Correlation between Preoperative Magnetic Resonance Imaging Signal Intensity Changes and Clinical Outcomes in Patients Surgically Treated for Cervical Myeloradiculopathy.

STUDY DESIGN: This was a single surgeon, single center-based retrospective study with prospective data collection. PURPOSE: To assess the correlation between T2-weighted magnetic resonance imaging (MRI) signal intensity (SI) changes and factors such as age, duration of symptoms, baseline modified Japanese Orthopedic Association (mJOA) score and to determine its prognostic value in predicting recovery after surgery. OVERVIEW OF LITERATURE: Whether intramedullary cord T2-weighted MRI SI changes can predict operative outcomes of cervical myeloradiculopathy remains debatable, with only a few prospective studies analyzing the same. METHODS: Forty-six consecutive patients who underwent cervical myeloradiculopathy were included and were followed up for an average of 1 year. Preoperative T2-weighted MRI SI grading was performed for all patients. The correlation between MRI SI changes and age, duration of symptoms, preoperative mJOA score, and mJOA score at 1-year follow-up were analyzed. RESULTS: Fifteen patients had single-level (21.73%) or double-level (10.86%) prolapsed discs; 54.34% had degenerative cervical spondylosis with canal stenosis or multilevel disc prolapse and 13.07% had ossified posterior longitudinal ligaments. The mean age was 56.17±9.53 years (range, 35-81 years). The mean baseline mJOA score was 10.83±2.58 (range, 6-16), which postoperatively improved to 13.59±2.28 (range, 8-17; p<0.001). There was a statistically significant correlation between mJOA score at 1 year and MRI T2 SI grading (p=0.017). CONCLUSIONS: Patients with longer symptom durations had high grades of intramedullary cord T2-weighted MRI SI changes. Age and preoperative neurological status were not significantly correlated with the existence of intramedullary cord SI changes. However, patients without or with mild and diffuse intramedullary cord T2-weighted MRI SI changes had better postoperative neurological recovery than those with sharp and focal SI changes.

Extraosseous thoracic foraminal osteoblastoma: diagnostic dilemma and management with 3 year follow-up.

Osteoblastomas are bone forming lesions arising mainly from posterior elements of the vertebra. They are commonly encountered in the cervical and lumbar regions. We present a case of a thoracic osteoblastoma which is extra osseous and is not communicating with any part of the vertebra present intraforaminally. This is a rare presentation of an osteoblastoma. Imaging studies do not accurately diagnose the osteiod lesion. The size of the lesion and cortical erosion seen on the computed tomography scan help in differentiating the osteoid osteoma and osteoblastoma, but they are less sensitive and specific. Thus a histopathology is the investigation of choice to diagnose the osteoblastoma. Early and adequate removal of mass prevents malignant transformation, metastasis, and recurrence. In our case we excised the pars interarticularis unilaterally, removed the osteoid mass intact, and performed unilateral instrumented fusion. There was no recurrence and solid fusion was seen at 3 years follow up.

Double transosseous pull out suture technique for transection of posterior horn of medial meniscus.

Transection injury (complete radial tear, root tear) in the posterior horn of medial meniscus will lead to loss of hoop strain, extrusion of the meniscus and early degenerative changes. The posterior horn of medial meniscus is amenable to repair due to its good blood supply and repair is the procedure of choice for these injuries. In cases of transection of the medial meniscus posterior horn, the meniscus can be repaired by a pull out suture technique using trans-septal portal. The single transosseous pull out suturing technique is a point fixation technique with limited contact area having low and inhomogeneous contact pressure. This article describes a double transosseous pull out suture technique using trans-septal portal for the repair of transection of posterior horn of medial meniscus. Use of double transosseous technique provides more secure fixation, more homogeneous and wider contact pressure area between meniscus and the bone, improving the healing potential of the repair.

Callus patterns in femur lengthening using a monolateral external fixator.

OBJECTIVE: We studied the callus pattern seen in femoral lengthening using monolateral external fixator to determine whether callus types and shapes can predict the final outcome of the procedure. MATERIAL AND METHODS: The radiographs of 41 cases of femoral lengthening (33 unilateral and 8 bilateral) in 33 patients with a mean age 11.9 years (range 4-22 years) were retrospectively analysed by four observers and classified into different shapes and types in concordance with the Ru Li classification. The classification was tested for concurrence and reproducibility by inter-observer studies. RESULTS: An average of 6.2 cm of lengthening (range 3-10.8) was achieved with an external fixator index of 36.5 (range 20.9-55.3). The fusiform type of callus (fixator index 32.04, maturation index 21.6) showed the best result followed by the cylinder type of callus (fixator index 35.7, maturation index 22.3) and the lateral type of callus (fixator index 33.2, maturation index 21.5). However, the concave type of callus showed poor results with a fixator index of 49.4 and a maturation index of 37.1. The homogeneous path showed the best results (fixator index 30.4, maturation index 18.6). The heterogeneous path also showed good results (fixator index 36.4, maturation index 23.9). The mixed path (fixator index 42.5, maturation index 30.8) and the lucent path (fixator index 45.1, maturation index 32.8) showed poor results. CONCLUSION: Analysis of the callus pattern helps the surgeon to predict the outcome of the procedure and guide him in planning any additional interventions if necessary.

Alcohol-induced multifocal osteonecrosis: a case report with 14-year follow-up.

Alcohol-induced osteonecrosis of femoral head is common but multifocal osteonecrosis secondary to alcohol is very rare. The authors report one case of multifocal alcohol-induced osteonecrosis involving both hips and both knees and its subsequent progression and management over a period of 14 years. There was bilateral involvement of hips in pre-collapse stage for which a core decompression was done. The left hip responded well and at 14-year follow-up was asymptomatic with full range of motion. The core decompression surgery failed in the right hip within 1 year and subsequently hybrid total hip replacement arthroplasty was done with good functional results at 13 years follow-up. The diagnosis of knee osteonecrosis was most probably missed initially and was subsequently diagnosed 6 months back due to symptoms of pain and radiographic findings for which a core decompression was done with good early results. The results of treatment of hip was excellent in our patient and despite the rarity, a high degree of suspicion and regular screening is necessary to detect involvement of other areas like the knee in alcohol-induced osteonecrosis.