Study DesignThis is a case series.PurposeWe wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders.Overview of LiteratureSpinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders.MethodsA questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant.ResultsOf the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury.ConclusionsOur results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.
Toxoplasmosis is an obligate intracellular, food borne parasite disease with variable clinical presentation. Although the neurological presentation of toxoplasmosis in immunocompetent patients is uncommon, broad differential diagnosis should be kept in consideration when attending to similar patients. Twenty years old man with no known co-morbid conditions presented with fever and unilateral limb weakness for three weeks. It increased gradually, associated with altered level of consciousness for the last five days, diagnosed as acute toxoplasmosis. MRI Brain showed multiple ring enhancing lesions in frontal, parietal and temporal lobes. Serology for toxoplasmosis denoted raised IgM levels 36IU/mL (cut off value > 18IU/mL). This case report describes the clinical presentation and management of neurological toxoplasmosis in immunocompetent patient. Early diagnosis and prompt management can resolve the symptoms at an earlier stage.
Study DesignRetrospective case series.PurposeThe objective of our study was to determine the change in management brought about by magnetic resonance imaging (MRI) of the cervical spine in alert and awake patients with facet dislocation and spinal cord injury presenting within 4 hours after injury.Overview of LiteratureSpinal cord injury is a common clinical entity. The role of MRI is well established in evaluating spinal trauma. However, the time at which MRI should be used is still controversial.MethodsRetrospective data from 2002-2010 was evaluated. All of the alert and awake patients with spinal cord injury, based on clinical examination with facet dislocation diagnosed on lateral cervical spine X-rays, were included. A questionnaire was also conducted, the data of which consisted of demographic details including age and sex, the mechanism of injury, clinical examination, X-ray findings, MRI findings, whether or not surgery was performed and the time elapsed since injury. Data was analyzed using SPSS ver. 17.0. Continuous variables such as age were expressed in terms of mean ± standard deviation. Categorical variables such as change in management, X-ray/MRI findings and neurological motor level were assessed in terms of percentage.ResultsFifty patients participated in our study. All these patients had spinal cord injury with defined motor levels. The mean age was 35.5 ± 8.95 years (range, 20 to 52 years). Fifty percent showed a motor level at C6 level. None of the patients required any change in management based on the MRI.ConclusionsMRI of the spine in awake patients within 4 hours after injury does not change the management of patients. However, we can hypothesize that such patients can proceed to traction without waiting for the MRI.
Objective:To quantify the increase in workload associated with multidisciplinary team meetings for radiologists in a tertiary care hospital over a period of 15 months.Methods:Data was collected prospectively regarding number of multidisciplinary team meetings, number of clinical cases discussed, number of individual imaging studies reviewed, and preparation time of residents, senior registrar and consultants and the delivery time of meeting.Results:Total 223 meetings were held over 15 months (April 2014 to June 2015) for 12 clinical specialty areas. There were 1120 clinical case discussions and a total of 2759 documented individual imaging studies reviewed. Resident’s preparation time was 74.6 hours/month, senior registrar’s preparation time was 47.93 hours/month, consultant’s preparation time was 18.67 hours/month and the total duration time for meetings was 18 hours/month.Conclusion:Multidisciplinary team meetings now represent a significant workload of radiology and has reduced the time for other academic activities within the department.
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Background: Carpal Tunnel Syndrome (CTS) is a common problem which interferes with the normal use of the hand. It has general population prevalence of 16%. Objective: The objective of this study was to determine the validity of high-resolution ultrasound (US) in carpal tunnel syndrome in adult patients using nerve conduction studies (NCS) as gold standard. Study design & Settings: Cross sectional validation study with purposive (non-probability) sampling conducted in the Department of Diagnostic Radiology, Federal Government Polyclinic Hospital, Islamabad in collaboration with outdoor departments of Neurology and Rheumatology of the same hospital. Study duration: The study was conducted in Federal Government Polyclinic Hospital Islamabad for duration of one year, from November 2021 to November2022. Methods : 152 patients were included in study group who underwent ultrasound by using 12 – 15MHz linear transducer. Later on their nerve conduction studies were performed & results were compared. Results: There were 152 patients included in the study, with 47 (30.9%) males and 105 (69.1%) females and overall mean age of 33.74±11.58 years. The sensitivity of ultrasound to detect carpel tunnel syndrome was calculated to be 90.6% while specificity was found to be 82.52 %. The positive predictive value, negative predictive value and diagnostic accuracy of 86.5%, 87.3% and 86.8% was reported, respectively. Conclusion: High resolution US is an accurate imaging study with diagnostic accuracy of 86.8% and gives results comparable to NCS. It can be used in patients unsuitable for the latter modality. Keywords: Carpel tunnel syndrome (CTS), ultrasound (US), Nerve conduction studies (NCS).
Background: Although rare, traumatic lumbosacral (L/S) Grade I spondylolisthesis (i.e., Lumbar locked facet syndrome) is characterized by unilateral or bilateral facet dislocations. Case Description: A 25-year-old male presented following a high velocity road traffic accident with back pain and tenderness at the L/S junction. His radiologic images showed bilateral locked facets at the L5/S1 level with Grade 1 spondylolisthesis, bilateral pars fractures, acute traumatic L5/S1 disc herniation, and disruption of the anterior and posterior longitudinal ligaments. After undergoing a L4-S1 laminectomy with pedicle screw fixation, he became asymptomatic and remained neurologically stable. Conclusion: L5/S1 facet dislocation whether unilateral or bilateral needs to be diagnosed early and treated with realignment and instrumented stabilization.
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