Neurosurgery

lateral vertebral body. Posterior instrumentation can be accomplished with both techniques, although the extracavitary approach allows for visualization of the level opposite to the pedicle base. Decompression and vertebrectomy with bone grafting follows.

Posterior approaches include laminectomy and transpedicular techniques. With the patient in the prone position, a midline incision is made and a high-speed drill is used to remove portions of the facets and pedicles. Dissection of bone fragments off the cord or the reimpaction of bone fragments anteriorly into the vertebral body can then be accomplished. Large midline bone fragments are difficult to remove with this approach. Intraoperative ultrasound to assess neural decompression is helpful when visualization is compromised. These approaches are associated with the risk of incomplete decompression due to the exposure, as well as increasing the risk of deformity without anterior bone grafting.

Regarding posterior instrumentation and fusion, pedicle screws provide the most rigidity, followed by hooks and sub-laminar wires. At the thoracolumbar junction, rod and pedicle screw placement is preferred because of the larger diameter of the pedicles in this region. At least two levels above and one below the injury site are engaged by pedicle screw fixation. The need for anterior neural decompression leads to the use of anterior instrumentation. In the past, a posterior procedure was always done after an anterior approach because of the low fusion rates and the difficulty associated with maintaining correction of the non-instrumented anterior segment. The use of anterior instrumentation with anterior fixation devices has decreased the need for a staged second procedure. The efficacy of these devices is comparable to that of posterior instrumentation systems. Among the existing systems rods, plates and interbody devices are the most commonly used. They should not be used with fracture dislocations unless supplemented by posterior instrumentation.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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