Curve severity and apical vertebral rotation and their association with curve flexibility in adolescent idiopathic scoliosis.

PURPOSE: To determine the association between coronal Cobb's angle and Nash-Moe index in patients with adolescent idiopathic scoliosis. We also attempted to determine whether apical vertebral derotation depended upon the curve flexibility. OVERVIEW OF LITERATURE: The three-dimensional nature of adolescent idiopathic scoliosis (AIS) is well established. Knowledge of all components of this complex deformity is essential to formulate effective treatment strategies. Though the importance of quantifying all the components of the deformity, in AIS, has been analysed in detail, very few studies have been done to ascertain the relationship between the coronal plane deformity and apical vertebral rotation. METHODS: Digitalised standing and supine stretch anteroposterior (AP) radiographs of 158 patients with AIS were analysed. The standing and supine stretch AP radiographs were compared to calculate the percentage reduction of Cobb's angle to determine curve flexibility. The derotation of the apical vertebra on application of traction was also noted. The one-way repeated ANOVA was used to determine the association between Cobb's angle and Nash-Moe index. The independent sample t test was used to determine whether a statistically significant difference was present, in the age of the patient, severity of the curve and percentage reduction of Cobb's angle between those curves that derotated and those that did not, when stretched. RESULTS: The one-way repeated ANOVA revealed an association between Cobb's angle and Nash-Moe index on the standing and supine AP stretch radiographs (P < 0.01). The Independent sample t-test showed a statistically significant difference in percentage reduction of Cobb's angle between those curves that derotated compared to those that did not, on stretch (P < 0.01). CONCLUSIONS: This study demonstrates that there is an association between apical vertebral rotation and the coronal plane deformity. It also demonstrates that flexible curves derotate to a greater extent compared to rigid curves, when stretched.

Vertebral, intraspinal and other organ anomalies in congenital scoliosis.

AIMS: This study was undertaken to describe the pattern of vertebral, intraspinal and other organ anomalies in patients with congenital scoliosis and to determine the correlation between them. METHODS: Complete medical and radiological records of 227 consecutive patients with congenital scoliosis were analysed. The radiographs were examined for type of vertebral anomaly, location and severity of deformity. The median curve progression index (MCPI) was calculated in 198 patients. The magnetic resonance imaging (MRI) of the whole spine was analysed to detect the presence of cord abnormalities. The presence of other organ-system anomalies was also noted. The independent sample t test was used to compare severity of deformity between those with and without cord anomalies. The Chi-square test was used to compare frequency of cord abnormalities in different vertebral and organ-system anomalies. RESULTS: Hemivertebra with contralateral bar had the highest MCPI, while block vertebrae and wedge vertebrae had the lowest MCPI. Forty-eight patients had 83 cord anomalies. There was no statistically significant difference in severity of deformity, between those with and without cord anomalies. Failure of segmentation had the highest frequency of cord anomalies (p = 0.01). There was no significant difference in the frequency of cord anomalies between those with and without other organ defects. CONCLUSION: Curve progression can be predicted by the underlying vertebral abnormalities. However, it cannot predict cord and other organ-system anomalies. Thus, all patients with congenital scoliosis must undergo MRI of the spine, electro- and echocardiography and ultrasonography of the abdomen to detect occult abnormalities and optimize the patient prior to deformity correction.

Linkage disequilibrium mapping for grain Fe and Zn enhancing QTLs useful for nutrient dense rice breeding.

