Tatalaksana Anestesi Posisi Telungkup pada Pasien Pediatrik yang Menjalani Prosedur Reseksi dan Rekonstruksi Human Tail

Human tail or additional tail is an unusual malformation and is divided into true tails and pseudotails (lipoma, teratoma, fetal parasitic mylomeningocele). Human tail is associated with spinal dysraphism. Myelomeningocele is spinal dysraphism in which the spinal cord and its contents herniate through a bone defect. congenital to the posterior element. The surgical management of MMC poses challenges, not only to the implementation of anesthesia but also to provide perioperative care depending on the pediatric age group, comorbid conditions, and associated systemic disorders. Anesthesia for the MMC in the lumbosacral region was performed in the prone position. Changing the patient's position to the prone position is a critical maneuver. Complications that occur due to the wrong prone position can cause morbidity and some cases cause mortality so that anesthesia with the prone position must be well understood to avoid the risks and complications that can occur. A 5 year old girl with myelomeninocele will undergo a resection and reconstruction procedure in a prone position. The hemodynamic status during the procedure which lasted 3 hours was quite stable with a hemorrhage of about 10cc. After surgery, patients were treated for 1 day in PICU and ward for 3 days.

The influence of spinal position on imaging findings: an observational study of thoracolumbar spine upright MRI in elite gymnasts

Purpose To investigate whether upright magnetic resonance imaging (MRI) has a role in defining thoracolumbar spine pathology in elite gymnastics. Methods A prospective cross-sectional observational study of National Senior and Junior Artistic gymnasts in three MRI positions (standard supine, upright flexed and extended positions). Two specialist musculoskeletal radiologists independently analysed images with neutral as a baseline with the effects of flexion and extension reported in line with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results Forty (18 males) gymnasts aged 13–24 years with a mean (SD) of 32 (5.3) training hours per week consented with 75% showing MRI abnormalities. Degenerative disc disease (DDD) was evident in 55% participants with vertebral end plate (VEP) changes in 42.5%. Spondylolysis was present in 40% with an additional 17% showing chronic bilateral complete L5 pars defects. 23% participants demonstrated different MRI findings in upright flexion compared to neutral. Conclusion Findings suggest a high levels of MRI abnormalities in elite gymnastics including altered disc morphology and posterior element abnormalities. High prevalence of T11/12 DDD and VEP changes reflects the thoracolumbar junction being a transition zone. Upright MRI and varying spine position offer promise for enhanced visualisation of posterior element abnormalities.

Who Needs Surgical Stabilization for Pyogenic Spondylodiscitis? Retrospective Analysis of Non-Surgically Treated Patients

Study Design: Retrospective case series analysis. Objective: To identify relevant clinical and radiographic markers for patients presenting with infectious spondylo-discitis associated with spinal instability directly related to the infectious process. Methods: We evaluated patients presenting with de-novo intervertebral discitis or vertebral osteomyelitis /discitis (VOD) who initiated non-surgical treatment. Patients who failed conservative treatment and required stabilization surgery within 90 days were defined as “ failed treatment group” (FTG). Patients who experienced an uneventful course served as controls and were labeled as “ nonsurgical group” (NSG). A wide array of baseline clinical and radiographic parameters was retrieved and compared between 2 groups. Results: Overall 35 patients had initiated non-surgical treatment for VOD. 25 patients had an uneventful course (NSG), while 10 patients failed conservative treatment (“FTG”) within 90 days. Factors found to be associated with poorer outcome were intra-venous drug abuse (IVDA) as well as the presence of fever upon initial presentation. Radiographically, involvement of the same-level facets and the extent of caudal and rostral VB involvement in both MRI and CT were found to be significantly associated with poorer clinical and radiographic outcome. Conclusions: We show that clinical factors such as IVDA status and fever as well as the extent of osseous and posterior element involvement may prove to be helpful in favoring surgical treatment early on in the management of spinal infections.

Front-Back Cervical Deformity Correction by Anterior Cervical Discectomy and Fusion With Posterior Instrumentation: 2-Dimensional Operative Video

Front-back procedures for cervical deformity permit the correction of cervical kyphosis in the setting of unfused facets. Here, we highlight the operative treatment of a 65-yr-old female entailing a 4-level anterior cervical discectomy and fusion (ACDF) at C3-C4, C4-C5, C5-C6, and C6-C7 with hyperlordotic interbody implants, supplemented by a posterior C2-T2 instrumented fusion. The patient initially presented with symptoms of treatment-refractory neck pain while neurologically intact on examination. Her imaging demonstrated significant cervical kyphosis measuring 46° as the Cobb angle between C2 and C7 without neural compression. The patient consented to the procedure and publication of their image. After 2 d of traction, the operation proceeded with the patient initially in a supine position with dissection medial to the sternocleidomastoid muscle down to the vertebral bodies. Discectomies were performed at each level followed by installation of the interbody implants. After closure of this access wound, the patient was turned to a prone position for the posterior element of the operation. The posterior bony elements were exposed and a C2-T2 instrumented fusion performed. Postoperative imaging demonstrated improvement of her sagittal cervical curvature and the patient described improvement in her neck pain.

