Reliability and Validity of the Adapted Nepali Version of the AO Spine Patient Reported Outcome Spine Trauma.

BACKGROUND: The AO Spine Patient Reported Outcome Spine Trauma has been validated in English and Dutch language, however, there is an absence of a translated and validated version in Nepali language. The purpose of this study was to translate the AO Spine Patient Reported Outcome Spine Trauma into Nepali and adapt cross-culturally as outlined by established guidelines, as well as test its psychometric properties among Nepali speaking spine trauma patients. METHODS: Patients were recruited from two Nepali centers as a cross-sectional multicenter validation study. The English version of AO Spine Patient Reported Outcome Spine Trauma was translated and cross-culturally adapted into Nepali language following international guidelines. Next to AO Spine Patient Reported Outcome Spine Trauma also the EQ-5D-3L was filled out by the patients for concurrent validity. Descriptive statistics were used to analyze the patient characteristics. Assessment of measurement properties included content validity (floor and ceiling effects), internal consistency (Cronbach's ? and item total-correlation coefficients) and test-retest reliability by the Bland-Altman plot and Intraclass Correlation Coefficients. Spearman correlation tests were performed within the items and in correlation to EQ-5D-3L. RESULTS: Sixty two spine trauma patients completed the instrument with a mean time of 6.8 minutes. The translated version showed good content validity with no floor and ceiling effects. The internal consistency was excellent with a Cronbach's ? of 0.95. The Spearman correlations within the AO Spine Patient Reported Outcome Spine Trauma items were 0.07 - 0.65 and the test-retest analysis showed excellent results with an Intraclass Correlation Coefficients value of 0.95 (CI 0.93 - 0.97). Inverse correlation was observed between Nepali AO Spine PROST with EQ-5D-3L components. CONCLUSIONS: The Nepali version of AO Spine Patient Reported Outcome Spine Trauma demonstrated excellent validity and reliability results for measuring patient-reported outcomes of spine trauma patients.

Spinal Intradural Intramedullary Mature Cystic Teratoma in a Young Adult: A Rare Tumor.

Intradural mature teratomas are spinal tumors containing all the germinal layers and rarely present in adulthood. This study describes an unusual case of intradural mature teratoma in a 19-year-old male who presented with persistent lower limb pain and difficulty in micturition. The magnetic resonance imaging (MRI) scan showed heterogeneously enhancing intramedullary mass in the L3-L4 vertebral region and was associated with tethering of the spinal cord. Scalloping of the posterior aspect of vertebral body and narrowing of the pedicles were present. Subtotal excision of the tumor was done because of its adherence to the conus. Attempt to completely excise such adherent intramedullary tumors can lead to permanent neurological deficits. The tissue was sent for histopathological examination which showed tissue from all the three germinal layers confirming the diagnosis. The patient showed improvement of symptoms following the surgery. This study also compared the literature of similar cases and the treatments available for this disease.

Closed internal degloving associated with a thoracolumbar burst fracture: a case report.

Internal degloving injuries are rare in association with thoracolumbar fractures. A high index of suspicion is warranted to identify and debride such lesions to prevent infection, which can be disastrous in the presence of spinal hardware. Whether such lesions should be routinely repaired is probably dependent on the extent of avulsion.

Neuroarthropathy of the hip following spinal cord injury.

We present the case of a 33-year-old male who sustained a burst fracture D12 vertebrae with spinal cord injury (ASIA impairment scale A) and a right mid-diaphysial femoral shaft fracture around 1.5 years back. The patient reported 1.5 years later with a swelling over the right buttock. Arthrotomy revealed serous fluid and fragmented bone debris. The biopsy showed a normal bony architecture with no evidence of infection and malignant cells. Hence, a diagnosis of Charcot's hip was made. Charcot's neuroarthropathy of the feet is a well-recognized entity in the setting of insensate feet resulting from causes such as diabetes or spina bifida. Although Charcot's disease of the hips has been described, it is uncommon in association with spinal cord injury, syphilis and even with the use of epidural injection. The present case highlights the fact that neuroarthropathy of the hip can occur in isolation in the setting of a spinal cord injury, and this can lead to considerable morbidity.

Epidemiology of surgical admissions to a children's disability hospital in Nepal.

BACKGROUND: The goal of this retrospective review was to characterize the spectrum of surgical admissions to a tertiary hospital specializing in musculoskeletal conditions in children and adolescents in Nepal. METHODS: We reviewed hospital records from 1996 to 2006 to categorize all major surgical procedures. Additional information collected included diagnosis, patient age, gender, and home district. RESULTS: Of 7,556 major surgical procedures performed from 1996 to 2006, 91% could be placed within the following categories: congenital (n = 2,984; 38%), burn contracture (n = 1,400; 19%), posttraumatic (n = 1,047; 14%), neuromuscular (n = 750; 10%), and infection (n = 731; 10%). The most common diagnosis was congenital clubfoot, which accounted for 2,348 cases (31%). Thirty-three percent of cases (n = 2,447) involved injuries (burns, fractures, dislocations). While burns most commonly involved the upper extremity, fractures in the elbow region were the most frequent posttraumatic problem. The most common neuromuscular diagnosis was poliomyelitis. The sequelae of musculoskeletal sepsis represented 731 cases (10%), most commonly chronic osteomyelitis. Other diagnoses termed miscellaneous included angular deformities of the lower extremities, scoliosis and other spinal deformities, hip dysplasia, and tumors. CONCLUSIONS: The majority of surgical pathology involved injuries and congenital problems (mainly clubfoot). The presentation was delayed in most patients, and in such cases, the treatment is more complex and costly, and the desired functional outcome is difficult to achieve. In addition to preventive measures, morbidity cases could have been reduced by the timely provision of services at the primary referral level. Strengthening the delivery of basic orthopedic services at primary health care facilities may eliminate or reduce the need for complex reconstructive procedures and diminish the likelihood of permanent disability in our population.

Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age.

UNLABELLED: Although the Ponseti method has been effective in patients up to 2 years old, limited information is available on the use of this method in older patients. We retrospectively reviewed the records of 171 patients (260 feet) to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 1 and 6 years. A mean of seven casts was required, and there were no differences in the number of casts between the different age groups. Two hundred fifty (95%) of the 260 feet were treated surgically for residual equinus after a plateau in casting, and procedures included percutaneous tendo-Achilles release (n = 205 [79%]), open tendo-Achilles lengthening (n = 8 [3%]), posterior release (n = 21 [8%]), and extensive soft tissue release (posteromedial release, n = 16 [6%]). The mean dorsiflexion after removal of the last cast was 12.5 degrees for the entire group and was greater in 1 year olds compared with 3 year olds. Although all patients achieved a plantigrade foot, the importance of the mild loss of passive dorsiflexion remains to be determined. An extensive soft tissue release was avoided in 94% of patients using the Ponseti method. We intend a followup study to ascertain whether the correction is maintained. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Ilio-lumbar fixation--the Amrita technique.

STUDY DESIGN: Surgical technique description. OBJECTIVE: To describe a surgical technique of ilio-lumbar fixation with iliac screws, which attempts to overcome some of the current limitations and technical difficulties associated with this surgery. SUMMARY OF BACKGROUND DATA: The iliac screw technique, which is the most commonly used method of ilio-lumbar fixation, has certain limitations that need special consideration. These include soft tissue coverage, improving the strength of distal anchorage, reducing hardware prominence, avoiding complex 3-dimensional rod contouring, preventing neurologic injury, and acetabular violation. MATERIALS AND RESULTS: Over the past 5 years, we have used our technique in 8 patients (4 sacral tumors, 2 fracture dislocations, and 2 spinal tuberculosis). In 6 cases, the sacrum was not available for anchoring and hence was bypassed. The follow-up ranged from 3 to 54 months, and 5 patients had resumed normal activities. In 7 cases, the wound healed primarily and the solitary wound failure was in a previously irradiated skin. Other complications like neurologic deficit secondary to the procedure, acetabular violation, and implant failure were not encountered. CONCLUSIONS: Our technique of ilio-lumbar fixation provides a stable and simple alternative to reconstruct potentially devastating instability of the lumbosacral junction. The 2 iliac screws, when used as described, make the procedure technically easier, reduce the hardware prominence without compromising the stability to construct and provide adequate bone graft.