Stavya Spine Hospital and Research Institute Pvt. Ltd, Mithakhali, Ahmedabad, Gujarat, India.
Spine Deform. 2022 Sep;10(5):1203-1208. doi: 10.1007/s43390-022-00504-w. Epub 2022 Apr 9.
Surgical technical note and literature review.
To describe a technique that uses 4 rod constructs in cases of complex thoracolumbar spinal deformity correction or revision surgeries based on the hybrid use of two different types of purchase points by a staggered pedicle screw fixation. It utilizes two rods on either side of the spine using a lateral and medial entry point of pedicle screws in the vertebral body.
Pedicle screws using extra-pedicular technique are more converging screws and are inserted alternately in the vertebral body and connected by rods. The left-out alternate vertebral bodies are fixed by a relatively straighter pedicle entry screw and connected to each other by a separate rod. So, two trajectories are independently used for a four-rod construct. This reconstruction has been named RCC (reinforced criss-cross construct). The screws in the index case were placed by free hand method, but we have increasingly utilized navigation guidance for placement of screws in recent times.
We present a surgical technical note in a patient with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV-AIDS). He was diagnosed to have multi-drug-resistant (MDR) tuberculous spondylodiscitis, complicated with Immune reconstitution inflammatory syndrome (IRIS) and implant failure resulting in kyphosis and thoracic myelopathy. RCC with pharmacological management achieved healing and union, which was maintained at 4 years follow-up. Our method of four-rod construct provides a strong and lasting construct in the management of spinal deformities and three-column osteotomies. It provides good structural support to the spine till bony union is achieved.
Hybrid multi-rod construct like RCC provides a rigid mechanical support to the instrumentation and reduces the chances of rod failure especially in complex thoraco-lumbar spinal deformity correction surgeries.
手术技术说明和文献回顾。
描述一种技术，该技术在基于杂交使用两种不同类型的进钉点的情况下，通过交错的椎弓根螺钉固定，在复杂的胸腰椎脊柱畸形矫正或翻修手术中使用 4 根棒结构。它在脊柱的两侧使用椎弓根螺钉的外侧和内侧入路，在椎体中使用两个棒。
使用额外椎弓根技术的椎弓根螺钉是更会聚的螺钉，并交替插入椎体中，并通过棒连接。留下的交替椎体由相对较直的椎弓根入钉螺钉固定，并通过单独的棒彼此连接。因此，两个轨迹独立用于四棒结构。这种重建被命名为 RCC（增强十字交叉结构）。索引病例中的螺钉是通过徒手方法放置的，但近年来我们越来越多地利用导航引导来放置螺钉。
我们在一名人类免疫缺陷病毒感染和获得性免疫缺陷综合征（HIV-AIDS）患者中介绍了手术技术说明。他被诊断患有多药耐药（MDR）结核性脊椎炎，并发免疫重建炎症综合征（IRIS）和植入物失败导致后凸和胸髓病。RCC 联合药物治疗实现了愈合和融合，在 4 年的随访中得到了维持。我们的四棒结构方法为脊柱畸形和三柱截骨术的管理提供了强大而持久的结构。它为脊柱提供了良好的结构支撑，直到实现骨性融合。
像 RCC 这样的混合多棒结构为器械提供了刚性的机械支撑，降低了棒断裂的可能性，特别是在复杂的胸腰椎脊柱畸形矫正手术中。
