Instrumentation in Potts Spine: A Two Year Retrospective Study in CCM Medical College and Hospital Durg

Most of the patient suffering from tuberculosis can be managed on anti-tuberculous therapy. Spinal TB patients can present with various signs and symptoms which include leg or back pain, palpable mass in the paraspinal region, kyphotic deformity and neurological compromise, out of these most important sequelae of TB spine are kyphotic deformity and neurological compromise. The spinal cord undergoes intrinsic changes due to tuberculosis and late-onset paraplegia is produced, with consequent poor chances of neural recovery even after surgery. When treatment is started the diseased segment of the spine or vertebral body is the weakest portion and it must be protected by suitable external braces. Fracture and dislocation of a diseased vertebral body may occur secondary to mechanical trauma and surgical decompression adds further instability. So indications for instrumented stabilisation can be advised. Surgical management or instrumentation in Pott’s spine helps regain motor function and ameliorates disability. Material and Methods: 38 patients were included with Thoracic and Thoracolumbar Pott's disease. Included patients were having severe kyphosis with an active disease. Clinical evaluation of the outcome measures were evaluated at baseline, postoperatively and at 3rd, 6th and 1 year. Preoperative and postoperative X-ray, loss of kyphotic correction. Average operation time, bony fusion and implant failure were observed. Results: During study period total 1456 patients were diagnosed as TB out of which 99 were extra pulmonary cases and 58 were diagnosed as pott’s spine with thoracic and thoracolumbar TB and 38 patients were included in the study who meet the inclusion criteria for our study. In our study of the 38 patients 18 were male and 20 were female patients. Mean age was 43.82. In Dorsal group D1 to D4, D5 to D8 and D9 to D12 involvement was seen in 4(10.53%), 10 (26.32%) and 13 (34.21%) respectively. Multi-segment involvement was observed in 3 (7.89%) patients. Dorsolumbar and lumbar involvement was seen in 5 patients. In lumber, L1 to L2, L2 to L3, L3 to L4 and L4 to L5 involvement was 1(2.63%), 0, 1(2.63%) and 2 (5.26%) respectively. Mean operation time was 290±41minutes and mean hospital stay was 16 days ranging from 8 days to 72 days. 34 patients had a successful bony fusion within a mean of 7±1.2 months, whereas 4 patients had late fusion or nonfusion because of secondary infections. Mean preoperative kyphosis was 21 degrees which was corrected to 9 degrees in final follow up after instrumentation. Conclusion: Instrumented stabilisation is safe in spinal TB. Posterior transpedicular approach is a safe surgical procedure for thoracic and thoracolumbar Pott's spine. Also Posterior transpedicular approach shows improved functional status and significantly improves neurological pain and fusion rate. However clinical trials with a larger sample size and a longer follow-up period are required.

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Functional and Radiological Outcomes of Anterior Decompression and Posterior Stabilization via Posterior Transpedicular Approach in Thoracic and Thoracolumbar Pott's Disease: A Retrospective Study

Asian Spine Journal ◽

10.4184/asj.2017.11.4.618 ◽

2017 ◽

Vol 11 (4) ◽

pp. 618-626

Author(s):

Suryakant Singh ◽

Hitesh Dawar ◽

Kalidutta Das ◽

Bibhudendu Mohapatra ◽

Somya Prasad

Keyword(s):

