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   2010| January-March  | Volume 44 | Issue 1  
    Online since December 31, 2009

 
 
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REVIEW ARTICLE
The natural history of adolescent idiopathic scoliosis
Hee-Kit Wong, Ken-Jin Tan
January-March 2010, 44(1):9-13
DOI:10.4103/0019-5413.58601  PMID:20165671
There have been great advances in the conservative and surgical treatment for adolescent idiopathic scoliosis in the last few decades. The challenge for the physician is the decision for the optimal time to institute therapy for the individual child. This makes an understanding of the natural history and risk factors for curve progression of significant importance. Reported rates of curve progression vary from 1.6% for skeletally mature children with a small curve magnitude to 68% for skeletally immature children with larger curve magnitudes. Although the patient's age at presentation, the Risser sign, the patient's menarchal status and the magnitude of the curve have been described as risk factors for curve progression, there is evidence that the absolute curve magnitude at presentation may be most predictive of progression in the long term. A curve magnitude of 25º at presentation may be predictive of a greater risk of curve progression. Advances in research may unlock novel predictive factors, which are based on the underlying pathogenesis of this disorder.
  6,293 444 17
ORIGINAL ARTICLES
Validity of the DEXA diagnosis of involutional osteoporosis in patients with femoral neck fractures
Ali Humadi, Rajit H Alhadithi, Sabhan I Alkudiari
January-March 2010, 44(1):73-78
DOI:10.4103/0019-5413.58609  PMID:20165680
Background : There exists no study comparing dual energy X-ray absorptimetry (DEXA) with histomorphometry to evaluate its accuracy and validity as an assessment tool. A prospective study was done comparing the measurements of osteoporosis in patients with femoral neck fractures using the histological method of diagnosis and in the same patients with DEXA postoperatively. Patients and Methods : The histological method depends on histomorphometric analysis of bone biopsies taken from the neck of femur during surgical treatment of the fracture. We depend on three indices in histomorphometric analysis: these are osteoid seam width, osteoblast surface, and osteoid surface. The radiological method depends on the measurement of the bone mineral density using DEXA for fractured patients with the scan performed onto the contralateral nonfractured hips and lumbar spines. Results : We found positive histological histomorphometric parameters of osteoporosis in 68% of patients with the femoral neck fracture, and there is a moderate correlation between histological histomorphometric analysis and DEXA in the diagnosis of osteoporosis in these patients. In our study, DEXA can detect up to 88.2% of possible cases of osteoporosis (sensitivity 88.2%), but the specificity of this diagnostic tool is 62.5% at a t-score of ≤ -2, i.e., it is sensitive but less specific. The mean difference in the t-score in femoral DEXA and lumbar DEXA is almost zero. Conclusions : DEXA is a noninvasive and an affordable and easy method for the diagnosis of osteoporosis but less efficient than the histological histomorphometric method of diagnosis with a low specificity. We also found that the mean difference in the t-score in femoral DEXA and lumbar DEXA is almost zero, so DEXA of one region can reflect the change in the other region and there is no need for DEXA of both regions as a routine unless indicated for a special reason. This avoids exposing the patient to unnecessary risk of radiation and reduces cost.
