tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 108

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 108. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 1074 Section Tumors and Inflammation a b c Figure 5. Multisegmental posterior wedge osteotomy d This technique creates lordosis and is usually applied to one or multiple levels. a The spine is instrumented with pedicle screws two levels above and below the planned osteotomies. b The interspinous ligament and the adjoining spinous process are resected with a rongeur. The yellow ligament is removed and v-shaped bilateral osteotomies are carried out through the isthmus. c These osteotomies are directed laterocranially at an angle of 30-40 degrees. The desired slot width of 5-7 mm is obtained by using appropriate rongeurs. If there is a scoliotic deformity the osteotomies are made slightly larger on the convex side. d The rods are applied first cranially. The osteotomy gaps are closed by stepwise segmental compression and connection to the rods. A posterior spinal fusion is added. With one single osteotomy approximately 10 degrees of correction can be achieved. Ankylosing Spondylitis Chapter 38 1075 monic bending of the spine. In contrast to a closing wedge osteotomy the MPWO removes the posterior elements of a thoracic and or lumbar level without the need for a wedge excision of the vertebral body Fig. 5 . Osteotomies can be performed at four to six thoracic or lumbar levels depending on the extent and location of the spinal deformity 47 98 . With one singular osteotomy approximately 10 degrees of correction can be achieved 98 . The results of this technique are satisfying 47 Table 7 . Cervical Wedge Osteotomy A fixed cervicothoracic kyphotic deformity is rare Case Study 1 . However this deformity can cause a significant morbidity because of an impingement of the chin with the chest making eating and drinking difficult. Furthermore patients lose their horizontal gaze. A cervical corrective osteotomy was first described by Urist in 1958 95 . The opening wedge osteotomy was originally carried out at the level of C7 T1 during local anesthesia. The osteotomy level is .