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Klinische Fälle

abord anterior

Anteriorer Zugang

Ventrale Zugänge zur Wirbelsäule — ACDF, ALIF, VLDS, kombinierte anterior-posteriore Korrekturen.

Fallserie

10-jähriges Mädchen — Larsen-Syndrom

3 Folien

Slide 1

10 y.o. girl, Larsen syndrome (feature no bony connection between the posterior elements and the vertebral body), progressive tetraparesis, loss of ambulation

Slide 2

After preoperative halo-traction and dorsal decompresion and instrumented fusion C2- T1

OP Branea 2019

Slide 3

After ACDF C2-4. Symptom release with ambulation again possible

OP Branea 2019

Fallserie

Thorakolumbale Kyphose — Revisionsserie

4 Folien

Slide 1

Law of the series: 3 interesting/problematic revision surgery for rigid thoracolumbar kyphosis in January 2023;

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Slide 2

Case 1: Female, 63 y.o., failed L1 corporectomy and short (to short) instrumented percutaneous fixation in another hospital. Pseudarthrosis and painfull kyphosis. Here I used tho old cage as fulcrum and did a closing-wedge procedure through segmental piece-meal L1 spondylectomy, all dorsal. The lateral MACS –plate is in my experience very hard to revise, had to leave it in, fortunately was very loose and didn´t hindered the reposition

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Slide 3

Case 2. Male, 63 y.o., failed T12 corporectomy and short (to short) instrumented percutaneous fixation in another hospital. Pseudarthrosis and painfull kyphosis. Did a re-thoraco-frenotomy, distracted and and replaced the cage using the still intact endplates on the right-side, then dorsal re-fixation and fusion

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Slide 4

Case 3: Female, 53. This was very tricky; probably congenital (postraumatic or post-Pott disease also possible). I did an opening-wedge osteotomy all dorsal; I had to partially resect 6 ribs, 6 pedicles (maybe 8, I really can´t say) cut 6 roots and resect 3 (maybe 4) hypoplastic vertebral bodies, distract anteriorly, insert a fulcrum and compress dorsally. The cross-link connector is there only to protect the buckled dural sac which protruded dorsal

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Fallserie

VLDS bei adulter Skoliose

1 Folien

Slide 1

Ventral derotation and instrumented fusion for lumbar curves can also be a feasable option in adult scoliosis. This is a 55y.o. patient with a Lenke 5 curve with a degenerative component. Dorsal or ventro-dorsal instrumented fusion were considered. In order to stay short and have a neutral LIV I opted for the solution below. Note the marked derotation of the lumbar apex which I feel is possible only with a thorough anterior (or if also dorsally instrumented, with a posterior) release of the ALL, PLL and anulus.