACDF. We aim to characterize the fusion order and level-specific rates of arthrodesis across four time points following 3-level ACDF. Patients who underwent 3-...
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Pseudarthrosis is a well-recognized complication following multi-level ACDF. We aim to characterize the fusion order and level-specific rates of arthrodesis across four time points following 3-level ACDF. Patients who underwent 3-level ACDF by three UCSF spine surgeons from August 2012 to December 2019 were identified. Fusion status at each level was determined by measuring the interspinous motion on flexion and extension radiographs and assessing for evidence of bridging bone. Measurements were performed post-operatively at 6 weeks, 6 months, 12 months, and 18-24 months. A total of 77 patients with 3-level ACDF were identified and included in this study. Specific ACDF levels include C3-C6 (17 patients), C4-C7 (57 patients), and C5-T1 (3 patients). At 6 months, the cranial, middle, and caudal level fusion rates were 17.0%, 34.0%, and 3.8%, respectively. By 24 months, fusion rates were 61.1%, 88.9%, and 27.8% at the cranial, middle, and caudal level, respectively. PEEK cages were associated with lower odds of multi-level arthrodesis. Arthrodesis occurred the quickest at the middle level with an 88.9% fusion rate by 24 months after surgery. The caudal level had the slowest rate of arthrodesis with only a 27.8% fusion rate at 24 months, likely due to increased biomechanical stress at the most caudal level. Allograft was associated with higher odds of multi-level arthrodesis compared to PEEK cages. (c) 2020 Elsevier Ltd. All rights reserved.
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Study Design.A retrospective cohort study. Objective.To evaluate the clinical efficacy and safety of hybrid anterior cervical fixation, focusing on stand-alone segments. Summary of Background Data.In the treatment of multilevel ce...
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Study Design.A retrospective cohort study. Objective.To evaluate the clinical efficacy and safety of hybrid anterior cervical fixation, focusing on stand-alone segments. Summary of Background Data.In the treatment of multilevel cervical stenosis, the number of segments fixed using a plate is limited by placing an interbody cage without plate supplementation at one end of the surgical segment to reduce long plate-related problems. However, the stand-alone segment may experience cage extrusion, subsidence, cervical alignment deterioration, and nonunion. Methods.Patients who underwent three-segment or four-segment fixation for cervical degenerative disease and completed one-year follow-up were included in this study. Patients were divided into two groups: a cranial group, with stand-alone segments located at the cranial end adjacent to plated segments, and a caudal group, with stand-alone segments located at the caudal end. Differences in radiographic outcomes between the groups were evaluated. Fusion was defined using dynamic radiographs or computed tomography. To identify factors associated with nonunion in stand-alone segments, multivariable logistic regression analyses were performed. To identify factors associated with cage subsidence, multiple regression analyses were performed. Results.A total of 116 patients (mean age, 59 & PLUSMN;11 y; 72% male; mean fixed segments, 3.7 & PLUSMN;0.5 segments) were included in this study. No case showed cage extrusion or plate dislodgement. In stand-alone segments, the fusion rate was significantly lower in the caudal group than in the cranial group (76% vs. 93%, P=0.019). Change in the cervical sagittal vertical axis was worse in the caudal group than in the cranial group (2.7 & PLUSMN;12.3 mm vs. -2.7 & PLUSMN;8.1 mm, P=0.006). One caudal group patient required additional surgery because of nonunion at the stand-alone segment. Multivariable logistic regression indicated factors associated with nonunion included the location of the stand-alone segment (caudal end: OR 4.67, 95% CI, 1.29-16.90), larger pre-disk space range of motion (OR 1.15, 95% CI, 1.04-1.27), and lower preoperative disk space height (OR 0.57, 95% CI, 0.37-0.87). Multiple regression analysis indicated that higher cage height and lower pre-disk space height were associated with cage subsidence. Conclusion.Hybrid anterior cervical fixation with stand-alone interbody cage placement adjacent to plated segments may avoid long plate-related problems. Our results suggest that the cranial end of the construct may be more suitable for the stand-alone segment than the caudal end.
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