ABSTRACT
BACKGROUND: We aimed to compare the rate of diagnostically successful vertebral biopsies using conventional bone biopsy needles versus those performed with bone biopsy needles with an acquisition cradle. METHODS: We retrospectively analyzed the data of patients who underwent CT-guided vertebral biopsy between December 2017 to December 2019 at our institute. From December 2017 to November 2018, the procedure was performed on 185 patients using an 11G conventional bone biopsy needle, Jamshidi needleTM "(group 1)". From December 2018 to December 2019, the procedure was performed on 242 patients using an 11G T-handle Jamshidi needle with an acquisition cradle "(group 2)". We reviewed their histopathological reports for both groups of patients to determine the rate of diagnostically successful biopsies. We also compared the crush artifact amongst the unsuccessful biopsy samples acquired by the two types of biopsy needles. RESULTS: 427 patients (270 male and 157 female patients; mean age, 46.4 years; age range, 25-67 years) who underwent CT-guided vertebral biopsy from December 2017 to December 2019 were included in our study. In group 1, diagnostic success was achieved in 136 out of 185 biopsies (73.5%); whereas in group 2, diagnostic success was achieved in 219 out of 242 biopsies (90.50%), p < 0.0001. Out of the diagnostically unsuccessful biopsies in Group 1, 36 out of 49 (73.5%) were due to crush artifact; whereas crush artifact accounted for only 3 out of 23 (13.0%) diagnostically unsuccessful biopsies in group 2, p < 0.0001. Other causes of unsuccessful biopsies (hemorrhagic contents or presence of normal osseous tissue and fibrin only) were statistically insignificant. CONCLUSION: The use of a T-handle Jamshidi needle with an acquisition cradle appears beneficial compared to the conventional Jamshidi needle in terms of the significantly higher rate of diagnostic success and a lower rate of crush artifact.
ABSTRACT
Spinal injuries constitute about 3% of all injury cases and most of these injuries affect the thoracolumbar region, but thoracolumbar fracture-dislocations are much rarer. Dislocations (AO Type C injuries) of the thoracic and lumbar vertebrae, with or without associated fractures, happen due to very high energy trauma involving simultaneous, multidirectional, distractive and compressive forces across various spinal elements, which results in translational and rotational instability of the spinal column. Various reduction maneuvers have been described for thoracolumbar fracture-dislocations in the literature aiming to provide standardization in surgery for this situation. The aim of this review article is to systematically review the literature till date and describe various reduction maneuvers which help to achieve adequate sagittal and coronal balance as well as vertebral alignment with minimal soft tissue trauma. We searched the PubMed, the Cochrane Library (the most recent issue), Scopus, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Web of Science, International Clinical Trials Registry Platform (WHO), ClinicalTrials.gov and Google Scholar databases, besides other sources and general internet search. The strategy used in the search was briefly(''thoracolumbar'' OR ''dorsolumbar'') AND "dislocation" in PubMed. Similar searches were made in the other databases.Reference lists of the relevant papers were also examined and any further relevant studies, which were also included in the review. The initial search revealed 332 papers in Pubmed, out of which 302 were human studies. A similar search on Scopus revealed 528 documents and on WoS revealed 289 papers. Searching the Cochrane library revealed 9 trials, which were already revealed in Pubmed search results. All the references were imported into Endnote and we had 632 references after excluding duplicates and 126 papers were left in endnote after manual title screening and duplicate removal. Finally, 70 relevant papers were selected for consideration based on inclusion criteria, after excluding unrelated papers manually. We have summarised the published literature on the surgical management of thoraco-lumbar fracture dislocations and described the reduction maneuvers used in detail.
ABSTRACT
STUDY DESIGN: A retrospective study was done to assess the outcome of the new technique of flipped reposition laminoplasty for excision of intradural extramedullary (IDEM) spinal tumors of the thoracolumbar region. PURPOSE: To describe flipped reposition laminoplasty technique and evaluate its outcomes. OVERVIEW OF LITERATURE: Laminectomy has been the conventional approach for the surgical excision of IDEM spinal tumors, but it has potential postoperative complications. Laminoplasty maintains the posterior arch of the spine and avoids complications seen in Laminectomy, such as instability, epidural scarring, and kyphotic deformity. METHODS: Fourteen patients (nine females and five males) diagnosed with IDEM tumors of the thoracolumbar region operated between 2016 and 2018 were included in this study. Pathologically, five cases were schwannomas; four cases were meningiomas; two cases were ependymomas; and one case each was lymphoma, neurofibroma, and teratoma. All patients had their neurological deficits documented using the American Spinal Injury Association (ASIA) impairment scale. After completion of all preanesthetic formalities, the patients were operated upon by a single surgeon using the flipped reposition laminoplasty technique. Follow-up was done at 1, 3, 6, and 12 months post operation and yearly thereafter. RESULTS: The mean age of the patients was 35.28 years (14-65 years), and the mean follow-up duration was 17 months (6-26 months). Two patients were assessed with ASIA grade A neurology, one patient improved to ASIA grade B, whereas the other did not improve. Two patients improved from ASIA grade B to ASIA grade D, and seven patients with ASIA grades C and D improved to ASIA grade E. Fusion at the osteotomy site was seen in 92.85% (13 out of 14) cases on one side within 6 months post operation. Fusion was seen in all the cases within 1 year post operation. CONCLUSIONS: Flipped reposition laminoplasty is an excellent technique providing adequate exposure and additional stability postoperatively.
