Limited dorsal myeloschisis, a form of cervical spinal dysraphism, is a rare anomaly and is typically associated with spinal cord tethering. The objective is to illustrate a rare dysraphic anomaly in ...the cervicothoracic spine causing myelopathy, not due to tethering but secondary to progressive kyphosis. To our knowledge, such an anomaly has not been described in the literature.
Case report METHODS: A 16-year-old boy presented with lower extremity spastic paraparesis due to progressive cervicothoracic deformity. The imaging studies revealed extensive posterior arch defects from C1 to T6. The cervical spinal cord and meninges had herniated out of the spinal canal in the hyperlordotic cervical spine, and the thoracic spinal cord was stretched and compressed over the T4/5 kyphotic apex. Free-floating spinous processes were found compressing the cord at the T4-5 level. Tethering was not detected.
The patient underwent a posterior vertebral column resection at T5 and excision of the free-floating spinous processes. The patient made a complete neurological recovery. At 8 year follow-up, he was asymptomatic and his deformity was stable.
We present a rare congenital cervical dystrophic anomaly causing myelopathy secondary to progressive kyphosis. We speculate that this anomaly was due to the sclerotomal cells' failure to migrate dorsally to the neural tube and fuse in the midline.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
A retrospective chart review.
To describe the presentation and the rationale for management of pathological odontoid fracture and complete odontoid destruction in craniovertebral junction ...tuberculosis (CVJ TB).
Presentation of CVJ TB ranges from minor osteomyelitic changes to severe structural damage leading to instability. Structural damage to the odontoid process is poorly characterized in the literature. Inadequate knowledge about the radiological presentations has led to controversy in the management of CVJ TB.
The cohort consisted of 15 consecutive patients with CVJ TB, with structural damage to the odontoid process in the form of either odontoid fracture (n = 7) or complete odontoid destruction (n = 8). These patients presented with pain, neurological deficit, torticollis, dysphagia, or respiratory distress. The cause of neurological deficit was craniocervical instability characterized as anterioposterior (n = 15), rotatory (n = 4), and vertical (n = 6). Displacement reduced anatomically in 13 patients. Apart from antibiotics, all patients were treated surgically by either C1-C2 fusion (n = 7) or occipitocervical fusion (n = 8).
Average duration of follow-up was 3.6 years (range, 1.5-8 yr). All patients achieved normal neurological status. No complications were noted, except for 1 case, who had a loss of reduction after the use of Hartshill rectangle for occipitocervical fusion. Postoperative computed tomographic scan showed nonunion of odontoid fracture in 2 of 4 patients. No patient of odontoid destruction, of the 5 investigated, revealed structural reformation of the dens.
CVJ TB can severely damage the odontoid process, resulting in atlantoaxial dislocation. In these patients, surgery restores and maintains the craniocervical alignment and has a predictable outcome compared with conservative therapy. Pathological odontoid fractures have the potential to go into nonunion. Odontoid process once destroyed completely is rarely restored after antibiotic therapy.
An eight-year-old boy presented with acute encephalopathy due to posterior circulation ischemic stroke. He was found to have vertebral artery stenosis secondary to atlantoaxial instability (AAI) due ...to an os odontoideum. Occipitocervical fusion was performed 4 weeks after stroke. The child improved neurologically and regained independent ambulation. He had indications of an underlying spondyloepiphyseal dysplasia with joint luxation and whole-exome sequencing diagnosed CHST3-related skeletal dysplasia.
As far as we know, this AAI due to an os odontoideum is a previously unreported complication of CHST3-related skeletal dysplasia. Occipitocervical fusion yielded good clinical results with the 1-year follow-up.
A 41-year-old woman sustained a degloving injury over her lumbosacral and perineal region with fractures of her right tibia and fibula. After diversion colostomy and osteosynthesis for the fractures ...at a primary center, a missed grade 2 lumbosacral dislocation was diagnosed at a tertiary center and the degloving injury was treated with debridement and skin grafting. After 5 months, the dislocation had progressed to grade 4 and she underwent delayed posterior lumbosacral reduction, interbody fusion, and L4-S1 fixation, with superior gluteal artery perforator flap and subsequent colostomy closure, with good outcomes (Oswestry Disability Index 10%) at the 3-year follow-up.
A rare, missed, progressive traumatic L5-S1 spondylolisthesis with associated injuries is described.
Introduction
Sciatica, a common affliction, has been a well known scourge throughout recorded history of mankind and finds a mention in the writings of Hippocrates 1. The clinical root tension signs ...were described in the late 19th century, and their discovery preceded the development of surgical techniques for this disorder. As surgeries became safe at the beginning of the 20th century, surgeons incorrectly diagnosed the pathology as cartilaginous tumors in these operated patients. Finally, by the 1930s, they had started connecting the dots and discovered that lumbar disc herniation was responsible for the clinical syndrome of sciatica. In this report, we trace an interesting history from the discovery of the root tension signs for sciatica to the invention of lumbar discectomy surgery for a herniated lumbar disc. There is a great deal of confusion in the eponymous naming of the passive SLR test in various textbooks. Bruce Reider’s The Orthopaedic Physical Examination, a book popular among orthopedic residents, describes the forced dorsiflexion maneuver as the Laségue’s test 2. While Todd Albert’s Physical Examination of the Spine describes the same maneuver as Bragard’s test 3. Most textbooks, however, refrain from using eponymous names to describe these neurological signs, especially because there is so much confusion about them. Nevertheless, the medical history behind these root tension signs is no less fascinating. Many attribute the first description of the passive SLR to Ernst Charlie Laségue (Fig. 1), who was a Professor of Medicine in Paris. In his 1864 paper, he described a syndrome of radicular pain which sometimes was associated with muscle atrophy 4. However, in this paper, he did not describe the leg raising test. Robert Wartenberg, the owner of a few eponymous signs and syndromes himself, worte in 1956: “it is highly embarrassing to state the plain fact that all authors who quoted Lasègue’s article of 1864 as a source of Lasègue’s sign did not
Prospective controlled study analyzing the donor site morbidity after reconstruction of full thickness iliac crest defects, using autologous rib grafts.
To compare the pain and cosmetic outcomes of ...patients with iliac crest reconstruction with those who have had no reconstruction of the iliac crest.
Chronic donor site pain and poor cosmesis have been the major deterrents in using iliac crest for long-segment spinal reconstructions. Iliac crest reconstruction with rib has been reported but most studies are uncontrolled and retrospective.
Patients with iliac defects <25 mm after graft harvest were excluded. Twenty patients were reconstructed using autogenous rib graft harvested during the anterolateral approach to spine. Rib graft of the appropriate contour was impacted into the notches created in the iliac crest defect. The control group comprised 16 patients without reconstruction of the iliac crest. The pain, cosmesis, and functional disability were assessed on the basis of visual analog scores and a predesigned questionnaire. Judet iliac views were used to assess the incorporation of the rib graft. Evaluation was performed at 1.5, 3, 6, and 12 months, respectively.
Intensity and incidence of pain was significantly lower in the reconstructed group. Cosmetic outcome was also significantly better in this group. Patients in control group had significant complications related to the tenting of skin over the defect such as bursitis and skin necrosis. Radiologic incorporation was documented in 95% of patients with 1 patient having resorption of the rib graft.
Rib graft reconstruction provides a cheap and effective alternative for iliac crest reconstruction. Patients undergoing thoracotomy or thoraco-phrenico-lumbotomy for spinal reconstruction, the unutilized rib graft should be used to reconstruct the iliac defect. Reduced donor site morbidity and better cosmesis are the major benefits of reconstruction.
Anterior instrumentation was performed in 42 cases of cervicothoracic tuberculosis operated using the modified anterior cervical approach.
To define the role of the modified anterior cervical ...approach in anterior reconstruction and instrumentation of the cervicothoracic vertebrae. To analyze the problems encountered during anterior stabilization in these patients.
In tuberculosis of cervicothoracic junction, direct anterior visualization is mandatory for optimal decompression of the spinal canal. Anterior reconstruction and stabilization has the advantage of providing immediate stability of vertebral column. The modified anterior cervical approach provides adequate exposure of the upper four thoracic vertebrae. However, radiologic and clinical criteria for anterior instrumentation of the cervicothoracic junction using the modified anterior cervical approach are unclear in literature.
A total of 42 patients with tuberculous kyphosis involving the cervicothoracic junction were operated. Based on the association of the sternal notch with the most distal normal vertebra, the patients were divided into 2 surgical groups. The long-neck patients were amenable to anterior instrumentation using the standard supraclavicular approach with a strap-muscle tenotomy. A manubriotomy was mandatory in short-neck patients for optimal visualization and proper placement of the implant.
Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable implant-bone construct anteriorly while preserving the posterior osseo-ligamentous tension band. Detailed preoperative assessment based on clinical and radiologic criteria helps in selection of patient for this procedure. Meticulous intraoperative technique helps to minimize the morbidity and complications associated with this procedure.
We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder ...involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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