Surgical treatment of acute TB spondylitis: indications and outcomes

Introduction: Spinal tuberculosis represents a challenging disease to treat, not because of the technical expertise or the time required to cure it, but more so because of the decisions involved to treat it. The Medical Research Council (MRC) Working Party on Tuberculosis of the Spine designed trials to help address several questions. Methods: A comprehensive literature search was performed using PubMed Medline, including English articles from 1934 to 1012, which pertain to spinal tuberculosis, with special effort in tracing the 13 MRC reports. The primary focus was on disease eradication, fusion rate, and a secondary focus on both short and long-term results in terms of disease recurrence and alignment. Additional searches were made on the use of spinal implants for infection cases. Results: After reviewing MRC and non-MRC reports, it was evident that the "Hong Kong operation", which involved radical debridement and strut grafting the lesion, produced better short-, medium- and long-term results in such aspects as fusion rate, spinal deformity and relapse of abscess/sinus. Subsequent work by others demonstrated the importance of prevention of progressive kyphosis, therefore the need to identify risk factors for these and pre-emptive measures such as kyphosis correction, careful graft selection, and instrumentation. Conclusion: Improvement in quality of life is also accompanied by higher patient expectations. Though developing nations may lack the resources now, eventually patients will demand better functional and cosmetic results after being afflicted by this disfiguring and potentially disabling disease, and the "Hong Kong operation" represented the best outcome, provided resources were available. © 2012 The Author(s).published_or_final_versio

Spinal cord compression secondary to brown tumour in a patient on long-term haemodialysis: a case report.

Brown tumours may occur secondary to hyperparathyroidism in patients with chronic renal failure (CRF). Diagnosing a spinal brown tumour causing cord compression requires a high index of suspicion. We report a 65-year-old woman, who had been on haemodialysis for CRF for over 10 years, who presented with leg weakness and back pain over the thoracolumbar junction. She had a brown tumour at T8 causing subacute spinal cord compression. Ambulation was regained after surgical decompression and stabilisation. Adherence to the National Kidney Foundation guidelines in the management of patients with CRF may prevent renal osteodystrophy. Treatment of spinal brown tumour depends on the severity of the neurological deficit. Remineralization is expected after correction of the parathyroid level, thus negating the need for total excision of the parathyroid glands.published_or_final_versio

The influence of a competition on noncompetitors

We report a series of experimental studies that investigate the influence of a competition on noncompetitors who do not participate in it but are aware of it. Our work is highly relevant across many domains of social life where competitions are prevalent, as it is typical in a competition that the competitors are far outnumbered by these noncompetitors. In our field experiment involving pay-what-you-want entrance at a German zoo (n = 22,886), customers who were aware of a competition over entrance payments, but did not participate in it, paid more than customers who were unaware of the competition. Further experiments provide confirmatory and process evidence for this contagion effect, showing that it is driven by heightened social comparison motivation due to mere awareness of the competition. Moreover, we find evidence that the reward level for the competitors could moderate the contagion effect on the noncompetitors. Even if an individual does not participate in a competition, their behavior can still be influenced by it, and this influence can change with the characteristics of the competition in an intriguing way

A Lethal Sequelae of Spinal Infection Complicating Surgery and Radiotherapy for Head and Neck Cancer

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A combination of functional magnetic resonance imaging and diffusion tensor image to explore structure-function relationship in healthy and myelopathic spinal cord

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Exploration of functional reorganization in cervical spondylosis myelopathy: a DTI and fMRI study

Poster: abstract no. 30792INTRODUCTION: The morphological and signal change in anatomical magnetic resonance images (MRI) did not necessarily parallel with clinical symptoms in cervical spondylosis myelopathy (CSM), which poses a big challenge to clinician for early diagnosis and precise prognosis. Functional reorganization may play an important role in the pathophysiological mechanism of this chronic degenerative disease. The present study sought to explore the relationship between functional reorganization and structural damage in …postprin

Surgical wound infection

Objective. To review the risk factors for surgical would infection; the use of prophylactic antibiotics in the prevention of wound infection; and the benefits of wound surveillance programmes to reduce the rate of surgical wound infection. Data sources. Medline literature search and review of published work on surgical wound infection, and the references cited in them. Study selection. Critical studies containing supporting evidence were selected. Data extraction. Data were extracted independently by multiple observers. Data synthesis. Factors that effect the susceptibility of a wound to infection include a pre-existing illness, the duration of the operative procedure, wound contamination, three or more diagnoses at the time of discharge, and abdominal operations. Antibiotic prophylaxis can decrease postoperative morbidity, shorten hospital stay, and reduce overall costs attributable to infection; the choice of antibiotic depends on the would class. Wound surveillance can also decrease wound infection rates. Conclusion. Surgical wound infections are common and consume a considerable portion of health care finances. A reduction in the infection rate to a minimal level, however, can be achieved by the judicious use of antibiotic prophylaxis and the use of an organised system of wound surveillance and reporting.published_or_final_versio

Anterior approach to cervical spine

Study Design: Review of surgical technique. Objective: To provide accounts of the authors' preferred methods for performing anterior cervical surgery with personal tips and pearls. Summary of Background Data: Many have described the various anterior surgical approaches to the cervical spine, and in this review, we hope to describe our preferences, highlighted with some tips and pearls. Methods: Various accounts of the transoral, the anterolateral (Smith-Robinson), and the split manubrium approaches were reviewed and used as the basis of the review. Additional notes with regard to the authors' preferences were noted to provide further guidance. The descriptions were delineated from the most cephalad to the most caudal. Results: The transoral, the anterolateral (Smith-Robinson), and the manubriotomy approaches were described. Each account starts with the basic preoperative considerations, then describes the incision and the main anatomical landmarks, and finally concludes with closure and main complications to monitor for. A brief description of the main pathologies that each approach may address is also provided. Conclusion: The 3 anterior approaches to the cervical spine are direct and elegant solutions to pathologies arising from the anterior column. They supplement the more commonly used posterior approaches, which provide stronger multilevel fixation, and thus provide an essential tool in the armamentarium of spine surgeons. Copyright © 2012 Lippincott Williams & Wilkins.postprin

Preventing Fusion Mass Shift Avoids Postoperative Distal Curve Adding-on in Adolescent Idiopathic Scoliosis

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