Columna y Ortopedia: Discusión entre pares / m 14 with severe backpain and left lower limb radicular pain . no weakness , no bladder involvement

martes, 22 de abril de 2014

Discusión entre pares / m 14 with severe backpain and left lower limb radicular pain . no weakness , no bladder involvement

Indian-Orthopaedic Research-Group

Sandeep Sonone ha añadido fotos al álbum "m 14 spondyloptosis ".

24 de marzo a la(s) 11:36

m 14 with severe backpain and left lower limb radicular pain . no weakness , no bladder involvement . no history of trauma ...CT awaited ... management options plzz

Una foto de Sandeep Sonone.

Una foto de Sandeep Sonone.

Una foto de Sandeep Sonone.

Una foto de Sandeep Sonone.

Una foto de Sandeep Sonone.

Sandeep Sonone Sanjay Dhar Kshitij Chaudhary Vishal B Peshattiwar Niraj B. Vasavada Jwalant Mehta Vedant Vaksha Damandeep Singh Advance Lumbar Spine Technique Mihir Bapat Shyamlal Mukhi

24 de marzo a la(s) 11:42 · Me gusta
Vedant Vaksha WOW!! Thats a scary picture. Please get a 36 inch lat (AP also) film also to look for pelvic & whole spine sagital profile. Is there trauma involved??

24 de marzo a la(s) 11:57 · Me gusta
Sandeep Sonone there is no history of trauma .

24 de marzo a la(s) 12:04 · Me gusta
Ahmed Ezz It is a congenital hemivertebra, we need more images

24 de marzo a la(s) 12:29 · Me gusta
Mushtaq Khosa Never seen Before

24 de marzo a la(s) 12:38 · Me gusta
Ahmed Ezz Ptosis

24 de marzo a la(s) 12:53 · Me gusta
Ahmed Ezz Sorry completely wrong like congenital spondylo pros is

24 de marzo a la(s) 12:54 · Me gusta
Anshul Garg spondyloptosis]

24 de marzo a la(s) 12:59 · Me gusta · 1
Ara Antaranyan Spondylolisis - ficsation in situ with autobone grafting ant and posterior

24 de marzo a la(s) 13:02 · Me gusta
Ambarish Mathesul sir r u planning for graines procedure?

24 de marzo a la(s) 13:10 · Me gusta · 1
Vishal Gupta Spondyloptosis. Need fixation

24 de marzo a la(s) 13:21 · Me gusta · 1
Sandeep Sonone Ambarish Mathesul - will wait fr ct ..suspect L5 body to be split into 2 ..one part carrying the proximal column with it ...so even gaines seems technically difficult

24 de marzo a la(s) 13:27 · Me gusta
Ahmed Hashhash Spondylptosis........

24 de marzo a la(s) 13:28 · Me gusta · 2
Rune Hedlund Agree, wow case. Not classifiable patology. Never seen, not described. Pathomechanism obscuring. If old vertebrae would have been remodeled more, if recent neuro deficit would have been more pronounced. In short, a mystery.
Treatment: I would considerations removing L4 + disc L4 -L5 fr.o.m. The back, partially reduce L4 on S1. Of course, high risk, but all other alternatives all are, even in situ fusion, not immediately, but With Time.

24 de marzo a la(s) 13:36 · Me gusta · 3
Damandeep Singh I am looking at for a long time and I have no ways to explain this pathology. All I know is I am not aiming reduction. What is the dermatome of pain ? I don't know but remove the l5 and fuse l4 to s1 insitu with decompression of nerve roots (easier said than done ) ....it's a once in a life time case.

24 de marzo a la(s) 13:48 · Me gusta · 1
Vedant Vaksha This is a (high dysplastic) Spondyloptosis. Sure needs CT to look for other dysplasias - Spina bifida etc & also bone anatomy (more so in this case). A standing lateral view to see if the sacropelvis is balanced (High SS & low PT) or not. If sacropelvis is balanced - go for in situ fusion (Bohlman procedure). If pelvis is unbalanced, check Spinopelvis confugration (36inch Lat film). if spinopelvis is balanced, reduction is difficult (should be attempted as a principle), in situ fusion is again preferable, but is spinopelvis is also unbalanced (C2/C7 falling in front of trochanters) then reduction is mandatory - Gains procedure. There seems to be a dysplasia of pedicles of level above also (elongated).

