The mHHS has adequate construct validity, internal validity and responsiveness to evaluate functional outcome of intramedullary nail fixation in pertrochanteric hip fractures in the Indian population.

Background: Anterior vertebral body tethering (AVBT) offers a dynamic fusion less correction option for children with adolescent idiopathic scoliosis (AIS). Few existing clinical studies evaluating novel AVBT in skeletally immature children have questioned the midterm efficacy with concerns of overcorrection and curve progression with remaining growth. The current study investigates the effect of this technique in skeletally mature children (Risser ! 4 and Sanders ! 7) with AIS with limited remaining growth potential.Methods: We evaluated skeletally mature children with AIS who underwent the AVBT technique for a single structural major curve between 408 and 808 with !50% flexibility on dynamic radiographs and a minimum of 1 year of follow-up. Pertinent clinical and radiographic data collected include skeletal maturity, curve type, Cobb angle, sagittal parameters, and a patient-reported outcome measure Scoliosis Research Society-22 (SRS-22) questionnaire.Results: All 10 children were female with a mean age of 14.9 6 2.7 years at the time of surgery. The mean followup was 24.1 6 3.6 months. The mean Risser and Sanders scores were 4.2 6 0.6 and 7.2 6 0.6, respectively. Three patients had major thoracic curves, and 7 patients had thoracolumbar/lumbar curves. Cranial and caudal instrumented levels were T5 and L4. Mean preoperative Cobb's angle was 52.08 6 11.68 and was corrected to 15.98 6 6.88 on the first erect postoperative radiograph, with stabilization of corrected curve at the 1-year follow-up (mean Cobb's angle of 15.38 6 8.78). Mean preoperative and postoperative SRS-22 scores were 78.0 6 3.2 and 92.5 6 3.1, respectively (P , .01). No complications were noted until the last follow-up.Conclusion: Our preliminary experience with this novel AVBT as an alternative technique to fusion to stabilize progressive idiopathic scoliosis in skeletally mature children is promising.

Background: Transforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw instrumentation is a well-accepted technique in lumbar degenerative disc disorder. Unilateral instrumentation in TLIF has been reported in the literature. This study aims to compare the clinical and radiological outcomes of unilateral and bilateral instrumented TLIF in a selected series of patients.Methods: We retrospectively analyzed patients operated with unilateral pedicle screw fixation in TLIF (UPSF TLIF) or with bilateral pedicle screw fixation in TLIF (BPSF TLIF) with a minimum of 2 years of follow-up. Patients were evaluated at regular intervals for functional and radiological outcomes. Functional outcome was assessed using the Oswestry disability index (ODI) and visual analog score (VAS) preoperatively and at 6 months, 1 year, and 2 years after surgery. Fusion rates were assessed using Bridwell interbody fusion grading.Results: Our study shows that there was a significant improvement in VAS and ODI in both groups at 2 years follow-up, and there was no significant difference in improvements between the groups. The complication rates between the groups were similar. The fusion rate in UPSF TLIF was 97.3% and was 98.34% in BPSF TLIF; this was not statistically significant between groups. There is a significant difference in terms of blood loss, duration of surgery, and average duration of hospital stay between the groups (P , .001), favoring UPSF TLIF.Conclusions: Unilateral pedicle screw fixation in open TLIF is comparable with bilateral pedicle screw fixation in terms of patient-reported clinical outcomes, fusion rates, and complication rates with the additional benefits of less operative time, less blood loss, shorter hospitalization, and less cost in selective cases.

Study Design: Prospective cohort. Objective: To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy). Methods: Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. During surgery motor-evoked potential (MEP) and somatosensory evoked potential (SSEP) at baseline and before and after decompression were documented. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes.” Patients were divided into subgroups based on IONM changes: group A (those with positive changes) and group B (those with no change or deterioration). Nurick grade and modified Japanese Orthopaedic Association (mJOA) score were evaluated before and after surgery. Results: Nine patients (32.1%) showed improvement in MEP. The mean preoperative Nurick grade and mJOA score of group A and B were (2.55 ± 0.83 and 11.11 ± 1.65) and (2.47 ± 0.7 and 11.32 ± 1.24), respectively. The mean postoperative Nurick grade of groups A and B at 6 months was 1.55 ± 0.74 and 1.63 ± 0.46, respectively, and this difference was not significant. The mean postoperative mJOA score of groups A and B at 6 months was 14.3 ± 1.03 and 12.9 ± 0.98, respectively, and this difference was statistically significant ( P = .011). Spearman correlation coefficient showed significant positive correlation between the IONM change and the mJOA score at 6 months postoperatively ( r = 0.47; P = .01). Conclusion: Our study shows that impact of positive changes in MEP during IONM reflect in functional improvement at 6 months postoperatively in cervical compressive myelopathy patients.

Background: Since the introduction of magnetic resonance imaging (MRI) into clinical practice in the mid-1980s, the role of computed tomography myelography (CTM) has become less important in spinal diagnostics but remains a method that is probably even superior to MRI for special clinical issues. The study aims to report the diagnostic utility of CTM as an adjunct to MRI in lumbar degenerative disc disorder (DDD).Methods: Included were 20 patients who presented with symptomatic DDD but with MRI findings that did not correlate with the clinical features. These patients underwent CTM as an additional imaging technique to aid preoperative surgical decision-making. Both imaging modalities were compared for the identification of the impinging pathology as well as the number of levels of compression.Results: MRI revealed compression and/or impingement at 38 levels, whereas CTM revealed these at 29 levels. Of 20 patients, 18 underwent surgery, and a total of 29 levels were decompressed as localized in the CTM. The visual analog scale (VAS) score for back pain and leg pain at baseline were 6 6 0.7 and 76 0.4, respectively, and at 6 months postintervention (surgical/conservative) were 2 6 0.8 and 0.3 6 0.1, respectively. The Oswestry Disability Index scores at baseline and 6 months postintervention were 56 6 6.9 and 18 6 4.2, respectively (P , .0001). There was agreement on the number of levels between MRI and CTM in 10 patients (50%). MRI overestimated the number of involved levels in 9 patients (45%), whereas in the remaining 1 patient (5%), MRI underestimated the number of involved levels. The weighted j value for agreement between MRI and CTM on the number of levels involved necessitating decompression was 0.4 (95% CI, 0.18-0.77; P ¼ .0009).Conclusions: CTM has a role as an adjunct imaging modality to formulate an effective management plan in patients presenting with symptomatic lumbar DDD in cases where MRI findings are inconclusive and ambiguous.