  5,818 267 5
Intraspinal anomalies in scoliosis: An MRI analysis of 177 consecutive scoliosis patients
S Rajasekaran, Vijay Kamath, R Kiran, Ajoy Prasad Shetty
January-March 2010, 44(1):57-63
DOI:10.4103/0019-5413.58607  PMID:20165678
Background : The association of intraspinal neural anomalies with scoliosis is known for more than six decades. However, there are no studies documenting the incidence of association of intraspinal anomalies in scoliotic patients in the Indian population. The guide lines to obtain an magnetic resonance imaging (MRI) scan to rule out neuro-axial abnormalities in presumed adolescent idiopathic scoliosis are also not clear. We conducted a prospective study (a) to document and analyze the incidence and types of intraspinal anomalies in different types of scoliosis in Indian patients. (b) to identify clinico-radiological 'indicators' that best predict the findings of neuro-axial abnormalities in patients with presumed adolescent idiopathic scoliosis, which will alert the physician to the possible presence of intraspinal anomalies and optimize the use of MRI in this sub group of patients. Materials and Methods : The data from 177 consecutive scoliotic patients aged less than 21 years were analyzed. Patients were categorized into three groups; Group A - congenital scoliosis (n=60), group B -presumed idiopathic scoliosis (n=94) and group C - scoliosis secondary to neurofibromatosis, neuromuscular and connective tissue disorders (n=23). The presence and type of anomaly in the MRI was correlated to patient symptoms, clinical signs and curve characteristics. Results : The incidence of intraspinal anomalies in congenital scoliosis was 35% (21/60), with tethered cord due to filum terminale being the commonest anomaly (10/21). Patients with multiple vertebral anomalies had the highest incidence (48%) of neural anomalies and isolated hemi vertebrae had none. In presumed 'idiopathic' scoliosis patients the incidence was higher (16%) than previously reported. Arnold Chiari-I malformation (AC-I) with syringomyelia was the most common neural anomaly (9/15) and the incidence was higher in the presence of neurological findings (100%), apical kyphosis (66.6%) and early onset scoliosis. Isolated lumbar curves had no anomalies. In group-C, incidence was 22% and most of the anomalies were in curves with connective tissue disorders. Conclusion : The high incidence of intraspinal anomalies in presumed idiopathic scoliosis in our study group emphasizes the need for detailed examination for subtle neurological signs that accompany neuro-axial anomalies. Preoperative MRI screening is recommended in patients with presumed 'idiopathic' scoliosis who present at young age, with neurological findings and in curves with apical thoracic kyphosis.
  5,468 257 22
Outcome of Gartland type II and type III supracondylar fractures treated by Blount's technique
Antoine de Gheldere, Damien Bellan
January-March 2010, 44(1):89-94
DOI:10.4103/0019-5413.58612  PMID:20165683
Background : According to some orthopedic surgeons, almost all supracondylar humerus fractures should be treated operatively by reduction and pinning. While according to others, closed reduction and immobolization should be used for Gartland type II and some type III fractures. However, the limit of this technique remains unclear. We present 74 patients with displaced extension-type supracondylar fractures treated by closed reduction and immobilization with a collar sling fixed to a cast around the wrist. The purpose of the study is to give a more precise limitation of this technique. Materials and Methods : Retrospective data acquisition of 74 patients with a Gartland type II or type III fractures treated by closed reduction and immobilization (Blount's technique) between January 2004 and December 2007 was done. The mean age was 6.3 years (range, 2-11). The mean time of follow-up was 6.5 months (range, 3-25). All open injuries and complex elbow fracture dislocations or T-condylar fractures were excluded from the study. All patients were evaluated with standardized anteroposterior and true lateral x-rays of the elbow, and Flynn criteria were used for functional assessment. Results : Gartland type II fractures had 94% good or excellent final results. Gartland type III fractures had 73% good or excellent final result. The Gartland type III outcome depended on the displacement. The fractures remained stable in 88% for the posterior displacement, and 58% for the posteromedial displacement. These displacements were mild. However, for the posterolaterally displaced fractures, only 36% were stable; 36% had a mild displacement and 27% had a major displacement. Conclusion : Pure posterior displacement is more stable than posteromedial displacement which is more stable than posterolaterally displaced fractures. This study suggests that Gartland type II and pure posterior or posteromedial displaced Gartland type III fractures can be treated by closed reduction and immobilization with success.
