scholarly journals Can We Extrapolate SINS Score to Evaluate Instability in Spinal Tuberculosis?

2021 ◽  
pp. 219256822110308
Author(s):  
Yogesh Kishorkant Pithwa ◽  
Vikrant Sinha Roy
Keyword(s):  
Prospective Observational Study ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Neurological Status ◽  
Structural Instability ◽  
Stable Group ◽  
Surgical Decision ◽  
Helpful Tool ◽  
Surgical Decision Making

Study Design: Prospective Observational Study. Objectives: To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis. Methods: Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with “indeterminate stability” were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc. Results: Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in “indeterminate group” were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [ P < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [ P < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [ P < .0001 for both groups]. Conclusions: SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.

scholarly journals Spinal Tuberculosis with Paraplegia in Pregnancy: a Case Report with Management of Spinal TB in Pregnancy

2015 ◽  
Vol 53 (198) ◽  
pp. 123-125
Author(s):  
Sushruti Kaushal ◽  
Santosh Kumar Dora ◽  
Sunil Thakur
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Neurological Status ◽  
Term Infant ◽  
Therapeutic Challenge ◽  
Healthy Term Infant ◽  
Mother And Child ◽  
In Pregnancy

Spinal tuberculosis leading to paraplegia is uncommon in pregnancy and is a diagnostic and therapeutic challenge. We report a case of tubercular paraplegia presenting at 35 weeks of gestation. She was managed with Anti-tubercular drugs and did not require surgical intervention. Her neurological status improved and she was allowed to go in labour. She delivered a healthy term infant by cesarean. At three months follow-up, both mother and child are doing well.  Keywords: paraplegia; pregnancy; spinal tuberculosis.

scholarly journals Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhenchao Xu ◽  
Zhicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Thoracic Spinal ◽  
Cobb’S Angle ◽  
Perioperative Complication ◽  
The Mean ◽  
Early Surgical Intervention ◽  
Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

scholarly journals Early Surgical Intervention for Active Thoracic Spinal Tuberculosis with Paraplegia

2020 ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhenchao Xu ◽  
Zhicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Complication Rate ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Thoracic Spinal ◽  
Cobb’S Angle ◽  
Perioperative Complication ◽  
Early Surgical Intervention ◽  
Thoracic Spinal Tuberculosis

Abstract Background: To explore the therapeutic effect of early surgical interventions for patients of active thoracic spinal tuberculosis (TB) with paraplegia. Methods: Data of 118 patients with active thoracic spinal TB and paraplegia who had undergone surgeries at an early stage (within three weeks of paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade of neurological status, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects. Results: Mean operation time was 194.2 minutes, mean blood loss was 871.2 ml. The perioperative complication rate was 5.1%. Mean preoperative VAS score was 5.3, significantly decreased to 3.2 after operation, and continued decreasing to 1.1 at the follow up (P＜0.05). All cases achieved at least one grade elevation after operation, specifically, 2 cases of ASIA grade A rose to grade B, 10 cases of ASIA grade A rose to grade C, 2 cases of ASIA grade A rose to grade E; 9 cases of ASIA grade B rose to grade D, 38 cases of ASIA grade B rose to grade E; all 57 cases of ASIA grade C rose to ASIA grade E. The rate of full neurological recovery for complete paraplegia patients was 14.3%, significantly lower than the rate (91.3%) for incomplete paraplegia patients. Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, insignificantly increased after operation (P＞0.05), then gradually decreased to 11.5 ± 1.8 mm /h and 2.6 ± 0.82 mg/L at the final follow up, respectively (P＜0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, significantly decreased to 6.5º after operation (P＜0.05) and the kyphotic correction had not lost during the follow up (P＞0.05). Mean duration of bone graft fusion was 8.6±1.3 months Conclusion: Early surgical intervention may be beneficial for patients with active thoracic spinal TB with and paraplegia, with surgical intervention being more beneficial for incomplete paraplegic recovery compared with that of complete paraplegia.

scholarly journals The surgical outcome of decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis

2018 ◽  
Vol 29 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Kenji Masuda ◽  
Takayuki Higashi ◽  
Katsutaka Yamada ◽  
Tatsuhiro Sekiya ◽  
Tomoyuki Saito
Keyword(s):  
Decision Making ◽  
Cobb Angle ◽  
Japanese Orthopaedic Association ◽  
Spinal Instability ◽  
Degenerative Lumbar Scoliosis ◽  
Surgical Decision ◽  
Lumbar Scoliosis ◽  
Radiological Parameters ◽  
Surgical Decision Making