Retrospective Study ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

Operation Time ◽

Anterior Decompression ◽

Posterior Stabilization ◽

Bony Fusion ◽

Transpedicular Approach ◽

The Mean

<sec><title>Study Design</title>This is a retrospective study.</sec><sec><title>Purpose</title>To determine the efficacy and safety of a posterior transpedicular approach with regard to functional and radiological outcomes in people with thoracic and thoracolumbar spinal tuberculosis.</sec><sec><title>Overview of Literature</title>Spinal tuberculosis can cause serious morbidity, including permanent neurological deficits and severe deformities. Medical treatment or a combination of medical and surgical strategies can control the disease in most patients, thereby decreasing morbidity incidence. A debate always existed regarding whether to achieve both decompression and stabilization via a combined anterior and posterior approach or a single posterior approach exists.</sec><sec><title>Methods</title>The study was conducted at the Indian Spinal injuries Centre and included all patients with thoracic and thoracolumbar Pott's disease who were operated via a Posterior transpedicular approach. Data regarding 60 patients were analyzed with respect to the average operation time, preoperative and postoperative, 6 months and final follow-up American Spinal Injury Association (ASIA) grading, bony fusion, implant loosening, implant failure, preoperative, postoperative, 6 months and final follow-up kyphotic angles, a loss of kyphotic correction, Oswestry disability index (ODI) score, and visual analog scale (VAS) score. Data were analyzed using either a paired t -test or a Wilcoxon Signed Rank test.</sec><sec><title>Results</title>The mean operation time was 260±30 minutes. Fifty-five patients presented with evidence of successful bony fusion within a mean period of 6±1.5 months. Preoperative dorsal and lumbar angles were significantly larger than postoperative angles, which were smaller than final follow-up angles. The mean kyphotic correction achieved was 12.11±14.8, with a mean decrease of 5.97 and 19.1 in VAS and ODI scores, respectively.</sec><sec><title>Conclusions</title>Anterior decompression and posterior stabilization via a posterior transpedicular approach are safe and effective procedures, with less intraoperative surgical duration and significant improvements in clinical and functional status.</sec>

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An analysis of the causes of transient paraplegia during percutaneous vertebral augmentation under local anesthesia: A case series of 12 patients

Journal of Orthopaedic Surgery ◽

10.1177/2309499019861879 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901986187

Author(s):

Guan Shi ◽

Fei Feng ◽

Chen Hao ◽

Jia Pu ◽

Bao Li ◽

...

Keyword(s):

Spinal Cord ◽

Local Anesthesia ◽

Vertebral Body ◽

Case Series ◽

Operation Time ◽

Complete Recovery ◽

Vertebral Compression Fractures ◽

Vertebral Augmentation ◽

Anesthetic Drugs

Background: Percutaneous vertebral augmentation (PVA) under local anesthesia has been widely used to treat osteoporotic vertebral compression fractures and vertebral body tumors. However, the occurrence of spinal cord or nerve root dysfunction may result in poor prognosis for patients. The aim of this study was to analyze the causes of transient paraplegia in 12 patients undergoing PVA. Methods: The medical records of 12 patients with transient paraplegia during PVA in our hospital were analyzed. Data, including operation, vertebral, anesthetic dose, operation time, recovery time, and follow-up, were extracted. Results: Among the 12 patients, ranging in age from 62 years to 83 years, with a mean age of 74 years, 8 were females and 4 were males. The average anesthetic dose injected per vertebral body was 6.38 ml. Patients required an average of 218.75 min to recover sensation and movement completely. However, the amount of anesthetic injected into each vertebral body was not related to the time required for complete recovery. Follow-up showed that all patients had regained normal bilateral sensation and motor function. Postoperative visual analog scale and Oswestry Disability Index values of the 12 patients were significantly improved compared with preoperative values. Conclusion: The complication of transient paraplegia was caused by local anesthetic drugs infiltrating into the spinal canal and inhibiting nerve conduction in the spinal cord.

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Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04585-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Siegmund Lang ◽

Carsten Neumann ◽

Christina Schwaiger ◽

Andreas Voss ◽

Volker Alt ◽

...

Keyword(s):

Vertebral Body ◽

Spinal Fractures ◽

Patient Reported Outcome ◽

Bony Fusion ◽

Sf 36 ◽

Patient Reported ◽

The Mean ◽

Lumbar Spinal

Abstract Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° (p < 0.01). A loss of correction of 1.0 ± 2.8° at the first follow-up (t1) and of 2.4 ± 4.0° at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 ± 12.4 years) completed the PROM questionnaires after 106.4 ± 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 ± 18.3%, the mean EQ-5D VAS reached 60.7 ± 4.1 points. Stratified SF-36 results (ISS < and ≥ 16) were lower compared to a reference population. Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

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Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_294_18 ◽

2019 ◽

Vol 10 (02) ◽

pp. 225-233

Author(s):

Mantu Jain ◽

Rabi Narayan Sahu ◽

Sudarsan Behera ◽

Rajesh Rana ◽

Sujit Kumar Tripathy ◽

...