BACKGROUND: High yielding rice varieties are usually low in grain iron (Fe) and zinc (Zn) content. These two micronutrients are involved in many enzymatic activities, lack of which cause many disorders in human body. Bio-fortification is a cheaper and easier way to improve the content of these nutrients in rice grain. RESULTS: A population panel was prepared representing all the phenotypic classes for grain Fe-Zn content from 485 germplasm lines. The panel was studied for genetic diversity, population structure and association mapping of grain Fe-Zn content in the milled rice. The population showed linkage disequilibrium showing deviation of Hardy-Weinberg's expectation for Fe-Zn content in rice. Population structure at K = 3 categorized the panel population into distinct sub-populations corroborating with their grain Fe-Zn content. STRUCTURE analysis revealed a common primary ancestor for each sub-population. Novel quantitative trait loci (QTLs) namely qFe3.3 and qFe7.3 for grain Fe and qZn2.2, qZn8.3 and qZn12.3 for Zn content were detected using association mapping. Four QTLs, namely qFe3.3, qFe7.3, qFe8.1 and qFe12.2 for grain Fe content were detected to be co-localized with qZn3.1, qZn7, qZn8.3 and qZn12.3 QTLs controlling grain Zn content, respectively. Additionally, some Fe-Zn controlling QTLs were co-localized with the yield component QTLs, qTBGW, OsSPL14 and qPN. The QTLs qFe1.1, qFe3.1, qFe5.1, qFe7.1, qFe8.1, qZn6, qZn7 and gRMm9-1 for grain Fe-Zn content reported in earlier studies were validated in this study. CONCLUSION: Novel QTLs, qFe3.3 and qFe7.3 for grain Fe and qZn2.2, qZn8.3 and qZn12.3 for Zn content were detected for these two traits. Four Fe-Zn controlling QTLs and few yield component QTLs were detected to be co-localized. The QTLs, qFe1.1, qFe3.1, qFe5.1, qFe7.1, qFe8.1, qFe3.3, qFe7.3, qZn6, qZn7, qZn2.2, qZn8.3 and qZn12.3 will be useful for biofortification of the micronutrients. Simultaneous enhancement of Fe-Zn content may be possible with yield component traits in rice.

The extended posterior approach for resection of sacral tumours.

PURPOSE: The conventional posterior approach is mostly advocated for excision of sacral tumours below S2. We describe an operative technique of single-stage en bloc resection of sacral tumours, extending up to S1, through an extended posterior approach. METHOD: Nine patients, who had undergone resection of sacral tumours, by the described technique formed the basis of this study. Four patients had chordomas, whereas schwannoma, neurilemmoma, giant-cell tumour, malignant paraganglioma and recurrent Ewing's sarcoma were seen in one patient each. They were followed up at regular intervals with a mean follow-up of 45.4 months. Perioperative complications, their functional and oncological outcomes at final follow-up were analysed. RESULT: None of the patients had any perioperative complications like uncontrolled haemorrhage, injury to the rectum, deep vein thrombosis or pulmonary embolism. One patient had a superficial wound infection which subsided with regular dressing, and another patient developed a wound breakdown that required an additional flap procedure. At final follow-up, six patients were able to walk without any assistive devices, six patients had normal bladder function, and five patients had normal bowel function. Five patients did not have any recurrence at final follow-up, whereas two were alive with the disease and two had died. CONCLUSION: The reported technique allows en bloc resection of sacral tumours up to S1, through a posterior-only approach. It is less invasive with minimal morbidity. The functional and oncological outcomes are similar to those reported by other investigators. These slides can be retrieved from electronic supplementary material.

Minimally invasive plate osteosynthesis (MIPO) in AO/OTA type B displaced clavicle fractures.

