Full Endoscopic Lumbar Transforaminal Interbody Fusion in DDD Lumbar Degenerative Disc Disease: A Latest Technique.

BACKGROUND: Lumbar interbody fusion has long been used in the treatment of degenerative disc disease. Lumbar spinal interbody fusion surgery traditionally is an open surgical technique. Although lumbar spinal interbody fusions using endoscopy have been reported, the endoscope was used partially for the interbody fusion. We are reporting a case where lumbar interbody fusion with discectomy was entirely done through direct visualization with the endoscope. METHODS: We report a case of a 55-year-old woman who underwent the transforaminal percutaneous full-endoscopic lumbar interbody fusion technique (FELTIF) under continuous and direct visualization at the L5-S1 level. To facilitate the interbody fusion, a foraminoplasty with complete resection of the superior articular process (SAP) and a partial pediculectomy of the S1 pedicle was performed. End plate sparing decortication techniques were used under direct video endoscopic visualization. The cage and bone graft insertion occurred through the endoscopic working cannula, thereby protecting the retracted traversing and exiting nerve roots at the surgical level. Posterior supplemental fixation with percutaneous pedicle screws was performed to complete the circumferential fusion. RESULT: The VAS leg score was reduced to 2 from preoperative score of 7 and the VAS back score reduced 3 from preoperative score of 9. Her neurogenic symptom score improved from 8 before surgery to 1 at the last follow-up. The fusion is assessed by plain radiographs in follow up. CONCLUSIONS: We concluded that the insertion of an interbody fusion cage device directly through an endoscopic working cannula was technically feasible. Future research should focus on examining the clinical outcomes of this technique. LEVEL OF EVIDENCE: 4.

A Rare Case of Radius Head Epiphyseal Aneurysmal Bone Cyst with Predisposing Factor as Trauma Tuberculosis of Elbow apart from Genetic.

INTRODUCTION: Aneurysmal bone cysts (ABCs) are benign aggressive bone lesions arising predominantly in the second decade of population in long bones at metaphyseal region which can cause local pain, swelling, and pathologic fracture. With two types, primary and secondary. diagnosis is made with various imaging modalities, although biopsy is important for diagnosis. Currently, the standard treatment is curettage or excision. Along with adjuvant therapy, chemical physical radiotherapy pharmacological to decrease recurrence was more in previous decades. CASE REPORT: A 40-year-old male presented with the complaint of pain swelling over the right elbow but no fever for the past10days with a history of trauma 15 days back. In the past, history of tuberculosis of the elbow treated 10 years back on antituberculosis therapy, antitubercular drugs, and surgery was done and recovered with satisfactory result. On investigation X-ray -pathological fracture of radial head with eccentric ballooned expanded radiolucency margin well circumscribed lesion bone cyst. Surgery aim was to excise diseased part and get good functional recovery. Wide excision of tumor was done via anterolateral approach with injection of phenol at excised tumor site Tumor bone soft tissues was send for biopsy after surgery. Post-operative recovery was satisfactory with good reasonable range of movement of elbow was achieved. CONCLUSION: A rare case of primary ABC at epiphyseal region rarest site less common bone involved radius has been reported with no reconstruction done due to it extensive extent with local predisposing factor apart from genetic. ABCs are aggressive benign lesions with high rates of recurrence challenging treatment, but it is curable when approached with multimodality treatment surgical along with radiotherapy pharmacological chemical physical.

Osteomyelitis of Fibula Rare Case with Various Differential Diagnosis.

INTRODUCTION: The osteomyelitis of fibula is a rare case to present. Osteomyelitis is clinical diagnosis with support of various investigation with proper surgical technique and various Differential Diagnosis it is treated with good satisfactory result. CASE REPORT: A 65-year-male operated 10 years back for tibial plateau fracture was asymptomatic but for last 3 months started pus discharging sinus from middle third of leg. We investigated and done implant removal with abnormal tissue abnormal bone was excised out, but very unusual presentation intraoperative necrotic massive debris was there like wood pieces mimic as neoplastic lesion, metastasis, fungal osteomyelitis, or granulomatous infection. However, after biopsy, it was diagnosed pyogenic osteomyelitis 2 weeks of injectable and 6 weeks of oral antibiotics were given. After that 4-6 weeks weight bearing was started, the patient returned to his obvious activities with normal range of motion. CONCLUSION: The osteomyelitis of fibula with various differential diagnosis clinically and intraoperatively with very rare necrotic tissues like wood pieces mimicked neoplasia fungal infection but after proper debridement curettage and biopsy report probable diagnosis is made with proper duration of antibiotic treatment chronic osteomyelitis is treated with satisfactory result with good outcome.