Posterior resection of sacral osteosarcoma utilizing cement-infused chest tube interbody reconstruction and lumbopelvic fusion

Background: Primary osteosarcoma (OS) of the spine is very rare. En bloc resection of spinal OS is challenging due to anatomical constraints. Surgical planning must balance the benefits of en bloc resection with its potential risks of causing a significant neurological deficit. In this case, we successfully performed a posterior-only approach for decompression with S1 reconstruction via a cement-infused chest tube interbody device, along with a navigated L4 to pelvis fusion. Case Description: A 49-year-old female presented with a primary sacral OS. Computed tomography (CT) and magnetic resonance (MR) imaging revealed an S1 lytic vertebral body lesion with severe stenosis and progressive L5 on S1 anterior subluxation. Surgical decompression with tumor resection and S1 corpectomy with S1 reconstruction via a cement-infused 32-French chest tube interbody device accompanied by L4 -pelvis fusion utilizing S2-alar-iliac screws was completed. 6 months postoperatively, the patient continues to have significant pain relief and the instrumentation remains intact. Conclusion: A 49-year-old female with an S1 OS successfully underwent a posterior-only approach that included an S1 corpectomy with anterior column reconstruction via a cement-infused chest tube interbody plus a navigated L4 to pelvis fusion.

Simulated weightbearing computed tomography for verification of radiographic staging of varus ankle osteoarthritis: a cross-sectional study

Background Varus ankle osteoarthritis is classified using only weightbearing anteroposterior ankle radiographs; however, sagittal ankle alignment may also affect the position and extent of joint space obliteration. We hypothesized that the sagittal alignment of the ankle may also affect the position and extent of joint space obliteration visible on the coronal section; therefore, we identified the sites of joint space obliteration in patients with stage 3 varus ankle osteoarthritis for comparison with the sites observed on simulated weightbearing computed tomography and investigated the effects of anterior and posterior ankle subluxation. Methods Simulated weightbearing computed tomography scans of 83 ft with varus ankle osteoarthritis (26 stage 3a, 57 stage 3b) were performed to check for joint space obliteration in the ankle. Further classification as exhibiting either anterior, posterior, or no subluxation on weightbearing lateral radiographs was performed. Results Anterior, posterior, and no subluxation was seen in 5, 9, and 12 ankles among the 26 classified as stage 3a, respectively, and in 22, 12, and 23 ankles among the 57 classified as stage 3b, respectively. The mean tibial lateral surface angle on weightbearing lateral radiographs in stage 3a ankles was 75.6, 83.3, and 80.3 degrees in the anterior, posterior, and no subluxation groups, respectively; and 75.5, 86.6, and 82.7 degrees in stage 3b ankles (p < .05). In stage 3b ankles, widespread joint space obliteration was observed at the anterior distal articular surface of the tibia in all 22 ankles with anterior subluxation and at the posterior distal articular surface of the tibia in all 12 ankles with posterior subluxation. Conclusions Simulated weightbearing computed tomography revealed joint space obliteration at the anterior distal articular surface of the tibia in stage 3b ankles with anterior subluxation and at the posterior side in stage 3a and 3b ankles with posterior subluxation. In some patients with stage 3 varus ankle osteoarthritis, the obliteration of the joint space is difficult to evaluate accurately using only weightbearing anteroposterior radiographs; weightbearing lateral radiographs should also be performed.

Need of additional iridotomies despite lens extraction in spherophakes

Spherophakes are known to have irregular anterior chamber (AC) depths due to their poorly supported zonules. This irregularity leads to an unstable AC, often resulting in angle closure glaucoma from anterior subluxation of globular lenses. A peripheral iridotomy may be helpful to encourage aqueous drainage in initial stages, however, is not often required once lens is extracted. But, we have observed persistent instability of AC in spherophakic eyes despite lens extraction, leading to frequent iridocorneal contact locally over some quadrants. The presumed aetiology in such scenarios could be constant anteroposterior instability of IOL-bag complex due to generalised zonulopathy and hence localised iris bombe in areas with previous iridocorneal contact. Timely identification and performing additional iridotomies during surgery at such sectors even after lens extraction facilitated symmetric deepening of the AC. Hence, we recommend use of additional iridotomies at areas with persistent iridocorneal contact even after lens extraction.

The Characteristics of the Favard E4 Glenoid Morphology in Cuff Tear Arthropathy: A CT Study

Background: Cuff tear arthropathy (CTA) is characterized by superior migration of the humeral head with superior erosion of the glenoid. Rarely, humeral head migration can be anteroinferior with associated anterior erosion of the glenoid, a pattern described by Favard as the type E4 glenoid. The purpose of this retrospective imaging study was to analyze the 2D and 3D characteristics of the E4 glenoid. Methods: A shoulder arthroplasty database of 258 cuff tear arthropathies was examined to identify patients with an E4 type deformity. This resulted in a study cohort of 15 females and 2 males with an average age of 75 years. All patients had radiographs and CT scans available for analysis. CT-scan DICOM (Digital Imaging and Communications in Medicine) data were uploaded to a validated three-dimensional (3D) imaging software. Muscle fatty infiltration, glenoid measurements (anteversion, inclination), and humeral head subluxation according to the scapular plane were determined. Results: The mean anteversion and inclination of the E4 cohort were 32° ± 14° and −5° ± 2, respectively. The mean anterior subluxation was 19% ± 16%. All cases had severe grade 3 or 4 fatty infiltration of the infraspinatus, whereas only 65% had grade 3 or 4 subscapularis fatty infiltration. A significant correlation existed between glenoid anteversion and humeral head subluxation (p < 0.001), but no correlation was found with muscle fatty infiltration. The CT analysis demonstrated an acquired erosive biconcave morphology in 11 patients (65%) and monoconcavity in 6 patients (35%). Conclusion: The E4 type glenoid deformity in cuff tear arthropathy is characterized by an anterior erosion and anteversion associated with anterior subluxation of the humeral head.

CT Classification of Vacuum Phenomenon Morphology and its Utility in Predicting Lumbar Vertebral Instability

Background: Lumbar vacuum phenomenon (VP) within the intervertebral disc has been classified based on CT imaging. We compared same-patient sagittal CT images and dynamic flexion-extension x-rays to determine if there is a difference in the amount of vertebral instability present between three VP morphologies on CT.Methods: Anterior subluxation measurements on x-ray were compared with same-segment VP on CT images from the same patient when both findings were present. VP were classified as spot, island, or linear. It was determined if there was a difference in the amount of anterior subluxation between the three morphologies. Secondary analysis looked at whether there was a difference in anterior subluxation between the three groups if patients had undergone a prior lumbar fusion surgery or not. Results: There was no difference in anterior subluxation between the three groups on dynamic flexion-extension x-rays. There was also no difference between the three groups on flexion-extension x-rays when patients were separated based on if they had received or not received a previous lumbar fusion surgery. Conclusion: IVD VP morphology is not a useful indicator in determining vertebral instability pre-operatively according to CT scan. Further fine-tuning of an IVD VP CT classification is needed to help radiologists and spine surgeons know when IVD VP presence is important.

Technical outcome of atlantoaxial transarticular screw fixation without supplementary posterior construct for rheumatoid arthritis

Background: transarticular screw (TAS) fixation without a supplementary posterior construct, even in rheumatoid arthritis (RA) patients, provides sufficient stability with acceptable clinical results. Here, we present our experience with 15 RA patients who underwent atlantoaxial (AA) TAS fixation without utilizing a supplementary posterior fusion. Methods: To treat AA instability, all 15 RA patients underwent C1–C2 TAS fixation without a supplementary posterior construct. Patients were followed for at least 24 months. Pre- and postoperative sagittal measures of C1– C2, C2–C7, and C1–C7 angles, atlanto-dens interval (ADI), posterior atlanto-dens interval (PADI), and adjacent segment (i.e., C2–C3) anterior disc height (ADH) were retrospectively recorded from lateral X-ray imaging. The presence or absence of superior migration of the odontoid (SMO), cervical subaxial subluxation, C1–C2 bony fusion, screw pull-out, and screw breakage were also noted. Results: There was little difference between the pre- and postoperative studies regarding angles measured. Following TAS fixation, the mean ADI shortened, and mean PADI lengthened. There was no difference in the mean measures of C2–C3 ADH. There was no evidence of SMO pre- or postoperatively. Two patients developed anterior subluxation at C5–C6; one of the two also developed anterior subluxation at C2–C3. All patients subsequently showed C1–C2 bony fusion without screw pull-out or breakage. Conclusion: In RA patients who have undergone C1–C2 TAS fixation, eliminating a supplementary posterior fusion resulted in adequate stability.

Atraumatic spontaneous swelling of sternoclavicular joint: a case report

Atraumatic spontaneous swelling of the Sternoclavicular Joint (SCJ) is not very common in elderly women. The SCJ is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Trauma, degeneration, infections and other disease processes that affect synovial joints are the common causes of swelling of the SCJ. Here authors report a case of nontraumatic spontaneous anterior subluxation of the sternoclavicular joint in 66-year-old women without any underlying pathology who presented with sudden onset of a nontender swelling in the suprasternal area. The patient was treated conservatively and remained asymptomatic throughout 6 months follow up.