Outcome Analysis of Posterolateral Decompression and Spinal Stabilization for Tuberculous Spine.

AIM: This is a prospective study to analyze the clinical, radiological, and functional outcomes of posterolateral decompression and spinal stabilization with pedicle screws and rods done for the thoracolumbar tuberculous spine. MATERIALS AND METHODS: This study was conducted at Gandhi Medical College and Hospital from September 2016 to September 2017 on 30 patients who underwent posterolateral decompression and spinal stabilization using pedicle screw and rod fixation for active spinal tuberculosis. Pain, erythrocyte sedimentation rate (ESR), kyphotic angle correction, and Frankel's grading were taken to study the clinical, radiological, and functional outcome at the end of 1 year. Other parameters taken into consideration were the duration of stay and level of involvement; antituberculous therapy was given to all the patients for 16-18 months until the signs of radiological healing were evident. RESULTS: This study comprised of 30 patients with a mean age of presentation of 39.835 ± 14.75 and M: F ratio of 1:1. The mean duration of stay is 10.67 ± 4.06, and the most common level of involvement is D6-D11. Kyphotic angle was corrected by a mean of 19.08 ± 5.44 at the end of 1 year (P < 0.001). Visual analog score improved from a median of 8 preoperatively to 2 at follow-up (P < 0.001). ESR improved from a mean of 37.08 ± 12.64 mm/h preoperatively to 19.83 ± 13.68 mm/h at follow-up (P = 0.01). There was an improvement in Frankel's grading in most of the patients at the end of 12 months. Radiological healing was evident in the form of the reappearance of trabeculae formation and bony fusion at the end of 12 months. CONCLUSION: Posterolateral approach is a good method for decompression and spinal stabilization because of significant kyphotic correction, improvement in pain, good neurological recovery, less duration of stay, and less morbidity.

Early Results of the PETTICOAT Technique for the Management of Acute Type A Aortic Dissection.

Conventional surgical techniques for acute Type A aortic dissection (ATAAD) generally fail to address residual dissection in the descending aorta. The persistence of a false lumen is associated with visceral malperfusion in the acute setting and adverse aortic remodeling in the chronic setting. Hybrid aortic arch repair techniques may improve perioperative and long-term mortality by expanding the true lumen and obliterating the false lumen. However, there is a limit to the extent of aortic coverage due to the concomitant risk of spinal cord ischemia. In Type B dissection, the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique, which entails stent graft coverage of the primary intimal tear followed by bare metal stent placement distally, may improve true lumen caliber and promote false lumen thrombosis without increasing the risk of spinal cord ischemia, as intercostal branches remain perfused through the bare metal stents. The technique of hybrid arch with surgical creation of a Dacron landing zone covering a stent graft in the proximal descending aorta and bare metal stents in the thoraco-abdominal aorta is a promising concept in the treatment of ATAAD.

Congenital gluteus maximus contracture syndrome--a case report with review of imaging findings.

Although the clinical features of gluteus maximus contracture syndrome have been frequently described, imaging features have been seldom described. Most commonly reported cases are those following intramuscular injection in the gluteal region although congenital contracture is an uncommon but important occurrence. This condition has most often been reported in children of school going age. These patients often present with difficulty in squatting, limitation of hip motion or specific deformities and often require surgical correction. We describe the plain radiography, ultrasonography (USG) and magnetic resonance imaging (MRI) features of this condition in a patient with no previous known history of intramuscular injections.

Migration of intraventricular neurocysticercus after ventriculostomy.

Intraventricular neurocysticerci are an uncommon occurrence and are often difficult to diagnose. They are often a cause of obstructive hydrocephalus and inflammatory reactions, which can be life threatening. Intraventricular neurocysticerci are most common in the fourth ventricle and surgical decompression of obstructive hydrocephalus is an important step in their management. However, these cysticerci are also known to migrate within the ventricular system and may cause confusion during surgery. It thus becomes very important for radiologists and neurosurgeons to be aware of this phenomenon.