Sarcopenia and its effects on outcome of lumbar spine surgeries.

PURPOSE: Sarcopenia, defined as progressive impairment of muscle function secondary to loss of skeletal muscle mass, has prevalence of 24-56% in patients > 60 years. Forty-four per cent of elderly patients undergoing orthopaedic surgery are found to be sarcopenic. It is a known risk factor for fall, fractures, disability, increased post-operative morbidity and mortality. If diagnosed pre-operatively, it can help prepare the patient and surgical team to foresee complications and thereby reduce morbidity and mortality. In the present study, we evaluated and correlated sarcopenia with the surgical outcome of operated patients with lumbar spine pathology. MATERIALS AND METHODS: A prospective, observational study was conducted on 114 patients > 40 years undergoing lumbar spine surgeries, who were studied and followed up for 3 months. They were segregated into 5 groups based on age (40-50 year, 50-60 year, 60-70 year, 70-80 year, and > 80 year) and were assessed separately. Data on demography, grip strength analysis, 30-s chair stand test, Psoas muscle index (calculated on pre-operative MRI), pre- and post-operative ODI (Oswestry Disability Index) scores at 2 weeks and 3 months, Dindo-Clavien Classification of peri-operative complications, 90-day readmission rates and mortality (if any) were included. Patients were segregated into sarcopenic and non-sarcopenic groups based on the definition and set parameters as per the European Working Group on Sarcopenia in Older People (EWGSOP). A comparative analysis between these groups was performed. RESULTS: Of 114 patients, there were 18 patients in 40-49 years, 24 in 50-59 years, 33 in 60-69 years, 30 in 70-79 years and 9 in > 80 years age group. Statistically significant difference in peri-operative ODI scores was seen in sarcopenic vs non-sarcopenic patients in all age groups (p < 0.05) except 40-49 years. The results showed that sarcopenic group had higher rate of peri-operative complications, delayed mobilisation, longer stay and mortality compared to non-sarcopenic group. CONCLUSION: We conclude that sarcopenic patients have poor outcome in lumbar spine surgery compared to those without. So, by diagnosing sarcopenia using tests routinely done as pre-operative requirement, one can reduce radiation exposure and cost of treatment. The management can be revolutionised by predicting those who are at high risk of developing post-operative complications and poor surgical outcomes by mere diagnosis of sarcopenia. This knowledge will benefit both the patients and the surgeons.

Plain roentgenographic and CT scan morphometric analysis of the anterior atlantodens interval (AADI) and posterior atlantodens interval (PADI) in the Indian population.

BACKGROUND: The anterior atlantodental interval (AADI) and posterior atlantodental interval (PADI) on X-ray and computed tomography (CT) studies can both be used to gauge the risk and/or presence of neurological compression. METHODS: This retrospective observational study was conducted at a tertiary care center in 116 patients with head injuries additionally warranting routine cervical X-ray and CT examinations. RESULTS: The AADI averaged 1.36 ± 0.45 mm (X-ray) and 1.393 ± 0.47 mm (CT), while the mean PADI was 18.04 ± 2.44 mm (X-ray), and 18.07 ± 2.43 mm (CT). Notably, 93.96% of the total subjects had AADI below 2 mm. Further, 6.8% of patients with PADI =/<14 mm had no neurological deficits. CONCLUSION: No significant differences were observed for X-ray versus CT studies, measuring AADI and PADI. Therefore, X-rays should continue to prove reliable for assessing craniovertebral junction anatomy in emergency settings. Of interest, the normal upper limit of AADI on sagittal CT reconstructions should now be changed to 2 mm from the previously accepted upper limit of 3 mm.

Prospective Randomized Controlled Trial to Study the Effect of Local Steroids in the Retropharyngeal Space After Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: Prospective randomized controlled trial. OBJECTIVE: To study the effect of local steroids in the retropharyngeal space after anterior cervical discectomy and fusion (ACDF) in reducing prevertebral soft-tissue swelling (PSTS) and complications associated with it. METHODS: A total of 50 consecutive patients operated with ACDF were double-blinded randomized into 2 groups: steroids (25) and control (25). Triamcinolone in collagen sponge was used in the steroid group and normal saline in gelatin sponge in the control group. Patients' lateral radiographs were taken on the immediate postoperative day; days 2, 4, and 6; at 2 weeks; and 2 and 6 months postoperatively. The PSTS ratio at C3 to C7 and PSTS index were calculated. Patients were clinically evaluated using the Visual Analogue Scale (VAS) score for odynophagia and radiating pain, modified Japanese Orthopedic Association Score (mJOA), and Neck Disability Index (NDI). RESULTS: PSTS showed a significant reduction in the steroid group as compared with the control group on the immediate postoperative day; days 2, 4, and 6; and at 2 weeks. However, at 2 and 6 months, PSTS remained the same. VAS score for odynophagia also showed a significant difference between the 2 groups on the immediate postoperative day; days 2, 4, and 6; and 2 weeks postoperatively, with no significant difference at the 2- and 6-month follow-up. mJOA and NDI showed no significant difference between the 2 groups at the 2- and 6-month follow-up. CONCLUSION: Use of retropharyngeal steroids helps in reducing the postoperative odynophagia on a short-term basis without any complication.