ABSTRACT
Reaming is an important step in long bone nailing and has a low complication rate. We report a case of a flexible reamer that got broken and incarcerated in the femoral canal during reaming in a segmental femur fracture. Routine extraction using guide wire was not possible. The incarcerated reamer was successfully extracted with the help of a jumbo cutter.
ABSTRACT
BACKGROUND: Post-traumatic unilateral or bilateral sub-axial cervical spine dislocations with locked facets are quite common. In developing countries like India, many patients with cervical injuries report late due to many reasons like rural backgrounds, lack of infrastructures and skilled surgeons, unawareness, poor socioeconomic status, lack of transportation to the specialized center with proper facility, etc. Early management is essential to maximize better neurological outcome. Delayed or neglected presentation makes treatment more challenging. Very few literatures are currently available regarding management of neglected cervical facet dislocation but no one offers clear cut management. Purpose of our study is to evaluate treatment outcome of 15 patients with post-traumatic neglected cervical facet dislocation. Here we have reviewed 15 patients with post-traumatic neglected presentation of cervical facet dislocations and evaluated their treatment outcome. MATERIALS AND METHODS: This is a retrospective type of study done in spine care unit of VMMC and Safdarjung Hospital, New Delhi from July 2013 to June 2016. Record of 15 patients with neglected cervical dislocation who were undergone anterior cervical discectomy and fusion along with posterior lateral mass screw fixation depending upon close reduction and integrity of disco-ligamentous complex. RESULTS: 15 patients were included in this study. 4 patients underwent only anterior cervical discectomy and fusion (ACDF) after complete close reduction with intact disco-ligamentous complex. Remaining 11 patients who failed to achieve complete reduction or had posterior disco-ligamentous injuries underwent posterior partial facetectomy and lateral mass screw fixation with anterior discectomy and fusion concomitantly. Mean follow up period was 14 months. All patients achieved pain relief and sufficient neck movements. 1 patient with only nerve root injuries recovered completely. 6 out of 11 patients with incomplete spinal cord injuries, improved by one Frankel grade and remaining 5 patients by two grades. 3 patients with complete quadriplegia showed no clinical and neurological improvement. CONCLUSION: Proper decompression, reduction and fixation should be done in neglected cervical dislocation as it provides mechanical stability and alignment, facilitates rehabilitation, prevent kyphotic deformity as well as offers a fair chance of neurological recovery.
ABSTRACT
BACKGROUND: Pedicle screw fixation in high grade lumbar listhetic vertebral body has been nightmare for Orthopaedic and spine surgeons. This is because of abnormally positioned listhetic pedicles and non-visualization of pedicle in conventional image intensifier (C-Arm). This results into increased surgical time, more blood loss, radiation exposure and more chances of infection. To overcome this problem, we have devised a new Technique of putting of pedicle screw fixation in listhetic vertebrae. METHODS: Total 20 patients of average age of 42 (25-56) were included during 2010 to 2015. Listhesis was classified according to etiology, Meyerding grading and DeWald modification of Newman criteria used for assessment of severity for spondylolisthesis on standing X-ray lumbosacral spine. Patients satisfying following criteria were considered for surgery. Age more than 20 years, with single involvement of either L4-5/L5-S1, high grade spondylolisthesis (≥ 50% Meyerding grade), unresolving radiculopathy, cauda equina syndrome or pain with and without instability not relieved by 6 months of conservative treatment. According to Meyerding radiographic grading system,10 patients were of type II and 8 of type III and 2 of type IV. Treatment given was pedicle screw fixation, reduction of listhesis vertebra and spinal fusion with our technique. PLT was done in 10 cases and transforaminal lumbar interbody fusion (TLIF) in the other 10 cases. RESULTS: Mean follow up duration was 2 years (range 1.3-3.3 year). The average preoperative LBP VAS of low back pain were 6.7 and average LP VAS for leg pain 5.7. Postoperatively at final follow up there was reduction of LBP VAS to 2.2 and LP VAS to 0.5. There was rapid reduction in their LBP VAS in first two visits at 4 weeks and in LP VAS in first three visits at 8 weeks. The pain-free walking distance improved significantly. The average pre-operative ODI score was 51.4, improved to 18.6 postoperatively. There was no difference in above scores between PLT and TLIF. CONCLUSION: Our surgical technique used for high grade spondylolisthesis is safe, cost-effective, bone-preserving, reliable, and reproducible for high grade Lumber spondylolisthesis.
