Challenges in Occipitocervical Fusion in a 9-Month-Old Infant: A Case Report and Review of Literature.

ABSTRACT: Traumatic cranio-cervical junction injuries in infants are rare and require early surgical stabilization. In view of the unique anatomy of the occipitocervical junction in infants, the creation of a fusion construct that is both safe and biomechanically sound is challenging. A 9-month-old male infant involved in an accident presented with weakness in both upper limbs. Imaging revealed a displaced odontoid synchondrosis fracture with combined occipitocervical and atlantoaxial dissociation. Due to the unstable nature of the injury, occiput to C2 arthrodesis using dual distal radius locking plates and autologous full-thickness parietal region calvarial bone graft was performed. Minerva jacket was applied. Computed tomography (CT) scan obtained at 12 weeks demonstrated evidence of bony fusion. Combined injuries to the occipitocervical and atlantoaxial joint in an infant can be fatal. A thorough assessment of multiple imaging modalities helps to make an early and accurate diagnosis.

Comparison of yoga and dynamic neuromuscular stabilization exercise in chronic low back pain on magnetic resonance imaging of lumbar multifidus- protocol for a randomized controlled trial.

Background: Degeneration of Lumbar muscle in chronic low back pain (CLBP) is characterized by an increase in fat infiltration of paraspinal muscle, decrease in the cross-sectional area (CSA) of lumbar multifidus muscle (LMM) and increased thickness of Thoracolumbar fascia (TLF) by 25%. The study objective is to compare the effects of yoga and dynamic neuromuscular stabilization (DNS) exercise on CSA, fat infiltration of LMM with magnetic resonance imaging (MRI), and TLF thickness using musculoskeletal ultrasound imaging (MSK-USI) in CLBP. Methods: One hundred and forty-four participants with CLBP, which persisted longer than three months, will be recruited for this trial. Both group interventions focused on LMM. The experimental group will receive structured yoga sessions, and the Control Group will receive exercise based on DNS. In each group, exercises will be performed for 3-5 days/week and progressed for 12 weeks. Baseline data will be collected, followed by the recording of primary outcome measure (MRI) and secondary outcome measures (MSK-USI, Oswestry disability index, visual analogue score, optimism, self-efficacy, mood, physical activity, fear of movement, pain catastrophizing, and coping) at baseline and the end of 12th weeks. The normality of data will be verified. Based on the data distribution, within-group analysis and between-group analysis will be performed. Discussion: This will be the first RCT to compare the effect of yoga and DNS exercise among chronic low back pain participants. This will provide evidence of these interventions' impact on CSA, fat infiltration of LMM, and thickness of TLF in CLBP. Registration number: CTRI/2021/08/035984 (This trial was registered prospectively).

The effectiveness of mindfulness-based stress reduction intervention on physical function in individuals with chronic low back pain: Systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Mindfulness-based stress reduction (MBSR) is often used as a complementary treatment for chronic low back pain (CLBP), but its effects on the physical function component of the outcome are not addressed. This systematic review aims to examine the effectiveness of MBSR on outcomes of physical functions in CLBP individuals. METHODS: Databases searched included PubMed/MEDLINE, PEDro, The Cochrane Database of Systematic Reviews, Web of Science, Scopus, CINAHL, Embase, and other sources (Google Scholar, ProQuest, Research Gate) from inception to January 2022. Randomized controlled trials (RCTs) comparing MBSR with additional interventions that evaluated physical function among CLBP individuals were included. Two independent reviewers performed data extraction. The risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS: Six RCTs involving CLBP individuals were eligible for review. The between-group differences in RMDQ for the MBSR therapies against comparator therapies were significant at eight weeks follow-up (3 RCTs; MD, -1.28 [CI, -2.04 to -0.53]) and six months follow-up (2 RCTs; MD, -0.16 [CI, -1.01 to 0.69]). CONCLUSION: MBSR therapy improves physical function at 8 weeks and 6 months follow-up in CLBP individuals. Further high-quality RCTs are warranted for the long-term effect of MBSR therapy on physical function outcomes.

Temporal Pattern of Pain and Disability Following the Administration of a Selective Nerve Root Block in Lumbar Disc Herniation With Radiculopathy.

BACKGROUND: Lumbar disc herniation with radiculopathy has a favorable natural history, and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of an SNRB in the management of lumbar disc herniation with radiculopathy because there is limited evidence regarding this issue in the published literature. METHODS: This prospective study included 50 patients who underwent an SNRB and were followed for 3 months. Numerical Rating Scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and Depression Anxiety Stress Scales-21 (DASS-21) scores were collected. At the final follow-up at 3 months, the number of patients who underwent surgery was ascertained. RESULTS: Forty-two of 50 (84%) patients avoided the surgery with a reduction in mean preinjection NRS for back and leg pain from 7.5 (SD 1.33) and 7.7 (SD 1.35) to 3.1 (SD 1.69) and 2.3 (SD 1.14) (P < 0.001), respectively, within the 30 minutes after injection. The pain relief was sustained until the last follow-up. The ODI score also decreased from a mean preinjection level of 59.4 (SD 14.69) to 26.3 (SD 9.43) (P < 0.001) at 3 months. The mean preinjection depression score was higher in patients who had recurrence of pain and eventually underwent surgery. CONCLUSION: Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients. CLINICAL RELEVANCE: SNRB should be administered early in the course of management of lumbar radiculopathy and should not be delayed until after other non-surgical modalities have failed. LEVEL OF EVIDENCE: 2.