Small Cell Prostate Cancer with Atypical Presentation -A Case Report and Review of Literature.

INTRODUCTION: Prostate cancer is one of the leading causes of death due to carcinoma in developed countries due to metastasis. Most of the patient at the time of diagnosis has shown metastasis. Metastasis to bone leads to various skeletal-related events such as fracture and neural compression leading to increase morbidity in such patients. An early diagnosis leads to favorable outcomes. Skeletal metastasis is usually presented as osteoblastic localized lesion in the spine or pelvis. Here, we like to present a case of prostatic metastasis in a patient with widespread metastasis making the diagnosis in such condition a challenging issue. CASE REPORT: A 61-year-old male comes with a complaint of right hip pain who has been diagnosed in some other clinic as a case of osteopoikilosis after an X-ray of the pelvis with both hips. However, on the further skeletal analysis found to involve most of the skeletal system with the diffuse osteolytic lesion. A bone scan, lab investigations helped in the arrival of diagnosis of atypical prostatic metastasis. CONCLUSION: Prostate cancer is less likely to present as widespread osteolytic lesions. A very few case reports have been found in the literature regarding such presentation. This case demonstrates how to differentiate between metastasis and other common condition showing such presentation leading to an early diagnosis and thus improving the overall mortality and morbidity of the patients.

Posterior Cervical Interbody Fusion - Single-Stage Approach of Anterior Reconstruction and Posterior Stabilization: A Case Report and Review of Literature.

The success and popularity of the transforaminal approach in the lumbar spine have been made possible by the routine use of pedicle screws in the lumbar spine. Transforaminal approach in the cervical spine can give access to the disc and the vertebral body anteriorly and avoid an additional anterior approach in certain clinical situations. A case of cervical spine trauma was managed by this approach. Technical details and difficulties faced were analyzed in this article. Transforaminal approach in the lower cervical spine, though has a learning curve, seems to be a feasible technique along with the use of cervical pedicle screws. The safety and reproducibility of the approach need to be substantiated with a larger study. Further, this procedure can avoid additional anterior surgery in certain situations in the cervical spine.

Reconstruction of First Metatarsal Bone Loss Following Osteomyelitis by a Modified Masquelet Technique: A Case Report.

INTRODUCTION: The literature regarding reconstruction of foot bone defects is limited. The reconstruction of diaphyseal bone defects is technically challenging and is often associated with poor outcomes. Associated osteomyelitis adversely affects the healing rates following a reconstruction procedure. CASE REPORT: We report a case of a 62-year-old male with lytic lesion involving the head of first metatarsal and proximal part of proximal phalanx following osteomyelitis treated with a two-stage reconstruction utilizing a modification of Masquelet's-induced membrane technique. A follow-up at 24 months post-surgery revealed a fully incorporated fibular graft with satisfactory functional outcomes. CONCLUSION: This two-stage modification of Masquelet technique provided an effective method to reconstruct the defect and restoration of the metatarsal length using minimal hardware to achieve a good functional recovery of the patient.

X-ray and Computed Tomography Scan-Based Morphometric Analysis of Skull Baselines in Indian Population.

INTRODUCTION: The study aims at providing an overview of morphometric measurements of the skull baselines in normal Indian population and compares these dimensions with those of other races and ethnicities. This study will help in defining "normal" baseline values for Indian population. It will also compare dimensions as measured on X-ray and computed tomography (CT) scan to assess the reliability of X-ray as a diagnostic modality for the assessment of the skull baselines in Indian population. MATERIALS AND METHODS: Retrospective study with a sample size of 116 patients and duration of 30 months. RESULTS: The mean value for distance between dens tip and Chamberlain line on CT was 0.498 mm and on X-ray was 0.528 mm and for the distance between dens tip and McGregor line on CT was 0.213 mm and on X-ray was 0.228 mm. The mean distance between the dens tip and McRae line was 4.67 1.69 mm on CT scan and 4.7 1.76 mm on X-ray. CONCLUSION: There was not a single patient in whom the dens tip crossed the McRae line. Any protrusion of the dens tip beyond the foramen magnum is abnormal. Hence, the McRae line is easiest to understand and remember. Furthermore, the Chamberlain and McGregor lines rely on identifying the hard palate, which may not be included in routine X-ray, CT, and magnetic resonance imaging studies depend on the field of view. Hence, we recommend the use of McRae line for screening purposes while evaluating pathologies of the craniovertebral junction. X-ray is a reliable diagnostic technique for assessing morphometry of the skull baselines in an emergency or rural setting if facility for CT scan is not available.