OBJECTIVEThe aim of this study was to assess the usefulness of radiological parameters for surgical decision-making in patients with degenerative lumbar scoliosis (DLS) by comparing the clinical and radiological results after decompression or decompression and fusion surgery.METHODSThe authors prospectively planned surgical treatment for 298 patients with degenerative lumbar disease between September 2005 and March 2013. The surgical method used at their institution to address intervertebral instability is precisely defined based on radiological parameters. Among 64 patients with a Cobb angle ranging from 10° to 25°, 57 patients who underwent follow-up for more than 2 years postoperatively were evaluated. These patients were divided into 2 groups: those in the decompression group underwent decompression alone (n = 25), and those in the fusion group underwent decompression and short segmental fusion (n = 32). Surgical outcomes were reviewed, including preoperative and postoperative Cobb angles, lumbar lordosis based on radiological parameters, and Japanese Orthopaedic Association (JOA) scores.RESULTSThe JOA scores of the decompression group and fusion group improved from 5.9 ± 1.6 to 10.0 ± 2.8 and from 7.2 ± 2.0 to 11.3 ± 2.8, respectively, which was not significantly different between the groups. At the final follow-up, the postoperative Cobb angle in the decompression group changed from 14° ± 2.9° to 14.3° ± 6.4° and remained stable, while the Cobb angle in the fusion group decreased from 14.8° ± 4.0° to 10.0° ± 8.5° after surgery.CONCLUSIONSThe patients in both groups demonstrated improved JOA scores and preserved Cobb angles after surgery. The improvement in JOA scores and preservation of Cobb angles in both groups show that the evaluation of spinal instability using radiological parameters is appropriate for surgical decision-making.

scholarly journals Role of sciatic nerve stiffness in surgical decision making and follow up in patients with deep gluteal syndrome

2018 ◽  
Author(s):  
Sava Stajic ◽  
Aleksandar Vojvodic ◽  
Luis Perez Carro ◽  
Jelena Mihailovic ◽  
Milos Gasic ◽  
...  
Keyword(s):  
Decision Making ◽  
Sciatic Nerve ◽  
Knee Flexion ◽  
Acoustic Radiation Force Impulse ◽  
Stiffness Ratio ◽  
Surgical Decision ◽  
Strain Elastography ◽  
Deep Gluteal Syndrome ◽  
Surgical Decision Making

AbstractThe study shows the relevance of sciatic nerve stiffness assessed by strain elastography using ARFI (Acoustic Radiation Force Impulse) for surgical decision making and the follow up of patients with deep gluteal syndrome (DGS). The research focuses on nerve stiffness associated with knee movements in order to determine the degree of nerve entrapment. Neurological examination, MRI of pelvis and electromyography (EMG) were performed as well. The sciatic nerve was scanned by ARFI (strain) elastography during knee movements in patients with DGS (143). In 54 patients surgical treatment was indicated, while 24 of them underwent surgery. The results were based on tissue response to ARFI by color elastogram and stiffness ratio. Diameters of the sciatic nerve in patients with DGS during knee flexion were statistically significantly lower than during extension movement (p<0.01). In patients with DGS (in ones without indication and the ones scheduled for surgery) sciatic nerve stiffness ratio was significantly increased (p<0.01) during knee flexion. Patients scheduled for surgery confirmed increased sciatic nerve stiffness during knee movements, compared with those without indications for surgery (p<0.05). Sciatic nerve recovery after surgery by diameter and stiffness ratio was marked (r=0.881). The correlation between MRI and EMG findings and ARFI nerve stiffness values in patients scheduled for surgery was high (r=0.963). The overall specificity of method was 93.5%, sensitivity was 88.9% with accuracy of 90.6%. ARFI elastography (by strain) is a diagnostic procedure based on nerve stiffness assessment and a useful tool in decision making for surgery and the follow up.

scholarly journals Outcomes of Meniscal Repair versus Meniscectomy in Patients with Concomitant ACL and Bucket Handle Meniscus Tears (200)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Laura Keeling ◽  
Alexandra Galel ◽  
Cooper Ehlers ◽  
David Wang ◽  
Edward Chang
Keyword(s):  
Meniscal Repair ◽  
Meniscus Tear ◽  
Patient Specific ◽  
Surgical Decision ◽  
Meniscus Tears ◽  
Patient Reported ◽  
Specific Factors ◽  
Surgical Decision Making ◽  
Bucket Handle

