Exostoses Research Articles

Reinsertion of the Achilles Tendon with Bony Anchor in Insertional Achilles Tendinitis with Haglund’s Deformity

Haglund’s deformity is a common cause of hindfoot pain in adults and functional disability. Conservative treatment is effective often. Surgery is required only in intractable cases. Many surgical treatments in a Haglund deformity have been described. After resect and debridement, an anchor suture may use to reattach Achille’s tendon. This study aims to show the place of the suture anchor to improve the reinsertion of the Achilles tendon in an insertional Achilles tendinitis and Haglund’s deformity. We report a 54-year-old male complains of 2 years of chronic right heel pain while strength training. A focused exam of the left ankle showed a bump on the posterior heel with inflammation to the anterior and posterior Achilles tendon. A lateral X-ray and CT scan of the left ankle showed a bone spur and intratendinous calcification of the Achilles tendon with the Philip – Fowler angle at 87°. The Bohler’s ankle was at 27°. After the failure of at least 6 months of conservative treatment, surgical management was indicated. It has consisted of a midline incision. Bursectomy and, resection of the posterosuperior tuberosity of the calcaneus was performed. Then, debridement of necrotic tissue and calcifications in the tendon and any posterior osteophytes were carried out. The tendon had been reinserted at its central part with single-row anchor. The lower leg was immobilized in 20° plantar flexion, this was switched to a walking boot with adjustable plantar flexion. Partial support was allowed at the 6th postoperative week. Full rehabilitation was prescribed after the removal of the cast. At 2-year follow-up, the patient is very satisfied and had no pain when standing on the toes of the operated leg. Dorsiflexion was symmetric. The effective return to full-sport activities was at 6 months at the same level.

Abstract #1412436: Nonclassical Presentation of Hypophosphatasia

Hypophosphatasia (HPP) is a rare genetic disorder characterized by impaired mineralization (calcification of bones and teeth). The signs and symptoms of HPP vary widely and can appear from birth to adulthood. We report a case of delayed bone fracture healing in the setting of hypophosphatasia. A 48-year-old male patient with a past medical history of vitamin D deficiency was seen in the outpatient clinic for low ALP levels. He had delayed wound healing involving the left clavicular and multiple rib fractures after a motor vehicle accident that occurred in 2012, which ultimately needed multiple surgeries requiring 1.5 years to fully heal/fuse. This involved placing and removing multiple plates and screws as well as bone grafts. He denied other fractures, skeletal deformities, or dental problems. He does have normal development and does not have short stature. He has a history of vitamin D deficiency and is on vitamin D 2000 units daily. He was found to have a family history remarkable with two sons with low ALP and vitamin D beginning in childhood. The older son was noted to have lost his teeth early at age 3-4 years, with no history of fractures. Musculoskeletal examination: no swelling noted, and no tenderness was noted but the patient did have a bone spur on the elbow, knee, and heel. He is able to ambulate without assistance and was found to have no other skeletal deformity. Laboratory findings: ALP 31 U/L (Normal 34-122). Bone-specific alkaline phosphatase: 5.6 ug/L (Normal 6.5-20.1). Vitamin D 25 OH level: 84 (on replacement therapy). Calcium: 9.2 mg/dl, phosphorus 3.5 mg/dl, iPTH levels 23 pg/ml. DXA scan: shows T values on the lumbar spine of -1.8, right hip of -1.4, and right neck of -1.9, consistent with osteopenia. We checked vitamin B6 level: 1087.7 nmol/L, consistent with hypophosphatasia. The patient then underwent genetic testing and is positive for ALPL gene mutation (heterozygous). Both his 2 sons are positive for ALPL gene mutation. We present a case of hypophosphatasia with nonclassical presentations, his mild symptoms likely from incomplete penetration. HPP causes pathogenic variants in ALPL gene. This gene provides instruction for making an enzyme called tissue non-specific alkaline phosphatase (TNSALP) which plays an essential role in the mineralization of the skeleton and teeth. Mutation in the ALP gene leads to the production of an abnormal version of TNSALP that cannot participate effectively in the mineralization process. There is currently no cure for hypophosphatasia, however human recombinant enzyme replacement therapy called asfotase alfa is now available.