  5,209 515 8
Gap nonunion of forearm bones treated by modified Nicoll's technique
Dinesh K Gupta, Gaurav Kumar
January-March 2010, 44(1):84-88
DOI:10.4103/0019-5413.58611  PMID:20165682
Background : The management of an atrophic nonunion with a gap following a fracture of the radius and/or ulna is a challenging problem. Various methods of treatment available in the literature are cortical tibial graft (Boyd), ulnar segment graft (Miller and Phalen), iliac crest graft (Spira), cancellous insert graft (Nicoll), vascularized fibular graft (Jupiter), and bone transport by ring fixator (Tesworth). The present study reports the results of tricorticocancellous bone block grafts using modified Nicoll's technique, in diaphyseal defects of forearm bones. Materials and Methods : A total of 38 forearm bones (either radius or ulna or both) in 23 patients with a gap of 1.5-7.5 cm were treated by debridement and tricorticocancellous bone block graft under compression with intramedullary nail fixation between June 1985 and June 2005. There were 15 male and 8 female patients. Sixteen patients had open and seven patients had closed fractures initially. Time of presentation since the original injury varied from 9 months to 84 months. Eighteen patients had already undergone one to three operations. Results : Thirty-six bones showed union at both host graft junctions. The mean duration of union was 17.5 weeks (range, 14-60 weeks). Two bones had union only at one host graft junction and did not show any evidence of callus formation up to 9 months on the other end, hence requiring subsequent procedure in the form of phemister bone grafting. Patients were followed for a minimum period of 2 years (range, 2-7 years). Results were based on the status of union and range of motion (ROM) for elbow/wrist and grip strength at the final follow-up. Complications observed were the reactivation of infection (n = 1) and herniation of the muscles at the donor site (n = 1). Conclusion : The tricorticocancellous strut bone grafting under optimal compression, augmented with intramedullary fixation, provides a promising solution to difficult problem of an atrophic nonunion of forearms bones with gap.
  4,645 447 4
Multimodal intraoperative neuromonitoring in corrective surgery for adolescent idiopathic scoliosis: Evaluation of 354 consecutive cases
Vishal K Kundnani, Lisa Zhu, HH Tak, HK Wong
January-March 2010, 44(1):64-72
DOI:10.4103/0019-5413.58608  PMID:20165679
Background : Multimodal intraoperative neuromonitoring is recommended during corrective spinal surgery, and has been widely used in surgery for spinal deformity with successful outcomes. Despite successful outcomes of corrective surgery due to increased safety of the patients with the usage of spinal cord monitoring in many large spine centers, this modality has not yet achieved widespread popularity. We report the analysis of prospectively collected intraoperative neurophysiological monitoring data of 354 consecutive patients undergoing corrective surgery for adolescent idiopathic scoliosis (AIS) to establish the efficacy of multimodal neuromonitoring and to evaluate comparative sensitivity and specificity. Materials and Methods : The study group consisted of 354 (female = 309; male = 45) patients undergoing spinal deformity corrective surgery between 2004 and 2008. Patients were monitored using electrophysiological methods including somatosensory-evoked potentials and motor-evoked potentials simultaneously. Results : Mean age of patients was 13.6 years (±2.3 years). The operative procedures involved were instrumented fusion of the thoracic/lumbar/both curves, Baseline somatosensory-evoked potentials (SSEP) and neurogenic motor-evoked potentials (NMEP) were recorded successfully in all cases. Thirteen cases expressed significant alert to prompt reversal of intervention. All these 13 cases with significant alert had detectable NMEP alerts, whereas significant SSEP alert was detected in 8 cases. Two patients awoke with new neurological deficit (0.56%) and had significant intraoperative SSEP + NMEP alerts. There were no false positives with SSEP (high specificity) but 5 patients with false negatives with SSEP (38%) reduced its sensitivity. There was no false negative with NMEP but 2 of 13 cases were false positive with NMEP (15%). The specificity of SSEP (100%) is higher than NMEP (96%); however, the sensitivity of NMEP (100%) is far better than SSEP (51%). Due to these results, the overall sensitivity, specificity and positive predictive value of combined multimodality neuromonitoring in this adult deformity series was 100, 98.5 and 85%, respectively. Conclusion : Neurogenic motor-evoked potential (NMEP) monitoring appears to be superior to conventional SSEP monitoring for identifying evolving spinal cord injury. Used in conjunction, the sensitivity and specificity of combined neuromonitoring may reach up to 100%. Multimodality monitoring with SSEP + NMEP should be the standard of care.
