development of spine surgery in poland - giedakaczmarczyk.pdf · step iii step iv rotation of...

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


Striking advances in spine management haveoccurred in Poland for last 20 years, but theseeds of spinal surgery were sown about 5decades earlier.


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.


Polish Spine Society was found in 2002

in Poznan


DEFORMITY

Scoliosis

Kyphosis

Spondylolisthesis


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


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


48 years old female case


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.


The result of manyinvestigations suggest that thelumbar curve in double majorscoliosis spontaneously followthe thoracic curve.


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.


Double or selective fusion?

Think and plan before the action


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


Selective fusion in double AIS

n = 60

Strong correlation between derotationof lumbar spine (iliopsoascontraction) and postoperative lumbarcorrection

P < 0,01


DEFORMITY

Neuromuscular scoliosis


NEUROMUSCULAR SCOLIOSISProgressive paralytic scoliosis with pelvic

obliquity may compromise functional abilities

Walking

Sitting


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


step I step II

Placing sublaminar wires introducing pre-shaped L-rodsbending rods for lordosis and kyphosis


step III step IV

Rotation of pelvis by lever(temporary connected long rods)

Connecting lumbar segmentsShortening the rods and final stabilization


In 1993 – 2007 34 patients weretreated surgically

Cerebral Palsy 26

Duchenne’s Muscular dystrophy 2

Spinal muscular atrophy 1

Spine tumor 1

Myelomeningocoele 4


DEFORMITY

Scoliosis

Kyphosis

Spondylolisthesis


KYPHOSIS

Mainly treated conservatively

Severe or some cases treated withmultisegmental posterior fusion with orwithout anterior release


DEFORMITY

Scoliosis

Kyphosis

Spondylolisthesis


SPONDYLOLISTHESIS

Posterolateral fusion only withpedicular screws

Combined fusion /PLIF with pedicularscrews/


PLIF with posterior fusion


Posterolateral fusion


Degenerative Spine

Tumors

Fractures


We use Modic

classification in

degenerative changes

observed in MRI


DDD

Disk replacement procedures seem to benatural consequence of arthroplastydevelopment

What is the role of fusion in cervical spineand in low back pain


Case of disk prosthesis onC5/C6 and C6/C7 levels


Male 42 - degenerative changes on level C5/C6


Female 46 Degenerative changes on level C5/C6


LOW BACK PAIN


PLIF


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


Porównywalna translacja przed i po operacji segmentu L5-S1(sposób wykreślenia)


Male. 43 y. Degenerative Disk Desease on L5/S1


Male 52 y. Degenerative Disk Desease on L5/S1


Male 48 y. DDD L5 /S1


Female. 43 DDD on L3/L4 i L4/L5 levels


TUMORS AND PATHOLOGICALFRACTURES

vertebroplasty

Vertebrectomy


vertebroplastyCompressive fracture L2


M. L. 48 Metastatic tumor of L1 (Ca. Renis)


a

Male 48 Y. Pathological fracture L3 (myeloma multiplex)

b


c d

cd.


Female 50 y. metastatic to sacrum ( leiomyosarcoma )

hemisacrectomy, discectomy L5/S1 Lumbo-iliac fusion


Male 36 y. chondrosacroma

development of spine surgery in poland - giedakaczmarczyk.pdf · step iii step iv rotation of...

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