Surgical, clinical, and radiological outcomes of occipitocervical fusion using the plate-screw-rod system with allograft in craniocervical instability.

OBJECTIVE: We evaluated surgical, clinical, and radiological outcomes of posterior occipitocervical fusion (OCF) using plate-rod-screw construct supplemented with allograft in cases of occipitocervical instability. STUDY DESIGN: This was a retrospective analysis of prospective collected data. METHODS: Data of 52 patients who underwent posterior OCF using plate-screw-rod construct supplemented with allograft at a single institute from 2009 to 2014 were analyzed. Demographics, clinical parameters (Visual Analog Score [VAS], ODI, and mJOA score), functional status (McCormick scale), radiological parameters - mean atlantodens interval, posterior occipitocervical angle, occipitocervical 2 angle, and surgical parameters (operative time, blood loss, hospital stay, and fusion) with complications were evaluated. RESULTS: The mean age of the patients was 54.56 ± 16.21 years with male: female was 28:24. The mean operative time was 142.2 min (90-185 min) and mean blood loss was 250.8 ml. The mean duration of hospital stay was 6.7 days and mean follow-up period was 65.17 ± 5.39 months. There was significant improvement in clinical parameters (modified JOA score, VAS, and Oswestry Disability Index values) postoperatively. Forty patients showed recovery in neurological status at least in Grade 1 in McCormick scale with no neurological deterioration in any patient. Furthermore, radiological parameters at cervicomedullary junction got into acceptable range. Implant-related complications noted in 1 patient and 1 patient had vertebral artery injury. We had dural tear in 3 patients and infection in 2 patients. Fusion was achieved in 46 cases with mean time for fusion was 11.039 months. CONCLUSION: Patients with occipitocervical instability can successfully undergo posterior OCF using plate-screw-rod construct supplemented with allograft with high fusion rate, good clinical and functional outcomes, and low complication rate.

The intense desire for healthy limb amputation: A dis-proprioceptive neuropsychiatric disorder.

BACKGROUND: The first mention of a condition in which apparently nonpsychotic individuals have a strong, unrelenting desire to amputate ≥1 of their healthy limbs was published nearly 4 decades ago. Once dismissed as a paraphilia, the condition in recent years has been re-investigated with neurologic testing and imaging, yielding evidence suggesting it may be attributable to a neuroanatomical anomaly. METHODS: A literature review of data was conducted of recently published studies with pinprick testing, magnetic resonance imaging (MRI)/functional MRI imaging, magnetoencephalography, and interviews of individuals with a desire for limb amputation. RESULTS: Published literature on this condition features studies with a limited number of participants. However, the results indicate that affected individuals predominantly desire amputation of the left lower limb, and correspondingly, usually have changes in cortical thickness in the right parietal lobe. CONCLUSIONS: Further investigation of this condition is warranted, particularly, more research into the precise nature of the anomalous neuroanatomy, biopsychosocial background of those with the condition, and longitudinal perspective of the childhood onset and evolution of symptoms. Large sample studies involving a collaborative effort across multiple sites are required.

Giant Cell Tumor Presenting as A Spindle Shaped Tumor Arising From the Costovertebral Junction at D7, d8, d9 Levels.

INTRODUCTION: Giant cell tumor accounts for 5 to 9 percent of all primary bony tumors. Giant cell tumors are usually found in the long bones, most often the distal femur, proximal tibia, distal radius and rarely arising from the ribs. In this paper, we describe a case of giant cell tumor presented at an unusual location of the costovertebral junction as a dumbbell shaped tumor. CASE REPORT: Authors report a case of a 27 year old male patient with a giant cell tumor arising from the costovertebral junction at D7, D8, and D9 levels compressing the cord. Well-defined osteolysis with nonsclerotic borders were visualized on radiographs and CT scan images. Intermediate signal intensity on T1 sequences and central high signal and peripheral intermediate signal intensity on T2 sequences was visualized on MRI images. CT guided biopsy was reported as a moderately vascular lesion with spindle cell neoplasm suggestive of schwannoma. The cord was decompressed, tumor mass was surgically resected and stabilization with instrumentation was done. Histopatholgy was suggestive of giant cell tumor. CONCLUSION: Giant cell tumor may be included in the differential diagnosis in a well-defined lytic lesion when involving the costovertebral junction presenting as a spindle cell tumor on biopsy reports.