  4,335 224 22
EDITORIALS
Scoliosis - The current concepts
Dilip Kumar Sengupta, John K Webb
January-March 2010, 44(1):5-8
DOI:10.4103/0019-5413.58600  PMID:20165670
  3,818 510 -
ORIGINAL ARTICLES
Outcome analysis of pelvic ring fractures
Ramesh K Sen, Lokesh A Veerappa
January-March 2010, 44(1):79-83
DOI:10.4103/0019-5413.58610  PMID:20165681
Background: The behavior of pelvic ring fractures in the long run has been very sparsely studied. The purpose of this study is to assess the long-term outcome of pelvic ring fractures. Materials and Methods: A total of 24 patients with pelvic ring fractures, not involving the acetabulum, were followed up for an average duration of 33 months (range 24-49 months). The clinicoradiological assessment was done using the pelvic scoring system adapted from Cole et al. Parameters assessed included sacroiliac (SI) joint involvement and, among SI joint injuries, the presence of a fracture disruption and the degree of displacement. Results: Pain and limp were present in 13 patients (54.2%) each and residual working disability in 9 patients (37.5%). The overall Cole's pelvic score was 31.3 ± 7.02 of a total score of 40. The average pelvic score in patients with SI disruption was 29.2 ± 6.75; much lower than patients without SI disruption with an average score of 34.9 ± 6.25 reaching statistical significance. The pelvic score among patients with a displacement ≤10 mm was 33.0 ± 3.92 and with a displacement >10 mm 25.88 ± 7.14. The difference was statistically significant. Conclusions: Pelvic ring injuries can lead to long term problems significantly. The involvement of the SI joint affects the long-term outcome adversely, more so if the residual displacement is >10 mm. The pelvic scoring system is comprehensive and depicts subtle differences in the outcome, which the individual parameters of the assessment fail to show.
  3,458 278 9
Spinal loop rectangle and sub laminar wiring as a technique for scoliosis correction
Shekhar Y Bhojraj, Raghuprasad G Varma, Abhay M Nene, Sheetal Mohite
January-March 2010, 44(1):50-56
DOI:10.4103/0019-5413.58606  PMID:20165677
Background: Most literature popularizes the efficacy of third generation instrumentation in the surgical correction of spinal deformities. A cheap and effective scoliotic deformity correction method is reviewed in this article. The aim of this study is to evaluate the efficacy of spinal loop rectangle and sub laminar wires as a modality for spinal deformity correction and its co-relation with patients' satisfaction and clinical outcome. Material and Methods: Thirty six patients of scoliotic spinal deformities with various etiologies (congenital-4, idiopathic- 25, neurofibromatosis-3, neuromuscular-2 and 'syndromic'-3) with ages ranging from 8 to 23 years underwent corrective posterior spinal arthrodesis with stainless steel Hartshill loop rectangle and sublaminar wires. Clinicoradiological evaluation was done at an average follow-up of 6 ½ years (min-2 ½, years). Along with clinicoradiological outcome, patient satisfaction (as per the SRS 24), was accounted. Results: Average preoperative Cobb's angle were 73.25º in the entire group and 66.48º in the idiopathic group. Average percentage correction was 64.34% in the entire group and the (average degree of correction was 47.13). In the idiopathic group, the respective values were 69.19% and 46º. Loss of correction in the whole group was 2.2º at two year follow up. Sagittal profiles, truncal balance were well corrected too; minimal complications were seen. Patient satisfaction results were encouraging in 36 patients as per - SRS24). About 80.2% patients were ready to undergo the same surgery if required. (SRS24). Conclusion: Segmental spinal fixation with locally made spinal loop rectangle and sublaminar wires is comparable as a modality to correct scoliotic spinal deformities.