INTRODUCTION: Open reduction and plate fixation is known to reduce chances of malunion and symptomatic nonunion in displaced middle-third clavicle fractures. However, this treatment modality is also associated with several complications, such as hardware irritation, numbness around the surgical scar, infection, nonunion and implant failure. The minimally invasive plate osteosynthesis (MIPO) technique may reduce these complications. OBJECTIVE: To study clinical, radiological and functional outcomes of MIPO in AO/OTA type B displaced clavicle fractures and report any complications. MATERIALS AND METHODS: A total of 22 patients underwent internal fixation of acute displaced AO/OTA type B clavicle fractures from Jan 2014 to Dec 2015 by MIPO using locking compression plates. Patients were followed up at a regular interval and assessed clinically and radiologically. The clavicle length difference was measured. Functional assessment was done at the end of 2 year using constant shoulder score (CSS) and disability of the arm, shoulder and hand score (Quick DASH) and complications if any were noted. RESULTS: All fractures united at a mean of 12.5 weeks. One (4.5%) patient had numbness around the surgical scar. None of the patients had wound-related complications. In four patients, hardware irritation was noted. The difference in clavicle length was not significant. All patients had excellent CSS and Quick DASH score at the final follow-up. CONCLUSION: Internal fixation of displaced AO/OTA type B clavicle fractures by MIPO showed high fracture union rates and good functional outcomes.

Single-stage anterior debridement, posterior instrumentation and global fusion in thoracic and thoracolumbar tubercular spondylodiscitis.

PURPOSE: The present study evaluated the clinical and radiological outcomes in patients with tuberculosis of the thoracic and thoracolumbar spine, treated by an operative technique in which anterior debridement with posterior instrumentation and global fusion was performed through a single-stage posterior approach. METHODS: Ninty-seven patients with spinal tuberculosis, between T1 and L1, in whom anterior debridement, bone grafting, with posterior instrumentation and fusion was performed through a single-stage posterior approach, with a minimum follow-up of 2 years, formed the basis of this study. During each follow-up, neurological recovery was assessed using modified American Spinal Injury Association grading, healing of the disease was assessed by appearance of sclerosis and interbody fusion and the degree of kyphotic deformity was analysed using the modified Konstam's angle. RESULT: Two hundred and twenty-six lesions were found in the radiographs of 97 patients with 28.9% of them having multiple lesions. The mean ± SD preoperative, post-operative, and 2-year follow-up kyphotic angle were 49.5 ± 18.4°, 22.6 ± 7.1° and 24.5 ± 7.6°, respectively, and showed significant kyphosis correction (P < 0.01). Sclerosis was seen as early as 3 months in 82(84.5%) patients whereas interbody fusion started appearing at the end of 6 months in 38.14% of patients and peaked at 1 year. All patients recovered neurologically, with no significant loss of kyphosis correction, at final follow-up. CONCLUSION: The surgical technique described in this study had favourable clinical and radiological outcomes. Early surgery helps in having a definitive diagnosis and detects the presence of drug-resistant strains.

Morphometry of the lower thoracic and lumbar pedicles and its relevance in pedicle fixation.

PURPOSE: To assess the pedicle morphology in the lower thoracic and lumbar spine in an Indian population and to determine the causes of pedicle wall violation by pedicle screws. METHODS: Computerised tomographic scans of 135 consecutive patients with thoracolumbar and lumbar spine fractures were prospectively analysed to determine the pedicle morphology. The transverse pedicle angle, pedicle diameter and screw path length at 527 uninjured levels were measured. Post-operative CT scans of 117 patients were analysed to determine the accuracy of 468 pedicle screws at 234 vertebrae. RESULTS: The lowest (mean ± SD) transverse pedicle width in the lower thoracic spine was 5.4 ± 0.70 mm, whereas in the lumbar spine it was 7.2 ± 0.87 mm. The shortest (mean ± SD) screw path length in lower thoracic pedicles was 35.8 ± 2.10 and 41.9 ± 2.18 mm in the lumbar spine. The mean transverse pedicle angle in the lower thoracic spine was consistently less than 5°, whereas it gradually increased from L1 through L5 from 8.5° to 30°. Forty-one screws violated the pedicle wall, due to erroneous angle of screw insertion. CONCLUSIONS: In the current study, pedicle dimensions were smaller compared to the Western population. In Indian patients, pedicle screws of 5 mm diameter and 30 mm length, and 6 mm diameter and 35 mm length can safely be used in the lower thoracic and lumbar spine, respectively. However, it is important to assess the pedicle morphology on imaging prior to pedicle fixation.

