Comparison of MRI with x-ray in the evaluation of tuberculosis of spine

Introduction: MRI is the most valuable method for detecting early disease and is preferred technique to define the activity and extent of infection followed by x–ray. Aim: To evaluate MRI as a valuable noninvasive diagnostic tool in spinal tuberculosis and to correlate with plain radiograph for the early detection of spinal tuberculosis. Material and method: This cross-sectional study was carried out on 40 patients who were suspected as cases of spinal tuberculosis. Plain X-ray were done before the MRI examination. Results: The comparison of X-ray and MRI for evaluating spinal TB on the basis of end plate irregularity, thecal sac compression, cord compression and cord changes was statistically highly significant. It was statistically significant on the basis of Disk Space Narrowing/Disk Involvement, paravertebral Widening/Psoas abscess and Posterior Element Involvement. X-ray when compared to MRI was found to have a sensitivity of 48.72% and a specificity of 100% in detection of end plate irregularities, sensitivity of 89.47% and specificity of 100% in detection of vertebral height reduction, sensitivity of 78.79% and specificity of 100% in detection of disk Space narrowing / disk Involvement and sensitivity of 28.57% and specificity of 92.31% in detection of paravertebral widening/psoas abscess. Conclusion: MRI is a better and more Informative imaging modality in evaluation of patients of Pott’s spine providing the diagnosis earlier than conventional methods.

Change in Sagittal Plane of the Lumbar Spine in Patients with Anterior Lumbar Interbody Fusion and Pedicle Instrumentation and its Influencing Factors / 대한정형외과학회잡지

PURPOSE: To evaluate long-term changes in sagittal plane of the lumbar spine in patients with anterior lumbar interbody fusion and pedicle instrumentation and to determine the influencing factors. MATERIALS AND METHODS: Eighty-seven patients underwent single level anterior lumbar interbody fusion with pedicle instrumentation. Each patient's disc space height and segmental sagittal angle was measured preoperatively, immediate postoperatively, and at the last follow-up. RESULTS: Immediate postoperative radiographs demonstrated an average increase in disc space height of 2.8 mm. The follow-up radio-graphic evaluation showed an average decrease of 4.2 mm from the immediate postoperative period and 1.4 mm from the preoperative period. Sagittal angles of the preoperative, postoperative and follow-up period were 10.3 degrees, 14.2degrees and 10.4degrees, respectively. Decrease in disc space height correlated with patient's age and the amount of distraction by the operation. CONCLUSION: Our data demonstrated that the change in the sagittal plane obtained by anterior lumbar interbody fusion with pedicle instrumentation is lost in the postoperative period. Most levels return to their original height or less. This finding suggests that a disc space distraction by this technique in elderly patients with kyphotic deformity is not reliable.

Anterior Cervical Fusion with the PCB Instrumentation (Cervical Plate Cage System) in Degenerative Cervical Disease

OBJECTIVE: The anterior interbody fusion for cervical spine disorder may not provide adequate immediate stabilization, whereas anterior cervical spine plating has overcome this main disadvantage. Recently, several types of hardware were introduced and the complications related to these were also reported. In case of degenerative cervical spine disorders, the adequate intervertebral disc space height and lordotic curvature are the major factors for preventing recurrence of symptoms. So we used the PCB instrumentation(cervical plate cage system) for these purpose. MATERIAL AND METHOD: From April 1998 to October 1998, 16 patients with degenerative cervical spine disorders who had radiculopathy or myelopathy were underwent anterior cervical spine fusion with the PCB instrumentation(cervical plate cage system). Single level fusion was accomplished in 8 patients and two level fusion in 8. The mean follow-up period was 4 month. RESULT: All patients show some recovery at discharge. There were no hardware problems. The intervertebral disc space height and lordotic curvature were not changed during follow up. CONCLUSION: These finding suggest that PCB instrumentation can be considered to be one of the useful hardwares for anterior cervical spine fusion in degenerative cervical spine disorders.