STUDY OF FUNCTIONAL OUTCOME OF DORSOLUMBAR SPINE FRACTURES TREATED WITH MINIMAL INVASIVE SPINE SURGERY

Introduction – Spine disorders including spinal instability, bone spurs, ruptured discs, scoliosis, or spinal malignancies, minimally invasive spine surgery (MIS) aims to stabilize the vertebral bones and spinal joints as well as relieve pressure on the spinal nerves. Aims & Objectives - To study the functional outcome of dorsolumbar spine fractures treated with minimal invasive surgery, to study complications of post minimal invasive spine surgery and the course of recovery and physical activity in the study patients, also to evaluate the neurological status post minimal invasive spine surgery. Materials And Methods – 35 patients were included in the study. Inclusion and exclusion criteria was followed. Routine investigations were carried out. Along with it radiographic examination , CTscan & MRI of cervical / thoracic / lumbar spine were also taken based on history. Results - The mean VAS In the present study group was 8.40 at presentation which came down to 1.65 at 6 month follow up which was statistically signicant (p value= <0.001). The mean ODI score in the present study was 61.00% preoperatively which gradually decreased to 24.3% at the end of 6 months which was statistically signicant (p <0.001). According to the modied Mcnab criteria at the nal follow up at 6 months,9 (25.71%) patients were excellent, 15 (42.85%) were good,6 (17.14%) were fair , 5 (14.28%) patients were poor. Conclusion - Minimal invasive spine surgery is safe and efcient technique when compared to traditional open spine surgery

Tracking patellar osteophytes to detect osteoarthritis

ABSTRACT The presence of bone spurs (osteophytes) in knee-joints provides an indication of the onset of osteoarthritis and related deformities in patients. The shape of the patella bone at knee-joint undergoes various changes with the advancement of the disease, which may be discerned accurately from X-ray images. The main objective of this work is to identify the presence of osteophytes in the patella bone of knee-joint. Geometric features are extracted that highlight protrusions present on the bone surface from lateral views of X-ray images. The patella region is extracted from the image by performing texture-based segmentation followed by adaptive thresholding. Characteristic features are extracted from the segmented patella using derived novel measures based on differential chain code of the contour and convex hull. Linear support vector machine is used to classify diseased test-cases from healthy ones using the extracted features. Experimental results demonstrate the capability of the proposed image-analysis tool for detecting osteoarthritis with average accuracy of 93.75%.

Cervical Spondylosis: An Ayurvedic Review

Cervical spondylosis is the common terminology for ageing related wear and tear of the neck that can cause pain, stiffness and tingling sensation with radiating pain etc. It is also called Neck Arthritis or Osteoarthritis of the cervical spine. It is characterized by bone spurs formation and Intervertebral disc degeneration. It is often co-related with Manyastambha in Ayurvedic prospective. Manyastambha has been described in various Ayurvedic literatures. It is a Vataja nanatmaja vikara (disease) in which causes ruka (pain), toda, stambha (stiffness with restricted movements) occur in Manya Pradesh (Neck region).

Ventral cervical spondylophytes as differential diagnosis of neurogenic dysphagia

Ventral cervical spondylophytes can lead to severe dysphagia if they are of sufficient extent and height localization and represent an important differential diagnosis of neurogenic dysphagia, especially in older patients. Presentation of various etiologies of ventral cervical spondylophytes, specific symptoms and abnormalities of the swallowing function caused by spondylophytes, their manifestation in the instrumental swallowing diagnostics and an outlook on treatment options. Summary of the current literature on spondylophyte-related dysphagia and an overview of research results regarding differential diagnostic aspects of neurogenic dysphagia. The manifestation forms of ventral cervical spondylophytes can be very diverse. With respect to dysphagia, disorders of pharyngeal bolus transfer and an increased tendency to aspiration have been observed. The occurrence and severity of the symptoms depend primarily on the extent of the bony attachments and their height localization. In some cases, symptomatic ventral cervical spondylophytes can be arelevant differential diagnosis of neurogenic dysphagia. For amore precise evaluation of the dysphagic symptoms and their association with the spondylophytic outgrowths, avideo fluoroscopy of swallowing (VFS) should be added to the fiber endoscopic evaluation (FEES). In most cases, aresection of the bone spurs leads to asignificant improvement or even to acomplete restitution of the swallowing disorders.