Objectives: Bucket handle meniscus tears often present concurrently with tears of the anterior cruciate ligament (ACL). However, little is known regarding the influence of demographic factors on surgical decision-making, or on outcomes following treatment of bucket handle meniscus tears in ACL-deficient patients. Furthermore, no study has compared outcomes in this population between patients undergoing meniscectomy versus repair. The purpose of this study was therefore to determine if there is a difference in outcomes between patients presenting with concomitant ACL and bucket handle meniscus tears treated with meniscal repair versus meniscectomy. A secondary aim of this study was to discover if there is an association between the decision to perform a meniscus repair or meniscectomy based on demographic factors. Methods: In this institutional review board-approved retrospective study, we evaluated 62 patients presenting with ACL tear who were found to have a bucket handle meniscus tear preoperatively or at the time of ACL reconstruction. Of those, 30 patients underwent partial meniscectomy, while 32 underwent meniscal repair. Primary outcome measures included ACL and meniscal retear rates, as well as patient-reported outcome measures (PROMs). Documented PROMs included the International Knee Documentation Committee (IKDC), Single Assessment Numeric Evaluation (SANE), and ACL-Return to Sport after Injury (ACL-RSI) scores. Demographic and patient-specific factors evaluated included age, body mass index (BMI), smoking status, and location of meniscus tear. Results: Of 62 patients presenting for ACL reconstruction with concomitant bucket handle meniscus tear, a total of 34 patients with greater than one year (mean 22.4 month) follow-up were included. 14 patients underwent repair, and 20 underwent meniscectomy. No significant differences were noted in IKDC (p = 0.36), delta IKDC (p = 0.18), SANE (p = 0.61), or ACL-RSI (p = 0.67) scores between the repair and meniscectomy groups at final follow-up. No significant differences were found in ACL (p = 1.00) or meniscus (p = 0.49) retear rates between the two groups. Younger age, lower BMI, and tear location (red-red zone) were significantly associated with the decision to perform meniscal repair over meniscectomy (p < 0.05). Conclusions: Among patients presenting with concomitant ACL and bucket handle meniscus tears, we found no difference in patient-reported outcomes or retear rates in patients undergoing meniscal repair versus meniscectomy. Demographic and patient-specific factors including age, BMI, and tear location may influence surgical decision-making when determining the optimal treatment of bucket handle meniscus tears in this population.

scholarly journals Early Surgical Intervention for Active Thoracic Spinal Tuberculosis with Paraparesis and Paraplegia

2020 ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhenchao Xu ◽  
Zhicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Complication Rate ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Thoracic Spinal ◽  
Cobb’S Angle ◽  
Perioperative Complication ◽  
Early Surgical Intervention ◽  
Thoracic Spinal Tuberculosis

Abstract Background: To explore the therapeutic effect of early surgical interventions for patients of active thoracic spinal tuberculosis (TB) with paraparesis and paraplegia.Methods: Data of 118 patients with active thoracic spinal TB and paraparesis and paraplegia who had undergone surgeries at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade of neurological status, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects.Results: Mean operation time was 194.2 minutes, mean blood loss was 871.2 ml. The perioperative complication rate was 5.1%. Mean preoperative VAS score was 5.3, significantly decreased to 3.2 after operation, and continued decreasing to 1.1 at the follow up (P＜0.05). All cases achieved at least one grade elevation after operation, specifically, 2 cases of ASIA grade A rose to grade B, 10 cases of ASIA grade A rose to grade C, 2 cases of ASIA grade A rose to grade E; 9 cases of ASIA grade B rose to grade D, 38 cases of ASIA grade B rose to grade E; all 57 cases of ASIA grade C rose to ASIA grade E. The rate of full neurological recovery for patients with paraplegia was 14.3%, significantly lower than the rate (91.3%) for patients with paraparesis. Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, insignificantly increased after operation (P＞0.05), then gradually decreased to 11.5 ± 1.8 mm /h and 2.6 ± 0.82 mg/L at the final follow up, respectively (P＜0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, significantly decreased to 6.5º after operation (P＜0.05) and the kyphotic correction had not lost during the follow up (P＞0.05). Mean duration of bone graft fusion was 8.6±1.3 monthsConclusion: Early surgical intervention may be beneficial for patients with active thoracic spinal TB and paraparesis or paraplegia, with surgical intervention being more beneficial for paraparesis recovery compared with paraplegia recovery.

scholarly journals Surgical treatment of tuberculosis of spine: Nepalese experience

2019 ◽  
Vol 1 (1) ◽  
pp. 8-20
Author(s):  
Binod Bijukachhe ◽  
Chester E. Sutterlin
Keyword(s):  
Surgical Treatment ◽  
Posterior Instrumentation ◽  
Spinal Tuberculosis ◽  
Disease Process ◽  
Neurological Status ◽  
Abscess Drainage ◽  
Ct Guided ◽  
Radiological Criteria ◽  
Early Return

