Functional outcome of operative management of Haglund deformity in non-athletic individuals-a case series

Haglund’s deformity is a symptomatic osseous outgrowth or prominence of the posterolateral corner of calcaneus usually in young individuals which presents in the form of posterior heel pain, sometimes intractable in chronic cases, which aggravates on walking or on dorsiflexion of the foot and is relieved with rest and anti-inflammatory medications in the initial phases. Management involves an initial conservative trial involving lifestyle changes and medical management, failure of which warrants surgical management for symptomatic relief along with ability to return to perform activities of daily living. We have a series of 4 patients with a Haglund’s deformity who presented to us with chronic posterior heel pain of varying duration with episodic exacerbations who were initially managed with a conservative trial with medications, physiotherapy, lifestyle modifications, usage of soft silicon sole for the footwear; the failure of which prompted us to go ahead with surgical management of these patients-all 4 patients were managed with a lateral wedge removal of the calcaneus with excision of the retrocalcaneal bursa. All 4 patients reported significant improvement in the symptoms with adequate postoperative care and rehabilitation. As we have seen in this case series of 4 patients presented here, Haglund’s deformity which is a part of a larger Haglund’s syndrome, has a chronic progression over a period of time with episodic exacerbations and remissions, which could be managed conservatively for a significant period initially but, if need be, surgical management should not be deferred not only to provide symptomatic relief as a major goal, but also to avoid permanent degenerative damages to the concerned soft tissues

Comprehensive Spinal Tuberculosis Score: A Clinical Guide for the Management of Thoracolumbar Spinal Tuberculosis

Study Design A newly proposed scoring tool was designed to assist in the clinical management of adult thoracolumbar spinal tuberculosis (TB). Purpose To formulate a comprehensive yet simple scoring tool to guide decision-making in the management of adult thoracolumbar spinal TB. Overview of Literature Spine surgeons have differing consensus in defining the threshold grade for clinico-radiological parameters when deciding between operative or conservative treatment for adult thoracolumbar spinal TB. Currently, the void in decision-making from the lack of well-defined guidelines is compensated by the surgeon’s experience in treating these patients. To the best of our knowledge, no scoring system holistically integrates multiple facets of spinal TB to guide clinical decision-making. Methods The RAND/University of California, Los Angeles appropriateness method was employed among an expert panel of 10 spine surgeons from four apex tertiary care centers. Vital characteristics that independently influenced treatment decisions in spinal TB were identified, and a scoring tool was formulated. Points were assigned for each component based on their severity. The cutoff scores to guide clinical management were determined from the receiver operating characteristic curve based on the retrospective records of 151 patients treated operatively or non-operatively with improved functional outcomes at the 1-year follow-up. Results The components of the comprehensive spinal TB score (CSTS) are pain, kyphosis angle, vertebral destruction, and neurological status. A score classification of 6.5 was established to guide the patient toward conservative, conservative/operative, and operative management, respectively. Conclusions The CSTS was designed to reflect the essential indicators of mechanical stability, neurological stability, and disease process stabilization in spinal TB. The scoring tool is devised to be practical and serve as a common language in the spine community to facilitate discussions and decision-making in thoracolumbar spinal TB. The validity, reliability, and reproducibility of this tool must be assessed through multicenter long-term studies