The surgical technique does not differ a lot from what we previously reported for long instrumentation of the thoraco-lumbar spine [1]. A crucial step at the beginning of the operation is the careful check of the optimal fluoroscopic view of the pedicles. The upper thoracic pedicles are generally better recognizable in anteroposterior (AP) views with selleckbio the C-arm rotated in the craniocaudal plane according to the degree of kyphosis. Shoulders and soft tissues, especially in obese patients, frequently hinder visualization on lateral views. A second important technical feature is the right contouring of the rods before their implantation to preserve sagittal alignment, which varies substantially from patient to patient. This variability of thoracic kyphosis sometimes increased the difficulty of the procedure.

Some patients had hyperkyphosis or worsening of preexisting pronounced kyphosis due to the vertebral lesion. Clinical assessment and implant surveillance were performed at 1, 3, 8, and 12 months. The accuracy of the pedicle screw placement was assessed at first postoperative control by means of CT scan with very thin slices in the three planes of the space and evaluated according to Youkilis’s method [2]. Of 92 screws implanted, 84 were positioned inside the thoracic pedicles of which 22 by open and 62 by percutaneous approach. Eight screws were placed in the lateral masses of the cervical spine. The survival of the construct was assessed with standard X-rays at the subsequent controls till the first 1y postoperative end-point, checking the failure of the implant, screw breakages or the presence of radiolucencies around the screws, signs of an impending loosening.

3. Results No complications related to the surgical technique were observed and all patients showed satisfactory clinical outcome after a minimum 1-year follow-up. None of the patients had excessive intraoperative bleeding estimated maximum 250cc Drug_discovery and 100cc for OPCA and completely percutaneous, respectively. Concerning the accuracy of the screws placement we observed that 22 of 24 open screws were good positioned and 2 were acceptable (more than 2mm cortical violation) while 63 of 70 percutaneous screws were good positioned and 5 were acceptable. No infection or delayed wound healing was observed, including an obese patient (120Kg), where the limited extension of the open approach facilitated mostly the postoperative nursing. No implant failed or loosened during follow-up. Patients treated for fractures started to walk in second day after the operation and were discharged from the hospital in 3�C5 day postoperatively. Two patients belonging to the tumoral group were transferred to another hospital for postoperative rehabilitation because of the neurologic impairment.