  3,525 183 3
Dorsal arthrodesis in prepubertal New Zealand white rabbits followed to skeletal maturity: Effect on thoracic dimensions, spine growth and neural elements
Federico Canavese, Alain Dimeglio, Charles D'Amato, Donatella Volpatti, Marie Granier, Marco Stebel, Fabio Cavalli, Bartolomeo Canavese
January-March 2010, 44(1):14-22
DOI:10.4103/0019-5413.57280  PMID:20165672
Background: Several studies have shown that severe spinal deformity and early arthrodesis can adversely affect the development of the spine and thorax by changing their shape and reducing their normal function. This article analyzes the consequences of posterior fusion on the growth of spine, thorax and neural elements in New Zealand white rabbits and compares with similar human data. Materials and Methods : The first section of the article analyzes the consequences of T1-T6 dorsal arthrodesis on the growth of the spine, sternum, thorax volume and neural elements in 12 prepubertal female New Zealand white rabbits, through a study of CT scans and histology specimens. The second part, evaluates thoracic dimensions in 21 children with spinal arthrodesis for treatment of deformity performed prior to nine years of age. Results: Dorsal arthrodesis in prepubertal rabbits changes thoracic growth patterns. In operated rabbits thoracic depth grows more slowly than thoracic width. The sternum as well as length of thoracic vertebral bodies in the spinal segment T1-T6 show reduced growth. Children undergoing spinal arthrodesis before nine years of age were noted to have shortened height, short trunk and disproportionate body habitus at skeletal maturity. Observed spine height and chest dimension values were reduced compared to the expected norms. The ratio between chest width and chest depth was below normal values. Conclusions: The first part of the study shows that thoracic dorsal arthrodesis in prepubertal New Zealand white rabbit influences thoracic, spine growth and affects the shape of pseudo unipolar neurons of the dorsal root ganglia. The second part demonstrates that children treated before nine years of age have significantly reduced spine height and thoracic dimensions. The thorax becomes elliptical as chest depth grows less than chest width. Both experimental and clinical findings contribute to explain reduced chest growth and subsequent thoracic growth disturbance in patients treated with early arthrodesis.
  3,534 101 7
CASE REPORTS
Extramedullary hemopoiesis with undiagnosed, early myelofibrosis causing spastic compressive myelopathy: Case report and review
Udita Dewan, Niraj Kumari, Awadesh Jaiswal, Sanjay Behari, Manoj Jain
January-March 2010, 44(1):98-103
DOI:10.4103/0019-5413.57281  PMID:20165685
Extramedullary hemopoiesis (EMH) is a common compensatory phenomenon associated with chronic hemolytic anemia. Abnormal hemopoietic tissue usually develops in sites responsible for fetal hemopoiesis, such as spleen, liver and kidney; however, other regions such as the spine may also become involved. In this study, a patient presenting with spastic paraparesis due to EMH in the dorsal spine is described. A 62-year-old man presented with paraparesis. Magnetic resonance imaging revealed a large lesion involving the T2-L2 vertebral levels with a large extradural component causing thecal sac compression. Laminectomy with excision of mass was carried out. The histopathology revealed EMH. The patient had no known cause for EMH at the time of diagnosis but, subsequently, a bone marrow examination revealed early myelofibrosis. This case represents the rare occurrence of a large extradural extramedullary hematopoiesis in a patient with no known predisposing factor for hemopoiesis at the time of presentation.