Keyword(s):

Visual Analog Scale ◽

Vertebral Body ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

X Rays ◽

Analog Scale ◽

Bony Fusion ◽

Universal Approach ◽

The Mean

ABSTRACT Background: Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach. Settings and Design: A retrospective case study series in a tertiary level hospital. Aims: The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a “universal approach” in tubercular spondylodiscitis of variable presentation. Materials and Methods: The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period. Statistical Analysis Used: The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired t-test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis. Results: The mean number of vertebrae involved was 3.29 ± 0.86 (2–6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause. Conclusions: The procedure in safe and has satisfactory results in variable group affection of Pott’s spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.

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A novel bone cement screw system combined with vertebroplasty for the treatment of Kummell disease with bone deficiency at vertebral anterior border: minimum 3-year follow-up study

10.21203/rs.3.rs-18781/v1 ◽

2020 ◽

Author(s):

Biao Wang ◽

Xinliang Zhang ◽

Lingbo Kong ◽

Li Yuan ◽

Simin He ◽

...

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Operation Time ◽

Anterior Border ◽

Body Angle ◽

Follow Up Study ◽

Bone Deficiency ◽

Sf 36 ◽

Significant Difference

Abstract Background: When vertebroplasty is used to treat Kummell disease with bone deficiency at vertebral anterior border, bone cement displacement often occurs intraoperative or postoperative. We designed and used a new bone cement screw system to avoid the serious complication. The purpose of this study is to evaluate the safety and effectiveness of this novel operation method through more than 3 years of follow-up. Methods: From January 2012 to August 2016, 27 patients suffering from single-segment Kummell disease with bone deficiency at vertebral anterior border were treated by vertebroplasty combined with novel bone cement screw. Bone cement is released into the diseased vertebrae through screw to fully fill the intravertebral vacuum cleft. Screw fixation of bone cement can avoid intraoperative or postoperative displacement. All patients were operated by unilateral technique, only one screw was implanted for each patient. The clinical efficacy was evaluated using Odom’s criteria and statistical analysis based on the results of vertebral body index (VBI), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analogue scale (VAS), oswestry disability index (ODI), and the MOS 36-item short from health survey (SF-36). Results: The operation was completed successfully in 27 cases. The average operation time was 49.63±10.82 min, and the average volume of cement injected was 4.70±0.87 ml. The patients’ preoperative VBI, VBA, BCA, VAS and ODI scores were 43.11±5.94, 21.04±2.55, 45.00±6.26, 7.59±0.84, and 79.85±7.58, respectively. The postoperative measurements were 78.70±2.55, 12.70±2.11, 26.11±4.73, 3.22±0.93 and 50.04±9.28. At the last follow-up, the measurements were 78.04±2.30, 13.15±2.38, 27.07±4.87, 2.04±0.65, and 22.85±5.06, respectively. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). Compared the results of SF-36 preoperative and at the last follow-up, there were significant differences in physical function, role-physical, body pain, vitality, and social function these 5 items (P<0.05). However, there were no significant differences in general health, emotional function and mental health. Finally, 26 patients (96.3%) had good to excellent clinical outcomes according to Odom's criteria. Conclusions: This 3-year follow-up study shows that the novel bone cement screw system combined with vertebroplasty has a good short and medium-term therapeutic effect on patients with Kummell disease and bone deficiency at vertebral anterior border, while its long-term efficacy is subject to further studies.

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Kyphoplasty With a New Device: A Comparison Study

10.21203/rs.3.rs-489228/v1 ◽

2021 ◽

Author(s):

Jian Huang ◽

Ming Chen ◽

Zongbo Zhou ◽

Zhifu Lu ◽

Chuangong Fu ◽

...

