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The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 8 | Pages 1024 - 1031
1 Aug 2012
Rajasekaran S Kanna RM Shetty AP

The identification of the extent of neural damage in patients with acute or chronic spinal cord injury is imperative for the accurate prediction of neurological recovery. The changes in signal intensity shown on routine MRI sequences are of limited value for predicting functional outcome. Diffusion tensor imaging (DTI) is a novel radiological imaging technique which has the potential to identify intact nerve fibre tracts, and has been used to image the brain for a variety of conditions. DTI imaging of the spinal cord is currently only a research tool, but preliminary studies have shown that it holds considerable promise in predicting the severity of spinal cord injury.

This paper briefly reviews our current knowledge of this technique.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 85 - 85
1 Jun 2012
Rajasekaran S Kanna R Shetty A
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Study design

Prospective clinical and radiological analysis of children with complex cervical deformities for the safety of cervical pedicle screw insertion.

Objectives

To analyse the possibility, safety and efficacy of cervical pedicle screw insertion in complex pediatric cervical deformities, where conventional stabilisation techniques would not have provided rigid fixation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 4 - 4
1 Jun 2012
Kanna R Shetty A Rajasekaran S
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Study Design

Prospective analysis of computerised tomogram images of 376 normal pediatric cervical pedicles

Objectives and Summary of Background Data

Although the usage of cervical pedicle screws (CPS) in adults has become established, the feasibility of its application in children has not been studied. There are no in-vivo studies that define the normal pediatric cervical pedicle morphometrics and its changes with growth and development of the child.


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 7 | Pages 954 - 962
1 Sep 2001
Rajasekaran S

The progression of post-tubercular kyphosis in 61 children who received ambulatory chemotherapy was studied prospectively. The angles of deformity and kyphosis were measured for each patient at diagnosis, 3, 6, 9, 12 and 18 months later and every year thereafter for 15 years. During the course of the disease signs of instability appeared on the radiographs of some of the children. These were dislocation of the facets, posterior retropulsion of the diseased fragments, lateral translation of the vertebrae in the anteroposterior view and toppling of the superior vertebra. Each sign was allocated one point to create a spinal instability score. The influence on the progression of the deformity of the level of the lesion, the vertebral body loss, the number of segments involved, the angle of deformity before treatment and the spinal instability score was analysed.

The mean angle of deformity at the start of treatment was 35°. This increased to 41° at 15 years. Progression occurred during the active phase of the disease and again after cure when variations in progression were observed. Type-I progression showed an increase in deformity until growth had ceased. This could occur either continuously (type Ia) or after a lag period of three to five years (type Ib). Type-II progression showed decrease in deformity with growth. This could occur immediately after the active phase (type IIa) or after a lag period of three to five years (type IIb). Type-III progression showed minimal change during either the active or healed phases and was seen only in those with limited disease.

Multiple regression analysis showed that a spinal instability score of more than 2 was a reliable predictor of patients with an increase of more than 30° in deformity and a final deformity of over 60°. Since signs of radiological instability appear early in the disease, they can be reliably used to identify children whose spine is at risk for late progressive collapse. Surgery is advised in these cases.