Pedicle screw fixation in thoracolumbar and lumbar spine assisted by lateral fluoroscopic imaging: a study to evaluate the accuracy of screw placement.

BACKGROUND: The purpose of this study was to evaluate the accuracy of pedicle screw placement, its advantages, and limitations in posterior instrumentation of thoracolumbar and lumbar burst fractures assisted only by lateral fluoroscopic imaging. MATERIALS AND METHODS: Pre- and postoperative computerized tomographic (CT) scans of 117 patients with thoracolumbar and lumbar burst fractures, who underwent posterior instrumentation with pedicle screw fixation, were prospectively analyzed. Accuracy of screw placement, reconstruction of the vertebral height, and correction of the kyphotic angle were studied. Position of the pedicle screws were determined, and cortical breach was graded on the postoperative axial CT scans. Percentage of vertebral height reconstruction and kyphotic angle correction were calculated from the postoperative midsagittal CT scans. RESULTS: Four hundred and sixty-eight pedicle screws in 234 motion segments were included in this study. 427 screws were centrally placed with an accuracy rate of 91.24%. Out of the 41 (8.76%) screws that breached the pedicle wall, 32 (6.84%) screws had violated the medial wall, while 9 (1.92%) screws breached the lateral wall. There were no "air-ball" screws. No screw penetrated the anterior wall. Postoperatively, none of the patients deteriorated neurologically, and no screw required revision. Postoperatively, there was significant restoration of vertebral height and correction of kyphosis (P < 0.05). CONCLUSION: Pedicle fixation performed on a Relton-Hall frame is relatively simple and, when performed carefully using only lateral fluoroscopic imaging, has a lower potential for complications due to cortical breach.

Morphometric study of the orientation of lumbar zygapophyseal joints in a South Indian population.

PURPOSE: To determine the orientation of lumbar zygapophyseal joints and prevalence of facet tropism (FT) identified by computerized tomographic (CT) scans. METHODS: In a cross-sectional study, 124 CT scans of patients with spinal injuries, seen between 2011and 2015, were retrospectively studied. A total of 566 uninjured motion segments were analysed. The right and left zygapophyseal joint angles (ZJAs) from L1-L2 to L5-S1 were measured on axial sections at uninjured levels. The absolute difference between the right and left ZJA was calculated to determine the prevalence and severity of FT at each level. RESULTS: The mean ZJA (mean ± SD) at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1 was 23.55 ± 7.21, 27.97 ± 6.95, 39.47 ± 6.07, 48.32 ± 6.38 and 53.45 ± 6.67, respectively. Prevalence of FT at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1 was 22.42%, 25%, 27.19%, 47.82% and 38.5%, respectively. One-way repeated analysis of variance test showed a statistically significant difference in mean ZJA ( p < 0.05) and prevalence of FT ( p < 0.05) at different levels of the lumbar spine. CONCLUSIONS: This study confirms that ZJA is not the same at different levels of the lumbar spine. The mean ZJA progressively increases from L1-L2 to L5-S1. This could explain the greater range of movements in the lumbar spine at the lower levels. The higher prevalence of FT at L4-L5 and L5-S1 seen in this study could explain the greater incidence of disc prolapse and other degenerative disorders at these levels.

Management of non-traumatic avascular necrosis of the femoral head-a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting.

BACKGROUND: The purpose of this study was to compare the clinical and radiological outcomes of multiple small diameter drilling and core decompression with fibular strut grafting in the management of non-traumatic avascular necrosis (AVN) of the femoral head. MATERIALS AND METHODS: Outcomes of patients with AVN treated by multiple small diameter drilling (group 1) were compared retrospectively with patients treated by core decompression and fibular grafting (group 2). Harris hip score (HHS) was used to assess the clinical status pre- and postoperatively. Modified Ficat and Arlet classification was used to assess the radiological stage pre- and postoperatively. RESULTS: Forty-six patients (68 hips) were included in this study. Group 1 consisted of 33 hips, and group 2 consisted of 35 hips. In stages I and IIB, there was no statistically significant difference in the final HHS between the two groups. However, in stages IIA and III, hips in group 2 had a better final HHS (P < 0.05). In terms of radiographic progression, there was no statistical difference between hips in stages I, IIA and stage IIB. However, in stage III, hips belonging to group 2 had better results (P < 0.05). Kaplan-Meier survivorship analysis showed better outcome in group 2 in stage III (P < 0.05). CONCLUSIONS: Hips with AVN in the precollapse stage can be salvaged by core decompression with or without fibular grafting. Multiple small diameter drilling is relatively simple and carries less morbidity and hence preferred in stages I and II. However, in stage III disease, core decompression with fibular strut grafting gives better results.

Anthropometric estimation of body height after surgical correction of scoliosis.

PURPOSE: To estimate the height loss in 28 patients who had undergone surgery for scoliosis before skeletal maturity. METHODS: 28 women patients aged 11 to 18 (mean, 15) years underwent Harrington instrumentation, segmental sublaminar wiring, and posterior spinal fusion for idiopathic scoliosis. The patients' mean age at menarche was 13 (range, 10-16) years. Pre- and post-operative radiographs of the spine were taken to determine curve types, the Cobb angle, and the degree of correction. The standing and sitting heights were measured using a flexible steel tape, and the expected standing and sitting heights were derived using formulae. RESULTS: At the final follow up, the mean patient age was 20 (16-32) years. The mean standing height was 155.2 cm and the mean sitting height was 77.4 cm. Using the formulae, the mean expected standing height was 158.4 cm, indicating height loss of 3.2 cm (t=4.6, p=0.0001), and the mean expected sitting height was 79.9 cm, indicating height loss of 2.6 cm (t=3.84, p=0.001). The curve types of the 28 patients were sub-divided as thoracic (n=7), thoracolumbar (n=18), and double major (n=3). Patients with thoracolumbar curves achieved better correction and less loss of standing and sitting heights. Percentage loss of standing and sitting heights were not correlated with the apex of the curve or the degree of correction. CONCLUSION: Height loss after surgery was acceptable in comparison with height loss associated with progression of scoliosis without surgery.

Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study.

STUDY DESIGN: Prospective study. OBJECTIVES: In a prospective study, 45 consecutive cases of cervical spinal cord injury without radiographic evidence of trauma (SCIWORET) who were treated non-operatively were analyzed to correlate the magnetic resonance image findings with the initial neurological deficit and the extent of neurological recovery at 2 years. SETTING: University tertiary-care teaching hospital in South India. METHODS: The neurological status of patients who did not have any radiographic or computerized tomographic abnormality at the time of admission was assessed by ASIA Impairment Scale (AIS) modification of Frankel's grading. The spinal cord abnormality seen in the magnetic resonance imaging was noted. The neurological status at the end of 2 years was recorded. RESULTS: Twenty-seven of the 45 patients (60%) had cord oedema, 8 (17.77%) had cord contusion, 8 (17.77%) patients had a normal cord and 2 (4.44%) patients had cord swelling on the magnetic resonance image. Out of 27 patients who presented with cord oedema, 14 (31.11%) patients recovered from AIS D to AIS E and 6 (13.33%) patients did not recover and remained at AIS D. Seven (15.55%) patients who had a normal cord recovered completely to AIS E. Five (11.11%) patients who had contusion of the cord recovered up to AIS D. CONCLUSION: The initial neurological status correlates with magnetic resonance imaging findings. Subsequent neurological recovery is dependent on the type of cord damage and initial neurological status. The rate of recovery and the final motor outcome are inversely related to the length of cord involvement.

An analysis of clinicoradiological and histopathological correlation in tuberculosis of spine.

