Ancient schwannoma of the thoracic spine treated with vertebroplasty: A case report.

INTRODUCTION: Intraosseous schwannomas or neurilemomas are rare benign neoplasms. Total resection of the intraosseous schwannoma is considered risky in immunocompromised patients, thus minimally invasive vertebroplasty was conducted in this study. CASE REPORT: In this case, we presented A 40-year-old male presented with intermittent back pain for the last two years. Imaging and histopathological examination conclude the diagnosis of intraosseous schwannoma. Vertebroplasty was conducted without the resection of the tumor. Excellent pain improvement and functional outcome were reported on one-year follow-up. CLINICAL DISCUSSION: Minimally invasive surgery could decrease post-operative pain and morbidity such as atelectasis and venous thrombosis, earlier hospital discharge, and improved cosmetics. We considered the use of minimally invasive vertebroplasty due to HIV infection comorbidities in the subject. Extensive tumor resection in this population could increase the risks of infection significantly thus affecting the outcome of the surgery. The aim of percutaneous vertebroplasty is to increase the stability of the collapsed vertebra and improve the symptoms, especially with severe back pain. CONCLUSION: Intraosseous schwannoma of the vertebrae could be treated effectively with vertebroplasty with excellent pain improvement and functional outcome.

Topographic anatomy and intraoperative USG-guided foreign bodies extraction of neglected Molotov cocktail victim: A rare case report.

INTRODUCTION AND SIGNIFICANCE: Foreign body implantation resulting from explosive devices is an extraordinary occurrence that often leads to substantial morbidity among the affected individuals. Explosions caused by such devices generate a rapidly propagating blast wave emanating from the point of detonation. This study aims to present a case involving a patient who experienced multiple foreign body implantations as a consequence of a bomb explosion. CASE PRESENTATION: A 41-year-old male presented with a history of multiple foreign bodies retained within his body for the past 22 years, originating from a homemade explosive device. At present, he reports weakness in his lower extremities, numbness extending from the umbilical region down to the lower extremities, and fecal incontinence. The patient underwent a surgical procedure for the removal of these foreign bodies, guided by ultrasonography (USG), which lasted for a duration of 12 h. CLINICAL DISCUSSION: The presence of foreign bodies within the human body incites an inflammatory response. In preparation for surgery, topographic anatomy is delineated through the use of pre-operative CT scans to ascertain the precise locations of these foreign bodies. Subsequently, the removal of these foreign bodies is executed under the guidance of ultrasound. CONCLUSION: The extraction of multiple foreign bodies from a patient's body is an infrequent surgical procedure. Meticulous surgical planning, aided by the utilization of X-rays and CT scans for topographic anatomical mapping, is imperative. Employing real-time ultrasound guidance during the procedure serves to minimize blood loss and mitigate potential damage to adjacent structures, thereby enhancing patient safety and reducing the likelihood of surgical complications.

Closed system paravertebral abscess evacuation on spinal infection: A case series.

INTRODUCTION: Paravertebral abscess is a common complication of spondylitis tuberculosis which has high prevalence in Indonesia. Surgical intervention such as open surgery or endoscopic debridement is needed to remove and drainage the abscess in addition to chemotherapy. However, this surgeries have several complications such as soft tissue damage and abscess contamination to the healthy tissue. We reported closed system strategy to evacuate the paravertebral abscess on spinal infection. METHODS: The technique is performed by orthopaedic team under guidance of the C-Arm and ultrasound sonography (USG) in March-June 202. The needle which connected to 20 cc syringe is inserted into the lesion to aspirate the abscess. After evacuation of the abscess, 2-g broad spectrum antibiotic is injected through the needle to eradicate the bacteria locally. RESULTS: We performed the closed system paravertebral abscess evacuation in three patients, a 30-year-old male, 43-year-old male, and 22-year-old female. All the patients had back pain and limitation spine movement due to pain and were diagnosed with spondylitis and paravertebral abscess based on the plain radiography and magnetic resonance imaging (MRI). It reported that up to 2000 cc abscess can be evacuated with this micro invasive technique. CONCLUSION: The closed system is a micro-invasive procedure result in minimal soft tissue injury and faster recovery. It succesfully remove paravertebral abscess followed by direct antibiotic eradication on spinal infection.

Recurrent spinal stenoses after implant removal: A case report.

Introduction and importance: Cervical spinal stenoses is becoming more and more common due to the aging population. The degenerative changes in the spine including discopathy or spondylosis will constrict and narrow the spinal canal and the usual site for the stenoses is in the cervical and lumbar region. The mainstay of the treatment is surgical, however there still a controversy regarding which approach is the best for the patient with cervical stenoses. Case presentation: In this case reports we present a case of 63-year-old male who came to our center due to weakness of arms and legs due to cervical spinal stenoses and underwent treatment after which the implant was removed, and the symptoms worsens. Clinical discussion: We performed Anterior Cervical Discectomy and Fusion (ACDF) and insertion of a cages to stabilize the spine. ACDF associated with lower intraoperative blood loss, similar surgical duration, and complication rate compared with laminoplasty. From the radiological outcome, ACDF showed a better-preserved cervical lordosis, which could affects patient's quality of life. Conclusion: ACDF is one of the viable methods for the treatment of the cervical stenoses with lower complication rate and good clinical outcomes.

Gardner Wells tongs modification in pre-operative management for cervical facet dislocation: A case report.

INTRODUCTION: Cervical facet dislocations are one of the traumas that caused the neurological disability, and it is often found and shows a spectrum of facet fracture-dislocations. Cervical facet dislocation classified by the mean of mechanism into a flexion-distraction injury. The goal of the treatment is to reduce the dislocation in favour of the patient's condition and hospital facility. METHOD: We reported a case of 32 years old female with incomplete spinal cord injury due to Flexion distraction injury of C4-C5 spine, cervical X-Ray shows anterior translation for about 50% of C4 relative to underlying C5 on lateral projection, the patient was diagnosed with bilateral facet cervical dislocation and treated by gradual closed reduction using Gardner Wells Tongs followed by posterior body stabilization and fusion. RESULTS: We initially load of 4 kg gradually along with continuous observation using lateral cervical radiograph and careful neurological assessment. The dislocation was finally reduced after gradual and dynamic loading with 14 kg load. DISCUSSION: There are several strategies for managing cervical injuries. Aside from whether the MRI has to perform before or after the reduction, the option on whether to use closed or open reduction can be managed at best in favour of the current condition. CONCLUSION: Gardner Wells tongs is one of the best alternatives when the surgical approach is unavailable.