24 de marzo a la(s) 14:03 · Editado · Me gusta
Abhishek Haldar This has to be evaluated.. Before commenting on procedure......... Lets get the ct pictures...

24 de marzo a la(s) 14:51 · Me gusta
Naresh Kumar Krishnamurthy never seen like this before. scared.

24 de marzo a la(s) 15:34 · Me gusta · 1
Shashidhar Bk May be trans fixation like GO -LIF with decompression of involved nerve root only..in view of radicular pain and no otger deficit....but I feel difficult to predict results or complications. ..ct scans will give clear pictute.. .navigation will be helpful to plan trajectory...(successful treatment can be the best orgasm of your life sirji...he he)

24 de marzo a la(s) 19:24 · Me gusta · 1
Gurusamy Nachimuthu Looks like collegen disorders

24 de marzo a la(s) 22:41 · Me gusta
Gurusamy Nachimuthu It is not dysplastic or congenital

24 de marzo a la(s) 22:42 · Me gusta
Gurusamy Nachimuthu Please give me MRI axial cuts L5 level

24 de marzo a la(s) 22:45 · Me gusta
Gurusamy Nachimuthu ???!!!!!

24 de marzo a la(s) 22:45 · Me gusta
Niraj B. Vasavada I was like when I saw the post !!! I agree with the forum it's rarest of the rare case !!!! Would surely wait for CT ... Agree with Damandeep Singh wouldn't worry about reduction ... Should we do also angiography to check the vascular structures around !!!! Any takers for anterior spondylectomy and reconstruction with strut graft and posterior fixation with decompression ???? Honestly I'm not sure what would be an ideal way of treatment ... Surely would want to take opinion of Dr. Alassandro luzzati from milan who has done even 4 level en bloc spondylectomy or a sacrectomy for tumors for the safest way to deal with the case. Mentioned him cause I have seen him operating such horrifying cases!!

24 de marzo a la(s) 23:40 · Editado · Me gusta · 3
Sandeep Sonone Thanks Niraj Vasavada ..will def take his opinion

25 de marzo a la(s) 0:03 · Me gusta · 1
Advance Lumbar Spine Technique interesting case. will need some more insight into the hidtory as well as axial ct cuts

25 de marzo a la(s) 2:16 · Me gusta
Jwalant Mehta was there an acute event leading to this

26 de marzo a la(s) 16:52 · Me gusta
Kshitij Chaudhary I am not in favor of reduction. I am thinking of a Bohlman-like procedure. Trans-sacral cage or fibula to transfix S1 and L4. Whether this is technically possible would depend on the CT. This is obvious very unstable situation but still the patient does not have serious neurology and he is still ambulatory. I wonder if there is some degree of auto stabilization which has occurred. CT would definitely shed more light.

26 de marzo a la(s) 22:29 · Me gusta · 1
Sandeep Sonone Jwalant Mehta - there is no history of any acute event

26 de marzo a la(s) 22:58 · Me gusta
Sandeep Sonone Kshitij Chaudhary - its not L4 .its L5 in front ...its split in sagital plane with one part with S1 and another one lying in front with proximal column .

26 de marzo a la(s) 23:00 · Me gusta
Kshitij Chaudhary Interesting. Please show us ct scan when available.

26 de marzo a la(s) 23:16 · Me gusta · 1
Sandeep Sonone Niraj B. Vasavada - opinion of dr alassandro luzzati Sorry for the delay in answering.

Probably i would try to reduce it slowly from posterior (not obliged to gain a complete reduction) and then fuse 2 upper levels to sacrum (S1 and S2 or sacro-iliac) with a PLIF (with cages and autografts) and posterior autogenous arthrodesis.

Let me know, best regards and sorry again for the delay!

Ciao from Milan

Alessandro Luzzati

28 de marzo a la(s) 23:56 · Me gusta · 1
Damandeep Singh Sir another person we can take an opnion from is dr. Alwin Crawford.

29 de marzo a la(s) 0:21 · Me gusta · 2
Niraj B. Vasavada I'm sure sandeep must have found a way by now!!!Sandeep Sonone pl tell us what u did!