Veillonella spondylodiscitis in a healthy 76-year-old lady.

PURPOSE: To report a case of Veillonella spondylodiscitis in a healthy 76-year-old lady. METHODS: A previously healthy 76-year-old lady presented with worsening axial back pain at the thoracolumbar junction, fever and loss of weight. Examination revealed deep tenderness over the thoracolumbar junction with painful and restricted spinal movements. The lower limb motor power, sensation and reflexes were normal. RESULTS: Radiographs of the lumbosacral spine showed evidence of spinal instability with lateral translation and loss of disc space at L1-L2. MRI scans revealed fluid intensity within the L1-L2 disc with infective debris elevating the posterior longitudinal ligament and narrowing the spinal canal. Both tissue and blood cultures were positive for the anaerobic organism, Veillonella. A staged anterior-posterior spinal surgery followed by an extended course of antibiotics resulted in the clinical improvement and normalisation of blood parameters. A review of the literature on Veillonella infections is also presented. CONCLUSION: The aim of this report is to bring Veillonella spondylodiscitis to the attention of spinal surgeons and infectious disease specialists and discuss the management options.

Restoration of compressive loading properties of lumbar discs with a nucleus implant-a finite element analysis study.

BACKGROUND CONTEXT: Discectomy is a common procedure for treating sciatica. However, both the operation and preceding herniated disc alter the biomechanical properties of the spinal segment. The disc mechanics are also altered in patients with chronic contained herniation. The biomechanical properties of the disc can potentially be restored with an elastomeric nucleus replacement implanted via minimally invasive surgery. PURPOSE: The purpose of this study was to determine whether the compressive characteristics of the intervertebral disc after a nucleotomy can be restored with an elastomeric nucleus replacement. STUDY DESIGN: A finite element model of the L4-L5 intervertebral disc was created to investigate the effect of the implantation of an elastomeric nucleus replacement on the biomechanical properties of the disc under axial loading. METHOD: A L4-L5 physiologic intervertebral disc model was constructed and then modified to contain a range by volume of nucleotomies and nucleus replacements. The material properties of the nucleus replacement were based on experimental data for an elastomeric implant. The compressive stiffness, radial annular bulge, and stress distribution of the nucleotomy and nucleus replacement models were investigated under displacement-controlled loading. RESULTS: Removal of nucleus pulposus from the physiologic disc reduced the force necessary to compress the disc 2 mm by 50%, altered the von Mises stress distribution, and reduced the outward radial annular bulge. Replacing the natural nucleus pulposus of the physiologic disc with an artificial nucleus reduced the force required to compress the disc 2 mm by 10%, indicating a restoration of disc compressive stiffness. The von Mises stress distribution and annular bulge observed in the disc with an artificial nucleus were similar to that observed in the physiologic disc. CONCLUSION: This study demonstrates that despite having different material properties, a nucleus replacement implant can restore the axial compressive mechanical properties of a disc after a discectomy. The implant carries compressive load and transfers the load into annular hoop stress.

Post-traumatic thoracic scoliosis with rib head dislocation and intrusion into the spinal canal: a case report and review of literature.

The objective of the study was to report a rare occurrence of dislocation and intrusion of two rib heads into the spinal canal at the convex apex of a post-traumatic thoracic scoliosis in an adult in the absence of any neurological impairment. A 47-year-old male presented with a slowly progressive, post-traumatic thoracic scoliosis and a mild aching sensation over the posterior chest wall. The lower limb neurology and bowel and bladder function were normal. There was no clinical evidence of neurofibromatosis. CT scans showed that the 8th and 9th ribs on the convex apex of the scoliotic curve had intruded into the spinal canal and were lying adjacent to the dura and spinal cord. The MRI scan did not show any cord signal intensity changes. Although rib dislocation and intrusion into the spinal canal is uncommon, images should be carefully analysed to rule out this condition in sharp angular scoliotic curves.

Fusion versus disk replacement for degenerative conditions of the lumbar and cervical spine: quid est testimonium?

This article compares the outcomes following spinal fusion and disk replacement for degenerative conditions of the lumbar and cervical spine. The short-term outcomes of lumbar and cervical total disk replacement are equivalent to that following spinal fusion. Long-term follow-up studies of total disk replacement are necessary to confirm its potential benefit in reducing or preventing adjacent level degeneration. Also discussed is the philosophy of the surgical management of degenerative conditions of the lumbar and cervical spine.