Detection of Spinal TB Infection: A Retrospective Study Evaluating Comparative Diagnostic Efficacy of AFB Smear, Gene Expert, Histopathology, Culture Sensitivity and LPA Tests From a Biopsy Sample

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Volume 7 | Issue 1 | January-June 2022 | Page: 01-06 | Abhijith Shetty, Saijyot Raut, Manikant Anand, Vishal Kundnani, Praveen Goparaju, Mukul Jain

DOI: 10.13107/ijs.2020.v07i01.031

Authors: Abhijith Shetty [1], Saijyot Raut [1], Manikant Anand [1], Vishal Kundnani [1], Praveen Goparaju [1], Mukul Jain [1]

[1] Department of Orthopaedics, Bombay Hospital and Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhijith Shetty,
Spine Surgeon, Department of Orthopaedics, Bombay Hospital and Research
Centre, Mumbai, Maharashtra, India.
E-mail: abhijithshettyabhi03@gmail.com

Abstract

Background: Spinal Tuberculosis (TB) is one of the significant health dangers that affect the general wellbeing of an individual. It is one of the most common form of extra pulmonary tuberculosis that affects the general population. Diagnosis of tuberculosis is done using an array of techniques. The present study has compared the efficacy of these tests used for detecting the spinal TB in biopsy samples.
Material and Methods: The study was conducted on patients who suffered from spondylodiscitis and with biopsy proven spinal TB by one of the following tests and were treated in the study center. The study included a total of 150 patients with spinal TB who visited the department for further treatment. The biopsy samples of these patients were then processed for Line probe assay (LPA), Gene Xpert, liquid culture (bactec MGIT) followed by gram staining and fungal staining, and histopathological examination.
Result: In this study total of 150 patients were included who had ages ranging from 16-77 years with 93male and 57 female patients. When the study results were compared Gene Experts showed a 100% sensitivity and 80% of specificity. When we compared the histopathology results with gene expert, we get a sensitivity of 16.7% and specificity of 50%.
Gram stain with the sensitive gene expert, the sensitivity is 45.5% and specificity is 25%. Similar analysis was done with sensitive gene and now with the resistant gene to identify their sensitivity was 0% and the specificity was at 42.9%. Gram stain when correlated with gene, the sensitivity came out to be 9.1% and specificity at 25%. Fungal stain with resistant gene, when correlated, sensitivity comes to 9.1% and specificity is at 0%.
Conclusion: This study showed that for detection of tuberculosis rather than relying on only single technique it should be done with a combination of techniques.
Keywords: Gene Xpert, LPA, Histopathological examination, Tuberculosis, Gram staining

References

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How to Cite this Article: Shetty A, Raut S, Anand M, Kundnani V, Goparaju P, Jain M | Detection of Spinal
TB Infection: A Retrospective Study Evaluating Comparative Diagnostic Efficacy of AFB Smear, Gene Expert, Histopathology, Culture Sensitivity and LPA Tests From a Biopsy Sample | International Journal of Spine | January-June 2020; 7(1): 01-06.

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Unusual Association of KBG Syndrome with Scheuermann’s Disease

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Volume 7 | Issue 1 | January-June 2022 | Page: 01-06 | Sanjay N. Murthy, Jaganaathan Srinivasan, Cheryl Honeyman, Rajendra Sakhrekar, Amit Bishnoi, Sriram H. Srinivasan

DOI: 10.13107/ijs.2020.v07i01.036

Authors: Sanjay N. Murthy [1], Jaganaathan Srinivasan [2], Cheryl Honeyman [3], Rajendra Sakhrekar [4], Amit Bishnoi [5], Sriram H. Srinivasan [6]

[1] Department of Orthopaedics, Royal Stoke University Hospital, UK.
[2] Department of Orthopaedics, James Cook University Hospital, Middlesbrough, BW.
[3] Department of Orthopaedic Nursing, James Cook University Hospital, Middlesbrough, BW.
[4] Department of Spinal Surgery, Schoen klinik Neustadt Holestine, Germany.
[5] Department of Spinal Surgery, Leicester University Hospital, UK.
[6] Department of Spinal Surgery, Ipswich University Hospital NHS Trust, UK.

Address of Correspondence
Dr. Sanjay N. Murthy,
Core Trainee, Department of Orthopaedics, Royal Stoke University Hospital, UK.
E-mail: sanjayn293@gmail.com

Abstract

In this paper we discuss a novel case in which a patient had a comorbid diagnosis of KBG syndrome and Scheuermann’s disease. The patient was a 14-year-old boy, referred to orthopaedics for assessment of his spinal deformity. Initial assessment revealed that he had a rib prominence on his right side, which was corrected upon bending forward. SLR examination indicated significantly tight hamstrings. Plantars were upturning, but other reflexes were normal. He had kyphosis measuring up to 59.4 degrees. MRI of the spine depicted features of classic Scheuermann’s disease, from D6-D10. The patient was given conservative treatment consisting of physical therapy and postural training. He remained asymptomatic during the course of a 5-year follow-up period. This case is unique due to the comorbidity of Scheuermann’s disease and KBG syndrome, which has never been reported in the literature. This case report suggests that routine spinal screening in cases of KBG syndrome would contribute to a better understanding of treatment and diagnosis.

Keywords: KBG syndrome, Scheuermann’s disease

References

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4. Goldenberg, A., Riccardi, F., Tessier, A., Pfundt, R., Busa, T., Cacciagli, P., … Philip, N. (2016). Clinical and molecular findings in 39 patients with KBG syndrome caused by deletion or mutation of ANKRD11. American Journal of Medical Genetics Part A, 170(11), 2847–2859. https://doi. org/10.1002/ajmg.a.37878

5. Damborg F, Engell V, Andersen M, et al. Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. J Bone Joint Surg Am 2006;88:2133–6.

6. Makurthou AA, Oei L, El Saddy S, et al. Scheuermann disease: Evaluation of radiological criteria and population prevalence. Spine (Phila Pa 1976) 2013;38:1690–4

7. McKenzie L, Sillence D. Familial Scheuermann disease: a genetic and linkage study. J Med Genet 1992;29:41–5.

8. Brancati, F., Sarkozy, A. & Dallapiccola, B. KBG syndrome. Orphanet J Rare Dis 1, 50 (2006). https://doi.org/10.1186/1750-1172-1-50

9. Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akri- topoulos P, Akritopoulou K. Scheuermann’s disease: Focus on weight and height role. Eur Spine J. 2008; 17: 673-678.

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13. Huq, Sakibul; Ehresman, Jeffrey; Cottrill, Ethan; Ahmed, A. Karim; Pennington, Zach; Westbroek, Erick M.; Sciubba, Daniel M. (2019-11-01). “Treatment approaches for Scheuermann kyphosis: a systematic review of historic and current management”. Journal of Neurosurgery: Spine. -1 (aop): 235–247. doi:10.3171/2019.8.SPINE19500. PMID 31675699.

14. Riouallon, Guillaume; Morin, Christian; Charles, Yann-Philippe; Roussouly, Pierre; Kreichati, Gaby; Obeid, Ibrahim; Wolff, Stéphane; French Scoliosis Study Group (2018-09-01). “Posterior-only versus combined anterior/posterior fusion in Scheuermann disease: a large retrospective study”. European Spine Journal. 27 (9): 2322–2330. doi:10.1007/s00586-018-5633-x. ISSN 1432-0932. PMID 29779056. S2CID 29169417

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How to Cite this Article: Murthy SN, Srinivasan J, Honeyman C, Sakhrekar R, Swamy G, Srinivasan SH Unusual Association of | KBG Syndrome with Scheuermann’s Disease | International Journal of Spine | January-June 2020; 7(1): 29-32.

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Horner’s Syndrome After Anterior Decompression And Fusion For Cervical Spine Pathologies: Report Of Two Cases

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Volume 5 | Issue 1 | January-June 2020 | Page: 6-8 | Tomotaka Umimura, Satoshi Maki, Masao Koda, Seiji Ohtori

Authors : Tomotaka Umimura [1], Satoshi Maki [1], Masao Koda [2], Seiji Ohtori [1]

[1] Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan.
[2] Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaragi, 305-8575 Japan.

Address of Correspondence
Dr. Tomotaka Umimura,
Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan.
Email : adna4547@gmail.com

Abstract

Introduction: Horner’s syndrome is caused by impairment of the sympathetic trunk, resulting in associated ptosis, miosis, and anhidrosis. The cervical sympathetic trunk is sometimes damaged during an anterior approach to the lower cervical spine. We report two cases of Horner’s syndrome after anterior decompression and fusion for lower cervical spine pathologies.
Case Presentation: Case 1 was in a 58-year-old Japanese woman with a herniated C5-6 intervertebral disc presenting myelopathy who underwent anterior cervical discectomy and fusion of C5–C6. After the operation, miosis, and anhidrosis of the right face occurred and the symptoms continued for more than 15 years. Case 2 was in a 40-year-old Japanese woman whose diagnosis was flexion myelopathy with kyphosis at C5–C6 and canal stenosis, so she underwent anterior cervical C5-6 discectomy and fusion of C5–C6. Immediately after surgery, ptosis and miosis occurred, which lasted for 4 months.
Conclusion: Horner’s syndrome tends to occur during anterior cervical spine procedures, especially at the lower level, and the syndrome may be transient or irreversible. During an anterior approach to the lower cervical spine, taking care not to damage the sympathetic trunk is important to avoid this complication.
Keywords: Horner’s syndrome, Anterior cervical spine surgery, Complication.

References

1. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007 Oct 1;32(21):2310-7.
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3. Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 1989;99(1-2):41-50.
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7. Ebraheim NA, Lu J, Yang H, Heck BE, Yeasting RA. Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine. Spine (Phila Pa 1976). 2000 Jul 1;25(13):1603-6.
8. Civelek E, Karasu A, Cansever T, Hepgul K, Kiris T, Sabanci A, Canbolat A. Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine. Eur Spine J 2008 Aug;17(8):991-5.

How to Cite this Article: Umimura T, Maki S, Koda M, Ohtori S | Horner’s Syndrome After Anterior Decompression And Fusion For Cervical Spine Pathologies: Report Of Two Cases | International Journal of Spine| January-June 2020; 5(1): 6-8 .

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Wide Open Laminectomy, Posterior Decompression and Discectomy in Lumbar Spine with Preservation of Posterior Ligamentous Complex in Cauda Equina Syndrome – Case Series, Early Outcome and Literature Review

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Volume 5 | Issue 1 | January-June 2020 | Page: 9-11 | Ong Kean Loong, Ng Bing Wui, Thuraikumar Kanniah, Wang Chee Seiang, Lim Sze Wei, Nor Azlin Zainal Abidin

Authors : Ong Kean Loong [1], Ng Bing Wui [2], Thuraikumar Kanniah [1], Wang Chee Seiang [1], Lim Sze Wei [1], Nor Azlin Zainal Abidin [1]

[1] Spine unit, Department of Orthopaedic, Hospital Sungai Buloh, Malaysia.
[2] Department of Orthopaedic, Hospital Segamat, Malaysia.

Address of Correspondence
Dr. Ng Bing Wui,
Spine unit, Department of Orthopaedic, Hospital Sungai Buloh, Malaysia.
Email : bingwuing@gmail.com

Abstract

Introduction: Spinous process osteotomy has been described as an alternative approach to allow better visualization during laminectomy and decompression of the spinal cord in cases of lumbar spinal stenosis.1 In this study, the authors describe the experience and early outcome of using this technique in treatment of Cauda Equina Syndrome.
Method: This is a retrospective study conducted between March 2018 until March 2019. Cases of Cauda Equina Syndrome treated with spinous process osteotomy, wide laminectomy, decompression and discectomy without instrumentation will be included in this study. Owestry Disability Index (ODI) and outcome of patients will be studied.
Result: 5 cases were found during the study period. All patients have shown marked improvement in terms of neurology and ODI score.
Conclusion: Spinous process osteotomy, wide laminectomy and discectomy can be used effectively for the treatment of Cauda Equina Syndrome. This study intend to be a pilot study in understanding the effectiveness and early outcome of patients treated with this approach. Larger prospective study is needed to provide meaningful comparison between this technique with the conventional approach used in treatment of Cauda Equina Syndrome.
Keywords: Cauda Equina Syndrome, Spinous process osteotomy, Posterior ligamentous complex.

References

1. Yong-Hing K, Kirkaldy-Willis WH. Osteotomy of lumbar spinous process to increase surgical exposure. Clinical orthopaedics and related research. 1978(134):218-20.
2. Dhatt S, Tahasildar N, Tripathy SK, et al. Outcome of spinal decompression in cauda equina syndrome presenting late in developing countries: case series of 50 cases. Eur Spine J 2011; 20:2235–2239.
3. GitelmanA,Hishmeh S, Morelli BN, Joseph SA Jr, Casden A, et al. (2008) Caudaequina syndrome: a comprehensive review.Am J Orthop (Belle Mead NJ) 37: 556-562
4. Waschke A, Hartmann C, Walter J, Dünisch P, Wahnschaff F, Kalff R, Ewald C. Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients. Acta neurochirurgica. 2014 Feb 1;156(2):235-44.
5. Kim DY, Lee SH, Chung SK, Lee HY. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine. 2005 Jan 1;30(1):123-9.
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8. Erland Hermansen, Gunnar Moen et al. Spinous Process Osteotomy to Facilitate the access to the spinal canal when decompressing the spinal canal in patients with lumbar spinal stenosis. Asian Spine Journal. 2014 Apr; 8(2): 138-144
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10. Namboothiri S, Gore S, Raja P (2016) Novel Surgical Technique for Discogenic Cauda Equina Syndrome – Transforaminal Intra Discal Access by Annulotomy outside Central Spinal Canal. J Spine S7:008.doi:10.4172/2165-7939.S7-008.

How to Cite this Article: Loong OK, Wui NB, Kanniah T, Seiang WC, Wei LS, Abidin NAZ | Wide Open Laminectomy, Posterior Decompression and Discectomy in Lumbar Spine with Preservation of Posterior Ligamentous Complex in Cauda Equina Syndrome – Case Series, Early Outcome and Literature Review | International Journal of Spine| January-June 2020; 5(1): 9-11.

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Revision Spine With Hartshill and Sublaminar Wiring in Operated Osteoporotic Fracture- A Case Note

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Volume 5 | Issue 1 | January-June 2020 | Page: 2-5 | Shailesh Hadgaonkar, Vivek Vincent, Pradhyumn Rathi, Parag Sancheti, Ashok Shyam

Authors : Shailesh Hadgaonkar [1], Vivek Vincent [1], Pradhyumn Rathi [1], Parag Sancheti [1], Ashok Shyam [1]

[1] Department of Spine, Sancheti Institute of Orthopedics and Rehabilitation

Address of Correspondence
Dr. Pradhyumn Rathi,
Row House No.1, Shamail complex, Balaji nagar, Bhayander west Thane 401101
E-mail: pradhyumnrathi@gmail.com

Abstract

Introduction: Osteoporotic vertebral compression fractures (OVCF) are one of the commonest fractures seen in day to day practise. We present a unique case of failure of pedicle screw instrumentation in OVCF revised by sublaminar wiring (SLW).
Case report: A 70 year old lady with old operated osteorporotic fracture with sagittal imbalance and implant loosening was revised with single spinal rectangular loop and sublaminar wires (SLW).
Conclusion: Pedicle screws constructs for short segment fixation are rigid and biomechanically superior with greatest pull out strength, which mainly depends on bone mineral density. But, sublaminar wires should be considered far more superior in severely osteoporotic bone.
Keywords: Bone density, Bone wires, Compression, Fractures, Osteoporosis, Pedical screws, Spinal fractures.

References

1. Bullmann V, Schmoelz W, Richter M, et al. Revision of cannulated and perforated cement-augmented pedicle screws: a biomechanical study in human cadavers. Spine 2010 ; 35 : E932–9.
2. Chang K-W, Chen Y-Y, Lin C-C, et al. Apical Lordosating Osteotomy and Minimal Segment Fixation for the Treatment of Thoracic or Thoracolumbar Osteoporotic Kyphosis. Spine 2005 : 1674–1681.
3. Coe JD, Warden KE, Herzig MA, et al. Influence of bone mineral density on the fixation of thoracolumbar implants. A comparative study of transpedicular screws, laminar hooks, and spinous process wires. Spine 1990 ; 15 : 902–907.
4. Cresswell TR, Marshall PD, Smith RB. Mechanical stability of the AO internal spinal fixation system compared with that of the Hartshill rectangle and sublaminar wiring in the management of unstable burst fractures of the thoracic and lumbar spine. Spine 1998 ; 23 : 111–115.
5. Faciszewski T, Winter RB, Lonstein JE, et al. The Surgical and Medical Perioperative Complications of Anterior Spinal Fusion Surgery in the Thoracic and Lumbar Spine in Adults. Spine 1995 : 1592–1599.
6. Glassman SD, Alegre GM. Adult spinal deformity in the osteoporotic spine: options and pitfalls. Instr Course Lect 2003 ; 52 : 579–588.
7. Hirabayashi S, Kumano K, Kuroki T. Cotrel-Dubousset pedicle screw system for various spinal disorders. Merits and problems. Spine 1991 ; 16 : 1298–1304.
8. Hodge WA, DeWald RL. Splenic injury complicating the anterior thoracoabdominal surgical approach for scoliosis. A report of two cases. The Journal of Bone & Joint Surgery 1983 : 396–397.
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10. McAfee PC. Complications of anterior approaches to the thoracolumbar spine. Emphasis on Kaneda instrumentation. Clin OrthopRelat Res 1994 : 110–119.
11. Mesfin A, Komanski CB, Jay Khanna A. Failure of Cement-Augmented Pedicle Screws in the Osteoporotic Spine. Geriatric Orthopaedic Surgery & Rehabilitation 2013 : 84–88.
12. Mohan AL, Das K. History of surgery for the correction of spinal deformity. Neurosurgical Focus 2003 : 1–5.
13. Moore DC, Maitra RS, Farjo LA, et al. Restoration of Pedicle Screw Fixation With an in Situ Setting Calcium Phosphate Cement. Spine 1997 : 1696–1705.
14. Nakai S, Zielke K. Chylothorax–a rare complication after anterior and posterior spinal correction. Report on six cases. Spine 1986 ; 11 : 830–833.
15. Parsons JR, Chokshi BV, Lee CK, et al. The biomechanical analysis of sublaminar wires and cables using luque segmental spinal instrumentation. Spine 1997 ; 22 : 267–273.
16. Patil S, Nene AM. Predictors of kyphotic deformity in osteoporotic vertebral compression fractures: a radiological study. Eur Spine J 2014 ; 23 : 2737–2742.
17. Patil SS, Bhojaraj SY, Nene AM. Safety and efficacy of spinal loop rectangle and sublaminar wires for osteoporotic vertebral compression fracture fixation. Asian J Neurosurg 2017 ; 12 : 436–440.
18. Weis JC, Betz RR, Clements DH 3rd, et al. Prevalence of perioperative complications after anterior spinal fusion for patients with idiopathic scoliosis. J Spinal Disord 1997 ; 10 : 371–375.
19. Wilber RG, Thompson GH, Shaffer JW, et al. Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring. J Bone Joint Surg Am 1984 ; 66 : 1178–1187.
20. Yuan HA, Garfin SR, Dickman CA, et al. A Historical Cohort Study of Pedicle Screw Fixation in Thoracic, Lumbar, and Sacral Spinal Fusion. Spine 1994 : 2279S–2296S.

How to Cite this Article: Hadgaonkar S, Vincent V, Rathi P, Sancheti P, Shyam A | Revision spine with Hartshill and Sublaminar wiring in operated osteoporotic fracture- A case note| International Journal of Spine| January-June 2020; 5(1): 2-5..

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A prospective Study of Dural Tears among 430 cases of Lumber Spine Surgery

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Volume 5 | Issue 1 | January-June 2020 | Page: 12-15 | Md. Alauddin, A.H.M Tanvir Hasan Siddiquee, Md. Matiur Rahman, Malay Kumar Roy, Shahidul Islam khan, Md. Abdullah Al Mahmud

Authors : Md. Alauddin [1], A.H.M Tanvir Hasan Siddiquee [1], Md. Matiur Rahman [1], Malay Kumar Roy [1], Shahidul Islam khan [2], Md. Abdullah Al Mahmud [3]

[1] Department of Orthopaedic Surgery, Mymensingh Medical College, Mymensingh, Bangladesh.
[2] Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
[3] Department of Orthopaedic Surgery, Rangpur Medical College, Rangpur, Bangladesh.

Address of Correspondence
Dr. Md. Alauddin,
Department of Orthopaedic Surgery, Mymensingh Medical College, Mymensingh, Bangladesh.
E-mail: alauddin.md.k49@gmail.com

Abstract

Inadvertent Dural tear (DT) is a possible feared complication of spinal surgery. This is a prospective study of 430 consecutive patients with different types of lumber spinal surgery within the period of ‘January 2010 to December 2018′. Aim of the study is to evaluate incidence of dural tear (DT) with risk factors, compare between DT and non DT group with outcome. Incidence of dural tear were more on patients with older age, degenerative spinal stenosis, spondylolisthesis, re-operative surgery, multiple level surgery and with instrumentation. No significance sex difference found. Postoperative complications were more and outcome poor in DT group in comparison to non DT group. Every spine surgeon should be aware of possible dural tear and must know how to deal it.
Keywords: Dural Tear (DT); DT group; Non DT group.

References

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How to Cite this Article: Alauddin M, Siddiquee AHMTH, Rahman MM, Roy MK, khan SI, Mahmud MAA | A prospective Study of Dural Tears among 430 cases of Lumber Spine Surgery | International Journal of Spine| January-June 2020; 5(1): 12-15.

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