Magnetic Resonance Imaging of the Cervical Spine: Frequency of Abnormal Findings with Relation to Age

Background: Patients with neck pain are frequently encountered in cervical spine (C-spine) magnetic resonance imaging (MRI) practice. However, the exact distribution and prevalence of cervical abnormalities are not known. Aim: The aim of this study is to evaluate the association between age, gender, and prevalence of abnormal cervical MRI findings. Methods: Records of 111 cervical MRIs were collected in 12 months from January to December 2019 from adults aged 20–89 years who were referred from neurosurgery, neurology, and orthopedic clinics. Findings were classified and analyzed using the Statistical Package for Social Science (SPSS), version 24.0 (IBM, Armonk, NY, USA). The chi-square test was used to determine the association between demographics and abnormalities using a significance of p = 0.05. Results: The majority of patients were female (72.1%). The number of abnormal incidences increased with age until it reached a peak at ages 50–59. Spondylodegenerative changes were the most frequent finding, which was present in 52.2% of the total sample, and was followed by disc bulge (25.2%). Incidences increased in lower discs, with C5–C6 being the most frequent in 65% of the total sample. Younger males in their 20s had more injuries than females of the same age. However, this rate was reversed in patients over 40, as women were the dominant gender among patients in their 40s with cervical injuries, with a rate of 81.5%. Conclusion: In our study, we found that older patients developed more C-spine injuries. Gender may play a role in the rate of incidents. However, we did not find any significant differences between men and women or between different types of abnormalities.

Most Common MRI finding in Lumbosacral Degenerative changes in Nepal Police

Introduction: Low back pain (LBP) is a common problem that affects about two-thirds of adults sometimes in their life. Magnetic Resonance Imaging (MRI) with excellent tissue contrast is a better modality for assessing it. We aimed to assess the common findings overall, gender-wise and age-wise in lumbosacral degenerative changes in Nepal police personnel. Methods: The 54 Nepalese police with disc degeneration changes in the MRI report were included . The following MRI findings were evaluated: decrease disc height, disc desiccation change, diffuse disc bulge, asymmetrical disc bulge, disc protrusion, disc extrusion, annular tear, central spinal canal stenosis, foraminal stenosis, spinal nerve compromise, lumbar lordosis preserved or not, osteophyte and modic changes. Results: Mostly involved lumbosacral discs were L4-L5 and L5-S1 and the least involved lumbosacral disc was L1-L2. Disc desiccation changes were the most common finding observed. Disc desiccation changes, decreased disc height, lateral recess stenosis, foraminal stenosis was common in L5-S1. Diffuse disc bulge, asymmetric disc bulge, disc protrusion, annular tear, central spinal canal stenosis were common in L4-L5. Modic type II change was the commonest endplate change observed.. Lateral recess stenosis and foraminal stenosis showed an increasing trend with increment in age group. The most common finding in both gender was disc desiccation changes and diffuse disc bulge. However, disc protrusion, disc extrusion, and annular tear were more common in males and asymmetrical disc bulge in females. Conclusion: This study shows L4-L5 and L5-S1 is the most common intervertebral disc involved in degeneration in Nepal police. Disc desiccation change and diffuse disc bulge are the most frequent finding irrespective of age and gender. Degenerative changes have an increasing trend with increasing age. Disc herniation is more common in male police individuals than female police individuals of Nepal.

PHYSIOTHERAPY REHABILITATION IN YOUNG PATIENT WITH IDIOPATHIC SCOLIOSIS

The cause of scoliosis is unknown. Males and females have almost the same rate of scoliosis; however, females have a 10-fold higher chance of curve progression. While many with scoliosis may not experience serious complications, it can lead to rib deformity and respiratory compromise, as well as cosmetic issues and emotional discomfort in some patients. However, it is the most common spinal deformity in adolescents. Physiotherapy Rehabilitation helps in correcting the deformity if functional deformity. A 20 year old female presented with dorso-lumbar scoliosis, L 4 – L5 disc bulge, Sacralization of L5 S1 diagnosed as adolescent idiopathic scoliosis. She had decreased muscular strength of back muscles, abdominals and pelvic floor muscles. She also complaint of radiating pain with tingling numbness in both lower limbs with restricted range of motion. Multiple tender points were present throughout her spinal musculature with muscle tightness. The Adam's forward bent test and a scoliometer calculation will help direct the use of radiologic tests for Cobb angle measurement and orthopaedic referrals. Proper conservative management with Prompt physical therapy which leads to achieve functional goals .The case report suggests that prompt structured physical rehabilitation led to improving functional goals progressively and significantly which is a major aspect leading to a successful recovery and better living.