Replantation of Spinous Process-lamina Complex in the Treatment of Cervical Spine Tumor : Two Cases Report and Literature Review

Purpose: The primary aim of our study was to prove that the replantation of spinous process-lamina complex is beneficial to restore the anatomical structure and function of the spine, and to find if it can reduce postoperative complications.Methods: We report two cases of cervical intraspinal tumor, whose postoperative pathological diagnosis, Respectively, are Neurilemmoma and meningioma. They all underwent the resection and replantation of spinous process-lamina complex, in which the resected spinous process-lamina complex was replanted at the end of the procedure, allowing a complete reconstruction of the posterior element of the spinal canal. Results：After the surgery, the symptoms were relieved, and no dysfunction of upper limbs and sphincter was observed. The tumors were benign pathologically and were diagnosed as Neurilemmoma and meningioma. The patient recovered and at 6-month follow-up had no complaints and in good health.Conclusion: After tumor resection, the replantation of spinous process-lamina complex is beneficial to restore the anatomical structure and function of the spine.

Evaluation of cervical spine injury and predicting neurological deficit by magnetic resonance imaging

Background: The consequences of cervical spine injuries range from simple neck pain, to quadriplegia, or even death. MR imaging has become part of the diagnostic and prognostic tools for spinal cord injury. Aim: To prospectively evaluate cervical spine injuries by MR imaging and to find out association of MR imaging findings with degree of neurological deficit. Material and Methods: Descriptive longitudinal hospital based study was conducted on 30 patients with known or suspected cervical spine trauma who presented to the emergency department. Results: Mean age of the cases was about 42 years, with female to male ratio of 1:6.5. C6-C7 spinal level was most commonly involved. Proportions complete spinal cord injury (CSCI), incomplete spinal cord injury (ISCI) and neurologically normal (NN) were 23.33%, 60% and 16.67% respectively. Out of 12 MRI findings, cord haemorrhage, contusion, posterior element fracture, disc injury, prevertebral hematoma, subluxation and soft tissue injury was statistically associated with degree of neurological deficit. Cord contusion, cord haemorrhage and posterior element fracture were potential predictors of neurological status at admission. Cord contusion, cord haemorrhage and subluxation were potential predictors at 3 months. Conclusion: MRI proved a pivotal role in the diagnosis of SCIs, deciding prompt management and predicting neurological deficit and prognosis of neurological recovery. So, MRI is an excellent diagnostic modality for the evaluation of spinal trauma and predicting the degree of neurological deficit and recovery.

Diagnostic accuracy of MRI for identifying posterior element bone stress injury in athletes with low back pain: a systematic review and narrative synthesis

ObjectiveTo investigate the diagnostic accuracy of MRI for identifying posterior element bone stress injury (PEBSI) in the athletic population with low back pain (LBP).Study DesignA systematic review searched for published sources up until July 2020. Eligibility criteria: prospective cohort design, MRI diagnosis, adolescents/young adults, chief symptoms of LBP, PEBSI as the clinical diagnosis and SPECT-CT as reference standard. Risk of bias and overall quality were assessed using QUADAS-2 and GRADE, respectively. A narrative synthesis was conducted.ResultsFour studies were included, with three included in the quantitative synthesis. Compared with SPECT-CT, two studies involving MRI demonstrated sensitivity and specificity of 80% and 100%, and 88% and 97%, respectively. Compared with CT, one study involving MRI demonstrated sensitivity and specificity of 97% and 91%, respectively. Risk of bias was moderate to high although consistency across studies was noted.ConclusionFindings support further research to consider MRI as the modality of choice for diagnosing PEBSI. MRI was consistent with SPECT-CT for ruling-in PEBSI, but the clinical value of cases where MRI had false negatives remains uncertain due to possible over-sensitivity by SPECT-CT.PROSPERO registration numberCRD42015023979.

Detailed observation of axis ring fractures using computed tomography: a retrospective analysis of 202 cases

Background: There is a dearth of research observing the precise anatomical location, pattern, and frequency of the fracture lines in axis ring fractures based on large size sample database and deducing the possible injury mechanism for such fractures. The study aimed to observe the anatomical features of axis ring fractures and evaluate the probable mechanism of injury.Methods: 202 patients with axis ring fractures were identified. According to the involvement of anatomical structures, the axis ring injuries were classified into facet joint injury and pure bony injury. The axis ring was also divided into: anterior, middle, and posterior elements. The anatomical structures involvement and fracture patterns of such fractures were observed using CT. Result: 501 anatomical structures of the axis ring were involved in 202 patients, including 288 facet joints injuries and 213 bony injuries. For facet joints injuries, the most common injuries were superior articular facet injuries, and for pure bony injuries, the most common injuries were pediculoisthmic component fractures. In regard to different element of the axis ring, the injuries of anterior element were more common than that of middle or posterior element. Most of (76.2%) axis ring fractures were asymmetrical, with different elements of the axis ring damaged on different side. Conclusion: In axis ring fractures, fracture lines could occur in any part of the ring. Facet joints injuries were more common than pure bony injuries, and the injuries of anterior element were more common than that of middle or posterior element. The probable mechanism of such injuries might be hyperextension and axial load, with an additional rotational load.