Two hundred and sixty-seven consecutive patients with clinical and radiological features suggestive of tuberculosis of the spine treated over a period of five years were analysed : (1) To assess how dependable clinical and radiological features are in establishing a diagnosis of spinal tuberculosis and (2) to identify other conditions which may have clinical and radiological features similar to those seen in patients with spinal tuberculosis. This retrospective case series analysis was done in a university teaching hospital in south India. The clinical presentation, radiological features and the erythrocyte sedimentation rate were correlated with the histopathological diagnosis on tissue obtained by open biopsy in 130 cases during surgery and in 137 cases by closed vertebral biopsy. One hundred sixty-six cases were histologically proved as tuberculosis and 74 proved to be non-tuberculous lesions. Twenty-seven cases in which the biopsy was inconclusive were excluded from the study. The study demonstrated that tuberculous lesions were commoner in younger patients and the lesion was more often in the paradiscal region as compared to non-tuberculous lesions. However, all other clinical and radiological variables were not significantly different to enable reliable identification of tuberculous lesions on the basis of clinical and radiological features alone. It is recommended that all vertebral lesions suspected to be of tuberculous origin not responding to empirical antituberculosis therapy should have a definitive histopathological diagnosis to facilitate appropriate treatment.

The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures.

A prospective study was designed to determine whether posterior instrumentation of the spine in thoracolumbar and lumbar burst fractures produces indirect decompression of the spinal canal leading to better remodeling and neurological recovery. The study was conducted in Kasturba Medical College Manipal, India. Sixty-eight consecutive cases of thoracolumbar and lumbar burst fractures were treated by posterior instrumentation, and approval from the hospital ethical committee was obtained. The degree of initial spinal canal compromise, indirect decompression, and remodeling were assessed from the computed tomography scans. The neurological status at the time of presentation and at final follow-up was assessed by the American Spinal Injury Association's modified Frankel's grading. The median canal compromise in patients with and without neurological deficit was 47.32 and 39.33%, respectively. The overall mean canal compromise at the time of admission, post-operative, and final follow-up were 47.37, 26.58 and 14.85%, respectively (P = <0.001). The median canal compromise in patients who recovered was 44.5% and in those with no neurological recovery was 55.85%. The median percentage of canal decompression achieved in patients who recovered was 22.15%, whereas it was 22% in those who did not recover. The median remodeling in recovered and non-recovered groups was 64.50 and 80%, respectively. None of these differences was statistically significant. This study shows that posterior instrumentation of the spine produces significant indirect decompression of the spinal canal and better remodeling. However, these factors may not improve the neurological recovery.

Chromatin-bound PCNA as S-phase marker in mononuclear blood cells of patients with acute lymphoblastic leukaemia or multiple myeloma.

OBJECTIVES: Proliferating cell nuclear antigen (PCNA) has often been used as a marker to aid assessment of tumour growth fraction. This paper addresses the question of whether it can be used as an S-phase marker, when the non-chromatin-bound form of the protein is removed by pepsin treatment. MATERIALS AND METHODS: Cytofluorometric measurements were carried out after immunofluorescence staining of PCNA and counterstaining of DNA. S-phase fraction was determined with the help of windows on PCNA versus DNA scattergrams, or mathematically from DNA histograms. RESULTS: S-phase fractions obtained using the two methods correlated well, but did not always agree, exact discrepancies depending on the mathematical model used for histogram analysis. CONCLUSIONS: Determination of S-phase fractions with the help of PCNA immunofluorescence staining is possible, and probably more reliable than calculation of S-fractions from DNA histograms. It thus offers an alternative to assays involving BrdU labelling in vivo.

Neurological deficit and canal compromise in thoracolumbar and lumbar burst fractures.

