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  • ISSN: 2373-9479
    Volume 5, Issue 2
    Case Report
    Irene Grazzini, Agnese Morello, Matteo Bellini, Alfonso Cerase, Paolo Galluzzi, and Lucia Monti*
    Bow hunter's syndrome (BHS) is a rare symptomatic vertebrobasilar insufficiency in which vertebral artery (VA) is mechanically occluded during head rotation. Various pathologic conditions have been reported as causes of bow hunter's stroke. To our knowledge, however, just two cases associated with complex cranio-cervical junction (CCJ) malformation with atlanto-occipital assimilation were reported. We present an unusual case of rotational occlusion of VA in a 12-year-old male with bow hunter's syndrome manifesting as repeated vertebrobasilar ischemic attacks induced by left head rotation during sport practice. Blood flow changes were dynamically detected with Color Doppler Sonography. Computer Tomography revealed the complex CCJ malformation. For accurate diagnosis and treatment of BHS, neuroimaging with cervical rotation is mandatory.
    Diez-Ulloa MA*
    Burst vertebral fractures pose a serious problem for elderly osteoporotic patients. Patients must be ambulant as soon as possible and braces mya not be enough or very cumbersome for them. It has been proposed a technique of short instrumentation plus balloon vertebroplasty (kyphoplasty). Considering the mechanical demands and the biomechanical environment in the spine at this stage of life it might be that we can skip instrumentation, transforming surgery in a wake patient surgical procedure. Then the hypothesis is that stand alone kyphoplasty is enough in this kind of patients.
    A series of 21 consecutive patients older than 65 years of age sustaining a vertebral burst fracture considered for non operative management (brace) is studied. Sixteen were older than 70 years of age and 7 were older than 80 years of age. Stand alone modified kyphoplasty (less pressurized PMMA) was carried out and patients were followed for at least 2 years, up to 11 years in some.
    Farcy index and regional Cobb were measured on admission (lying down), immediate postoperative standing (4 hours), 3 months follow-uup , one year follow-up and then yearly radiographies. Besides, vertebral height at both anterior and posterior walls and vertical height at the point of maximum collapse were measured. Differences up to 2 mm or 2º were considered not relevant (measurement error).
    Radiological results: Farcy improved with intervention in 9, remained in 9 and deteriorated in 3; during follow-up (comparison 3 months to one year) no-one improved, fourteen remained the same and 7 had a bigger kyphosis. As for the Cobb data (vertebra above to vertebra below), with intervention 9 improved, nine remained unchanged and 3 deteriorated; during follow-up 2 improved, eight remained and 11 deteriorated.
    Clinical outcome: all patients were satisfied with the treatment, no deaths, no reinterventions, no local pain at the site of fracture, two adjacent fractures (lower vertebra) treated successfully and uneventfully with a Taylor brace, there was a 25% incidence of self resolving low back pain (one patient received one session of facet blocks).
    Conclusion: Stand alone kyphoplasty is clinically successful in patient older than 65 years of age, despite fair radiological results, especially in patients older than 80 years of age.
    Case Series
    Syggelos SA*, Megas P, Tyllianakis M, Papachristou DJ, and Panagiotopoulos EC
    The most common spinal etiology of sciatica, even in children, is lumbar inter-vertebral disk herniation. Several diseases related either to vertebras and inter-vertebral joints (such as infection, tumors, spondylolysthesis, and facet joints hypertrophy) or to spinal neurological structures (such as neural tumors or infection) can also produce sciatica symptoms. Rare extra-pelvic pathologies, which cause pressure or irritation of the sciatic nerve through its course in the gluteal area and/or lower limb, should always be investigated in cases of sciatica, especially in patients without remarkable low back pain. These pathologies may be related either to diseases of the neural tissue (such as peripheral nerve tumor) or to other musculoskeletal disorders (such as muscular or soft tissues contractures, as well as bony diseases), able to cause dysfunction of the nerve. Diagnosis of sciatica may be limited, especially if the clinician, the physical examination and the routine radiological examination (X-ray or MRI scan) are exclusively focused to the lumbar spine only. In this paper, we present two cases of sciatica, with extra-pelvicetiology, where nerve dysfunction resulted to irritation because of nerve impingement on hip implants (acetabular metal cage in one case and reconstruction plate for fracture fixation in the other) and we review the analogue literature.
    Short Communication
    Michel A. Audette*, Craig Goodmurphy, Stacie Ringleb, Sebastian Bawab, Lucas Potter, Michael Polanco, and H. Sheldon St-Clair
    This paper describes a new research project that will establish the foundation of a scoliosis surgery planning and simulation system, emphasizing i) minimally supervised, multi-surface deformable model-based segmentation of ligaments, vertebrae and intervertebral discs, featuring statistical shape priors of bones and ligaments produced with cadaveric tissue mapping studies, ii) the estimation the forces needed for corrective therapies through subject-specific finite elements (FE) studies, in turn iii) validated and fine-tuned by cadaveric loading studies and tool instrumentation studies. The project builds on the team’s prior work on Simplex deformable multi-surface models, used successfully to segment vertebrae and intervertebral discs of the spine without overlap. It also builds on expertise in FE-based biomechanical simulations, in positioning and loading devices for the musculoskeletal anatomy, in scoliosis surgery, and in cadaveric tissue identification. The ligaments and bones identified on cadaveric subjects will form the basis of a ligament skeletal template anatomy that can be nonrigidly registered to any subject subsequently, in a manner anchored by bones well contrasted in either MRI or CT. This deformable multi-surface Simplex model approach will mitigate any ambiguity present in the identification of ligaments due to limited contrast in CT or MRI.
    Thulasi Das P* and Midhuna Prathap
    We present our experience in managing spontaneous CSF rhinorrhoea which could be devastating if untreated. This is a retrospective study of all the cases of spontaneous CSF leaks treated by the first author between 1991 and 2016 in a tertiary referral centre.
    A total of 450 patients underwent endoscopic repair of CSF fistula, with an overall success rate of 98.8%. 14 patients required revision, of which nine patients underwent second surgery successfully. The remaining opted to get treated elsewhere. Apart from three patients who had minor post operative early meningitis, which were treated promptly, no serious complications were encountered. Patient follow up ranged from 6 months to 25 years.
    The principles of diagnosis of CSF rhinorrhoea, surgical management and results are discussed. Precise identification of the bony defect, meticulous preparation of the graft bed, careful elevation of dura, placement of cartilage in the extra-dural pocket and judicious use of just enough tissues and adequate graft support are key factors in a successful repair.
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