Keyword(s):

Vertebral Body ◽

Wedge Angle ◽

Operation Time ◽

Control Group ◽

New Device ◽

The Third ◽

Significant Difference ◽

Experimental Group ◽

Operation Cost

Abstract Study design: Retrospective cohort study.Objective: To explore the effect of a new device for kyphoplasty.Methods: 80 patients with kyphoplasty from January 2019 to December 2020 were selected and divided into experimental group (n = 40) and control group (n = 40) according to different surgical methods. The experimental group was treated with new puncture needle puncture technology, while the control group was treated with traditional puncture needle puncture technology. The operation time and intraoperative blood loss were recorded. The pain improvement was evaluated by VAS score. The operation effect was evaluated by anterior height of injured vertebral body, middle height of injured vertebral body and wedge angle of injured vertebral body. The number of fluoroscopy and the cost of operation were also evaluated.Results: Compared with the control group, the operation time and intraoperative blood loss of the experimental group were significantly less than those of the control group, and the differences were statistically significant. There was no significant difference in the ratio of anterior height of injured vertebral body between the two groups on the third day and the last follow-up. There was no significant difference in the ratio of middle height of in injured vertebral body between the two groups on the third day and the last follow-up. There was no significant difference in wedge angle of injured vertebral body between the two groups at the third day and the last follow-up. There was significant difference in the number of fluoroscopy between the two groups. There was no significant difference in the operation cost between the two groups.Conclusion: The new surgical method can shorten the operation time and reduce the radiation exposure rate of surgeons, but it has no effect on the operation effect and operation cost.

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Percutaneous Kyphoplasty in Treating Osteoporotic Vertebral Compression Fracture With Kyphotic Deformity: A Compared Study

10.21203/rs.3.rs-62386/v1 ◽

2020 ◽

Author(s):

Wenye Yao ◽

Runsheng Guo ◽

Qi Lai ◽

Bin Zhang

Keyword(s):

Vertebral Compression Fracture ◽

Compression Fracture ◽

Operation Time ◽

Osteoporotic Vertebral Compression Fracture ◽

Kyphotic Deformity ◽

Percutaneous Kyphoplasty ◽

Bilateral Group ◽

Significant Difference ◽

Unilateral Group

Abstract Objective: To evaluate the efficacy and safety of percutaneous kyphoplasty (PKP) for thoracolumbar osteoporotic vertebral compression fracture (OVCF) with kyphosis via unilateral versus bilateral approach.Methods: All patients suffered OVCF with kyphosis were retrospectively reviewed. Of those, performed unilateral PKP or underwent bilateral PKP with random. The clinical and radiological data such as the correction of deformity, sagittal profle and record of the perioperative morbidity of the patients were analyzed.Results: All patients (76±3.6 years) were enrolled in this investigation, including 47 in the unilateral and 39 in the bilateral group. No significant difference in general data was detected between the two groups (p >0.05). Howere, the operation time and cement amount 28.2±3.4 min, 3.8±0.6 ml in the unilateral group, while 50.1±4.6 min, 5.4±0.5 ml in the bilateral group, respectively (P <0.05).In addition,The preoperative visual analog scale(VAS) and Vertebral local kyphosis angle were 8.8±0.65 and 16.3 ± 6.5°compared to last follow-up 3.15±0.78 and 14.26± 2.16°in unilateral group, while 8.5±0.78 and 16.5 ± 7.1°compared to last follow-up 2.66±0.86 and 13.81±2.38°in bilateral group, respectively (P < 0.05). Furthermore, Oswestry Disablility Index (ODI) and prevertebral height ratio in both groups were significantly different before and after surgery, but no significant difference between the two groups (p >0.05).Conclusion: Both bilateral and unilateral PKP are relatively safe and provide effective treatment for patients with painful thoracolumbar osteoporotic vertebral compression fracture with mild kyphotic deformity. However, unilateral PKP need less operation time and volume of cement.

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Outcomes, Complications, and Technical Aspects of One-Level Vertebral Column Decancellation Osteotomy for Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience of 39 Patients with Minimum 2-Year Follow-Up

10.21203/rs.2.22709/v1 ◽

2020 ◽

Author(s):

