GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
LOROLORO OrthopedicsOrthopedics andand RehabilitationRehabilitation CenterCenter SWIEBODZINSWIEBODZIN
UniversityUniversity ofof MedicalMedical SciencesSciences POZNANPOZNAN
DEVELOPMENT OF SPINE SURGERY IN POLAND
Jacek Kaczmarczyk, Andrzej Nowakowski, Radoslaw Stanek.
POLISH SPINE SOCIETY
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Striking advances in spine management haveoccurred in Poland for last 20 years, but theseeds of spinal surgery were sown about 5decades earlier.
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
As a result of collaboration with French
language spine surgeons as professors Cotrel,
Dubousset, Chopin, Steib, Lokietek,Passutti,Onimus
and many others.
In 1995 first Central
European GICD congress took place in Poznan.
History of spine surgery in Poland is in fact a
history of Polish-French relationship.
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Polish Spine Society was found in 2002
in Poznan
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
DEFORMITY
Scoliosis
Kyphosis
Spondylolisthesis
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Idiopathic Scoliosis
The goal of surgical management of
scoliosis is to achieve a stable,
balanced spine centered over the
pelvis, while fusing as few segments
as possible
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Golden standard is still posterior orcombined fusion
More often we use multisegmental pedicularscrew to achieve proper stabilization
This procedure is very helpful in adultscoliosis as well
Idiopathic Scoliosis
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
The etiology / etiologies ?/ of idiopathic scoliosisremains a puzzle. Although a large body ofinformation about the deformity has beenaccumulated, there are still more missing thanknown puzzle pieces.
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
The result of manyinvestigations suggest that thelumbar curve in double majorscoliosis spontaneously followthe thoracic curve.
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
There is a strong correlation betweenthe correction of the lumbar and
thoracic curves in AIS, although it isnot the reflexion of the thoracic
correction.
Van Rhijn L. W., Arlet V., Lenke L.
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Double or selective fusion?
Think and plan before the action
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
It is acceptable that the tension and exercises of
the psoas and illiacus muscle can correct the
curve and rotation of the lumbar spine after the
Selective fusion of the thoracic spine in double
IS.
The role of iliopsoas tension inselective fusion
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Selective fusion in double AIS
n = 60
Strong correlation between derotationof lumbar spine (iliopsoascontraction) and postoperative lumbarcorrection
P < 0,01
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
NEUROMUSCULAR SCOLIOSISProgressive paralytic scoliosis with pelvic
obliquity may compromise functional abilities
Walking
Sitting
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
PELVIC OBLIQUITY
Uneven weight bearing in sittingposition
Intact sensations, pressure sores
Upper extremities supportingtrunk (functional quadriplegia)
Limited sitting tolerance
Rib-pelvis impingment
Hip dislocation
Fig. from: Textbook of Spinal Surgery BRIDWELL, DeWALD
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
step I step II
Placing sublaminar wires introducing pre-shaped L-rodsbending rods for lordosis and kyphosis
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
step III step IV
Rotation of pelvis by lever(temporary connected long rods)
Connecting lumbar segmentsShortening the rods and final stabilization
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
In 1993 – 2007 34 patients weretreated surgically
Cerebral Palsy 26
Duchenne’s Muscular dystrophy 2
Spinal muscular atrophy 1
Spine tumor 1
Myelomeningocoele 4
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
DEFORMITY
Scoliosis
Kyphosis
Spondylolisthesis
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
KYPHOSIS
Mainly treated conservatively
Severe or some cases treated withmultisegmental posterior fusion with orwithout anterior release
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
DEFORMITY
Scoliosis
Kyphosis
Spondylolisthesis
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
SPONDYLOLISTHESIS
Posterolateral fusion only withpedicular screws
Combined fusion /PLIF with pedicularscrews/
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
We use Modic
classification in
degenerative changes
observed in MRI
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
DDD
Disk replacement procedures seem to benatural consequence of arthroplastydevelopment
What is the role of fusion in cervical spineand in low back pain
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Case of disk prosthesis onC5/C6 and C6/C7 levels
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Male 42 - degenerative changes on level C5/C6
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Female 46 Degenerative changes on level C5/C6
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Disk replacement
31 cases / F. 19 i M. 12/ age 31 to 45 in years 2002-2005
arthroplasty on L4-L5 level 9
arthroplasty on L5-S1 level 22
PRODISC 30
MAVERIC 1
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Porównywalna translacja przed i po operacji segmentu L5-S1(sposób wykreślenia)
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Male. 43 y. Degenerative Disk Desease on L5/S1
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Male 52 y. Degenerative Disk Desease on L5/S1
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
TUMORS AND PATHOLOGICALFRACTURES
vertebroplasty
Vertebrectomy
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
M. L. 48 Metastatic tumor of L1 (Ca. Renis)
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
a
Male 48 Y. Pathological fracture L3 (myeloma multiplex)
b
GIEDA Inter Rachis Spine Meeting Bruxelles December 2008
Female 50 y. metastatic to sacrum ( leiomyosarcoma )
hemisacrectomy, discectomy L5/S1 Lumbo-iliac fusion