Dr. Arjun Rajan

Background: Osteoporosis is a global problem involving majority of elderly population. Vertebral compression fracture in this population leads to severe pain and decreased quality of life. Percutaneous vertebroplasty alleviates the pain, with a minimal invasive approach. The aim of our study was to analyze the technical considerations and complications of this surgery. Materials and methods: Vertebroplasty was performed in 35 patients with male: female ratio 13:22 in the age group of 52–80 years. We used unipedicular needle insertion and injected 2–3 mL of high-viscosity polymethylmethacrylate in the fractured vertebral body. Visual analog score, Oswestry disability score, and Oswestry disability index were used to analyze functional outcome. Results: Pain relief had a significant p value (<0.0001). Oswestry disability score and index showed a good improvement in the quality of life with a p value < 0.0001. The Beck index did not show a significant change postoperatively. Complications encountered were cement extravasation into venous pathway, cement extravasation into the soft tissue, cement extravasation into the needle tract, and adjacent vertebral fractures. No major complication was encountered. Conclusion: Vertebroplasty provides better pain relief, improved function, and quality of life than conservative management. Use of an appropriate technique will improve the overall success rate of the procedure and minimize the complications. Clinical significance: For patients with osteoporotic fractures who do not respond to conservative measures, vertebroplasty is a simple, effective, and minimally invasive procedure providing adequate pain relief and improving the quality of life.

Introduction: Among various spine disorders, degenerative conditions like lumbar disc disease and spondylolisthesis are commonly encountered. Surgery is the option if conservative management fails. Fusion is the only option to alleviate instability. Transforaminal Lumbar Interbody Fusion (TLIF) is a promising procedure to achieve this goal. The aim of our study was to evaluate whether unilateral TLIF with one cage is comparable with other established techniques. Materials and Methods: This is a prospective study with 11 males & 11 females who have undergone TLIF for disc disease and low grade listhesis. A single TLIF cage was used for single level pathologies. In one patient with contiguous two level disc disease, two level TLIF was performed. Results: Results were analysed with respect to intra-op parameters (like surgery duration, blood loss, etc.) and post-op parameters (like fusion, pain relief, etc.). Oswestry Disability Index was used to measure functional outcome. There was a statistically significant improvement in post-op scores (p<0> Conclusion: Proper patient selection and surgeon’s expertise are important for a successful outcome. TLIF has many advantages when compared to other fusion techniques. It is an ideal management for treating degenerative disc disease and listhesis of low grades.

Assessment of bone geometry and its considerations in implant selection for polio affected femoral fractures: An outcome analysis Author(s): Dr. V Thirunarayanan, Dr. DR Ramprasath, Dr. Arjun Rajan Abstract: Introduction: Fractures occurring in the femurs of polio affected limbs pose various challenges in their management since they have an altered anatomy. In this study, the bone geometry of femoral fractures in post-polio residual paralysis patients is analysed and compared with standard implants for proper implant selection to provide a stable fixation. Materials and methods: A total of 20 femoral fractures in adult post-polio residual paralysis patients were included in this study and their bone geometry was assessed. Based on the bone geometry in each case, appropriate implants were used. The mean age was 41.6 years (Range 26 to 58 years). 9 cases out of the 20 required the use of non-standard implants, including a custom-made femoral nail, a humerus nail, proximal humerus LCP, proximal tibial LCP and a modular bipolar hemiarthroplasty prosthesis with DDH stem. Mean duration of follow up was 34.5 months (Range 2 to 5 years). Results: The mean union time was 4.63 months. The mean duration of surgery was 81min (Range 65-145 mins). Intra-operative blood loss ranged from 80-250ml (Mean 130ml) with no case requiring blood transfusion. Mean hospital stay ranged from 7-9 days. All patients returned to their pre-operative function (assessed according to Vignos scale for lower extremities), except for two cases showing a deterioration of function post-operatively. Conclusion: No implant is unique for surgical management of femur fractures in post-polio residual paralysis patients. Proper pre-operative evaluation and planning should be individualised for each case according to the measured femoral geometry. The best implant should be chosen and a wide array of implants should be made available during surgery to achieve good results.