Anterior Thoracic Discectomy and Fusion for Symptomatic Ventral Bone Spur Associated Type I Cerebrospinal Fluid Leak: A Technical Report and Operative Video.

Technical Report. Cerebrospinal fluid (CSF) leak secondary to anterior osteophytes at the cervico-thoracic junction is a rare cause of intracranial hypotension. In this article we describe a technique for anterior repair of spontaneous ventral cerebrospinal fluid leaks in the upper thoracic spine. In this technical report and operative video, we describe a 23-year-old male who presented with positional headaches and bilateral subdural hematoma. Dynamic CT myelography demonstrated a high flow ventral cerebrospinal fluid leak associated with a ventral osteophyte at the level of the T1-T2 disc space. Targeted blood patch provided only temporary improvement in symptoms. An anterior approach was chosen to remove the offending spur and micro-surgically repair the dural defect. The patient had complete resolution of his preoperative symptoms after primary repair. In select cases, an anterior approach to the upper thoracic spine is effective to repair Type 1 cerebrospinal fluid leaks.

Increased Medial Femoral Condyle Angle and Narrow Intercondylar Notch Are Associated With Medial Meniscus Posterior Root Tear

To investigate the correlation between nontraumatic medial meniscus posteriorroot tear (MMPRT) and bone morphology of the knee with a particular emphasis on MMPR impingement. Magnetic resonance imaging (MRI) findings were examined between January 2018 and December 2020. MRI findings of patients with traumatic MMPRT, Kellgren Lawrence stage 3-4 arthropathy on radiographs, single- or multiple-ligament injuries and/or those who underwent treatment for these diseases, and surgery in and around the knee were excluded from the study. MRI measurements included medial femoral condylar angle (MFCA), intercondylar distance (ICD), and intercondylar notch width (ICNW), distal/posterior medial femoral condylar offset ratio, notch shape, medial tibial slope (MTS) angle, and medial proximal tibial angle (MPTA) measurements and spur presence and were compared between groups. All measurements were performed by two board-certified orthopedic surgeons on a best agreement basis. MRI examinations of patients aged 40-60 were analyzed. MRI findings were divided into two groups: the study group of MRI findings of patients with MMPRT (n= 100) and the control group of MRI findings of patients without MMPRT (n= 100). MFCA was found to be significantly higher in the study group (mean: 46.5 ± 3.58) than in the control group (mean: 40.04 ± 4.61) (P < .001). In the study group, the ICD (study group mean: 76.26 ± 4.89; control group mean: 78.18 ± 6.1) was significantly narrower (P= .018), and the ICNW (study group mean: 17.19 ± 2.23; control group mean: 20.48 ± 2.13) was significantly shorter (P < .001). The ICNW/ICD ratio was significantly lower in patients in the study group (0.22 ± 0.02) than in the control group (0.25 ± 0.02) (P < .001). Bone spurs were present in 84% of the study group and only in 28% of those in the control group. In the study group, the most common notch type was A-type with 78%, while the least common was the U-type notch with 10%. However, in the control group, the most common notch type was A-type with 43%, and the least common was the W-type notch with 22%. The distal/posterior medial femoral condylar offset ratio was statistically lower in the study group (0.72 ± 0.07) than in the control group 0.78 ± 0.07) (P < .001). No significant intergroup differences were found in MTS (study group mean: 7.51 ±2.59; control group mean: 7.83 ± 2.57) (P= .390) and MPTA (study group mean: 86.92 ±2.15; control group mean: 87.48 ±1.8) measurements (P=.67). Increased medial femoral condylar angle, low distal/posterior femoral offset ratio, narrow intercondylar distance and intercondylar notch width, A-type notch shape, and spur presence are associated with MMPRT. Level III, retrospective cohort study.

Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain

To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain. The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability. The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05). Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

Minimally Invasive Foot and Ankle Surgery: A Primer for Orthopaedic Surgeons.

There is rapidly growing interest in minimally invasive surgery (MIS) of the foot and ankle. Technological advances, specifically with the advent of low-speed high-torque burrs, have enabled the expansion of MIS techniques. Accordingly, there is growing literature reporting excellent outcomes of MIS surgery to address many different pathologies of the foot and ankle. MIS techniques are particularly useful for conducting percutaneous osteotomies and bony débridement. These can be used to address bunion deformity, hammertoes, metatarsalgia, bunionette deformity, bone spurs, and hindfoot deformity. A detailed understanding of the technology, equipment, and techniques is crucial to safely conduct MIS of the foot and ankle. When done safely, MIS provides favorable outcomes with an expedited recovery and limited complications.

The Efficacy of Simple Debridement Compared to Augmentation with Flexor Hallicus Longus Transfer for Surgical Treatment of Moderate to Severe Insertional Achilles Tendinopathy

Category: Hindfoot; Sports Introduction/ Purpose: Insertional Achilles tendinopathy is a common condition with several treatment modalities encompassing conservative and operative strategies. Surgical treatment often includes debridement and reattachment of the tendon usually with ostectomy of impinging calcaneal bone spurs. Augmentation with a flexor hallicus longus (FHL) tendon transfer is performed to help provide extra strength to the degenerated tendon in more severe cases. Few studies have compared these procedures, and it is currently unclear whether simple debridement is effective for patients with advanced Achilles degeneration. Therefore, the aim of this study is to investigate the efficacy of simple debridement compared to augmentation with FHL transfer for the surgical treatment of moderate to severe insertional Achilles tendinopathy. Methods: This retrospective cohort study included 57 patients who underwent surgical treatment of moderate to severe insertional Achilles tendinopathy as graded on magnetic resonance imaging (MRI) using a classification system described previously. Moderate tendinopathy was defined as tendon thickening greater than 8 mm with less than 50% degeneration while severe was defined by the same degree of thickening but greater than 50% degeneration. Thirty-one patients underwent Achilles tendon debridement and reattachment with or without calcaneal ostectomy and were classified into the “simple debridement” group (mean age: 57.6 years). Twenty-six patients had the same procedures with the addition of a FHL transfer and were classified into the “FHL transfer” group (mean age: 57.9 years). Preoperative, minimum 1-year postoperative, and preoperative to postoperative change in six domains of PROMIS scores were compared within and between groups. Clinical outcomes such as complications, recurrence, and reoperations were also compared. Results: There were no significant differences in demographics between groups. Preoperatively as well as postoperatively, there were no significant differences in PROMIS scores in any domain between groups (Table 1). Both groups demonstrated significant preoperative to postoperative improvements in PROMIS Physical Function, Pain Interference, Pain Intensity, and Global Physical Health (all P&lt; .001). Only the FHL transfer group had significant improvements in Global Mental Health (P = 0.02). Conclusion: Our study found no significant differences in functional and pain-related outcomes between simple debridement and augmentation with FHL transfer for the treatment of moderate to severe insertional Achilles tendinopathy. These results suggest that simple debridement may also be effective in more advanced Achilles tendinopathy and may spare patients the need for FHL augmentation. However, our study is limited by its retrospective design and relatively small sample size. Thus, additional research including prospective long-term follow-up in more advanced tendinopathic stages is required to understand the true differences between the procedures.

