Scoliocorrector Fatma-UI for correction of adolescent idiopathic scoliosis: Development, effectivity, safety and functional outcome.

BACKGROUND: Adolescent idiopathic scoliosis remains a major problem due to its high incidence, high risk, and high cost. One of the aims of the management in scoliosis is to correct the deformity. Many techniques are available to correct scoliosis deformity; however, they are all far from ideal to achieve three-dimensional correction in scoliosis. AIM: To develop a set of tools named Scoliocorrector Fatma-UI (SCFUI) to aid three-dimensional correction and to evaluate the efficacy, safety, and functional outcome. METHODS: This study consists of two stages. In the first stage, we developed the SCFUI and tested it in finite element and biomechanical tests. The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation (DVR). Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group (n = 23) and SCFUI group (n = 21). Radiological, neurological, and functional outcome was compared between the groups. RESULTS: Finite element revealed the maximum stress of the SCFUI components to be between 31.2 - 252 MPa. Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324 ± 633277 MPa. Both groups showed improvement in Cobb angle and sagittal profile, however the rotation angle was lower in the SCFUI group (11.59 ± 7.46 vs 18.23 ± 6.39, P = 0.001). Neurological and functional outcome were comparable in both groups. CONCLUSION: We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR. The safety and functional outcomes were also similar to DVR.

Preoperative skull tongs-femoral traction versus cotrel longitudinal traction for rigid and severe scoliosis: Cohort study.

BACKGROUND: To compare two methods of preoperative traction (Cotrel traction exercises and skull tongs femoral traction) in severe scoliosis treatment. METHODS: We collected retrospective data of severe (>80°) and rigid scoliosis patients who underwent preoperative traction before correction surgery from 2016 to 2018. The first group consisted of patients who underwent Cotrel traction exercises and second group underwent continuous-progressively increasing Skull Tongs Femoral Traction (STFT) traction. Posterior fusion was performed in all patients. Intraoperative parameters (blood loss, operation time and level instrumented) and radiologic change (initial, post-traction and postoperative Cobb Angle) was evaluated and analyzed. RESULTS: Thirty consecutive case of severe and rigid scoliosis were included (15 in each group). Despite Cotrel group having larger initial Cobb angle, the amount of post traction correction was statistically similar in both groups (16.4° and 11.8°, in STFT and Cotrel group respectively). Mean traction duration was 14.0 days for Cotrel group and 12 days for STFT. There were also no significant differences in postoperative curve correction rate between two groups, although STFT group had a slightly higher correction rate (69.3° vs 55.0°). No major/neurologic complication were found in our series. CONCLUSIONS: Both preoperative traction methods were found safe and beneficial to reduce preoperative curve degree before definitive scoliosis correction surgery. Although, no statistical difference were found between two methods, STFT may provide better correction rate. LEVEL OF EVIDENCE: 3.

Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oswestry Disability Index.

PURPOSE: The Oswestry Disability Index (ODI) is one of the most common patient-reported outcome measures used for low back pain (LBP). Since it was not available in Indonesian, this study aimed to perform a cross-cultural adaptation of ODI to Indonesian and evaluate its psychometric properties. METHODS: We performed a cross-cultural adaptation of ODI v2.1a into Indonesian language (ODI-ID) and determined its internal consistency, test-retest reliability, measurement error, confirmatory factor analysis, floor-ceiling effect, and construct validity by hypotheses testing of its correlation with Short Form-36 (SF-36) and visual analog scale (VAS). Adults (> 17 years of age) diagnosed with low back pain were included. RESULTS: A total of 96 subjects were included in this study. The original ODI questionnaire was translated into an Indonesian version and showed a good internal consistency (Cronbach's alpha = 0.90) and good reliability (intraclass correlation = 0.97). The standard error of measurement values of 3.35 resulted in a minimal detectable change score of 9. Nine out of nine (100%) a priori hypotheses were met, confirming the construct validity. A strong correlation was found with the physical component of SF-36 (0.77 and 0.76 for pain and physical function, respectively) and VAS (0.79). Confirmatory factor analysis resulted in a poor but significant fit to the original one-factor structure and the static-dynamic two-factor structure. Floor-ceiling effects were not found. CONCLUSIONS: The Indonesian version of ODI displayed similar reliability, validity, and psychometric characteristics to the original ODI. This questionnaire will be a suitable instrument for assessing LBP-related disability for Indonesian-speaking patients.

An unusual case of extensive contiguous cervicothoracic spinal tuberculosis involving fourteen damaged segments: A case report.

INTRODUCTION: Cervicothoracic spinal tuberculosis (CTSTB) is a rare and disabling disease involving the mobile, transitional zone between the lordotic cervical and the kyphotic thoracic spine. Approximately half of those cases involves one or two segments of cervicothoracic vertebrae. We reported a 28-year-old female with tuberculous involvement of fourteen contiguous vertebral segments. PRESENTATION OF CASE: A 28-year-old female presented with tuberculous involvement of fourteen contiguous vertebral segments is presented. A series of radiographic and CT scan depicted multiple vertebral body destruction anteriorly, along with facet joint dislocation and mild retrolisthesis of C4-C5 segments. MR images of the cervical region was demonstrated pathologic contrast enhancement on C4 to T7 vertebrae, a total of fourteen contiguous segments. DISCUSSION: Of all spinal tuberculosis, CTSTB accounts for only 5%. In addition to its rarity as a site for tuberculosis, the cervicothoracic junction has anatomical and clinical peculiarities, as a reversal of the mobile-lordotic cervical vertebrae to rigid-kyphotic thoracic vertebrae occurs at this location. Most CTSTB involves only two segments; however, in this case, we found a very extensive case wherein there were fourteen damaged segments. CONCLUSIONS: Our report demonstrates one of the longest involvement of extensive contiguous CTSTB who was treated with one-stage posterior-only approach. However, as this is only a report of one case, further studies are required to investigate the safety and efficacy of such approach for treating extensive CTSTB.

