Atlantoaxial dislocation with associated type II odontoid fracture in adolescent with cervical spondylitis tuberculosis: A case report.

INTRODUCTION AND IMPORTANCE: Atlantoaxial dislocation is a loss of joint stability between the C1 (atlas) and C2 (axis) spine and could be associated with type II odontoid fracture. In a few previous studies, atlantoaxial dislocation with odontoid fracture has been reported to be the complication of upper cervical spondylitis tuberculosis (TB). CASE PRESENTATION: A 14-year-old girl came with sudden neck pain and difficulty moving her head that has worsened in the last 2 days. There was no motoric weakness in her limbs. However, tingling in both hands and feet was felt. X-ray examination showed atlantoaxial dislocation with odontoid fracture. Traction and immobilization using Garden-Well Tongs obtained the reduction of the atlantoaxial dislocation. Transarticular atlantoaxial fixation using cerclage wire and cannulated screw with an autologous graft from the iliac wing was performed through the posterior approach. A postoperative X-ray showed stable transarticular fixation with excellent screw placement. CLINICAL DISCUSSION: The application of Garden-Well tongs as a treatment for cervical spine injury has been documented in the previous study with a low rate of complications such as pin loosening, the asymmetrical position of the pin, and superficial infection. The reduction attempt did not significantly improve Atlantoaxial dislocation (ADI). Thus surgical treatment of atlantoaxial fixation using cannulated screw and c-wire with the application of an autologous bone graft is performed. CONCLUSION: Atlantoaxial dislocation with an odontoid fracture in cervical spondylitis TB is a rare spinal injury. The use of traction with surgical fixation is needed to reduce and immobilize atlantoaxial dislocation and odontoid fracture.

Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oswestry Disability Index.

PURPOSE: The Oswestry Disability Index (ODI) is one of the most common patient-reported outcome measures used for low back pain (LBP). Since it was not available in Indonesian, this study aimed to perform a cross-cultural adaptation of ODI to Indonesian and evaluate its psychometric properties. METHODS: We performed a cross-cultural adaptation of ODI v2.1a into Indonesian language (ODI-ID) and determined its internal consistency, test-retest reliability, measurement error, confirmatory factor analysis, floor-ceiling effect, and construct validity by hypotheses testing of its correlation with Short Form-36 (SF-36) and visual analog scale (VAS). Adults (> 17 years of age) diagnosed with low back pain were included. RESULTS: A total of 96 subjects were included in this study. The original ODI questionnaire was translated into an Indonesian version and showed a good internal consistency (Cronbach's alpha = 0.90) and good reliability (intraclass correlation = 0.97). The standard error of measurement values of 3.35 resulted in a minimal detectable change score of 9. Nine out of nine (100%) a priori hypotheses were met, confirming the construct validity. A strong correlation was found with the physical component of SF-36 (0.77 and 0.76 for pain and physical function, respectively) and VAS (0.79). Confirmatory factor analysis resulted in a poor but significant fit to the original one-factor structure and the static-dynamic two-factor structure. Floor-ceiling effects were not found. CONCLUSIONS: The Indonesian version of ODI displayed similar reliability, validity, and psychometric characteristics to the original ODI. This questionnaire will be a suitable instrument for assessing LBP-related disability for Indonesian-speaking patients.

Minimally invasive technique for the abscess drainage in lumbosacral tuberculosis using arthroscopy sheath: A case report.

INTRODUCTION: Spinal tuberculosis usually affects the thoracolumbar spine, with only 2-3% involving the lumbosacral region. Lumbosacral tuberculosis can lead to the formation of a presacral abscess. For drainage of the spinal abscess, the presacral region is one of the problematic regions to perform. Minimally invasive surgery (MIS) is an essential clinical technique for the debridement of the spinal abscess in order to decrease the morbidity acquired by the patient. We presented a case of lumbosacral tuberculosis treated with abscess evacuation using the MIS technique. PRESENTATION OF CASE: A 28-year-old male came with the chief complaint of back pain and a lump in the right groin area for four months before admission. Physical examination showed a lump and bilateral positive straight leg raising. Preoperative Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) scores showed moderate disability and normal function, respectively. Radiologic examinations showed signs of lumbosacral tuberculosis. The patient underwent abscess evacuation using MIS of presacral approach as described for axial lumbar interbody fusion (AxiaLIF), and improvement in ODI score was noted. DISCUSSION: A presacral approach, as what we performed, is a simple approach that can reach the location of the abscess by using fluoroscopic guidance. Abscess evacuation was confirmed by the presence of clear fluid, which indicated that the caseous material had been removed thoroughly, and also, as the clear fluid was no longer noticed. CONCLUSION: The success of this approach depends on the time of surgery. When surgery is delayed, the granulation tissue has been formed, making minimally invasive techniques for surgical evacuation much more difficult.

Recurrent traumatic atlantoaxial rotatory subluxation: Case report.

INTRODUCTION: Atlantoaxial rotatory subluxation (AARS) is not uncommon in paediatric emergencies, however, the complications might be fatal. Long onset before presentation is correlated with higher recurrence and persistent deformity. There is no consensus on the treatment of AARS yet. Selected patients may benefit from conservative approaches; however, retention might be difficult, and subluxation may recur. PRESENTATION OF CASE: A 6-year-old boy was admitted to our institution with AARS for three months before admission. Typical Cock-Robin position was observed. Computed tomography (CT) indicated AARS Fielding and Hawkins grade III. We treated the case conservatively by closed reduction and cervical traction using Gardner-Wells tongs. However, poor compliance resulted recurrence of subluxation, so we decided to fuse the atlantoaxial joint using transarticular screws, posterior wiring, and autologous bone grafting. Posterior fusion resulted in a satisfactory outcome, in which the wound healed accordingly. Six months of follow up examination revealed normal motoric and sensory function. The patient was able to perform daily activities with no significant issues. DISCUSSION: Patients with fixed deformity of more than three weeks have a higher rate for recurrence or persistent deformity, as reduction is harder and difficult to maintain. The use of posterior wiring alone is limited in maintaining reduction, while using transarticular screws alone is considered better in maintaining reduction; however, not providing it. CONCLUSION: The use of posterior cervical fusion using C-wire, transarticular screws, and autologous bone grafting may be applied in recurrent case of AARS to ensure adequate reduction and fixation of the atlantoaxial joint.