Outcome of a posterior spinal fusion technique using spinous process wire and vertical strut

Background/Objective: Spinal fusion is a rapidly developing area of spine surgery. Many of the implants often used are not within the reach of the patients in the developing world. In this study; we describe the outcome of a novel technique of posterior spinal fusion using the rush nail and spinous process wire. Materials and Methods: We prospectively evaluated patients who underwent the technique since October 2006. We reviewed the patients' biodata; clinical diagnosis; imaging studies; indications for surgery; type of operations; and complications related to the implants and the technique. Clinical test of instability was also determined. Results: The technique was used in 11 female and 19 male patients. The age range was 11-82 years. The indication for surgery was trauma in 15 patients; degenerative disease in seven patients; tuberculosis of the spine in four patients; and four patients had neoplasms. Occipitocervical fusion was performed in three patients; cervical fusion in six patients; thoracic fusion in 10 patients; thoracolumbar fusion in seven patients; lumbar fusion in three patients; and lumbosacral fusion in one patient. The distal segment of the implant backed out in one patient following fracture of the spinal process. The implant was eventually removed. Clinical evidence of instability necessitating external orthotics was also seen in one patient. Two patients had wound infection. These were managed without removing the implants. We did not observe significant complications in other patients. Conclusion: The technique appears safe and effective in carefully selected cases. The technique needs further evaluation in a larger patient population and with a longer duration of follow-up

Intraoperative magnetic resonance imaging and meningioma surgery

Objective: To determine if intraoperative magnetic resonance imaging improves surgical resection and postoperative outcome of intracranial meningioma. Study design: Prospective; on-randomized; cohort study Method: Intraoperative Magnetic Resonance Imaging (iMRI) was used to evaluate patients with meningioma undergoing surgery. Images were obtained after induction of anaesthesia and at various stages of tumour resection. Extent of surgical resection was graded using Simpson grading system for meningioma. The images were reviewed together with histopathology and early outcome. Primary outcome measure was determined by finding unexpected tumur in interdissection images. Secondary outcome measures were determined by postoperative complications including infections and mortalities. Results: There were 39 procedures in 38 patients from January 1998 to December 2002. Surgical-planning images helped to optimize craniotomy placement. Interdissection images revealed unexpected residual tumour in only 1 patient. Complete resection (Simpson grades 1-3) was achieved in 33 procedures. The average follow up period was 16.4 months. Tumour recurrence has been observed in three patients. Two of these patients had anaplastic meningioma. There was no mortality in the 30-day postoperative period. Conclusion: Intraoperative MRI was beneficial in siting the craniotomy in addition to providing anatomical relationships between the tumour and adjacent structures in lesions located at the skull base though the full benefit of these is yet to be determined. The low morbidity and zero mortality recorded in the study may be related to all these factors