Comparison of Segmental Mobility in Lumbar Extension Radiographs between a New Technique (“Fulcrum Bending Position”) and Conventional Standing Position in Spondylolisthesis Patients

STUDY DESIGN: Cross-sectional study.PURPOSE: This was carried out to evaluate the benefit of a ‘fulcrum bending position’ compared with the standing position for evaluation of sagittal translation and sagittal rotation in symptomatic patients with spondylolisthesis.OVERVIEW OF LITERATURE: In lumbar X-ray, the standing position is the most common position used in determining abnormalities in lumbar movement. Lack of standardized method is one of the pitfalls in this technique. We hypothesized that the new technique, that is, fulcrum bending position, may reveal a higher translation and rotation in spondylolisthesis patients.METHODS: The extension lumbar radiographs of 36 patients with low-grade spondylolisthesis were included in the analysis and measurement. Sagittal translation and sagittal rotation were measured in both the routine standing position and in our new technique, the fulcrum bending position, which involves taking lateral cross-table images in the supine position wherein the patient lies on a cylindrical pipe to achieve maximum passive back extension by the fulcrum principle.RESULTS: Results of the measurement of sagittal translation in both positions revealed that compared with the extension standing position, the fulcrum bending position achieved a statistically significant increase of 1.57 mm in translation of the vertebra position (95% confidence interval [CI], 0.52–2.61; p=0.004). The measurement of sagittal rotation in both positions revealed that when compared with the extension standing position, the fulcrum bending position achieved a statistically significant increase of 3.47° in the rotation of the vertebra (95% CI, 1.64–5.30; p<0.001).CONCLUSIONS: For evaluation of both sagittal translation and sagittal rotation in symptomatic patients with spondylolisthesis, compared with the extension standing position, the fulcrum bending position can achieve an increased change in magnitude. Our technique, that is, the fulcrum bending position, may offer an alternative method in the detection or exclusion of pathological mobility in patients with spondylolisthesis.

Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis

STUDY DESIGN: Retrospective cohort.PURPOSE: To evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments.OVERVIEW OF LITERATURE: The standard surgical treatment of spinal tuberculosis is radical debridement via anterior approach. However, this approach may lead to several serious complications. Meanwhile, extended posterior approach, the posterior surgical approach, involving the removal of posterior elements, ribs, and pedicles, is an alternative option that can achieve the aims of treatment in this disease and may reduce the serious complications from anterior approach.METHODS: The medical records and imaging of 50 patients admitted with spinal tuberculosis from January 2010 to June 2016 were reviewed. The Visual Analog Scale (VAS), Frankel grading scale, and kyphotic Cobb angle between the pre- and postoperative periods were used to evaluate the patients.RESULTS: The patients had significant improvement of VAS score in all the groups. The T/T–L, L, and L–S group scores improved from 7.2±1.5 to 1.7±1.2 (p<0.01), from 8.1±1.8 to 1.7±1.4 (p<0.01), and from 7.9±2.2 to 1.7±0.8 (p<0.01), respectively, and overall, the patient scores (n=50) improved from 7.8±1.4 to 1.7±1.3 (p<0.01). Ten patients (20%) had Frankel grade E preoperatively, which was improved to 38 patients (76%) postoperatively. A significant improvement of the kyphotic Cobb angle was observed when compared at the preoperative, early postoperative, and final follow-up period in the T/T–L, L, and L–S groups. The loss of correction angle in the LS group was 7.7°±4.3° at the final follow-up compared with the early postoperative correction angle at 9.1°±5.8°, with no statistically significant difference.CONCLUSIONS: Extended posterior decompression, posterior instrumentation, and fusion are effective methods of surgery for treatment of spinal tuberculosis involved in the thoracic, thoracolumbar, lumbar, and lumbosacral regions.

Initial fluid resuscitation for children with dengue shock syndrome: a systematic review

Background: Currently, there is no standard recommendation of fluid resuscitation in dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The types of fluid as initial choice for resuscitation are still questionable. It is important to review what type of fluid is used for clinical outcome improvement. Objective: To assess the effectiveness and safety of fluid for initial resuscitation of DSS in children. Methods: Randomized control trials (RCTs) of initial fluid resuscitation in 1-15 years-old DSS children were researched. Characteristics of the study (design, methods of randomization, and withdraws/dropouts), participants (age), intervention (type, dose and duration, and fluid after the ending of intervention), outcomes (types of outcome measures, timing, and adverse events), and results were extracted from three selected RCTs. Results: Moderate DSS had no significant difference between each type of crystalloids and colloids in volume of rescue colloid and pulse pressure recovery time (PPRT). In severe DSS, colloids had significantly less median PPRT than crystalloids. Additionally, no difference was found in the incidence of allergic reaction from all the RCTs in both moderate and severe DSS. Conclusion: In moderate DSS, there is no significant difference between crystalloids (Ringer’s lactate solution/normal saline solution) and colloids (dextran/hydroxyethyl starch/gelatin) in the initial fluid resuscitation. The decision in choosing the appropriate type of fluid depends on the physician’s judgment. Some data suggest colloids as the fluid of choice for the initial resuscitation in severe DSS, but there is no significant evidence to support this data. Moreover, any type of colloid is not significantly different from one another. The decision in choosing fluid also depends on the physician’s judgment.