Neurological recovery after surgical intervention of a complete spinal cord injury secondary to a chronic untreated odontoid neck fracture: a lesson in patient prognostication.

Odontoid fractures are injuries that can either be benign or devastatingly progress to quadriplegia and significant morbidity and mortality. Management is not clear cut for patients who already present late and with severe neurological deficits. We present a case of a type 2 odontoid fracture with associated complete spinal cord injury (American Spinal Injury Association A) initially untreated for 3 months but was subsequently managed with posterior decompression, instrumentation and occipitocervical fusion. The patient fully recovered all deficits and is independent of activities of daily living.

A Novel Patient-Specific Drill Guide Template for Pedicle Screw Insertion into the Subaxial Cervical Spine Utilizing Stereolithographic Modelling: An In Vitro Study.

STUDY DESIGN: Cadaveric study. PURPOSE: The purpose of this study was to assess the accuracy and feasibility of cervical pedicle screw (CPS) insertion into the subaxial cervical spine placed using a patient-specific drill guide template constructed from a stereolithographic model. OVERVIEW OF LITERATURE: CPS fixation is an invaluable tool for posterior cervical fixation because of its biomechanical advantages. The major drawback is its narrow corridor that allows very little clearance for neural and vascular injuries. METHODS: Fifty subaxial pedicles of the cervical vertebrae from five cadavers were scanned into thin slices using computed tomography (CT). Digital imaging and communications in medicine images of the cadaver spine were digitally processed and printed to scale as a three-dimensional (3D) model. Drill guide templates were manually moulded over the 3D-printed models incorporating pins inserted in the pedicles. The drill guide templates were used for precise placement of the drill holes in the pedicles of cadaveric specimens for pedicle screw fixation. RESULTS: The instrumented cadaveric spines were subjected to CT to assess the accuracy of our pedicle placement by an external observer. Our patient-specific drill guide template had an accuracy of 94%. CONCLUSIONS: The use of a patient-specific drill guide constructed using stereolithography improved the accuracy of CPS placement in a cadaveric model.

Assessment of skeletal maturity in scoliosis patients to determine clinical management: a new classification scheme using distal radius and ulna radiographs.

BACKGROUND: Assessment of skeletal maturity in patients with adolescent idiopathic scoliosis (AIS) is important to guide clinical management. Understanding growth peak and cessation is crucial to determine clinical observational intervals, timing to initiate or end bracing therapy, and when to instrument and fuse. The commonly used clinical or radiologic methods to assess skeletal maturity are still deficient in predicting the growth peak and cessation among adolescents, and bone age is too complicated to apply. PURPOSE: To address these concerns, we describe a new distal radius and ulna (DRU) classification scheme to assess skeletal maturity. STUDY DESIGN: A prospective study. PATIENT SAMPLE: One hundred fifty young, female AIS patients with hand x-rays and no previous history of spine surgery from a single institute were assessed. OUTCOME MEASURES: Radius and ulna plain radiographs, and various anthropomorphic parameters were assessed. METHODS: We identified various stages of radius and ulna epiphysis maturity, which were graded as R1-R11 for the radius and U1-U9 for the ulna. The bone age, development of sexual characteristics, standing height, sitting height, arm span, radius length, and tibia length were studied prospectively at each stage of these epiphysis changes. RESULTS: Standing height, sitting height, and arm span growth were at their peak during stages R7 (mean, 11.4 years old) and U5 (mean, 11.0 years old). The long bone growths also demonstrated a common peak at R7 and U5. Cessation of height and arm span growth was noted after stages R10 (mean, 15.6 years old) and U9 (mean, 17.3 years old). CONCLUSIONS: The new DRU classification is a practical and easy-to-use scheme that can provide skeletal maturation status. This classification scheme provides close relationship with adolescent growth spurt and cessation of growth. This classification may have a tremendous utility in improving clinical-decision making in the conservative and operative management of scoliosis patients.

Osteosarcoma of the spine- A dilemma in diagnosis and management

Osteosarcoma of the spine accounts for 1 to 3 percent of osteosarcoma. When this afflication of the spine occurs, it is often fraught with diagnostic dilemmas and treatment challenges.OBJECTIVE: This manuscript reports on the cases reported over a 15- year period from the UP Musculoskeletal Tumor Unit. Only 2 of the 3 cases were available for review.RESULTS: Both patients were initially misdiagnosed. This delay in diagnosis led to a delay in instituting appropriate chemotheraphy inevitable causing poor outcomes of treatment.CONCLUSION: This report highlights the dilemma of treating a difficult site. Spinal osteosarcoma presents with numerous diagnostics and management obstacles. Unless clinician awareness is improved and these treatment options become available to patients, prognosis will not improve.