Age estimation using vertebral bone spurs; Testing the efficacy of three methods on a European population

Age-at-death estimation is an essential step in both bioarchaeological and forensic studies when human remains are found, as this can also contribute to the identification of the individual. It is critical that age-at-death methods be tested verified in various populations, to obtain the most accurate estimation, making research into new age-at-death methods also imperative. Since osteophyte formation on the vertebral column increases with age, this can be used as a possible method of age-at-death estimation. Snodgrass (2004), Watanabe and Terazawa (2006) and Praneatpolgrang et al. (2019) have tested this method before and have provided promising results. We test the efficacy of Snodgrass (2004), Watanabe and Terazawa (2006), and Praneatpolgrang et al. (2019) on a 19th-century archivally recorded Dutch population. A total of 88 individuals, 40 males, and 48 females were scored for the degree of osteophyte formation on the vertebral column. In addition to testing the three methods above, population-specific regression equations were developed and tested. Accuracy percentages for estimating the age-at-death based on the mean osteophyte score of the entire vertebral column were obtained for all three methods (73.86%, 76.14%, and 72.73%, respectively). In this study, a general pattern of osteophyte formation could be established, which is useful for estimating the age at death. We therefore recommend that this method can be used, cautiously as a means of age-at-death estimation.

Comparison of the treatments of osteoarthritis

Osteoarthritis is one of the most prevalent diseases in the world, which affects a wide range of age groups, ranging from children to the elderly. More than 300 million people worldwide suffer from osteoarthritis, which may cause pain, stiffness, tenderness, loss of flexibility, grating sensation, bone spurs and swelling, and other diseases. Medication, surgery, and therapy are the main treatments. For medication, there are Analgesics and Nonsteroidal anti-inflammatory drugs, which have the function of reducing pain and inflammation. Nonsteroidal anti-inflammatory drugs can also reduce pain. For surgery, there are arthroplasty, arthrodesis, and osteotomy. In addition, there are physical therapy and occupational therapy. Those different kinds of therapies have their own advantages. Recent studies have shown that mesenchymal stem cells (MSCS) can be used to treat osteoarthritis, which has the properties of differentiating into chondrocytes and having anti-inflammatory and immunomodulatory effects. These cells are ideal for treating osteoarthritis that requires anti-inflammatory and cartilage replacement. This paper provides a brief overview of the different treatment approaches and aims to compare the pros and cons of each approach.

Efficacy of Oral Glucosamine Sulphate and Sulfasalazine combination in the treatment of Osteoarthritis

Background: Osteoarthritis is a degenerative disorder commonly affecting any joints mostly joints of hands, knees, spine and hips. The disorder occurs when wear and tear of the protective layer of cartilage cushioning the ends of the bones occurs. The symptoms start with pain and stiffness the joints slowly leading to stiffness, tenderness, loss of flexibility, grating sensation, swelling and formation of bone spurs. Osteoarthritis causes deterioration of connective tissue and inflammation of the joint lining. Glucosamine sulphate found in the human body is a naturally occurring chemical which is especially present in the fluid around the joints and is involved in building ligaments cartilage and thick fluid that surrounds the joints. Sulphate part is important for building the cartilage. Sulfasalazine is anti-inflammatory drug and is used to treat and reduce inflammation. In this study the combination of glucosamine sulphate and sulfasalazine is used in combination to test the efficacy in reduction of inflammation and pain in comparison with sulfasalazine alone. Materials and Methods: In this prospective randomized controlled study 60 patients of osteoarthritites between the age group of 18 to 60 years were selected. Patients were divided into two groups (A and B). Age, severity of the disease was taken into consideration while grouping the patients. Group A was treated with Sulfasalazine alone 500mg once a day and group B with combination of Glucosamine Sulphate (oral) 750mg twice a day and Sulfasalazine (oral) 500mg once a day. Assessments of number of swollen joints and VAS and faces pain rating (scale) were carried out once in a month. Results: After six months 67% reduction in number of swollen joints and 76% of duration of morning stiffness in combination therapy was observed compared to 54% and 65% of reduction respectively in sulfasalazine alone. VAS score after six months was found to be 1 in combination therapy and 3 in suflasalazine alone. Conclusion: The study concluded that the combination treatment regimen glucosamine sulfate and oral sulfasalazine improved patient mobility, decreased number of swollen joints and decreased arthritic pain gradually.