Zhijun Xin ◽

Guoquan Zheng ◽

Xinwen Feng ◽

Peng Huang ◽

Xuesong Zhang ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Blood Loss ◽

Vertebral Column ◽

Perioperative Complications ◽

Operation Time ◽

Clinical Results ◽

Kyphotic Deformity ◽

Thoracolumbar Kyphosis ◽

Complete Paralysis

Abstract Objective To evaluate the safety and efficacy of one-level vertebral column decancellation (VCD) for the correction of thoracolumbar kyphosis in ankylosing spondylitis (AS) will beneficial for clarify the application of this procedure. Methods With a minimum 2-year follow-up, 39 AS patients with kyphotic deformity who underwent one-level VCD were retrospectively reviewed. The operation time, blood loss, and perioperative complications were investigated to evaluate the technical safety. Pre- and postoperative radiographic and clinical parameters were compared to evaluate the technical efficacy. Results All of the osteotomy sites were located between T12 and L3. With an average operation time of 257.8±49.9 minutes, the average blood loss was 596.1±218 ml. 4 patients (10.3%) experienced complications during the follow-up period, while no deaths or complete paralysis were occurred. With an average correction of 45.07±11.27° have obtained for one-level VCD, the radiographic parameters improved significantly from preoperative to postoperative, including global kyphosis (from 42.05±13.82° to 1.51±12.08°), local kyphosis (from 20.54±15.43° to -24.54±12.83°), lumbar lordosis (from -8.01±16.34° to -42.81±13.98°), and SVA (from 17.47±6.77 cm to 7.45±5.37). At final follow-up, the clinical results were significantly improved compared with the preoperative results, including VAS for back pain (from 6.82±0.91 to 0.15±0.37), CBVA (from 30.44±10.81° to 10.10±3.92°) and all items of SRS-22 questionnaire. Conclusion With an acceptable complication rate, one-level VCD is an effective technique which can provide an average correction of 45° for correcting kyphotic deformity caused by AS, and can achieve good results even for severe AS kyphosis with a necessary correction angular up to 60°.

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Spinal TB: Impact of Research Evidence on Clinical Practice

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0040-1712820 ◽

2018 ◽

Vol 54 (01) ◽

pp. 033-042 ◽

Cited By ~ 1

Author(s):

Anil K Jain

Keyword(s):

Clinical Practice ◽

Vertebral Body ◽

Spinal Deformity ◽

Late Onset ◽

Spinal Tuberculosis ◽

Deformity Correction ◽

Kyphotic Deformity ◽

Fatty Replacement ◽

Anterior Corpectomy ◽

Research Questions

ABSTRACTThe evidence generated while treating the patients is the key for growth of science. Finding answers to series of research questions spread over many years may change the clinical practice. This presentation is based on 25 research questions, 44 publications while treating 3300 patients over last 28 years ( 1990-2017) which has substantially changed the objective of treatment in spinal tuberculosis (TB) from healing of lesion with sequelae of spinal deformity and paraplegia to achieving healed status with near normal spine.Three cases of late-onset paraplegia were evaluated (1990) by newly introduced MRI. The syringohydromyelia and severe cord atrophy were attributed as the cause of paraplegia. We conducted a series of prospective studies to define and correlate MRI observations on spinal cord in paraplegia and followed the treatment outcomes. The cord edema, myelomalacia, cord atrophy and syringomyelia were observed in cases with neural complications. The patients with cord edema and liquid compression are predictor for neural recovery, while dry lesions and myelomalacia for poor neural recovery. The mild cord atrophy was consistent with neural recovery while severe cord atrophy with sequalae of neural deficit. Upto 76% canal encroachment was found compatible with intact neural state. Spinal deformity in TB spine is better prevented than treated. The contagious vertebral body disease with intact disc spaces, subperiosteal and paravertebral, septate abscesses, intra-osseous and intraspinal abscesses are considered features of spinal TB and resolution of abscess and fatty replacement is characteristic of healing. The clinicoradiological predictors for diagnosing spinal TB in predestructive disease were defined. Only 35% patients achieved healed status on MRI by DOTS regimen at 8 months, Hence, it is unscientific to stop antitubercular treatment (ATT) at fixed time schedule. The criteria to suspect multi-drug resistant (MDR)-TB and guide to treatment were definedResidual Kyphotic deformity in spine TB produces severe proximal/distal degeneration of spine and/or late-onset paraplegia. We correlated the final kyphosis with initial vertebral body (VB) loss, where 1.5 VB height loss will produce 600 spinal deformity or more, hence surgical correction of spinal deformity is indicated. The surgical steps of kyphotic deformity correction are: anterior corpectomy, posterior column shortening, instrumented stabilization, anterior gap grafting and posterior fusion in a single stage and sequentially. The surgical incision of costo-transversectomy was modified so that kyphosis correction and posterior Hartshill instrumentation can be performed simultaneously. The retroperitoneal extrapleural approach for dorsolumbar spine was described. Meta-analysis of spinal instrumentation in TB spine established the lack of defined indication of instrumented stabilisation. Panvertebral/ long segment disease, kyphotic deformity correction are listed as indications of instrumented stabilisation in TB spine. The end point of treatment in spinal TB still eludes us to resolve the optimum duration of ATT regimen. The PET scan may be used to define it. We believe if a clinician works slow and steady on a series of research questions and by sustained focused efforts can change the clinical practice. We after this sustained research work could contribute in framing Bone and Joint TB guidelines and publish as monograph.