  3,474 134 7
ORIGINAL ARTICLES
Results of the spine-to-rib-cage distraction in the treatment of early onset scoliosis
Marco Teli, Alessio Lovi, Marco Brayda-Bruno
January-March 2010, 44(1):23-27
DOI:10.4103/0019-5413.58602  PMID:20165673
Background: Growing rod systems have been used in the last 30 years for the treatment of early onset scoliosis (EOS) with variable success rates. We report the results of treatment of EOS with a newly developed hybrid rod distraction system applied to the rib cage and spine with a nonfusion technique in a prospective multicenter clinical trial. Materials and Methods: A total of 22 patients affected by progressive EOS resistant to cast and/or brace treatment were enrolled from 2004 to 2005 after informed consent into a trial of surgical treatment with a single spine-to-rib growing rod instrumentation growing spine profiler (GSP). Curves >60° Cobb in the frontal plane or bending <50% were addressed with staged anterior annulotomy and fusion and posterior implantation of a GSP rod. Less severe and rigid curves were treated with posterior implantation of GSP only. The elongation of GSP was planned according to spinal growth. Patients were kept in a brace between elongations. Results: A total of 20 patients were available to follow-up with complete data. The mean follow up is 4.1 years. Mean age at time of initial surgery was 5 years (3-8). Nine patients had staged antero-posterior surgeries, 11 posterior only surgeries. Mean spinal growth was 1.9 cm (1.5-2.3) or 0.5 cm per year. Mean coronal Cobb's angle correction was from 56° to 45°. Major complications affected 40% of patients and included rod failure in 6/20 and crankshaft in 5/20 (all in the anteroposterior surgery group). Conclusion: Treatment of EOS with spine-to-rib growing rod in the present form provides similar correction and complication rates to those published in the series considering traditional single or dual growing rod systems. Based on this, the authors recommend revision of the GSP design and a new clinical trial to test safety and efficacy.
  3,387 149 2
Posterior scoliosis correction for adolescent idiopathic scoliosis using side-opening pedicle screw-rod system utilizing the axial translation technique
Saumyajit Basu, Sreeramalingam Rathinavelu, Prashant Baid
January-March 2010, 44(1):42-49
DOI:10.4103/0019-5413.58605  PMID:20165676
Background : Though adequate literature is present depicting the results of pedicle screw-rod instrumentation using top loading systems for correction of adolescent idiopathic scoliosis (AIS), using the rod rotation technique, few published data is available regarding side loading systems used for a similar purpose. We report a retrospective study of a cohort of patients with strict inclusion criteria who underwent surgical correction of AIS with side-opening pedicle screw-rod posterior instrumentation using the axial translation technique of curve correction to assess the efficacy of side opening system for scoliosis correction with regards to patient satisfaction, Cobb's angle correction and spinal balance. Materials and Methods : Clinical and radiological outcomes were measured in 14 consecutive patients (3 males, 11 females) with an average age of 14.0 years (range 9 to 23 years). They were followed up for an average period of 13.0 months (range - 2.2 to 28.5). All patients underwent posterior instrumentation only with pedicle screws used as anchor points. Hybrid constructs using hooks/wires or curves requiring anterior release were excluded from the study. All levels were not instrumented - more screws were put on the concavity and in the peri-apical region. Radiological evaluation was done by whole spine standing AP, lateral radiograms preoperatively and 1, 3, 6 and12 months after surgery. Cobb's angles were measured and the spinal balance was noted. Clinical evaluation was done by SRS questionnaire. The complications were documented. Results : The mean preoperative Cobb's angle was 58.35Ί (range - 44 to 72Ί), which came down postoperatively to 23.45Ί (range - 10 to 38Ί) signifying a mean correction of 59.57% (range - 26.92 to 76.17%). Clinical outcomes were evaluated using the SRS - 30 questionnaires. The values of mean pre- and postoperative scores are 3.68 and 4.18, showing an improvement of 0.5 points. Other than one patient of superficial wound infection, which healed with antibiotics, there was no major complication. No patient had neurological deterioration. Conclusion : Side-opening spinal instrumentation systems, using the axial translation technique, achieved good clinical and radiological outcome for patients of AIS.