Heterotopic ossification after alloplastic temporomandibular joint replacement: a case cohort study

BackgroundHeterotopic ossification (HO) is one of the serious complications leading to the failure of alloplastic temporomandibular joint replacement (TJR). However, there was few research on its exact incidence and occurrence. Severe HO might result in pain and limited mouth opening after surgery. Therefore, it is necessary to clarify its clinical and imaging manifestations. The purpose of this study was to study the occurrence and classify HO after the alloplastic TJR.MethodPatients who underwent standard TJR (Zimmer Biomet stock prostheses or Chinese stock prostheses) with fat graft and at least 1-year-follow-up were included. HO was classified into 4 types according to postoperative computed tomography (CT) scans. Type and occurrence in different TMJ disease were compared. Joint space within 1 week after operation was measured and compared between HO and non-HO TJRs. Maximum incisal opening (MIO), pain, and quality of life (QoL) were recorded and their relevance with HO was analyzed statistically.Result81cases with 101 joints were included in the study. The mean follow-up time was 22.9 months (12 ~ 56 months). Among the 48 joints, 27 (56.3%) were type I (bone islands); 16 (33.3%) were type II (bone spurs from the mandibular ramus); 3 (6.3%) were type III (bone spurs from the fossa); and 2 (4.2%) were type IV (bone spurs from both the mandibular ramus and fossa). In HO patients, joint space in type IV was smaller than the other 3 types. Pain scores in HO were significantly greater than non-HO patients before and after operations (p < 0.05). 1 patient in Type IV HO developed ankylosis and had prosthesis revision which accounted for 2.1% in HO patients and 1.0% in all TJR patients.ConclusionHO after alloplastic TJR with fat graft was not severe except for type IV, which was easy to cause ankylosis. Preserving sufficient TJR space was important for ankylosis prevention.

Comparison between electrotherapy and manual therapy in cervical radiculopathy: Literature review

Background: Cervical radiculopathy (CR) is a broad term that included any dysfunction related to the nerve root on cervical area. Most commonly affected nerve root C6- C7. Cervical radiculopathy is the condition in which patient feel pain, numbness, paraesthesia, tingling effect in cervical hand and upper extremity due to impingement of nerve in cervical area. The cause of nerve impingement is PIVD, instability, trauma, athletic changes; slip disc, cervical foraminal stenosis, and bone spur formation. A large number of Physiotherapy treatment was suggested which are feasible for CR including exercise mobilisation isometric exercise with therapeutic modalities TENS, US, IFT. This study is to discover the efficacy of TENS, IFT, US versus mobilization and isometric exercises, as an intervention for the patients having CR. Aim- -The purpose of this study was to compare manual therapy and electrotherapy in cervical radiculopathy patients. Method- We included 30 articles in this study, 15 for manual therapy and 15 for electrotherapy, based on randomised controlled trials. Manual therapy included isometric exercises, mobilisation, and physical exercises, while electrotherapy included ultrasonography and interferential current. T

Development of a Novel Rat Intervertebral Disc Degeneration Model by Surgical Multifidus Resection–Induced Instability

This study aimed to investigate whether surgical resection of multifidus in rats could generate a reliable model of intervertebral disc degeneration (IVDD). Instability of the lumbar spine in Sprague-Dawley rats was induced by multifidus resection. Longissimus changes were examined by hematoxylin and eosin staining and immunohistochemistry. Specific protein and mRNA changes in the nucleus pulposus (NP) were quantified by Western blot and reverse transcription-polymerase chain reaction. Bone alterations were assessed using X-ray imaging, and disc changes were evaluated by hematoxylin and eosin staining, immunofluorescence, and immunohistochemistry. Fat infiltration and increased tumor necrosis factor-α expression in the longissimus were detected following surgery. Reverse transcription-polymerase chain reaction and Western blot results demonstrated that the inflammation and catabolism in the NP were increased after the surgical intervention. Moreover, X-ray imaging showed that the disc height had decreased and bone spurs had formed at the vertebral rims. Histological analyses further revealed degeneration of the annulus fibrosus, endplate, and NP. Furthermore, in contrast to the sham group, the collagen II expression was reduced, while matrix metalloproteinase-13 was increased in the surgery group. Surgical resection of the multifidus in rats resulted in a reproducible IVDD model. Because the present procedure does not impart direct injury to the intervertebral disc, it can better imitate the pathological states in humans. Therefore, our rat multifidus resection model might help us further understand the intrinsic pathophysiology of IVDD.

