Pedicle screw fixation commonly uses a manual probe technique for preparation and insertion of the screw. However, the accuracy of obtaining a centrally located path using the probe is often dependent on the experience of the surgeon and may lead to increased complications. Fluoroscopy and navigation assistance improves accuracy but may expose the patient and surgeon to excessive radiation. DSG measures electrical conductivity at the tip and provides the surgeon with real-time audio and visual feedback based on differences in tissue density between cortical and cancellous bone and soft tissue. The authors investigated the effectiveness of DSG for training residents on safe placement of pedicle screws. 15 male cadaveric thoracolumbar spine specimens were fresh-frozen at the time of expiration. Residents were assigned 3 specimens each and randomised by pedicle side and order of technique for pedicle screw placement (free-hand versus DSG). Fluoroscopy and other navigation assistance were not used for pedicle preparation. All specimens were imaged using CT following insertion of all pedicle screws. The accuracy was assessed by a senior radiologist and graded as within (≤ 2mm breach) or outside (> 2mm breach) the pedicle.Introduction
Methods
The aim of this study is to evaluate the long-term outcome after posterior spinal stabilization surgery for the management of de novo non-tuberculous bacterial spinal infection. Patients presenting to a single tertiary referral spinal centre between August 2011 and June 2014 were included in the study. 21 patients with nontuberculous bacterial infection were identified and included in the study. All patients were managed surgically with posterior stabilisation, with or without neural decompression, without debridement of the infected tissue. Neurological state was assessed using the frankel grading system before and after urgery. Long-term follow-up data was collected using SpineTango COMI questionnaires and Euro Qol EQ-5D system with a mean follow-up duration of 20 months postoperatively. The mean improvement in neurological deficits was 0.92 Frankel grade (range 0–4). At final followup, at a mean of 20 months, mean COMI score was 4.59, average VAS for back pain was 4.28. These symptoms were having no effect or only minor effect on the work or usual activities in 52%. 38% of patients reported a good quality of life. The average EQ-5D value was 0.569. There were no problems with mobility in 44% of patients. In 72% there were no problems with self-care.Back ground:
Method and Result:
To assess healing pattern of Achilles tendons across the gap created by a percutaneous tenotomy and maintained by cast in club feet. Twenty-one tenotomies in 16 patients (Age range 12 weeks-36 months) were monitored with dynamic and static ultrasonographic studies. Ultrasounds were performed before and immediately after tenotomy and at approximately 3, 6 and 12 weeks post tenotomy. Cast removal was done at three weeks. Two patients above age of two were casted for 6 weeks. The healing pattern went through different phases although they were not distinctively exclusive from each other and did show considerable overlap. First phase showed formation of a bulbous mass with some continuity of scar tissue across tendon gap. The transition zone between new fibre and the original tend quite distinct. However dynamic ultrasound showed the Achilles tendon moved as a single unit. Second phase showed fibres resembling normal tendon crossing the gap and reduction of bulbous mass. The transition zone was still discernible. Final stage demonstrated more homogenous fibres of Achilles tendon with an indistinct transition zone. Two older children showed a distinctly longer process of healing. One child showed an irregular mass of fluid and soft tissue structures in the gap at six weeks. The other child demonstrated a relative reduction in the proportion of tendon fibres across the gap. At 12 weeks there was evidence of continuation of tendon fibres, but transition zone partly visible. Young Child (<1 Year): when cast immobilisation is discontinued, the tendon is in mid phase of healing. There may be a positive effect on continued improvement in dorsiflexion while using boots and bars. Older Child: safe to consider percutaneous tenotomy in children up to 3 years of ages provided the period of immobilisation is extended.Conclusion
