Objective: The most dreaded and crippling complication of spinal tuberculosis is pott’s
There have been many reports on fracture-dislocation of the lumbar spine in recent years. Hyperextension as a mechanism for fracture-dislocation in the thoracolumbar spine was first described by Holdsworth accounting for only less than 3 percent of all fractures of the spine. De Oliverira reported an unusual pattern of sagittal shear fracture-dislocation secondary to posterior impact injuries. Hyperextension injuries result in the disruption of all ligaments &
supporting elements of the spine starting with the anterior column. Sagittal translation and comminution of the posterior elements are the most common radiographic findings. Computed Tomography can accurately demonstrate the destruction of the posterior elements, and MRI is able to demonstrate the anterior ligamentous disruption. Nearly all cases suffered from
Introduction Management of bedsores in traumatic
Intrathecal morphine (IM) is a common adjunct in paediatric spinal deformity surgery. We previously demonstrated with idiopathic scoliosis it provides safe and effective analgesia in the immediate postoperative period. This study represents our 25 year experience with IM in all diagnostic groups. Our prospective Pediatric Orthopaedic Spine Database (1993–2018) was reviewed to identify all patients undergoing spinal deformity surgery who received IM and who did not. Patients 21 years of age or less who had a posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI), and received 9–19 mcg/kg (up to 1 mg) of IM were included. Early onset scoliosis surgical patients were excluded. We assessed demographics, pain scores, time to first dose of opioids, diagnoses, surgical time, paediatric intensive care unit (PICU) admission and IM complications (respiratory depression, pruritus, nausea/ vomiting). There were 986 patients who met inclusion criteria. This included 760 patients who received IM and 226 who did not. IM was not used for short procedures (< 3 hrs), respiratory concerns, unsuccessful access of intrathecal space,
Spinal tuberculosis is one of the most common presentations of skeletal tuberculosis. It is one of the major health issues of developing countries as it is associated with significant morbidity and mortality. Pott's
Cervical spine fractures are frequent in impact sports, such as rugby union. The consequences of these fractures can be devastating as they can lead to
The purpose of this study was to evaluate the use of spinal rehabilitation services in Gauteng Province. During the period November 2001 to March 2002 we sent a questionnaire to all hospitals under the control of the Gauteng Health Department. Identified individuals in each hospital completed the questionnaires. The results were analysed statistically. A mean 153 patients were admitted every month. On average, traumatic penetrating injuries accounted for 64 patients, fractures for 52, infectious diseases for 14, tumours for eight, vascular compromise for one, miscellaneous causes for five and readmissions for nine. On average, four patients died after admission. The majority (61%) of readmissions were because of pressure sores. Every month a mean 24 patients were discharged. Neurological levels were as follows: incomplete
Rigid angular kyphotic deformities of the spine have been corrected by staged anterior and posterior procedures. This paper evaluates the efficacy of single stage transpedicular decancellation, vertebral column mobilization and spinal shortening in the correction of rigid THORACIC kyphotic deformities in adolescent patients. Between 1993 and 1999, 21 patients with rigid kyphosis underwent deformity correction using the above procedure. The deformity was thoracic in 6 patients, thoraco-lumbar in 14 and lumbar in one patient. This report focuses on 6 patients with thoracic deformity. The etiology in 5 patients was due to tuberculosis while one patient had a congenital anomaly. There were 4 females and 2 male patients. The average age was 12 years. The average kyphosis was 75 degrees (38 – 135 degrees). Of the 6 patients, 2 had preoperative
A total number of 428 patients underwent surgical procedure due to different acquired spinal disorders. Conservative approaches were tried where it was indicated. When there was no improvement with conservative treatment then surgical procedures were adopted. It was a prospective study which was done in both Govt. and private hospitals irrespective of age &
sex. Total period was from August 2002 to February, 2008. Age of the patients ranged between from 8–65 years. In this series male was more dominant than female. In this series main causes were traumatic, infective, degenerative &
neoplastic disorders. Prolapsed Lumber Inter-vertibral Disc 202, prolapse cervical disc 15, unstable spinal injuries 86, Pott’s
Introduction: Spontaneous spinal epidural haematoma is an uncommon clinical problem which may lead to severe and permanent neurological deficit. The treatment options for spinal cord compression by extradural haematoma in the anticoagulated patient are limited. The majority of cases reported have been treated surgically. 1. Operative intervention carries a potential risk of extending the haematoma with further deterioration of the neurological deficit. Methods: A case of
Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date. Patients treated for IPOS from January 2006 to December 2020 were included. Patient demographics, parameters upon admission and discharge, radiological imaging, and microbiological results were retrieved from medical records. CT and MRI were analyzed for epidural, paravertebral, and intervertebral abscess formation, vertebral destruction, and endplate involvement. Pathogens were identified by CT-guided or intraoperative biopsy, intraoperative tissue sampling, or implant sonication.Aims
Methods
Objective: To asses the outcome of hermivertebrectomy and fusion for symptomatic thoracic disc herniation. Design: A retrospective case analysis. Subjects: Between 1993 and 1999, ten patients (M5, F5) were treated surgically for thoracic disc herniation by the two senior authors (JKW &
SHM). The average age of patients at presentation was 5Oyears (range 32–77years). Two patients had two level disc herniations (total 12 disc herniation). The most common sites of disc herniation were at T10/11(4 patients). Duration of diffuse mid thoracic hock pain in eight patients varied from one week to six months. The initial neurological evaluation demonstrated weakness and spasticity of varying grades in eight patients, of which five had
The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years’ follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined.Aims
Methods
Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents. Cite this article:
Introduction: The management of patients with thoracolumbar burst fractures has evolved over the last 60 years from the days of conservative management through to the current era of anterior decompression combined with either anterior or posterior stabilisation. There is no doubt that surgical outcomes have improved markedly with the more modern techniques. Nevertheless, there are still technical and other difficulties, which the surgeon may encounter. Based upon his experience with posterior vertebrectomy and reconstruction for thoracolumbar tumours, the author has used this technique for the management of acute burst fractures in this region. This paper presents a review of 10 patients with severe thoracolumbar burst fracture or fracture dislocation managed since 1997, using a single stage posterior decompression, realignment and stabilisation/interbody fusion. Methods: Data were acquired prospectively on consecutive patients between June 1997 and October 2000. All patients underwent single stage posterior decompression via laminectomy and then a subtotal eggshell vertebrectomy with removal of any herniated bone fragment(s) or partial vertebrectomy/ pedicle subtraction osteotomy. Pedicle screw stabilisation was performed to include one or two vertebrae above and below the involved vertebra(e). The intervertebral discs adjacent to the fractured vertebra were removed prior to realigning the vertebral column and performing inter-body fusion using carbon fibre spacers and autograft (4 patients) or vertebral body reconstruction with Titanium mesh cages and autograft (6 patients). Results: The mean age was 37 years (21–52 years). There were six males and four females. Three patients had no neurological deficit. Seven had incomplete
The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI). Patients with tSCI requiring surgical spinal decompression presenting to 17 centres in Europe were recruited. Depending on the timing of decompression, patients were divided into early (≤ 12 hours after injury) and late (> 12 hours and < 14 days after injury) groups. The American Spinal Injury Association neurological (ASIA) examination was performed at baseline (after injury but before decompression) and at 12 months. The primary endpoint was the change in Lower Extremity Motor Score (LEMS) from baseline to 12 months.Aims
Methods
Hydatid disease of the bone and soft tissue of the musculoskeletal system is uncommon. The dissemination mode leads to local malignancy with severe prognosis. Tunisia is an endemic area of the disease. Therefore we treated many patients affected the disease. We retrosectivelly reviwed 6 cases of bone hydatid cyst from 1990 to 2010. There were 3 males and 3 females. The mean age was 13 years. The localisation were 03 spinal, 2 in the proximal tibia and & localisation in trochanter. The diagnosis were histoligical in all patient. the mean delay for the diagnosis was 3 years. One patient with spinal localisation had neurological complication
To systematically review the efficacy of split tendon transfer surgery on gait-related outcomes for children and adolescents with cerebral palsy (CP) and spastic equinovarus foot deformity. Five databases (CENTRAL, CINAHL, PubMed, Embase, Web of Science) were systematically screened for studies investigating split tibialis anterior or split tibialis posterior tendon transfer for spastic equinovarus foot deformity, with gait-related outcomes (published pre-September 2022). Study quality and evidence were assessed using the Methodological Index for Non-Randomized Studies, the Risk of Bias In Non-Randomized Studies of Interventions, and the Grading of Recommendations Assessment, Development and Evaluation.Aims
Methods