Minimally invasive transforaminal lumbar interbody fusion using bone cement-augmented pedicle screws for lumbar spondylolisthesis in patients with osteoporosis. Case series and review of literature.

BACKGROUND: Instrumentation in patients with osteoporosis is challenging. Bone cement-augmented fenestrated pedicle screw fixation is a new procedure for fixation in the osteoporotic bone; and, applying minimally invasive techniques to the above is a challenging and novel concept. AIMS: To evaluate the clinical and radiological outcome of minimally invasive spine surgery transforaminal lumbar interbody fusion (MIS-TLIF) in patients with spondylolisthesis and poor bone quality, performed with rigid instrumentation using bone cement [poly(methylmethacrylate)]-augmented fenestrated pedicle screws. SETTINGS AND DESIGN: Prospective, observational, single-center study. STATISTICAL ANALYSIS USED: Wilcoxon nonparametric test for paired samples with a level of significance of 0.05. METHODS: A clinical series of 25 patients with lumbar spondylolisthesis and osteoporosis who underwent minimally invasive TLIF with bone cement-augmented pedicle screws were included in the study. Clinical outcome and the function were assessed using the visual analog scale (VAS) score for pain and the Oswestry Disability Index (ODI). Perioperative, postoperative, and long-term complications were monitored with a mean follow-up of 18 months. RESULTS: A total of 25 (20 female and 5 male) patients were included in the study with an average age of 61.05 years. The major symptom was low back pain with radiating pain to lower limbs. The average T-score was -3.0. All the patients were followed clinically and radiologically. There was a statistically significant improvement in the VAS scores and ODI scores postoperatively. No events of cement extravasation, radiological loosening, or pulling out of screws were observed. CONCLUSIONS: Fenestrated pedicle screw fixation with bone cement augmentation in patients with osteoporosis is a well-established alternative to increase the pullout strength of screws placed in the osteoporotic bone. Applying the concept of minimally invasive surgery to this procedure makes it a more complete solution for instrumentation in osteoporotic spine. Our series is the largest in literature on spondylolisthesis and confirms the feasibility and safety of this procedure in treating spondylolisthesis in the aging population.

Nonmissile penetrating spinal injury with an impaled knife: case report.

We report a case of non missile penetrating spinal injury (NMPSI) caused due to an impaled knife in the lumbar region. The patient was neurologically preserved and presented with the knife blade retained in his back. The wound with the knife in situ was explored, the knife removed and a dural laceration was repaired. The wound healed without evidence for cerebrospinal fluid leakage or infection.

Ulnar nerve tuberculoma.

The authors report a very rare case of tuberculoma involving the ulnar nerve. The patient, a 7-year-old girl, presented with swelling over the medial aspect of her right forearm just below the elbow joint, with features of ulnar nerve palsy, including paresthesias along the little and ring fingers and claw hand deformity. There was a history of trauma and contact with a contagious case of tuberculosis. There were no other signs of tuberculosis. At surgical exploration the ulnar nerve was found to be thickened, and on opening the sheath there was evidence of caseous material enclosed in a fibrous capsule compressing and displacing the nerve fibers. The lesion, along with the capsule, was subtotally removed using curettage, and a part of the capsule that was densely adherent to the nerve fibers was left in the patient. Histopathological examination of the specimen was consistent with tuberculoma. The patient received adequate antitubercular treatment and showed significant improvement.