Delayed Treatment of a Traumatic Lumbosacral Dislocation With Associated Injuries: A Case Report.

CASE: A 41-year-old woman sustained a degloving injury over her lumbosacral and perineal region with fractures of her right tibia and fibula. After diversion colostomy and osteosynthesis for the fractures at a primary center, a missed grade 2 lumbosacral dislocation was diagnosed at a tertiary center and the degloving injury was treated with debridement and skin grafting. After 5 months, the dislocation had progressed to grade 4 and she underwent delayed posterior lumbosacral reduction, interbody fusion, and L4-S1 fixation, with superior gluteal artery perforator flap and subsequent colostomy closure, with good outcomes (Oswestry Disability Index 10%) at the 3-year follow-up. CONCLUSION: A rare, missed, progressive traumatic L5-S1 spondylolisthesis with associated injuries is described.

Skeletal Fluorosis With Thoracic Myelopathy: A Report of 2 Cases.

BACKGROUND: To report 2 different presentations of thoracic myelopathy with ossification of ligamantum flavum (OLF) due to fluorosis. METHODS: Two females presented with thoracic myelopathy secondary to spinal stenosis with OLF due to fluorosis. On examination, the first patient had a grade 4 power in both lower limbs with altered sensation below L1 dermatome. She had segmental OLF on magnetic resonance imaging and computed tomography and was treated with posterior thoracic laminectomy and recovered well. The second patient had a history of a prior thoracic laminectomy at another institution and presented with paraplegia with bladder involvement. Radiological investigations revealed a 3-column injury at the level of D8/D9. This patient was treated with decompression and stabilization. RESULTS: The first patient recovered neurologically and regained independent ambulation while the second patient had a reduction in spasticity but no recovery of power or bladder function. CONCLUSION: Different presentations and causes of myelopathy due to OLF should be recognized and treated. An unstable injury is very rare and should not be missed.

Transoral release to realign postoperative loss of reduction following occipitocervical fixation for congenital basilar invagination.

PURPOSE: Revision surgery in an irreducible atlantoaxial dislocation (IAAD) previously operated with a posterior approach is challenging. Multiple modalities using anterior, posterior, and dual approaches have been described. We report a so far unreported technique of revision surgery by posterior implant removal and decompression with anterior transoral release followed by posterior instrumentation. METHODS: 14-year male with basilar invagination (BI) with IAAD, previously operated with posterior decompression and instrumented occipitocervical fusion presented three months later with post-traumatic recurrence of myelopathy with quadriparesis with Di Lorenzo grade 4 and loss of reduction. He was operated with a posterior implant and early fusion mass removal with extended foramen magnum decompression (FMD), followed by anterior transoral release with a satisfactory reduction on traction, and finally, a posterior revision instrumented occipitocervical fusion. RESULTS: At 2-year follow-up, the patient was symptom-free with Di Lorenzo grade 1 and cervicomedullary angle improvement from 97.4° to 141.2°; achieving bony fusion. CONCLUSION: Single-stage posterior-anterior transoral-posterior approach can be used to achieve satisfactory reduction for a revision BI with IAAD with prior posterior instrumentation.

Robotic-Assisted Knee Arthroplasty (RAKA): The Technique, the Technology and the Transition.

BACKGROUND: There has been an exponential increase in knee arthroplasty over the past 20 years. This has led to a quest for improvement in outcomes and patient satisfaction. While the last decade of last century proved to be the decade for Computer-Assisted Surgery (CAS) or Computer Navigation wherein the technology demonstrated a clear benefit in terms of improving mechanical axis alignment and component positioning, this decade is likely to belong to Robotics. Robotics adds an independent dimension to the benefits that CAS offers. The article deals with the generation of robots, technical steps in robotics, advantages and downsides of robotics and way forward in the field of knee arthroplasty. MATERIALS AND METHODS: The review article was designed and edited by six different authors reviewing 32 relevant pubmed-based articles related to robotics in arthroplasty and orthopaedics. The concept, design and the definition of the intellectual content were based on the internationally published literature and insightful articles. The review is also based on the clinical experimental studies published in the literature. DISCUSSION: The robotic arm is actively involved with surgeon to achieve the precision and outcomes that the surgeon aims for. With the concept of haptic boundaries and augmented reality being incorporated in most systems, Robotic Assisted Arthroplasty (RAA) is likely to offer several advantages. The potential advantages of these systems may include accuracy in gap balancing, component positioning, minimal bone resection, reduced soft tissue handling and trauma, patient anatomy specific resection, and real time feedback. They, however, come with their own downsides in terms of capital cost, learning curve, time consumption and unclear advantages in term of long-term clinical outcomes. CONCLUSION: To conclude, this review article offers a balanced view on how the technology is impacting current arthroplasty practice and what can be expected in coming years. The commitment of almost all major implant manufacturers in investing in robotics likely means that the evolution of Robotic technology and this decade will be exciting with rapid strides revealing paradigm shift and evolution of technology with significant reductions of cost enabling it to be available universally. For technology to populate in operating room, I think it will be result of exposure of young surgeons to these computers and robotics, as they grow in with confidence with technology from residency days to offer better precision in future.