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   Table of Contents - Current issue
January-June 2021
Volume 18 | Issue 1
Page Nos. 1-41

Online since Sunday, July 25, 2021

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Medical Research p. 1
Suresh S Pillai
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Prevalence, location along the spine and demographic distribution of vertebral hemangiomas in southern India: An magnetic resonance imaging-based cross-sectional study of 624 subjects p. 3
Suresh S Pillai, M Harisankar
Purpose: Vertebral hemangiomas (VHs) are the most common benign tumors of the spine. The aim of this study is to find the prevalence of VHs in the general population and its distribution along the vertebral column. Materials and Methods: The presence of VHs was assessed in the full spine magnetic resonance imaging of 624 participants. Demographic data were obtained from the patient's medical records. Results: VHs were present in 14.4% of the total study population. Multiple VHs were present in 2.2% of the study group and 15.5% of the participantswith VHs. The prevalence of VHs was sex independent with similar occurrence among males and females. The prevalence was age dependent with maximum appearing in the 40–59 age cohort. Lumbar vertebrae were found to be the most prone vertebrae for the occurrence of VHs. Conclusions: The prevalence of VHs is age dependent and sex independent. The lumbar region is the most common site of occurrence of VHs. The overall incidence of VHs is much higher than previously reported, probably due to the newer advancements in imaging techniques.
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Denosumab in giant cell tumor of bone – science wins over evidence p. 7
Dominic Puthoor
Denosumab is a relatively new drug and is used in the treatment of giant cell tumor (GCT) of bone. There are hardly any drugs such as denosumab, indication of which changed in a short period of 10 years. The author analyses the cause of this transformation of indication of that drug in the treatment of GCT of bone, based on the scientific ground, review of the literature, and personal experience.
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Charcot foot – current concepts p. 10
Gautam Kumar, Rajesh Simon, Dennis P Jose
Charcot neuropathic osteoarthropathy (CNO) is painless, progressive, noninfectious, degenerative arthropathy affecting single or multiple joints and soft tissues of foot and ankle caused by an underlying neurological deficit. The primary indication for surgical correction is a nonbraceble, nonplantigrade foot, instability, and impending or established ulceration. The goal of surgical management is to provide a stable, ulcer-free, plantigrade foot that can accommodate therapeutic footwear for self-ambulation. The choice of implants in midfoot CNO can be a combination of plate and screws well beyond the area of deformity to achieve rigid stability and good alignment following the principle of a super construct. The deformities involving the talus and ankle joint require a Total contact casting (TCC) arthrodesis, preferably with an intramedullary nail. The choices for soft tissue coverage as an additional procedure for ulcer management are guided by anatomic location, size, depth of ulcer, condition of surrounding soft tissue, and underlying deformity.
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Ulnar club hand: A rare case report p. 18
Prasanth Srinivasan
Ulnar club hand is a rare postaxial partial or complete longitudinal deficiency of the ulna, with relative incidence of one-tenth to one-third of radial deficiencies. The absence of postaxial metacarpal and digital bones is a frequent finding in this rare disorder. However, we report a rare case of unilateral ulnar club hand with the absence of two preaxial digits and two preaxial metacarpals.
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Sternal tuberculous osteomyelitis in a young adult presenting as atypical chest pain: A rare case report p. 21
PP Sunil, KR Renjith, T Ajayakumar, Arvind P Vijayan
Sternal tuberculosis (TB) is an uncommon involvement of osteoarticular tissues where the diagnosis is most often delayed due to an insidious presentation. We present an unusual case of a young female with TB osteomyelitis of the sternum presenting as atypical chest pain in which a timely diagnosis could result in successful management by conservative means.
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Acute spondylodiscitis - A rare presentation of sacrocolpopexy complicated with chronic left iliac fossa discharging sinus p. 24
Suresh S Pillai, Premdeep Dennison, Usha Sreekumar, Sailesh Aikot, KV Deepa
Spondylodiscitis following sacrocolopopexy is a rare complication. Many cases of spondylodiscitis are preceded by infection elsewhere, most commonly the genitourinary tract. Inadvertent placement of bone anchors into the L5-S1 disc space likely results in an L5-S1 inflammatory process with infection often tracking along the suspension sutures attached to the bone anchors. Commonly onset of spondylodiscitis is in <1 year of index surgery (average 4 months) but is reported as late as 8 years. However, the patient presenting with chronic discharging sinus (6 years) and acute spondylodiscitis following sacrocolpopexy is not reported in the literature to the best of our knowledge. To report a case of lumbosacral (L5-S1) discitis in a patient who had a discharging sinus at the left iliac fossa following a sacral colpopexy procedure 6 years back. A 44-year-old female underwent laparoscopic sacral colpopexy for uterovaginal prolapse approximately 6 years back. Approximately 4 months after the surgery, she had abdominal pain and fever, followed by discharge from the left iliac fossa. She presented to the spine surgery outpatient department with severe back pain and difficulty in walking for the last 2 weeks. Magnetic resonance imaging revealed L5-S1 spondylodiscitis. She was managed collectively by a spine surgeon, gynecologist, and gastro surgeon. The principal aims of surgery are to debride infected disc tissue, which is avascular, and excision of the sinus tract along with the removal of the sling along with its anchor. To minimize L5-S1 spondylodiscitis during sacrocolpopexy, it is recommended to start the presacral dissection at the sacral promontory, which generally lies just below the steep lumbosacral angle.
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An unusual case of vertebral metastasis as initial presentation of follicular thyroid carcinoma complicated with misplaced pedicle screw p. 28
Lakshay Raheja, R Krishnakumar
Vertebral metastasis as initial presentation for follicular thyroid carcinomas is rare and requires proactive management to minimize disability considering a good associated long-term survival. A review of literature in 2019 noted 27 such cases – most of the patients had solitary vertebral metastases or multiple adjacent level involvement. Surgical treatment in such cases is usually based on the extent of fractures or neural compression in the form of decompression, debulking, or total en bloc resection and biopsy. Pedicle screw placement has been studied in several large studies, and clinically relevant misplacement is rare and revision may be required. We present a case where a patient with a pathological fracture previously evaluated and operated came to us with radiculopathy caused by metastatic mass lesion and a misplaced pedicle screw.
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JOASIS-Quiz 1 p. 31
Suresh S Pillai, CS Nikhil, Gopakumar
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