Background: Pott's disease may cause late neurological involvement due to development of sharp kyphosis. Anterior decompression and fusion is the treatment of choice for this disorder. Objective: To determine the mid-term clinical results of patients with late onset Pott's paraplegia, who underwent anterior decompression and grafting after neurological deterioration. Setting: A university hospital in I . stanbul, Turkey. Methods: Eight patients who developed late onset paraplegia with a mean period of 24.6 years (range, 9 ± 46 years) after the active disease were treated with anterior decompression and grafting. The mean age at surgery was 36.1 years (range, 18 ± 63 years) and the mean duration of neurological deterioration before surgery was 7.4 weeks (range, 2 ± 13 weeks). The mean kyphosis angle of the patients was 105.638 (range, 808 ± 1358). No attempt to correct the curve was made in any operation. All but two patients' neurological status were evaluated according to the International Standards for Neurological and Functional Classi®cation of Spinal Cord Injury determined by ASIA-IMSOP on admission. Results: Neurological status of all patients showed progression either in Frankel scale or in motor scores in the early postoperative period. One patient needed to be reoperated on because of a deterioration of neurological status 26 months after surgery. The mean length of time since the operations is 75.9 months (range, 48 ± 173 months) and all the patients are carrying out their lives independently with a mean motor score of 97.5 and full pin-prick and light touch scores. Conclusions: Anterior decompression and grafting is an e ective procedure for the treatment of late onset paraplegia in Pott's disease. Spinal Cord (2000) 38, 669 ± 674
The two-portal hindfoot endoscopy is a relatively new technique that is becoming increasingly popular. It gives excellent access to the posterior ankle compartment, the subtalar joint, and extra-articular structures. We report a 24-year-old man with a complex talus fracture involving the posterior part of the talar body and posterolateral process. He was treated endoscopically, with a two-portal posterior approach to the hindfoot. This approach allowed a better visualization and treatment of accompanying pathologies. Combined excision of the posterolateral process and fixation of the fracture was performed with the two-portal hindfoot endoscopy, which has not been previously described to our knowledge. The two-portal posterior endoscopic approach can be an attractive treatment alternative for the posterior part fractures of the talus, which can in turn, be a new indication for this technique.
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