29 de marzo a la(s) 0:57 · Me gusta · 1
Sandeep Sonone Niraj Vasavada - still hvnt operated the patient ...waiting for ct !!!!:(

29 de marzo a la(s) 3:13 · Me gusta
Sandeep Sonone sorry for delay in posting ct images ... pt had almost absconded and had to catch him and get back ...:)))....posting Ct cuts - Vedant Vaksha Shashidhar Bk Kshitij Chaudhary Advance Lumbar Spine TechniqueNiraj B. Vasavada

17 de abril a la(s) 2:07 · Me gusta
Gurusamy Nachimuthu Can anybody say, how this developed? Pathomechanics

17 de abril a la(s) 2:47 · Me gusta
Sandeep Sonone Gurusamy Nachimuthu the axial cuts show elongation of L5 pedicle /pars which goes more in favour of gradual progressuve slip rather than acute event .Also , there seems to be some fusion between L5 pedicle on rt side with S1 body ....wonder if its a part of autostabilisation Kshitij Chaudharywas hinting at .

17 de abril a la(s) 7:04 · Me gusta
Vedant Vaksha If there is autofusion, then insitu fixation is all that is needed. If there is mobility then a post partial reduction can be attempted followed by fusion. The pedicles of upper 2 vertebra (L4 & L3) also seem to have elongated!!

17 de abril a la(s) 20:23 · Me gusta
Gurusamy Nachimuthu Can it be L5 end plate slip
It seems slipped L4 with L5 superior endplate in front of L5

18 de abril a la(s) 3:02 · Me gusta
Vishal B Peshattiwar Decompression with s1 to l4 long screws l3 n l2 screws. Sos iliac screws. In situ.

19 de abril a la(s) 5:35 · Me gusta · 1
Sandeep Sonone thats the final postop ...... it was all fused on opening up with bony bars from anterolateral part of L5 to anterior part of S1 . Did decompression and fusion from L4 TO S1 and tricortical graft in a notch created between posteroinferior part of l5 and superior endplate of S1 ....am not so sure if it was needed but just wanted to add to the fusion ..... sometimes wonder if radiological and clinical defination of instability make a contradiction !!!!

19 de abril a la(s) 20:26 · Me gusta · 9
Niraj B. Vasavada A decent job done to a challenging case !!!! Bravo !!

19 de abril a la(s) 21:28 · Me gusta · 2
Ambarish Mathesul Ap view sir

19 de abril a la(s) 22:47 · Me gusta · 1
Vishal B Peshattiwar You are the cool one!!! Nice!!

20 de abril a la(s) 2:33 · Me gusta · 1
Sunil Gupta Dr Sandeep Sonone what is the diagnosis sir?

20 de abril a la(s) 8:59 · Me gusta · 1
Damandeep Singh That's a work of art sir !!! Awesome stuff sir !!!!

20 de abril a la(s) 9:18 · Me gusta · 1
Sandeep Sonone Thnk u guys .
Ambarish Mathesul - will post it soon .
Sunil Gupta - i really dont know the diagnosis as it was always clinicoradiological and not histopathological ...but looks like some sort of dysplasia as a part of chronic process as the pedicle of L4 was elongated too with slope downwards and bony mass lateral to the pars of L5 with elongation of L5 pedicles fused to lateral aspect of S1 ..so at end of day i still dont hv Diagnosis .

20 de abril a la(s) 11:24 · Me gusta · 2
Vishal Gupta Great work sir.please post ap veiw

20 de abril a la(s) 11:29 · Me gusta
Jwalant Mehta Case reports are difficult to publish in leading journals. Would recommend sending it, with the postop outcome to the 'grand round' section of European Spine Journal.

20 de abril a la(s) 12:00 · Me gusta · 3
Sandeep Sonone Ambarish Mathesul - Ap view .

Hace 19 horas · Me gusta · 1
Shashidhar Bk Sandeep Sonone b badiya hai sirji, very challeneging case...for the sake of adding to the discussion and planning . ...sir particularly lateral view could the rod contouring been done any different ...i dont know how much difference that could make to the clinical profile of the patient ..

Hace 14 horas · Editado · Me gusta
Shashidhar Bk example from bridwel deformity sir

Hace 14 horas · Me gusta

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