Bilateral Primary Iliopsoas Abscess with Bilateral Hip Septic Arthritis – A Rare Case Report

Introduction:Iliopsoas abscess is an uncommon condition, often with insidious and nonspecific symptoms. Patients often present with a limp, fever, weight loss, and flank or abdominal pain. An iliopsoas abscess can be either primary or secondary depending on the presence or absence of an underlying disease. Primary abscess is very common in Asia and other developing countries. If untreated, iliopsoas abscess can spread to lower limbs, compress iliac vein, ureter and can end up in sepsis. There have been only a very small number of cases of psoas abscess with associated hip septic arthritis reported so far. Bilateral iliopsoas abscess is also a rare entity. Case Report:We report here a 58-year-old diabetic lady with fever and both hip pain subsequent to a fall at home one month back around one 1 month before. . She was initially seen elsewhere, and a diagnosis of L4-L5 disc bulge was made following which rest , analgesics and steroids were given. Later, repeat magnetic resonance imageMRI showed bilateral Iliacus abscess and bilateral hip synovitis. She was started on anti anti-tuberculosis medications and referred to us. We investigated for occult sources of infection and did bilateral iliopsoas abscess drainage followed by staged bilateral total hip replacement. She now continues to be symptom free. Conclusion: Our patient had primary bilateral iliopsoas abscess with bilateral hip Streptococcus faeeacalis septic arthritis. It has not been reported in the literature till now. Clinical Message:Early diagnosis through meticulous clinical examination and investigations is important in treatment of the abscess and reducing morbidity and mortality. Keywords:Primary iliopsoas abscess, septic arthritis, bilateral iliopsoas abscess.

Impact of patient-specific factors and spinopelvic alignment on the development of adjacent segment degeneration after short-segment lumbar fusion

Objectives: The main purpose of the study was to analyse the different demographical, morphological, and surgery-related parameters influencing the development or progress of degeneration in adjacent segments after routine, short-segment lumbar fusions.Summary of Background data: Adjacent segment degeneration (ASD) considered as a major long-term complication after lumbar fusions. Possible risk factors are related to the patients’ demographics, spinopelvic anatomy or preoperative lumbar intervertebral disc conditions. The current literature lacks of well-designed prospective studies focusing on the multidimensional nature of the condition.Methods: A prospective cohort of 100 patients who underwent one- or two-level lumbar transforaminal interbody fusions due to lumbar degenerative pathology was conducted. Demographical, radiological findings (spinopelvic parameters, adjacent segmental radiological as well as magnetic resonance imaging (MRI) features) and long-term outcome data (5-year) were analysed to identify factors associated with ASD. Results: ASD patients showed higher level of pain (p=0.004) and disability (p=0.020) at follow-up. In univariate analysis, older age, upper-level lumbar fusion (p=0.007), lower L4-S1 lordosis (p=0.039), PI-LL mismatch (p=0.021), Pfirrmann grade III or higher disc degeneration (p=0.002) and the presence of disc bulge/herniation were (p=0.007) associated with ASD. Final result of multivariate analysis showed major degenerative sign (disc degeneration and/or disc bulge) as a risk factor (OR 3.85, CI 1.43-10.37, p=0.006).Conclusion: By examining the role of different patient- and procedure-specific factors, we found that preoperative major degenerative signs at the adjacent segment increase the risk of ASD causing significantly worse outcome after short-segment lumbar fusion. Adjacent disc conditions should be considered carefully during surgical planning.

Magnetic Resonance Imaging Findings Among Young Adults with Low Back Pain at Nsambya Hospital

Back ground: Studies on MRI findings among patients with LBP have been conducted; especially among adolescents and young adult population in developed countries. However, MRI lumber spine evaluation findings in young adult patients with low back pain in Uganda is not known. The purpose of this study was to determine the MRI findings and their correlation to clinical features in young adult patients with low back pain in Nsambya hospitalMethods: This was a descriptive cross sectional study. One hundred and fifty-seven patients with low back pain in the 18 - 39year age group underwent MRI lumbar spine evaluation. The MRI changes in the lumbar spine and correlation to clinical features were determined. Correlation was assessed by Pearson chi square tests (Fisher’s exact test) and p-values reported at 0.05 level of significance. Results: Of the 157 patients 129 (82.2%) had severe pain, whereas ninety (57.3%) had pain that had lasted more than 10 weeks. Sixty-five (41.4%) patients were found to have MRI evidence of disc desiccation, majority (61%) of whom had multiple level disease, mostly involving the lowest 2 disc levels. Facet joint arthropathy (47.8%), marginal osteophyte (31.8%) and disc contour irregularity [disc bulge] (31.2%) were other common MRI features seen. There was an association between duration of pain and limb weakness, and development of marginal osteophytes. There was also association between clinical presentation and disc bulge. Conclusions: The MRI finding of disc degeneration among young adult patients with LBP is higher than reported. Age and pain distribution are predictors of developing disc desiccation.

A study on functional outcome following surgical fixation for lower spine injuries

<p class="abstract"><strong>Background:</strong> Cervical spine injuries are one of the common causes of serious morbidity mortality following trauma. 6% of trauma patients have spine injuries of which &gt;50% is contributed by a cervical spine injury. The aim of the study was to determine the functional outcome following surgical fixation for sub-axial cervical spine.</p><p class="abstract"><strong>Methods:</strong> this prospective study involving 17 patients who were all admitted with sub-axial cervical spine injuries and amenable to intervention in our department of orthopedics and traumatology, government Theni medical college, Tamil Nadu, India in the year 2019-2020. Duration of 6 months from December 2019 to may 2020.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most of the injuries presented within 24 hours of injury. Most of the patients presented with an incomplete neurological deficit. C5-C6 subluxation with disc bulge was the most common spinal injury. 5 patients were operated on more than 2 levels. The rest of the patients were operated on at 2 levels.</p><p class="abstract"><strong>Conclusions:</strong> We consider that the anterior decompression and fusion with a locking compression plate is a viable procedure in sub-axial cervical spine injuries.</p>

FOOT DROP AFTER SPINAL ANAESTHESIA FOLLOWING EMERGENCY APPENDECTOMY

Spinal anesthesia is the preferred anesthetic technique for cesarean section. Neurological complications are very rare and often transient after spinal anesthesia. A 11-year old male child present with pain abdomen in emergency department and underwent emergency appendectomy on 12-07-2019. During operation spinal anesthesia was induced. On 15-07-2019 patients was discharged from hospital. Patient revisited Neurology OPD with complaints of Foot Drop on 31-07-2019. Patient investigated with MRI and Nerve Conduction Studies. On MRI was found diffuse disc bulge at L3, L4, L5 level causing bilateral neural foramina narrowing and in nerve conduction study was found neuropathy of left peroneal and sural nerves. Patient was treated conservatively. Foot drop is a neurological disorder, which occurs following natural childbirth and spinal anesthesia due to direct needle trauma or local anesthetic toxicity. This complication is transient and usually resolves within a few days

Experimental and Computational Comparison of Intervertebral Disc Bulge for Specimen-Specific Model Evaluation Based on Imaging

Finite element modelling of the spinal unit is a promising preclinical tool to assess the biomechanical outcome of emerging interventions. Currently, most models are calibrated and validated against range of motion and rarely directly against soft-tissue deformation. The aim of this contribution was to develop an in vitro methodology to measure disc bulge and assess the ability of different specimen-specific modelling approaches to predict disc bulge. Bovine bone-disc-bone sections (N = 6) were prepared with 40 glass markers on the intervertebral disc surface. These were initially magnetic resonance (MR)-imaged and then sequentially imaged using peripheral-qCT under axial compression of 1 mm increments. Specimen-specific finite-element models were developed from the CT data, using three different methods to represent the nucleus pulposus geometry with and without complementary use of the MR images. Both calibrated specimen-specific and averaged compressive material properties for the disc tissues were investigated. A successful methodology was developed to quantify the disc bulge in vitro, enabling observation of surface displacement on qCT. From the finite element model results, no clear advantage was found in using geometrical information from the MR images in terms of the models’ ability to predict stiffness or disc bulge for bovine intervertebral disc.

Finite element analysis of middle cervical spine

The spinal cord may be injured through various spinal column injury patterns. However, the relationship between column injury pattern and cord damage is not well understood. This investigation was conducted to develop a detailed, asymmetric three-dimensional finite element model of the C3-C5 cervical spine. The model was validated by comparing the simulation results obtained in this study with experimental published data. Upon validation of the model, the spinal cord was included into the model the simulation were performed. The disc bulge in the model with spinal cord were measured and compared with the results of the model without spinal cord. The results showed that inclusion of the spinal cord reduced the amount of lateral disc bulged. The results of the analysis of the model with spinal cord showed that in compression, the anterior surface of spinal cord sees more displacement, stress and strain that posterior surface and vice versa for flexion/extension.