FULL-ENDOSCOPIC TRANSFORAMINAL DECOMPRESSION TO TREAT A HIGH-RISK PATIENT WITH LUMBAR SPINAL STENOSIS AND DEGENERATIVE SPONDYLOLISTHESIS: A CASE REPORT AND LITERATURE REVIEW

Lumbar spinal stenosis (LSS) with degenerative spondylolisthesis (DS) is prevalent in the aging population while they often have multiple comorbidities which are related to the higher risk for general anesthesia. Full-endoscopic transforaminal decompression (FETD) has been utilized under local anesthesia to remove herniated intervertebral disc, resect hypertrophic ligament and enlarged bone spur in order to decompress the affected neural structure without compromising the stability. In this study, we would present that a 71-year-old male patient, who had multiple comorbidities, underwent FETD to treat LSS with DS. We also conducted literature review to illustrate the feasibility of FETD in the treatment of LSS with DS. Reviewing 80 patients with LSS and DS in the four case-series studies, there was no difference in vertebral slippage percentage before and after operation. The overall complication rate was 3.75%, including three patients who had small dural tears which did not develop neurological sequelae during the follow-up period and did not require surgical or medical intervention. Four patients (5%) underwent reoperation due to recurrent or persistent sciatica symptoms. In conclusion, FETD can not only provide complete decompression but also maintain the original stability in treatment of LSS with DS. FETD can be an effective and safe approach to treat lumbar spinal stenosis with degenerative spondylolisthesis and can be an alternative for patients with multiple comorbidities or high risks for general anesthesia.

MRI lesions of the spine in patients with axial spondyloarthritis: an update of lesion definitions and validation by the ASAS MRI working group

ObjectivesSpinal MRI is used to visualise lesions associated with axial spondyloarthritis (axSpA). The ASAS MRI working group (WG) updated and validated the definitions for inflammatory and structural spinal lesions in...

MORPHOMETRIC STUDY OF THE STYLOID PROCESS AND ITS CLINICAL IMPLICATIONS

Background: Styloid process is a slender, cylindrical spur of bone fused with the inferior aspect of the temporal bone in front of the stylomastoid foramen. Present study aimed to evaluate the length, angulation, interstyloid distance and styloid ratio to highlight their possible etiological importance in clinical and surgical conditions. Interstyloid distance is used for sexual dimorphism. Excessive length and angulation of styloid process is clinically important, as it may cause Eagle's syndrome. Material And Methods: The study was done on both sides of 52 dry human skulls of unknown age and sex without any obvious deformity. Each skull was carefully examined for the presence of elongated styloid process (length&gt;30 mm). The length was measured using Vernier caliper and interstyloid distance was measured using divider. Angle of styloid process with the Reid's baseline and styloid ratio was also calculated. Results: Out of 52 skulls, elongated styloid process was observed in thirteen skulls, amongst them eight skulls (15.38%) with unilateral and ve (9.62%) with bilateral elongation. Rest of the skulls (n=39) had lengths varying from 20-30 mm. Mean angle between styloid process and Reid's baseline was 51.13°. Average interstyloid distance was 75.42 mm while 70-80 mm was the most common range. Styloid ratio varied from 3-4. Conclusions: Unilateral elongated styloid process was found more frequently as compared to bilateral. The results can be used as a baseline data for identication of male and female skull by calculating the interstyloid distance. The ndings of the present study may be of utmost importance in the examination of styloid process in patients with symptoms of stylalgia.