Neural tube dysraphism: review of cutaneous markers and imaging.

Neural tube dysraphisms are congenital anomalies resulting from impaired formation of structures along the craniospinal axis during central nervous system development. When these malformations are large or lack a skin covering, they are easily recognized, whereas smaller or skin-covered malformations may not be readily apparent. Due to the intimate embryologic origin of the skin and nervous system, these occult malformations are often heralded by associated cutaneous abnormalities. In this article, the common clinical presentations and cutaneous markers of craniospinal dysraphism are reviewed, along with the recommended imaging modalities.

Restoration of elective spine surgery during the first wave of COVID-19 : a UK-wide British Association of Spine Surgeons (BASS) prospective, multicentre, observational study.

AIMS: With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic. METHODS: A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay. RESULTS: In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium "risk stratification" category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication. CONCLUSION: This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units. Cite this article: Bone Jt Open 2021;2(12):1096-1101.

Differences in aortic valve area measured with CT planimetry and echocardiography (continuity equation) are related to divergent estimates of left ventricular outflow tract area.

OBJECTIVE: The purpose of this study was to compare measurements of aortic valve area (AVA) obtained with coronary CT angiography (CCTA) and transthoracic echocardiography (TTE) and to determine whether differences in these estimates are related to underestimation of the area of the left ventricular outflow tract (LVOT) measured with echocardiography. MATERIALS AND METHODS: A retrospective database review yielded the cases of 41 patients who had undergone CCTA and TTE within a 60-day period. AVA was measured with direct planimetry on CCTA images and was computed with the continuity equation at TTE. To ascertain the effect of LVOT measurements on the continuity equation, AVA was recomputed with substitution of the LVOT area and diameter measured on CCTA images for the dimensions obtained at TTE. RESULTS: TTE estimates of AVA varied from 0.6 to 7.0 cm(2) and included 10 patients with moderate to severe aortic stenosis (AVA < or = 1.5 cm(2)). AVA obtained with CT planimetry was greater than that computed with TTE measurements (mean difference, 0.6 cm(2); p = 0.0037). There was little difference between CT and TTE measurements of LVOT diameter (mean difference, 0.05 cm; p = 0.37), but measurements of LVOT area were significantly greater on CT planimetric images (mean difference, 0.6 cm(2); p = 0.0002). When CT measurements of LVOT area were substituted into the continuity equation in place of LVOT diameter, correlation between the CT planimetric and continuity equation values of AVA improved from r = 0.65 to r = 0.88, whereas the mean difference in AVA between the CT planimetric and continuity equation values decreased to 0.17 cm(2) (p = 0.36). CONCLUSION: AVA measured with CT planimetry is significantly greater than AVA calculated with the continuity equation. This difference is at least partially related to differences in LVOT area based on LVOT diameter versus direct planimetry of the LVOT area.

Alternative technique in atypical spinal decompression: the use of the ultrasonic scalpel in paediatric achondroplasia.

Spinal stenosis can be a very disabling condition. Surgical decompression carries a risk of dural tear and neural injury, which is increased in patients with severe stenosis or an atypical anatomy. We present an unusual case of symptomatic stenosis secondary to achondroplasia presenting in a paediatric patient, and highlight a new surgical technique used to minimise the risk of dural and neural injury during decompression.

The incidence of deep vein thrombosis and pulmonary embolism with the elective use of external fixators.

Little evidence exists about the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of external fixators. We investigated this in a cohort of 207 consecutive patients undergoing 258 elective frame applications by case note review. Case notes were obtained for 84 % of the sample population. The type of surgery, demographic data, thromboembolic risk factors and the incidence of DVT/PE were recorded. One patient experienced DVT (0.39 %) and one a PE (0.39 %). Both were of high risk and had received mechanical and chemical thromboprophylaxis during their inpatient stay. These complications were identified at least 3 months post-operatively. These findings help to more accurately counsel patients undergoing elective frame surgery on the risks of DVT/PE and also contribute to the discussion between surgeons about whether or not extended course chemical thromboprophylaxis would be of overall benefit.