Surgical treatment of posterior approach for spondylodiscitis after lumbar discectomy / 重庆医科大学学报

Objective:To discuss the surgical management of spondylodiscitis after the lumbar discectomy.Methods:7 cases of spondylodiscitis after the lumbar discectomy were analysed retrospectively.All patients were treated with surgical management of posterior approach combined with antibiotics.Results:In 7 patients,4 were males and 3 females.The mean age was 45 years old.The spinal segment involved included L 4/5 in three and L 5S 1 in four cases.The history, clinical courses,ESR and MRI are very useful in the diagnosis of postoperative spondylodiscitis.3 cases presented positive in the bacterial culture and 4 cases negative.After the surgery of the posterior focal debridement and bone plantation with internal fixation, the symptoms were relieved in a short period of time.The roentgenographic followe-up showed the spinal fusion 2.5～3.5 months after surgery.Conclusion:The surgical management of the posterior approach has more advantages over the anterior approach.It is one of the most effective methods for treatment of the spondylodiscitis after lumbar discectomy.

Plain Radiological Measurement of Relationships Between Intervertebral Disc Space and Spinous Process

The mean values of the height, depth and lateral shifting of the spinous processes and the height of the intervertebral disc spaces of 100 patients were measured in the lumbar region. The application of microsurgical techniques in the operation for lumbar disc herniation clearly reduced the overall surgical trauma suffered by patient, but the spinous process might disturb the insertional course and multidirectional activities of the pituitary forceps due to a very small skin incision. The purpose of this study was to prove the relationships between intervertebral disc space and spinous process in the lumbar region. The results were as follows; 1) The height of the intervertebral disc space from L3-4 to L5-S1 intervertebral disc space was 12.63mm, 12.57mm and 11.71mm respectively. 2) The depth of the spinous process from L3 to L5 was 28.87mm, 27.87mm and 23.97mm respectively. 3) The lateral shifting of the spinous process from midline to the right side was 4.39mm, 4.35mm and 4.01mm at L3, L4 and L5 spinous process respectively and to the left side was 3.61mm, 3.70mm and 3.69mm at L3, L4 and L5 spinous process respectively. Conclusively, the lower part of the spinous process was overlapped above the intervertebral disc space at L3-4, L4-5 and L5-S1 intervertebral disc space. About 4mm of the lateral shifting of the spinous process was protruded to both right and left side in the insertional course(about 2-3cm) of the pituitary forceps. The spinous process might disturb the multidirectional activities and perpendicular insertion of the pituitary forceps. So, the removal of the spinous process to the midline was recommended to perform the complete removal of disc materials in microlumbar discectomy.

Anterior Interbody Fusion in Unstable Fracture and Fracture / 대한정형외과학회잡지

Authors had reviewed the results of 20 anterior cervical fusions performed between 1975 and 1980 to determine which factors were important to a successful result. There had been 18 single level fusions and 2 fusions at two levels, the majority at C and C. The indications for fusion operation were: firstly in acutely traumatized patient was the spine representing radiologically the signs of segmental instability, secondly was the chronic segmental instability in old traumatized spine representing the nuchal rigidity and severe cervicobrachial pain which. was not ceased by conservative treatments. The index of successful fusion was complete relief of pain, loss of cervical rigidity and radiologlcal stability of fused segment indicated by no-movement in flexion-extension lateral radiograms, and the bony bridges between the fused segments. The postoperative stability of spine was assessed by measuring the changes of disc space and kyphotic angle. The result obtained were as follows: 1. Pre-and post-operative immobilization with cervical traction played an immportant role for successful results after fusion: 4–6 weeks of pre-operative traction in acutely injured spine provided the torn soft tissue structures with sufficient time needed for its healing, and 6 weeks of postoperative traction also provided the bone graft with sufficient time needed for its cooperation with graft bed. 2. ln all cases succeasful fusion was obtained. In a case a adjacent level was incorrectly fused, but it was fused soundly in time, while the unstable unfused segment was not fused spontaneously. 3. The fused segment or segments of spine stabilized clinically in 6-8 weeks after fusion operation which was proven by serial radiograms, and solid bony fusion was obtained radiologically averaging in 12 weeks after fusion operation. 4. The average increase of kyphosis after interbody fusion till solid fusion was negligible, averaging 3.0 degrees. 5. The solid fusion occurred in one to 2 weeks earlier in the spines with wedge and axial conpression fractures than the spines with flexion-rotation and shear types of fractures. 6. No further neurogical damage developed after successful fusion.