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Background: Spinal tuberculosis (TB) is a leading cause of damage to the spine and associated neural structures. Purpose: This study aims to identify the risk factors for neurological deterioration in spinal TB patients to promptly care for the patients before paralysis develops. Methods: The demographics, clinical characteristics, laboratory results, and radiographic findings of spinal TB patients were collected between 1993 and 2016. The data were analyzed using logistic regression methods. The predictive factors for neurological deficit were identified. Results: There were 125 spinal TB patients (70 men and 55 women). The average age ± standard deviation was 55.7 ± 2.0 and 52.3 ± 2.4=years, respectively. According to the univariate analysis, the significant risk factors associated with neurological deterioration were signal cord changes, notable Cobb angle (>30°), radiating pain, and epidural abscess. The multivariate analysis revealed that only signal cord change and notable Cobb angle significantly influenced neurological status. Conclusion: The predictive factors for neurological deterioration in spinal TB patients are signal cord change and notable Cobb angle. Surgery should be considered in patients who present with these factors before the development of neurological deterioration.

The combined treatment was more effective in reducing lumbar facet pain and improving the functional index than either treatment alone. This approach should be the preferred treatment.

Study DesignAgreement study.PurposeTo validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model.Overview of LiteratureEpidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated.MethodsFive identical sets of histopathological digital files of L5-L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed.ResultsFour hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81-0.86).ConclusionsThe postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model.

Objective. The aim of the present study was to investigate the incidence of occipitalization of the atlas among Thai dried skulls, in order to contribute to baseline awareness of this condition. Materials and methods. The skulls of 633 adult Thais from the collection maintained in the Department of Anatomy, Faculty of Medicine, Khon Kaen University, Thailand, were examined for evidence of occipitalization of the atlas. The skulls were well-preserved and did not show any traits of craniofacial deformation. The skulls for which the age and sex were unknown were excluded from the analysis. From the cadaveric records on each individual, we learned that the skulls belonged to 373 men (age of decease between 25 and 90 years), and 260 women (age of decease between 28 and 92 years). Results. Occipitalization of the atlas was detected in 2 skulls (0.32%). The first case was a male skull (54 years of age at decease), where the atlas was partially fused to the occipital bone. The second case was also a male skull (59 years of age at decease) showing complete fusion of the anterior arch of the atlas. Conclusion. The incidence of occipitalization of the atlas is low; however, if present this abnormality may cause a wide range of neurological problems. Knowledge of occipitalization of the atlas may be of substantial importance to orthopedists, neurosurgeons, physiotherapists and radiologists dealing with abnormalities of the cervical spine. Mistaken diagnoses have led to delayed treatment and at times adverse results.

Patients with neck pain may experience cervical myelopathy, this may be detected by clinical myelopathic signs, although they did not have any symptom of myelopathy, except having neck pain. Decreasing physical performance is one symptom of cervical myelopathy that can lead to reduced quality of life in the elderly, however, in adult neck pain with clinical myelopathic signs have not been evaluated. Therefore, this research aimed to compare physical performance in two groups of adult patients with neck pain: those with and without clinical myelopathic signs. A total of 52 participants, gender, age, and body mass index (BMI) matched were allocated into 2 groups of 26 subjects with neck pain, those with, and without, clinical myelopathic signs. The grip and release test, nine-hole peg test, ten second step test and foot-tapping test were evaluated. The group of neck pain participants with clinical myelopathic signs exhibited greater impairment in all the tests than the group without clinical myelopathic signs (p < 0.001). Effect sizes (Cohen’s d) were grip and release test: 2.031, nine-hole peg test: 1.143, ten second step test: 1.329, and foot-tapping test: 0.798. Neck pain participants with clinical myelopathic signs demonstrated reduced physical performance. Physical performance tests may need to assessed in adult patients with neck pain who had clinical myelopathic signs.

The high-dose parecoxib-soaked absorbable gelatin sponge can prevent peridural fibrosis without complications. The low-dose parecoxib and cellulose membrane provided no significant benefit vis-à-vis prevention of peridural fibrosis, as adduced from the lack of any statistically significant difference between the test and control rats.

Study Design. This study investigated the subaxial cervical pedicles from C3 to C7 to provide information for accurately transpedicular screw fixation in this region. Objective. This study was evaluated the morphology of the subaxial cervical pedicle to determine the size and trajectory of screw fixation. Summary of Background Data. Cervical vertebrae are an important structure to protect the neurovascular structure. The cervical spine surgery using screw fixation is an effective method to treat the cervical spine instability. There have been many research morphological data of subaxial cervical vertebrae. However, no studies have reports on dried cervical vertebrae of Thai's people. Methods. The measurement was conducted in 130 dried cervical vertebrae (C3–C7), including 61 males and 69 females. The measurement parameters were pedicle width (PW), pedicle length (PL), pedicle height (PH), pedicle axis length (PAL), pedicle transverse angle (PTA), and pedicle sagittal angle (PSA), which determined using ImageJ software. Results. The results of morphological data of C3 to C7 was found that the mean of PW, PL, PH, PAL, PTA, and PSA that obtained from male were significantly higher than female excepted for PL (C7) and PTA (C3, C5). Except for the C6 PW, C3 PL, C4 to C5 to C7 PTA, and C4 PSA, there were no significant differences of these parameters between male and female. Conclusion. The appropriate pedicle screw size is 4.0 mm for C3 and C4, and 4.5 mm for C5 to C7. The results of this study are the useful information for cervical spine fixation while prevent the vascular and neurological injuries from the large screw causing pedicle breakage. Level of Evidence: 3