Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

No abstract

No abstract

Background:Spinal cord/nerve root compression secondary to a tubercular epidural abscess leads to neurological deficit. Depending on the extent and duration of compression, the end result after treatment may vary from complete recovery to permanent deficit. ASIA has been used extensively to correlate between MRI and neurological status due to traumatic spine injuries. MRI has stood as an invaluable diagnostic tool out of the entire range of current imaging modalities. However, inspite of considerable literature on the applications of MRI in spinal tuberculosis, there have been few studies to assess the relationship between the MRI findings and the neurological deficit as assessed by clinical examination.Aims:The objective of this study was to ascertain whether the findings of magnetic resonance imaging (MRI) correlate well with the actual neurological recovery status using the American Spinal Injury Association impairment scale (ASIA) in patients with spinal compression secondary to tuberculous spondylitis.Materials and Methods:60 patients (mean age 43.6 years) diagnosed as spinal tuberculosis by MRI/cytology/histopathology were examined and classified into ASIA impairment scale A-E based on the ASIA and again reclassified after 6 months of therapy to assess functional recovery. Similarly, they underwent MR imaging at the start and at the completion of 6 months of therapy to assess the structural recovery. The MRI features of recovery were correlated with the actual neurological recovery as ascertained by the ASIA.Results:Before starting treatment 1 patient (2.08%) was in ASIA A, 2 (4.16%) were in ASIA B, 9 (18.75%) were in ASIA C, 36 (75%) were in ASIA D and 12 (20%) were in ASIA E. There was a significant difference in the epidural abscess thickness, thecal compression and cord compression between ambulatory (ASIA D and ASIA E) and non ambulatory patients (ASIA A, ASIA B and ASIA C). After 6 months of therapy 30 (90%) patients in ASIA D and 5 (55.5%) in ASIA C had complete neurological recovery. Both patients from ASIA B improved to ASIA D. Single patient who was in ASIA A before treatment remained non ambulatory (ASIA C) after treatment. Overall 33 (78.5%) patients showed complete recovery at final followup. Out of all the MRI features, only size of epidural abscess was found to be a poor prognostic factor for recovery of neurological deficit.Conclusions:There are several parameters on MRI which correlate with the severity of neurological impairment according to ASIA score and resolution of those features on treatment is also correlated well with neurological recovery.

Background:Treatment of proximal humerus fractures is controversial and various operative modalities have been tried in the literature. The aim of the present study was to evaluate functional outcome and complication rate after open reduction and internal fixation of displaced proximal humerus fractures by proximal humerus locking plate.Materials and Methods:52 patients with displaced proximal humerus fractures treated with proximal humerus locking plate between May 2008 and October 2010 were included in the study. Fractures were classified according to Neer's classification into displaced 2-part, 3-part, and 4-part fractures. Patients were followed for a minimum period of 1 year. 11 patients had less than 1 year of followup and were not considered in the evaluation of final results. Forty one patients were considered for final evaluation. Functional evaluation was done according to the Constant-Murley scoring system. Constant score was compared between 2-part, 3-part, and 4-part fractures at final up and also between young (≤60 yrs) and old (>60 yrs).Results:11 patients had 2-part fractures, 22 patients had 3-part fractures, and 19 patients had 4-part fractures. The mean followup period was 15.21 ± 2.59 months. 65.8% (n = 27) patients had good to excellent result, 19.5% (n = 8) had fair, and 14.7% (n = 6) had poor result. Constant scores for 2-part (79.83 ± 6.95) and 3-part fractures (74.22 ± 12.53) were significantly superior to those of 4-part fractures (61.09 ± 14.29) (P value = 0.002 and 0.018, respectively). Difference between 2-part and 3-part fractures was not significant (P value = 0.623). There was no significant difference between younger (≤60) and older patients (>60). Complications encountered in this series were varus malreduction in 17% (n = 7), screw perforation in 10% (n = 4), plate impingement in 12% (n = 5), infection in 2% (n = 1), and nonunion in 2% (n = 1) of cases.Conclusion:Proximal humerus locking plate gives reliable fixation for 2-part and 3-part fractures. Its use in more complicated fracture patterns of 4-part fractures is associated with poor clinical outcome.