![]() ![]() This approach can be reinforced with fixation from the anterior approach as well. However, in patients with ASIA 'C' and 'D' status, the posterior approach is necessary to first to unlocking the jammed facet, and the anatomical fixation is carried out following lateral mass and translaminar screw and rod fixation. If reduction fails in patients with ASIA 'A' and 'B' status, posterior-only fixation by interspinous wiring is justified for anatomical fixation to aid in early rehabilitation. Sometimes, owing to financial barriers, simple graft placement can also be undertaken. In cases of failed reduction from traction, the clinician can attempt reduction following muscle relaxation after induction of anesthesia. If there is a good reduction following traction, the patients can receive an anterior approach with discectomy or median corpectomy followed by in-situ bony graft fusion or the usage of allograft spacers aided with plate and screw fixations. ![]() The treatment algorithm is also determined by the patient's characteristics as well as the expertise of the team. The anterior approach is better suited to deal with the herniated disc, whereas the posterior approach helps restore the posterior tension band. The surgical plan in the management of the patient then varies according to the Meyerding grading system, the ASIA neurological status, and the relevant scoring system of the patient. The failure of reduction needs the posterior reduction of the jumped facets, followed by 360-degree global fixations in neurologically preserved patients. The reduction can then take place by anterior-only fusion. If there is no reduction and the preoperative MR images show the presence of disc prolapse, an anterior approach is the next step, with discectomy followed by open reduction with the aid of a Casper distractor. ![]() In cases with locked facets, the clinician should attempt a closed reduction under anesthesia, which is successful in almost 95% of cases. Reduction of the grade of the subluxation in cases of reducible locked facet jointsĬare always needs to avoid cord traction due to heavy tractional weights. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |