Lumbosacral Transitional Vertebra among Patients Visiting the Department of Orthopaedics in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Lumbosacral transitional vertebra is a normal anatomical variant at the L5-S1 junction with an incidence as high as 4-36%. This alteration results in incorrect identification of vertebral segments leading to wrong surgery. The aim of the study was to find out the prevalence of lumbosacral transitional vertebra among patients visiting the department of orthopaedics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted from 11 September 2021 to 31 May 2022, after receiving ethical clearance from the Institutional Review Committee (Reference number: IRC-2021-9-10-09). The patients with plain radiographs of the lumbosacral spine (anteroposterior view) were assessed and evaluated by a fellow and consultant of the orthopaedic spine and classified as per Castellvi's radiographic classification. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1002 patients, lumbosacral transitional vertebra was detected in 95 (9.48%) patients (9.40-9.56, 95% Confidence Interval). Out of 95 (9.48%), patients with the lumbosacral transitional vertebra, 67 (70.53%) had sacralisation and 28 (29.47%) had lumbarization. The mean age of the patients at the time of the study included in the study was 41.6±15.12 years (range 18-85 years). The lumbosacral transitional vertebra was more common in females than males. According to the Castellvi classification, type IIa was the most common type 47 (49.47%). Conclusions: The prevalence of lumbosacral transitional vertebra was similar to other studies done in similar settings. Keywords: lumbar vertebrae; orthopedics; prevalence.

Misdiagnosis of "White Cord Syndrome" following posterior cervical surgery for ossification of the posterior longitudinal ligament: A case report.

BACKGROUND: Following decompressive cervical surgery for significant spinal cord compression/myelopathy, patients may rarely develop the "White Cord Syndrome (WCS)." This acute postoperative reperfusion injury is characterized on T2W MRI images by an increased intramedullary cord signal. However, it is a diagnosis of exclusion, and WCS can only be invoked once all other etiologies for cord injury have been ruled out. CASE DESCRIPTION: A 49-year-old male, 3 days following a C3-C7 cervical laminectomy and C2-T1 fusion for extensive cord compression due to ossification of the posterior longitudinal ligament (OPLL), developed acute quadriparesis. This new deficit should have been attributed to an intraoperative iatrogenic cord injury, not the WCS. CONCLUSION: Very rarely patients sustain postoperative significant/severe new neurological deficits attributable to the WCS. Notably, the WCS is a diagnosis of exclusion, and all other etiologies (i.e. intraoperative iatrogenic surgeon-based mechanical cord injury, graft/instrumentation extrusion, failure to adequately remove/resect OPLL thus stretching cord over residual disease, other reasons for continued cord compression, including the need for secondary surgery, etc.) of cord injury must first be ruled out.

Delayed asymptomatic retroperitoneal dislodgement into the pouch of Douglas of a TLIF cage: A case report and review of the literature.

BACKGROUND: Intraoperative anteropulsion of a transforaminal lumbar interbody fusion (TLIF) cage is infrequent but may have disastrous complications. Here, we present an 80-year-old female whose L5-S1 TLIF cage extruded anteriorly and later migrated into the pouch of Douglas (i.e. an anterior peritoneal reflection between the uterus and the rectum) posing potential significant risks/complications, particularly of a major vessel injury. Notably, this 80-year-old patient with degenerative lumbosacral scoliosis should have only undergone a lumbar decompression alone. CASE DESCRIPTION: An 80-year-old female underwent a two-level L4-L5 and L5-S1 TLIF to address lumbosacral canal stenosis with degenerative scoliosis. During the L5-S1 TLIF, intraoperative fluoroscopy showed the anterior displacement of the cage ventral to the sacrum. As she remained hemodynamically stable, the cage was left in place. The postoperative CT scan confirmed that the cage was located in the retroperitoneum but did not jeopardize the major vascular structures. Three months later, however, the cage migrated inferiorly into the pouch of Douglas. Although asymptomatic, general surgery and gynecology advised laparoscopic removal of the cage to avoid the potential for a major vessel/bowel perforation. However, the patient refused further surgery, and 3 years later remained asymptomatic. CONCLUSION: Anterior cage migration following TLIF has been rarely reported. In this case, an L5-S1 TLIF cage extruded anteriorly in an 80-year-old severely osteoporotic female and migrated 3 months later into the pouch of Douglas, posing the risk of a major vessel/bowel injury. Although surgical removal was recommended, the patient refused further surgery but remained asymptomatic 3 years later. Notably, the authors, in retrospect, recognized that choosing to perform a 2-level TLIF in an 80-year-old female reflected poor judgment.

Correlation between Radiological Outcome and Health Related Quality of Life after Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

BACKGROUND: Posterior spinal surgery for adolescent idiopathic scoliosis is aimed at correcting deformity and stopping deformity progression to improve the health related quality of life. The correlation between radiological outcome and health related quality of life is yet unclear. This study aimed to assess the correlation between radiological outcome and health related quality of life. METHODS: A descriptive cross-sectional study of 31 cases of adolescent idiopathic scoliosis who underwent posterior spinal surgery at our center from July 2013 to August 2019, was done. Radiological outcomes were measured by the Cobb's angle before and after surgery in standing whole spine X-ray and compared by paired t-test. Health related quality of life was measured by Scoliosis Research Society-30 questionnaire. Correlation between radiological outcomes and Scoliosis Research Society-30 and its domains were assessed by Pearson's correlation coefficient, and Spearman's rank correlation coefficient. RESULTS: There were 18 females (58.06%) and 13 males (41.93%) with a mean age of 14.81 years (range 12-18 years). Average post-operative follow-up was 37 months (range 6-82 months).The mean amount of deformity correction post-operatively was 460 (range 300-740). The mean of total SRS-30 score was 137.64±7.84. The post-operative Cobb angle correlated significantly with the mean total Scoliosis Research Society-30 score (p=0.046). Self-image/appearance and satisfaction with management correlated significantly with residual deformity and amount of deformity correction. Self-image/appearance and pain correlated significantly with satisfaction with management. Self-image/appearance had a significant positive correlation with mental health (p=0.004). CONCLUSIONS: Posterior spinal surgery for adolescent idiopathic scoliosis provided better radiological outcomes, and a positive correlation with health related quality of life. There was significant improvement of self-image/appearance and satisfaction after surgery, which in turn, improved mental health.