Diagnostic treatment-level discrepancies in patients with lumbosacral radicular pain and lumbar spine anomalies

2021 ◽  
pp. rapm-2021-103174
Author(s):  
Bart Liebrand ◽  
Koen Brakel ◽  
Arthur Boon ◽  
Walter van der Weegen ◽  
Selina van der Wal ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Interobserver Reliability ◽  
Case Series ◽  
Lumbar Vertebrae ◽  
Radicular Pain ◽  
Treatment Level ◽  
Vertebral Level ◽  
Retrospective Case ◽  
Transitional Vertebra ◽  
Lumbosacral Transitional Vertebrae

BackgroundLumbosacral transitional vertebra can result in an anomalous number of lumbar vertebrae associated with wrong level treatment. The primary aim of this study was to characterize discrepancies between reported referring levels and levels from MRI reports with treated levels. The secondary aim was to analyze interobserver variability between a pain physician and a radiologist when determining levels and classifying lumbosacral transitional vertebrae.MethodsBetween February 2016 and October 2019, a retrospective case series of prospectively collected data of the affected levels mentioned in referrals, MRI reports and treated levels was performed. The counting process, level determination, classification of lumbosacral transitional vertebrae and a secondary control were carried out by independent researchers using a standard methodology.ResultsOf the 2443 referrals, 143 patients had an anomalous number of lumbar vertebrae; of these, 114 were included for analysis. The vertebral level noted in the patient’s file, in the referral, and the reported level of treatment differed in 40% of these cases. The vertebral level between the MRI reports and treatment differed in 46% of cases. The interobserver reliability (radiologist vs pain physician) for classifying a transitional vertebra was fair ((κ=0.40) and was substantial (κ=0.70) when counting the vertebrae.ConclusionIn the presence of lumbar spine anomalies, we report a high prevalence of discrepancies between referral levels and MRI pathological findings with treatment levels. Further research is needed to better understand clinical implications.

Comparison of Computed Tomography, Traction, and Inverted Grayscale Radiographs for Understanding Pilon Fracture Morphology

2021 ◽  
pp. 107110072110492
Author(s):  
Gokay Eken ◽  
Abdulhamit Misir
Keyword(s):  
Computed Tomography ◽  
Interobserver Reliability ◽  
Case Series ◽  
Fracture Morphology ◽  
Correct Identification ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Fracture Fragment ◽  
Plain Radiographs ◽  
Pilon Fractures

Background: There have been no studies evaluating the usefulness of grayscale radiographs in extremity fractures. We aimed to compare the ability and reliability of traction radiographs vs traction grayscale inversion radiographs to detect fracture fragment and comminution zones in comminuted tibia pilon fractures. Methods: Plain radiographs and grayscale inversion images of 60 patients with Orthopaedic Trauma Association/AO Foundation type C3 fracture were evaluated by 20 observers (15 orthopedic surgeons and 5 radiologists) after traction had been applied. The anterolateral, posterolateral, and medial malleolar fragments, as well as the lateral, central, and medial column comminution zones, were identified by all physicians. Computed tomography scan images were used as the “gold standard” against which plain radiographs and grayscale inversion image interpretation were measured. Intra- and interobserver reliability and correct identification of fracture fragments and comminution zones were evaluated. Results: The interobserver reliability for 3 of the fracture fragments and comminution zones on the traction plain radiographs was moderate, whereas it was substantial on traction grayscale inversion radiographs. The lateral comminution zones ( P = .001) and presence or absence of posterolateral fragments ( P < .001) were significantly better identified in grayscale inversion radiographs compared to standard radiographs. Conclusion: After traction was applied, we found grayscale inversion radiographs are superior to plain radiographs in the identification of posterolateral fragment and lateral zone of comminution in comminuted intraarticular pilon fractures. Level of Evidence: III, Retrospective Case Series.

scholarly journals Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
William L. Sheppard ◽  
Kevin M. McKay ◽  
Alexander Upfill-Brown ◽  
Gideon Blumstein ◽  
Howard Y. Park ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lumbar Spine ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Flexion Contracture ◽  
Lumbar Spine Surgery ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Targeted Analysis ◽  
Total Knee

Abstract Background Recent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA. Methods This retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. Results Patients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p < 0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p < 0.001). The same was noted with respect to increased morphological grade (p < 0.001), with a 5 degree decrease for patients’ most stenotic level (p < 0.001). Conclusion Severe LSS, which is readily demonstrated by a reduction in the AP diameter of the thecal sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of evidence: Level 4

Management of isoniazid-monoresistant tuberculosis (Hr-TB) in Queensland, Australia: a retrospective case series

2020 ◽  
Vol 173 ◽  
pp. 106163
Author(s):  
Malcolm Wilson ◽  
Bridget O'Connor ◽  
Nicholas Matigian ◽  
Geoffrey Eather
Keyword(s):  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series

scholarly journals Peripartum hysterectomy: a five year review at a tertiary care centre

2017 ◽  
Vol 6 (8) ◽  
pp. 3590
Author(s):  
Deepak A. V. ◽  
K. J. Jacob ◽  
Sumi P. Maria
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
College Hospital ◽  
Peripartum Hysterectomy ◽  
Medical College ◽  
Obstetric Haemorrhage ◽  
Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally. 

Non-vascularized fibular autograft for resistant humeral diaphyseal nonunion: Retrospective case series

2021 ◽  
pp. 102843
Author(s):  
Ahmed Fathy Sadek ◽  
Ezzat Hassan Fouly ◽  
Ahmad Fouad Abdelbaki Allam ◽  
Alaa Zenhom Mahmoud
Keyword(s):  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Fibular Autograft
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