  3,040 203 3
Adolescent idiopathic scoliosis: Retrospective analysis of 235 surgically treated cases
Ranjith Unnikrishnan, J Renjitkumar, Venugopal K Menon
January-March 2010, 44(1):35-41
DOI:10.4103/0019-5413.58604  PMID:20165675
Background : The surgical treatment of adolescent idiopathic scoliosis (AIS) has taken great strides in the last two decades. There have been no long term reported studies on AIS from India with documented long term followup. In this study we review a single surgical team's series of 235 surgically treated cases of AIS with a follow-up from two to six years. Materials and Methods : Pre operative charts, radiographs and MRI scans for 235 patients were collected for this study. The patients were grouped into three groups where anterior correction and fusion (n=47), posterior correction and fusion (n=123) and combined anterior release and posterior instrumentation (n=65) was performed. Each group was divided into two subgroups based on the surgical approach and instrumentation strategy (all screw construct or hybrid construct) used. Patients were followed up for coronal and saggital plane corrections, apical vertebral translation (AVT), trunk balance and back pain. The percentage of correction was calculated in each group as well as sub groups. Results : The incidence of MRI detected intraspinal anomaly in this series is 5.9% with 3.4% of them requiring neurosurgical procedure along with scoliosis correction. Average coronal major curve correction was 66% in the all screw group and 58.5% in the hybrid group. The coronal plane correction was better when the all screw constructs were employed. Also, the AVT and trunk balance was better with the all screw constructs. The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction. There were eight (3.4%) complications in this series. The coronal and saggital plane correction paralleled the published international standards. Conclusion : The coronal plane correction was better when all screw constructs were employed. Use of all pedicle screw systems obviated the need for costoplasty in most cases. The increased incidence of intraspinal anomaly may warrant a routine pre operative MR imaging of all adolescent scoliosis needing surgical treatment.
  3,005 235 6
CASE REPORTS
Primary synovial osteochondromatosis of a subdeltoid bursa
Anil Kumar, Arvind Aggarwal, Virender K Sahni
January-March 2010, 44(1):104-107
DOI:10.4103/0019-5413.58613  PMID:20165686
Primary synovial osteochondromatosis (SOC) is known to be intra-articular and wherever it is observed outside a synovial joint, it is associated with the involvement of the nearby joint. Primary SOC has not been reported to involve a subdeltoid bursa. We present a case of a 52-year-old woman having a large number of loose bodies in a large tumor in the subdeltoid bursa. The swelling was first noticed by the patient 2 years back. Plain roentgenogram revealed soft tissue swelling only with no areas of calcification. On MRI, multiple nonosseous loose bodies were visualized in the bursa deep to the deltoid muscle. A surgical excision of subdeltoid bursa was done. A biopsy confirmed it to be cartilaginous loose bodies in synovial lining sugestive of metaplastic transformation of the synovial tissue.
  2,790 143 7
Cervical neurofibromatosis with quadriparesis: Management by fibular strut graft
Wichien Laohacharoensombat, Wiwat Wajanavisit, Patarawan Woratanarat
January-March 2010, 44(1):95-97
DOI:10.4103/0019-5413.54968  PMID:20165684
This is a case report of an eight-year old boy with neurofibromatosis and a 120º dystrophic kyphosis of the cervical spine. He presented with progressive quadriparesis caused by spondyloptosis of the C2/C3, and was successfully treated by skull traction and one-stage anterior fibular strut graft lying between the tubercle of the atlas through the C2 body slot and lower vertebrae. At seven years follow-up there was, loosening of lower vertebral screws which allowed growth and residual mobility of lower vertebral joints while the fusion of upper cervical spines was still solid.
  2,656 109 5
EDITORIALS
Indian Journal of Orthopaedics: The journey so far
Anil K Jain, DK Sahu
January-March 2010, 44(1):1-4
DOI:10.4103/0019-5413.58599  PMID:20165669
  2,542 176 3
LETTER TO EDITOR
Nonsecretory multiple myeloma, how to make a diagnosis?
