Slalom technique for multilevel degenerative spinal stenosis, surgical outcome and complication rate: Review of our experience.

Lumbar canal stenosis (LCS) is a common spinal disease affecting the elderly. Primarily it is asymptomatic until there is neurogenic claudication. Minimally invasive surgical (MIS) techniques are used to treat patients with lumbar spinal stenosis (LSS), while tubular system with alternative multilevel decompression is specifically used for those with minimal back pain and no mechanical instability on dynamic imaging. The aim of the study is to evaluate surgical outcome of Slalom procedure and complications in Middle East population. One hundred and five patients with lumbar stenosis (61 males and 44 females) underwent the procedure between 2015-2021 who were regularly followed-up using preoperative and postoperative COMI score (the core outcome measure index) at six months after index surgery. Progressive improvement in COMI score from average seven pre-op score to an average of three after six months of index surgery. The postoperative complications were dural tear (6.67%), Postoperative infection (3.81%), mechanical instability (1.9%), postoperative neuritis (8.57%) and death (1.9%).

Primary constrained condylar knee arthroplasty in severe varus deformity: a prospective 5-year functional follow-up study in Iraqi patients.

PURPOSE: The outcomes of the constrained condylar knee (CCK) implant used during primary total knee arthroplasty (TKA) in knees with severe varus in patients from low- and middle-income countries (LMICs) such as Iraq are not known. Hence, this study aimed to analyze and report the functional outcome of CCK TKA in patients with severe varus deformities at the end of 5 years in Iraqi patients. METHODS: In this prospective study, pre- and post-operative (at the end of 5 years) clinical outcome using Knee Society Score (KSS) and radiological deformity using hip-knee-ankle (HKA) angle was analyzed in 76 CCK TKAs (20 bilateral and 36 unilateral TKAs) performed in 56 patients with severe varus deformity (> 15°). RESULTS: At a mean follow-up of 60.3 months (range 60-68 months), the mean preoperative KSS knee score of 6.6 ± 4.5 improved significantly (p < 0.0001) to 87.2 ± 6.6 and the mean preoperative KSS function score of 7.1 ± 6.4 improved significantly (p < 0.0001) to 70.4 ± 7.8. The function score was good to excellent in 64.3% (36 patients), fair in 28.5% (16 patients), and poor in 7.1% (4 patients) at the end of 5 years. The mean preoperative HKA angle significantly improved (p < 0.001) from 25.5° ± 6° varus (range 17°-37°) to 3° ± 2.5° varus (range 0°-7.5°) at final follow-up. CONCLUSION: The CCK implant significantly improved pain and function in patients with severe varus deformity at the end of 5 years. The CCK implant is a good option during primary TKA in severe varus knees in patients from LMICs and can help achieve clinical outcomes similar to patients from high-income countries.

Tuberculous lumbar spinal epidural abscess in a young adult (case report).

INTRODUCTION: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal from L2-L5 vertebrae with extesion to the posterior paraspinal muscles and presenting with bilateral progressive lower limb weakness.   Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. A magnetic resonance imaging (MRI) scan revealed a paraspinal intermuscular abscess and an abscess occupying the spinal canal compressing the dural sac from L2-L4/5, without any signs of vertebral involvement. Surgery was done by a posterior midline incision. Pus was evacuated from multiple pockets through the paraspinal muscle layers. Laminectomy for L3/4, and hemilaminectomy for L2/3, and L4/5 were performed. Pus and bone specimens were negative for acid-fast bacilli. However, both histopathological studies and Polymerase Chain Reaction (PCR) testing confirmed the presence of tuberculosis (TB). The patient received TB antibiotics, and a follow-up MRI scan at 2 months showed complete evacuation of the abscess. However, signs of L5 spondylitis were evident. No further surgery was needed as there was no vertebral collapse or neural compression and the patient's clinical condition was improving. He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. Bowels and bladder function was normal. CONCLUSION: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess.