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  • ISSN: 2373-9479
    Volume 3, Issue 3
    Research Article
    Ahmad Faried, Imam Hidayat, Farid Yudoyono, Rully Hanafi Dahlan, and Muhammad Zafrullah Arifin
    Spondylitis TB is an infection of Mycobacterium TB involving the spine. The course of spondylitis TB is relatively indolent (without pain), thus early diagnosis is challenging. This study was conducted to evaluate the clinical presentation and the goal of surgery in twelve patients who had been operated for spondylitis tuberculosis (TB) in the Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin Hospital, Bandung, Indonesia between May 2012–2013 were reviewed retrospectively. This study analized the medical records of patients operated in our center. A clinical examination, spinal X-Ray, computed tomography scans were obtained before and after the operation is examined. Final diagnosis was based on histological characteristics and polymerase chain reaction (PCR) result of the Mycobacterium TB bacteria. The chief complaint of spondylitis TB patients admitted or consulted to our center is lower limb weakness. There were 12 cases of spondylitis TB (5 women and 7 men with a ratio of 1: 1.4). The average age was 34.3 (the youngest patient was 17 years old and the oldest was 56 years) with a standard deviation ± 9.9. The infected spines are: one patient in the cervical, eight patients in thoracal and three patients in lumbar. The chief complaint of spondylitis TB patients admitted or consulted is lower limb weakness (83.3%). Gibbus is observed in 83.3% of patients. Anterior cervical discectomy and fusion was performed in 1 case and posterior was used in 11 cases. A comprehensive history taking, along with correct sampling using various imaging modalities and PCR, will certainly lead to the diagnosis of spondylitis TB. It must be noted that neurological deficit due to spinal tuberculosis is reversible in majority of cases, especially if decompression is achieved promptly.
    Alvaro Baik Cho*, Gustavo Bersani Silva, Raquel Bernardelli Iamaguchi da Costa, Leandro Yoshinobu Kiyohara, Luiz Sorrenti, Marcelo Rosa de Rezende, Teng Hsiang Wei, and Rames Mattar Junior
    Introduction: The aim of this retrospective study was to evaluate the restoration of shoulder flexion and external rotation by neurotization of the Suprascapular Nerve with the Spinal Accessory Nerve (SAN-SSN) in patients with severe traction injuries of the brachial plexus involving C-5 and C-6 cervical roots.
    Methods: Eleven SAN-SSN neurotizations by direct suture were performed. Inclusion criteria were: root avulsion/rupture of C-5 and C-6; suprascapular nerve and upper trunk not stimulable intraoperatively; Minimum follow-up: 12 months. Patient average age at surgery was 28 years (13-43). The mean interval between trauma and operation was 7 months (4-13). The mean follow-up was 31 months (13-60). Shoulder function was evaluated by determining the muscular strength of abduction and external rotation according to the British Medical Research Council.
    Results: 73 % of the patients (8/11) did not regain useful shoulder function after SAN-SSN. Only 3 patients reached muscle strength grade 3 or greater, and in only one child the neurotization had been the isolated procedure for shoulder reconstruction. The other two patients that recovered shoulder flexion and external rotation had an upper trunk reconstruction with sural nerve grafts concurrently with SAN-SSN neurotization.
    Discussion: Postoperative clinical evaluation of the SAN-SSN neurotization showed poor reestablishment of shoulder function and these results led to a critical analysis of this procedure - classic and widely popular among hand surgeons - especially when performed in isolation for restoration of shoulder flexion and external rotation. The authors recommend the transfer of accessory nerve to the Suprascapular nerve only when direct coaptation is possible and when other procedures for reinnervation of the shoulder, such as grafting to the upper trunk or radial nerve transfer to axillary nerve may be performed concurrently.
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