Role of percutaneous transpedicular biopsy in diagnosis of spinal tuberculosis and its correlation with the clinico-radiological features.

INTRODUCTION: Tuberculosis (TB) has long been an important cause of destructive lesions of spine in India. However the scenario is fast changing with atypical presentations and increasing reports of non-tubercular conditions. This poses a great diagnostic dilemma. AIM: The present study is aimed at evaluating the diagnostic efficacy of percutaneous transpedicular needle biopsy and the correlation of the histology with clinico-radiological features. METHODS: Forty-one patients diagnosed of TB spine by magnetic resonance imaging (MRI) were revaluated of their clinical presentations, radiological and MRI features and underwent transpedicular needle biopsy under fluoroscopic guidance. Quality of the sample and radiological/MRI features between the tubercular and non-tubercular lesions were studied. RESULTS: A good sample obtained in 92.7% patients. Of these 28 patients had TB, 3 non-specific inflammatory lesion and 7 with other non-tubercular conditions (3 pyogenic, 3 metastasis, 1 multiple myeloma). Statistically there is no significant difference among the TB and non-TB groups in terms of vertebral involvement and MRI features. However risk of presentation with cord compression, cord changes and neurodeficit are higher with TB spine. CONCLUSION: It is very difficult to differentiate between tubercular and non-tubercular pathology of spine on the basis of most of the clinical and MRI features. It is more difficult in early cases without any neurodeficit. Thus histopathological confirmation is must for further management and percutaneous needle biopsy is the best option considering the simplicity and minimally invasive nature of the procedure.

Patellar ligament rupture during total knee arthroplasty in an ochronotic patient.

Ochronotic arthropathy mainly involves the spine and large joints. Along with blackening of the joint, degeneration rapidly progresses mostly in the knee, resulting in symptoms by the 4th or 5th decade. As the role of medical treatment and joint conservation surgeries are limited in the early stages, joint replacement is the only effective option in one third of patients. We present a case of the unique complication of patellar ligament rupture during total knee replacement (TKR) of an ochronotic joint. A 51-year-old male presented with bilateral severe tricompartmental osteoarthritis with varus deformities and restriction of motion. Bilateral TKR was performed. At the 28-month follow-up, the patient was walking pain free with acceptable position of implants in radiographs. To our knowledge this is the first report of rupture of the patellar ligament during TKR of an ochronotic joint. We propose appropriate preoperative preparation and greater care in the handling of the tendon during TKR of an ochronotic joint in order to avoid complication.

Posterior-only approach surgery for fixation and decompression of thoracolumbar spinal tuberculosis: a retrospective study.

STUDY DESIGN: A retrospective case study series. OBJECTIVE: To evaluate the results of posterior decompression and transpedicular screw fixation in 18 cases of thoracolumbar spinal tuberculosis with neurological deficit. SUMMARY OF BACKGROUND DATA: Spinal tuberculosis has been managed with various modalities of treatment ranging from only antitubercular drugs to radical procedures such as anterior or combined approach surgeries. However, although the former method of treatment sometimes is met with unacceptable kyphosis, the later is considered to be too drastic. In the present study, authors have shown the results of posterior decompression and pedicle screw fixation in selected cases of Pott paraplegia. METHODS: The cases (12 males and 6 females) were operated with a posterior decompression and transpedicular screw fixation in a single stage along with antitubercular drug treatment. All of these patients had varying degrees of neurological deficit (4 with Frankel grade A, 8 Frankel B, 4 Frankel C, and 2 Frankel D) and single level involvement with <50% vertebral body destruction and mild kyphosis of 8-27 degrees. Short-segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage. RESULTS: Kyphosis improved from preoperative value of 17.7±5.8 degrees to 9.4±4.6 degrees postoperatively. At a follow-up period of 24-46 months, final kyphosis correction was maintained at 11.6±5.4 degrees. Bony fusion was achieved in 55.5% cases. Neurological recovery occurred in 17 patients (94.4%). All patients became pain free, with final visual analogue score 0-2. CONCLUSIONS: The procedure in safe and has satisfactory results in early active cases of Pott paraplegia with less destruction of vertebral bodies.