MODIFIED TECHNIQUE OF HARTSHILL INSTRUMENTATION SYSTEM FOR SPINAL FIXATION AND STABILIZATION.

Kotipalli Vishnu Prasad M.S. M. Ch. Proff. & HOD, Department of Neurosurgery, King George Hospital, Andhra Medical College, Andhra Pradesh, Visakhapatnam, India

Introduction
Posterior Spinal instrumentation and facet joint arthrodesis has been an accepted procedure for segmental spinal instability. Hartshill rectangle spinal instrumentation is a world wide accepted and established system for post spinal fixation and stabilization. Hartshill Rectangle is available either in S.S metal or Titanium with standard sublaminar wires.

Aim of the Study
To evaluate the application of Hartshill Instrumentation for Posterior Spinal Stablization under microscopic technique.

Material and Methods
Hartshill Rectangle has been used in 120 cases of spinal segmental instabilities from June 2005 to Dec 2008.

Demographics
Nature of Lesion

Procedure
A microneurosurgical technique has been used to do a fenestration by removing the ligamentum flavum on either side and if necessary to do a micro discectomy and de roofing of root canal under operating microscope. A microhook has been used to deliver out the double sublaminar wires. The posterior supra spinous and inter spinous ligaments were kept undisturbed to maintain the post spinal stability. The Canal dimensions were restored. Hartshill Rectangle has been positioned( if necessary contoured) after cutting the inter spinous ligaments at superior and inferior horizontal ends. The sublaminar wires were tightened over the rectangle at each level, cut, twisted and turned. The implant construct was strong, stable and fixation was tight.The loose spinal segment was tightly fixed to the rectanlge with wires in spondylolysis. In traumatic wedge compression also,the construct was strong, stable and adequate. The facet joints were denuded and arthrodesis was done with blocks of onlay G graft. For S1 fixation a fenestration with power drill was done between S1 and S2. Both in the traumatic spines and Koch's Spine two spinal segments above and below the involved segment were fixed. Clinical and Radiological assesment was done at 1, 2, 3, 6 months, 1, 2 and 3 years after surgery. No post operative brace was required in all the cases.
Results
The cases were followed up for 3 months to 3 years. In grade1 lysis/ lysthesis, patients had complete relief of low back pain.
There was no wire breakage in any of the cases. In two cases there was minimal dural csf leakage and was promptly controlled. Neurological recovery depended on the initial spinal cord injury in spinal trauma. Those cases which had total cord transaction did not recover at all but these patients were mobilized early to maintain the cardio respiratory tone and to avoid further complications of bed ridden state.
In Kock's spine also out of 24 cases, 18 cases recovered fully, 4 cases made partial recovery and 2 cased did not recover at all. For all these patients, biopsy was taken at the time of surgery and confirmed histopathologically and were kept on anti tubercolosis treatment.
Conclusions
Hartshill Fixation has been safe, easy to apply, cost effective and proved to be quite adequate for spinal fixation and stabilization. This modified microsurgical technique without much disturbance to the posterior spinal elements would achieve good results.

References
  • Dove J. Internal fixation of the lumbar spine: The Hartshill Rectangle Clin. Orthop., 1986, 203, 135.
  • Fidler M.W. Posterior instrumentation of the spine. Spine 1986, 11, 367.

Hartshill Fixation has been safe, easy to apply, cost effective and proved to be quite adequate for spinal fixation and stabilization.

DR. K. VISHNU PRASAD

CNS CONFERENCE 2009

Author: Dr. K. Vishnu Prasad

The Congress of Neurological Surgeons 2009 Annual Meeting features high-impact science and innovative presentations set against the backdrop of America’s most welcoming and exciting cities. Dr. K. Vishnu Prasad's paper was selected for the 2009 Digital Poster Presentation.