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Measuring the Ability of Primary-Care Physicians To Diagnose and Manage Patients with Hematologic Malignancies.

Blood ◽

10.1182/blood.v110.11.3312.3312 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3312-3312 ◽

Cited By ~ 2

Author(s):

Peter J. Rosen ◽

Richard C. Wender ◽

Haleh Kadkhoda ◽

Scott L. Kober

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Late Onset ◽

Signs And Symptoms ◽

Hematologic Malignancies ◽

Thyroid Function Tests ◽

Term Care ◽

Laboratory Test Results

Abstract In 2004, the Centers for Disease Control and Prevention awarded funding (Coop. Agreement No. U58/CCU324301-01) for the Hematologic Oncology Primary Intervention Networking Group (HOPING), a national educational initiative of the Institute for Continuing Healthcare Education (the Institute). HOPING was developed to increase survivorship of patients with hematologic malignancies beyond 5 years. Its intent was to educate PCPs on the signs and symptoms of hematologic malignances to encourage more appropriate and timely referrals to a specialist, as well as to identify and bridge gaps in knowledge regarding the long-term follow-up and care of survivors of hematologic malignancies. Methods: Educational strategies included live presentations at primary care conferences, distribution of resource materials at an educational booth, and a resource Web site (www.hopingdocs.org). As part of the HOPING initiative, immediate participant feedback was gathered during live programs through an audience response system as well as through registrant surveys distributed at the booth and on the Web. The questions within those two settings were intended to gauge the practitioner’s ability to properly recognize the signs and symptoms of hematologic malignancies and provide appropriate follow-up care for patients with hematologic malignancies. Results: Data were collected from a total of 357 individuals (277 from live activities, 80 from online/booth surveys). Approximately 64% of the live program survey respondents were physicians; the majority identified themselves as family practice/family medicine or internal medicine specialists. When asked how they would monitor a 54-year-old male patient free from Hodgkin’s lymphoma for five years, only 44% of respondents correctly indicated that they would conduct an annual physical exam, clinical lab tests, thyroid function tests, and a chest x-ray. Respondents also showed lack of knowledge regarding appropriate studies to order for a patient presenting with specific symptoms and laboratory test results consistent with leukemia. The online/booth surveys were completed by 80 respondents; specific demographic data were not collected. Only 22% of respondents said that they are confident educating patients (and/or their caregivers) about hematologic malignancies. Respondents’ experience with available blood tests for MGUS and MDS was particularly poor -- only 10% said that they "have ordered" such tests while 46% were "unaware" of available tests. The overall ability of respondents to detect possible signs and symptoms of hematologic malignancies (specifically, leukemia, lymphoma, and multiple myeloma) was also low. Conclusion: In the eyes of the primary care community, hematologic malignancies are low-volume, high-risk conditions, and the complexity of diagnosing and providing long-term care to patients with hematologic malignancies is a growing challenge. Post-treatment chronic conditions such as late-onset cardiomyopathy, hypertension, and secondary malignancies often develop after therapy for hematologic malignancies and must be properly managed. Gaps in knowledge regarding the signs, symptoms, and diagnosis of hematologic malignancies may negatively impact timely referral to specialists. Because of their increasingly vital role in the cancer care continuum, PCPs need additional education to improve the short- and long-term outcomes of patients with hematologic malignancies.

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