Viroj Wiwanitkit
January-March 2010, 44(1):112-112
DOI:10.4103/0019-5413.58615  PMID:20165688
  2,556 150 -
CASE REPORTS
Pseudoaneurysm as a complication of ankle arthroscopy
Olubusola A Brimmo, Selene G Parekh
January-March 2010, 44(1):108-111
DOI:10.4103/0019-5413.58614  PMID:20165687
We present a case of a pseudoaneurysm of the anterior tibial artery following ankle arthroscopy with synovectomy, an extremely rare complication when standard anteromedial and anterolateral portals are used. The patient was diagnosed and treated with appropriate interventions which led to an uneventful recovery. Nevertheless, the potential sequelae of delayed diagnosis or misdiagnosis of the complication are dangerous; therefore, a high index of suspicion for a pseudoaneurysm must be maintained in the postoperative period.
  2,541 104 14
ORIGINAL ARTICLES
The evaluation of short fusion in idiopathic scoliosis
Wiwat Wajanavisit, Patarawan Woratanarat, Thira Woratanarat, Kitti Aroonjaruthum, Noratep Kulachote, Wajana Leelapatana, Wichien Laohacharoensombat
January-March 2010, 44(1):28-34
DOI:10.4103/0019-5413.58603  PMID:20165674
Background: Selective thoracic fusion in type II curve has been recommended by King et al. since 1983. They suggested that care must be taken to use the vertebra that is neutral and stable so that the lower level of fusion is centered over the sacrum. Since then there has been the trend to do shorter and selective fusion of the major curve. This study was conducted to find out whether short posterior pedicle instrumentation alone could provide efficient correction and maintain trunk balance comparing to the anterior instrumentation. Materials and Methods: A prospective study was conducted during 2005-2007 on 39 consecutive cases with idiopathic scoliosis cases King 2 and 3 (Lenke 1A, 1B), 5C and miscellaneous. Only the major curve was instrumented unless both curves were equally rigid and of the same magnitude. The level of fusion was planned as the end vertebra (EVB) to EVB fusion, although minor adjustment was modified by the surgeons intraoperatively. The most common fusion levels in major thoracic curves were T6-T12, whereas the most common fusion levels in the thoraco-lumbar curves were T10-L3. Fusion was performed from the posterior only approach and the implants utilized were uniformly plate and pedicle screw system. All the patients were followed at least 2 years till skeletal maturity. The correction of the curve were assessed according to type of curve (lenke IA, IB and 5), severity of curve (less than 450, 450-890 and more than 900), age at surgery (14 or less and 15 or more) and number of the segment involved in instrumentation (fusion level less than curve, fusion level as of the curve and fusion more than the curve) Results: The average long-term curve correction for the thoracic was 40.4% in Lenke 1A, 52.2% in Lenke 1B and 56.3% in Lenke 5. The factors associated with poorer outcome were younger age at surgery (<11 years or Risser 0), fusion at wrong levels (shorter than the measured end vertebra) and rigid curve identified by bending study. However, all patients had significant improved trunk balance and coronal hump at the final assessment at maturity. Two patients underwent late extension fusion because of junctional scoliosis. Conclusions: With modern instrumentations, the EVB of the major curve can be used at the end of the instrumentation in most cases of idiopathic scoliosis. In those cases with either severe trunk shift, younger than 11 years old, or extreme rigid curve, an extension of one or more levels might be safer. In particular situations, the concept of centering the lowest vertebra over the sacrum should be adopted.
  2,389 145 3
OBITUARY
The life and legacy of Ignacio Ponseti
Matthew B Dobbs, Shah Alam Khan
January-March 2010, 44(1):114-114
  1,659 165 -
BOOK REVIEW
Basic Methods of Medical Research
Piyush Gupta
January-March 2010, 44(1):113-113
  1,371 147 -
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