Introduction : Spinal tuberculosis treatment goal is eradication of the disease, neurological protection, and deformity prevention. Accepted indications for conservative or surgical management of the disease are still lacking. The purpose of this study was to classify disease based on pre- and post-treatment clinical and radiological criteria to help management. Material and methods : Out of 101 patients, retrospectively reviewed between 2007 and 2015, seventy adult patients (44 males, mean age 29 years, range 16-76) were included in the study. Patients were evaluated clinically for pain, deformity and neurological status while radiological evaluation included sagittal deformity, vertebra destruction and number of vertebrae involvement. 60 patients underwent surgery (abscess drainage, 2; anterior radical debridement and fusion, 12; anterior debridement + posterior instrumentation, 26; posterior instrumentation, 20) All patients were given anti-tuberculous treatment for 12 months. Mean follow up period was 44.9 months (range: 6-108 months). Result: Pre-treatment pain (Visual analogue score, VAS 0-10, mean 7.52) improved by 0.99 at last follow up. Number of vertebrae involved ranged from 1 to 15 (mean 4.2). 38 patients had obvious clinical deformity with Cobb angle mean 36.6° (range 10°-130°). Deformity was corrected at mean of 17.5° (range: -60° to 90°) at last follow up. There were two ASIA A, eight ASIA B, five ASIA C, four ASIA D and 51 patients with ASIA E neurology at the time of presentation. One patient with ASIA A neurology remained same even after decompression while other patient died on the day of surgery. Out of 8 patients with ASIA B neurology six patients improved to ASIA E, one patient remained same and one patient deteriorated to ASIA A. In ASIA C group, three patients improved to ASIA E. One patient deteriorated to ASIA A. All four patients with ASIA D neurological status improved to ASIA E. And all 51 patients with pre-operative ASIA E status remained same but one deteriorated to ASIA C. Eight patients had deformity progression, two patients had deep vein thrombosis, two patients had superficial wound infection and one patients had recurrent cold abscess. Two patients died due to associated co-morbidities. Based upon the clinical and radiological pre- and post-operative findings; Uncomplicated spines were managed conservatively or with abscess drainage (USG or CT – guided). Complicated spines were managed with posterior instrumentation and complex spines were managed with anterior / posterior procedure (posterior only approach) Conclusion: Based upon the outcome of treatment of spinal tuberculosis, conservative treatment results in healing of the disease process with residual deformity while surgical treatment in selected cases results in early pain alleviation, spinal balance, neurologic protection and eventually early return to work.

scholarly journals Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach?

2009 ◽  
Vol 110 (6) ◽  
pp. 1179-1185 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Jesus Rubio ◽  
Gregory D. Cascino ◽  
Gregory A. Worrell ◽  
Fredric B. Meyer
Keyword(s):  
Temporal Lobe ◽  
Surgical Approach ◽  
Brain Regions ◽  
Surgical Removal ◽  
Seizure Outcome ◽  
Surgical Decision ◽  
Cavernous Hemangiomas ◽  
Study Support ◽  
Surgical Decision Making

Object Cavernous hemangiomas associated with epilepsy present an interesting surgical dilemma in terms of whether one should perform a pure lesionectomy or tailored resection, especially in the temporal lobe given the potential for cognitive damage. This decision is often guided by electrocorticography (ECoG), despite the lack of data regarding its value in cavernoma surgery. The purpose of the present study was several-fold: first, to determine the epilepsy outcome following resection of cavernomas in all brain regions; second, to evaluate the usefulness of ECoG in guiding surgical decision making; and third, to determine the optimum surgical approach for temporal lobe cavernomas. Methods The authors identified from their surgical database 173 patients who had undergone resection of cavernomas. One hundred two of these patients presented with epilepsy, and 61 harbored temporal lobe cavernomas. Preoperatively, all patients were initially evaluated by an epileptologist. The mean follow-up was 37 months. Results Regardless of the cavernoma location, surgery resulted in an excellent seizure control rate: Engel Class I outcome in 88% of patients at 2 years postoperatively. Of 61 patients with temporal lobe cavernomas, the mesial structures were involved in 35. Among the patients with temporal lobe cavernomas, those who underwent ECoG typically had a more extensive parenchymal resection rather than a lesionectomy (p < 0.0001). The use of ECoG in cases of temporal lobe cavernomas resulted in a superior seizure-free outcome: 79% (29 patients) versus 91% (23 patients) of patients at 6 months postresection, 77% (22 patients) versus 90% (20 patients) at 1 year, and 79% (14 patients) versus 83% (18 patients) at 2 years without ECoG versus with ECoG, respectively. Conclusions The surgical removal of cavernomas most often leads to an excellent epilepsy outcome. In cases of temporal lobe cavernomas, the more extensive the ECoG-guided resection, the better the seizure outcome. In addition to upholding the concept of kindling, the data in this study support the use of ECoG in temporal lobe cavernoma surgery in patients presenting with epilepsy.

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