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Stabile interkorporelle Fusion des lumbosakralen Bandscheibenfachs uber einen alleinigen ventralen retroperitonealen Zugang mit einem Cage, der uber eine ventral integrierte Titanplatte in den angrenzenden Wirbelkorpern verankert wird. Degenerative Bandscheibenerkrankungen ohne Instabilitat oder Deformitat, Anschlussdegenerationen, Pseudarthrosen bei Zustand nach dorsalen Spondylodesen. Segmentinstabilitaten, Deformitaten, ausgepragte sakrale Inklination, inadaquate pravertebrale Gefassituation, Osteoporose, relativ: vorausgegangene intraabdominelle/gynakologische Operationen, Infektionen/Tumor/Trauma. Uber einen minimal-invasiven retroperitonealen Zugang Darstellung des Bandscheibenfachs L5/S1, Einsetzen eines Spreizersystems, Eroffnung des Bandscheibenfachs und vollstandige Diskektomie, Aufdistrahieren des Bandscheibenfachs mittels eines Spreizersystems, Festlegen der Implantatgrose (Cage) mittels Probeimplantaten, Fullen des Implantats sowie des Bandscheibenfachs mit Knochenersatzmaterial, festes Einbringen des Cages im Zwischenwirbelraum, Fixieren des Cages mit jeweils 2 in den kranialen bzw. kaudalen Wirbelkorper einzubringenden Schrauben, Rontgenkontrolle, Ruckzug aus Operationssitus unter Uberprufung evtl. Lasionen, schichtweiser Wundverschluss. Sofortige Mobilisation bis zur Vollbelastung 4–6 h postoperativ, Ruhigstellung im Korsett fakultativ, Wiederaufnahme sportlicher Aktivitat 3 bis 6 Monate postoperativ mit Erreichen einer zunehmenden knochernen Konsolidierung. Von 2005 bis 2012 wurden insgesamt 77 Patienten (26 mannlich, 45 weiblich) mit einer degenerativen Bandscheibenerkrankung im Segment L5/S1 uber einen retroperitonealen Zugang mit einem SynFix-LR (Fa. Synthes, Solothurn, Schweiz) operativ versorgt; 71 Patienten (92,2 %) konnten mit einem mittleren Follow-up von 35,1 Monaten (12 bis 85 Monate) nachuntersucht werden. Die Komplikationsrate betrug 12,7 %, die Reoperationsrate 2,8 %; 77,5 % der Patienten waren zum Zeitpunkt der Nachuntersuchung mit dem Operationsergebnis zufrieden, 22,5 % unzufrieden. Die Auswertung des ODI(Oswestry Disability Index)- und des VAS(visuelle Analogskala)-Score ergab statistisch signifikante Verbesserungen. Radiologisch konnte eine statisch signifikante Zunahme der segmentalen Lordose erreicht werden, die Fusionsrate (ermittelt in der Computertomographie [CT]) betrug 97,3 %.

Purpose The purpose of this study was to assess the mid-term clinical and radiological results as well as patient safety in terms of complication and reoperation rates in patients treated with a novel anterior stand-alone fusion (ASAF) device (Synfix-LR, DePuy Synthes, West Chester, PA, USA) in a cohort of patients with predominant and intractable low back pain originating from monosegmental degenerative disc disease at the lumbosacral junction.

The treatment of a comminuted open fracture of the lower extremity caused by high-energy trauma often requires serial debridements and preliminary external fixation before open reduction and internal fixation and wound closure10. The prevalence of complications, including delayed fracture-healing, nonunion, and deep infection, has stimulated interest in the use of the Ilizarov ring fixator, with initial shortening and early wound closure followed by a corticotomy and segmental bone transport for restoration of limb length11. The disadvantages of stabilization with a ring fixator and subsequent segmental bone transport include a high rate of delayed union or nonunion at the docking site, pin-loosening, pin-track infection, and the pain and inconvenience that are associated with the long treatment period7,12. We report the case of a patient who had a comminuted fracture of the distal part of the femur that was associated with a large osseous defect, hypertrophic callus formation, and deep infection. The patient was managed successfully with multiple debridements and distraction osteogenesis through the callus. A thirty-nine-year-old man who had been involved in a motorcycle accident was initially seen at another institution for the treatment of multiple injuries, including a pulmonary contusion, a grade-II head injury (a score of 8 points on the Glasgow coma scale18), a Le Fort type-I maxillary fracture, a bilateral mandibular fracture, fractures of the ninth thoracic and first lumbar vertebrae, a supracondylar fracture of the left humerus, a fracture of the left olecranon, a fracture of both bones of the left forearm, bilateral hand injuries, an intertrochanteric fracture of the left femur, and a comminuted, open, grade-IIIB6 supracondylar fracture of the left femur (a type-33 A3.3 fracture according to the AO/ASIF classification system8) associated with a loss of eight centimeters of segmental bone from the distal …

Introduction Fusion of lumbar motion segments has been shown to be effective for the treatment of low back pain (LBP) from degenerative disc disease (DDD) in a cohort of patients that has been shown to be unresponsive to conservative treatment. However, previous fusion techniques performed via posterior approaches have been associated with a variety of negative side effects. The goal of this investigation was to assess the clinical and radiological results in a cohort of patients treated with an anterior standalone device (Synfix LR, DePuy Synthes, West Chester, Pennsylvania, United States). Patients and Methods Patients included in this study are part of an ongoing prospective clinical trial with Synfix-LR (DePuy Synthes, West Chester, Pennsylvania, United States). The minimum follow-up (FU) for inclusion in this study was 12 months. Clinical outcome scores VAS, ODI, and satisfaction rates were acquired within the framework of an ongoing prospective clinical trial. Evaluation of radiological data included the pre- and postoperative segmental and global lumbar lordosis, neuroforaminal height and width. Interbody fusion was assessed from postoperative CT scans. Results The initial cohort consisted of 77 patients. A total of 71 patients were available for final FU, resembling a 92.2% FU rate after a mean FU of 35.1 months (range, 12.0–85.5 months). The overall results revealed a highly significant improvement from baseline VAS and ODI levels ( p 0.05). A high rate of solid first ( n = 30/37; 81.1%) or second degree ( n = 6/37; 16.2%) interbody fusion was confirmed in 97.3% of all cases ( n = 36/37). Conclusion The data demonstrate satisfactory clinical results following anterior standalone fusion of the lumbosacral junction. Patient safety was proven with acceptable complication and reoperation rates, particularly when compared with posterior pedicle screw instrumented techniques. Radiological data demonstrated a significant reconstruction of lordosis at the lumbosacral junction while maintaining the overall global lumbar lordosis, which was accompanied by solid interbody fusion in 97.3% of all cases. The present data reveal that the currently described anterior standalone fusion is a viable treatment alternative in an attempt to avoid fusion related negative side-effects, which have previously been linked to a variety of posterior instrumented approaches and techniques.