Autologous mesenchymal stem cell implantation, hydroxyapatite, bone morphogenetic protein-2, and internal fixation for treating critical-sized defects: a translational study.

INTRODUCTION: Critical-sized defect (CSD) is one of the most challenging cases for orthopaedic surgeons. We aim to explore the therapeutic potential of the combination of bone marrow-derived mesenchymal stem cells (BM-MSCs), hydroxyapatite (HA) granules, bone morphogenetic protein-2 (BMP-2), and internal fixation for treating CSDs. METHODS: This was a translational study performed during the period of January 2012 to 2016. Subjects were patients diagnosed with CSDs who had previously failed surgical attempts. They were treated with the combination of autologous BM-MSCs, HA granules, BMP-2, and mechanical stabilization. Post-operative pain level, functional outcome, defect volume, and radiological healing were evaluated after a minimum follow-up of 12 months. RESULTS: A total of six subjects were recruited in this study. The pain was significantly reduced in all cases; with the decrease of mean preoperative visual analog scale (VAS) from 4 ± 2.2 to 0 after six month follow-up. Clinical functional outcome percentage increased significantly from 25 ± 13.7 to 70.79 ± 19.5. Radiological healing assessment using Tiedemann score also showed an increase from 0.16 ± 0.4 to 8 ± 3 at one year follow-up. No immunologic nor neoplastic side effects were found. CONCLUSIONS: The combination of autologous BM-MSCs, HA granules, and BMP-2 is safe and remains to be a good option for the definitive treatment for CSD with previous failed surgical attempts. Further studies with a larger sample size are required to be done.

Submuscular gluteal abcess: An unusual presentation of rare sacral tuberculosis.

INTRODUCTION: Both gluteal abscess and sacral tuberculosis are rare entities in spinal tuberculosis cases. Even in endemic country, this atypical presentation may be the cause of delayed diagnosis and treatment. PRESENTATION OF CASE: A 51-year-old woman was admitted with painless massive lump on both of her thighs that have been enlarging for the past 6 months. She had a history of previous tuberculosis treatment. From the MRI examination submuscular gluteal abscess, which was an extension of the sacral tuberculosis, were found. Open debridement and biopsy were performed, which confirmed the suspicion of tuberculosis. Oral anti tuberculosis drugs were administered after. There was no recurrence and complication at the final follow up. DISCUSSION: Cold abscess formation is common in spine tuberculosis however the formation of gluteal abscess as the extension of sacral tuberculosis is rare. Although MRI's specificity in determining the underlying cause is poor, it has a great role not only determining the location and size of the lesion, but also to describe anatomical pathophysiology of the abscess dissemination from sacral tuberculosis. CONCLUSION: Despite the limitation of the study and the rarity of this case, tuberculosis should be made as the main differential diagnosis for atypical sacral lesion that occurs with submuscular gluteal abscess.

Hypersensitivity to orthopaedic implant manifested as erythroderma: Timing of implant removal.

INTRODUCTION: Incidence of hypersensitivity to orthopaedic implant, once estimated in less than 1% of population, recently has increased to 10%. Controversies about the timing of implant removal remain, especially due to the fact that implant hypersensitivity may be a contributing factor to implant failure. We present a case report and literature reviews to establish the decision making for the timing of implant removal in the presence of implant hypersensitivity. PRESENTATION OF CASE: Female, 42 years old with nonunion of mid-shaft tibia and fibula which was treated with ORIF with conventional SAE16 stainless steel plate and bone graft. A week after, she developed a generalized rash, which is later diagnosed as erythroderma, that relapsed despite adequate systemic corticosteroid. Poor healing of surgical site wound were marked. After the implant removal, the cutaneous condition improved and no relapse were found. DISCUSSION: Management of hypersensitivity to implants involved corticosteroid administration, removal or replacement of implants, or implants coating with polytetrafluoroethylene. Currently there are no specific guidelines regulating the management of implant allergy based on the timing of the onset, especially in fracture cases. The decision-making would be straightforward if union was already achieved. Otherwise, controversies would still occur. In this paper, we proposed an algorithm regarding the steps in managing metal allergy due to implant in fracture cases. CONCLUSION: Despite the concerns regarding implant survival in hypersensitivity cases, the decision whether the implant should be removed or replaced should be based on the time and condition of the fracture healing process.

Total hip replacement: A meta-analysis to evaluate survival of cemented, cementless and hybrid implants.

AIM: To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate. METHODS: Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement (THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS: Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47 (95%CI: 0.45-0.48), 0.9 (0.84-0.95), 1.29 (1.06-1.57) and 0.69 (0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82 (0.76-0.89), 2.65 (1.14-6.17), 0.98 (0.7-1.38), and 0.67 (0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7 (0.65-0.75), 0.85 (0.49-1.5), 1.47 (0.93-2.34) and 1.13 (0.98-1.3). CONCLUSION: Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.