Pubic Symphysis Tuberculosis Recurrence - A Rare Case Report and Literature Review.

Introduction: Tuberculosis (TB) of pubic symphysis is an extremely uncommon condition accounting <1% of all musculoskeletal TB. Further recurrence of TB of symphysis pubis is a rare clinical scenario requiring a high level of suspicion for diagnosing the condition. Recurrence of tuberculosis can occur either be due to relapse of the original infection or reinfection due to exogenous Mycobacterium tuberculosis strain. There have only been nine case reports on TB of the pubic symphysis in the last three decades and only 40 patients were identified in English language medical literature so to the best of our knowledge this is the first case report on the recurrence of TB of pubic symphysis. Case Report: A 26-year-old female patient presented with pain over symphyseal area for 2 months. Laboratory and radiological investigations were suggestive of TB of symphysis pubis. She was started on oral, category I anti-tubercular therapy (ATT) from DOTS center. Patient on improvement in symptoms discontinued taking ATT after 6 months. About 7 months after stopping ATT, she again presented with pain over symphyseal area and difficulty in walking. Laboratory, radiological investigation, and biopsy were obtained to rule out multidrug-resistant (MDR) TB. The patient improved on 12 months' oral daily ATT regime (HRZES2+HRZE4+HRE6). She was followed up for another 1 year with clinical examination and laboratory investigation after stopping ATT. At present, she is asymptomatic with no signs of recurrence after 1 year of completion of treatment. Conclusion: ATT intake should be continued for 12 months for musculoskeletal TB for preventing recurrence. The biopsy needs to be taken from the affected region in recurrence TB to rule out MDR.

Spondyloptosis at Subaxial Cervical Spine with Minimal Neurological Compromise and Complete Recovery: A Rare Case Report.

Introduction: Subaxial cervical spine (C3-7) injuries are among the most common and potentially most devastating injuries involving the axial skeleton. The treatment of fracture dislocations of the cervical spine still varies. Early operative treatment has gained increasing acceptance. This case report will discuss a case of subaxial cervical spine fracture dislocation and spondyloptosis with minimal neurological compromise and after reduction and stabilization, complete recovery of neurological functional was achieved. Case Report: A 26-year-old male patient presented to emergency department with history of road traffic accident with injury to his neck having complain of severe neck and shoulder pain and weakness in the right upper limb. On clinical and radiological evaluation, it was diagnosed a case of high-grade anterolisthesis C5 over C6 (spondyloptosis) with neurological compromise. Surgical intervention was done within 48 h with complete neurological recovery. Conclusion: Satisfactory clinical and good long-term outcome can be obtained in fracture dislocation of subaxial cervical spine by anterior approach, discectomy, and anterior cervical plating.

MRI-Based Morphometric Study Regarding Operative Windows of Oblique Lumbar Interbody Fusion in Indian Population.

BACKGROUND: The novel Oblique lumbar interbody fusion [OLIF] technique has been proposed as a solution to approach related complications of anterior lumbar interbody fusion [ALIF] and lateral lumbar interbody fusion [LLIF]. There exists no study concerning morphological evaluation of retroperitoneal oblique corridor for the Oblique lumbar interbody fusion (OLIF) technique in the Indian population. The aim of our study was (a) to measure magnetic resonance imaging (MRI) based anatomic parameters concerning OLIF operative windows from L2-L3 to L4-L5 level (b) to determine the feasibility of this technique following MRI-based morphometric evaluation in the Indian population. MATERIAL AND METHODS: We did retrospective MRI analysis of 307 consecutive patients following our exclusion criteria. Bare window, psoas major window and psoas major width were measured from axial T2 MRI image taken at mid disc level from L2-L3 to L4-L5 levels. RESULTS: The mean bare window size was largest at L2-L3 (1.39 cm) level followed by L3-L4 and L4-L5 level (1.28 and 0.62 cm respectively), and differences between them were statistically significant (P < 0.001). Females had statistically significant larger bare windows at L2-L3 and L3-L4 level than males (P < 0.001). With increasing age, there was a significant increase in bare window size at each level (P < 0.001). The mean psoas major window (PMO) and mean psoas major width (PMI) were largest at L4-L5 level (PMO = 1.27 cm, PMI = 3.61 cm) followed by L3-L4 and L2-L3 level (L3-L4: PMO = 1.19 cm, PMI = 2.36 cm; L2-L3: PMO = 0.88 cm, PMI = 1.39 cm), and differences among each level concerning both parameters were statistically significant (P < 0.001). Both parameters (PMO, PMI) were significantly larger in males than females at each level (P < 0.001). CONCLUSION: The OLIF technique is well suited for lumbar interbody fusion at L2 -L3 and L3-L4 level in the Indian population irrespective of age and sex. At L4-L5 level, overall 17.9 percent of the study population were unsuitable for this technique due to inaccessible bare window. In our opinion, this level may be better suited for OLIF approach in the elderly Indian population, especially for surgeons who are beginning to attempt this technique in their surgical practice. Preoperative MRI evaluation for the OLIF is important to assess its feasibility, as there exists significant age and gender differences in the Indian population for anatomic parameters concerning OLIF operative windows from L2-L3 to L4-L5 levels. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00393-7.