PURPOSE: To assess whether canal compromise determines neurological deficit in thoracolumbar and lumbar burst fractures. METHODS: 105 patients aged 17 to 60 (mean, 34) years who had burst fractures in the thoracolumbar (n=82) and lumbar (n=23) regions were included. Fractures were classified according to the Denis classification. The extent of spinal canal compromise was assessed by computed tomography, and the neurological status according to the modified Frankel grading for traumatic paraplegia. RESULTS: 19 (18%) of the patients had no neurological deficit. Of the remaining 86 (82%) with a deficit, 26 had complete paraplegia. The correlation between the type of the burst fracture and the severity of neurological deficit was not significant (Chi squared=10.57, p=0.835). The mean extent of spinal canal compromise in patients with deficits was 50%, whereas in patients with no deficit it was 36%. The difference between the extent of canal compromise and the severity of neurological deficit at the thoracolumbar and lumbar spine was not significant (p=0.08). Further subanalysis revealed a significant correlation at T11 and T12 (p=0.007) but not at the L1 (p=0.42) level. CONCLUSION: When studying neurological deficit, T11 and T12 injuries should be analysed separately from L1 injuries.

Use of antibiotic-loaded polymethyl methacrylate beads in the management of musculoskeletal sepsis--a retrospective study.

OBJECTIVE: To assess the use of antibiotic-loaded polymethyl methacrylate beads in the management of chronic osteomyelitis of different aetiologies: infected osteosynthesis, infected open fractures, and haematogenous osteomyelitis. METHODS: Records of 49 patients with chronic osteomyelitis who were treated at Department of Orthopaedics, Kasturba Medical College, from 1995 to 1999 were studied retrospectively. The diagnosis of chronic osteomyelitis was made on the basis of clinical and radiographic features. Of the 49 patients, 4 had haematogenous osteomyelitis, which later proved to be tuberculosis, and were thus excluded. Antibiotic-loaded acrylic beads were implanted in the remaining patients after thorough debridement. The implant was removed primarily in 16 patients with infected osteosynthesis, who then underwent decompression and sequestrectomy. All wounds were closed primarily. Peri-operative antibiotics were given for 7 days. Beads were removed at the end of 3 weeks followed by bone grafting in 26 patients. Patients were followed up for an average period of 3.7 years. RESULTS: The infective organisms were sensitive to gentamycin in 26 cases and resistant in 19 cases; 14 cases were sensitive to cefuroxime, 11 to cloxacillin, 8 to ampicillin, and 5 to cotrimoxazole. Seven cases were resistant to all antibiotics tested. Of the 19 patients with gentamycin-resistant infection, only one had a poor result. No adverse systemic side-effects such as ototoxicity or nephrotoxicity were seen. Infection did not recur in 39 patients, but 6 patients had low-grade persistent infection at the last follow-up visit. CONCLUSION: In chronic infections, especially those following osteosynthesis, antibiotic beads are a valuable adjuvant. The most valuable advantage is that the wound can be closed primarily, thereby reducing the incidence of nosocomial infections and requirement of nursing care.

Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise?

STUDY DESIGN: Prospective study. OBJECTIVES: Forty-five consecutive cases of thoracolumbar and lumbar burst fractures treated non-operatively were analyzed to correlate the extent of canal compromise at the time of injury with (i) the initial neurologic deficit and (ii) with the extent of neurological recovery at 1 year. The effect of spinal canal remodeling on neurological recovery was also analyzed. SETTING: University teaching hospital in south India. METHODS: The degree of spinal canal compromise and canal remodeling were assessed from computed tomography scans. The neurologic status was assessed by Frankel's grading. RESULTS: The mean canal compromise in patients with neurologic deficit was 46.2% while in patients with no neurological deficit it was 36.3%. The mean spinal canal compromise in patients with neurological recovery was 46.1% and 48.4% in those with no recovery. The amount of canal remodeling in patients who recovered was 51.7% and 46.1% in the patients who did not recover. None of these differences was statistically significant. CONCLUSION: This study shows that there is no correlation between the neurologic deficit and subsequent recovery with the extent of spinal canal compromise in thoracolumbar burst fractures.