HEROES: Unreal Engine-based Human and Emergency Robot Operation Education System

Training and preparing first responders and humanitarian robots for Mass Casualty Incidents (MCIs) often poses a challenge owing to the lack of realistic and easily accessible test facilities. While such facilities can offer realistic scenarios post an MCI that can serve training and educational purposes for first responders and humanitarian robots, they are often hard to access owing to logistical constraints. To overcome this challenge, we present HEROES- a versatile Unreal Engine simulator for designing novel training simulations for humans and emergency robots for such urban search and rescue operations. The proposed HEROES simulator is capable of generating synthetic datasets for machine learning pipelines that are used for training robot navigation. This work addresses the necessity for a comprehensive training platform in the robotics community, ensuring pragmatic and efficient preparation for real-world emergency scenarios. The strengths of our simulator lie in its adaptability, scalability, and ability to facilitate collaboration between robot developers and first responders, fostering synergy in developing effective strategies for search and rescue operations in MCIs. We conducted a preliminary user study with an 81% positive response supporting the ability of HEROES to generate sufficiently varied environments, and a 78% positive response affirming the usefulness of the simulation environment of HEROES

Minimally Invasive Temporary Posterior stabilization in Isolated Unstable L5 Burst Fracture with Predominant Radiculopathy: A Case Report

To report an isolated L5 burst fracture with predominant radiculopathy treated with MIS, implant removal at one year and its clinical and radiological outcomes at two-year follow-up. A 29-year male sustained an isolated burst fracture of the fifth lumbar vertebra after a train accident. After being treated conservatively at a primary centre for 2 weeks, he presented with back pain with severe radicular pain and hypoesthesia over his left leg. CT and MRI showed a retropulsed fragment with ‘reverse cortical sign’ causing severe stenosis. As the symptoms were refractory, he was treated with MIS L4-S1 posterior instrumentation without direct decompression, with post-operative resolution of symptoms. The fracture healed and implant removal was done at one year. Clinical and radiological outcomes were evaluated at 2-year follow-up. Results: At 2-year follow-up, Oswestry Disability Index score was 4%; there was partial remodeling of the spinal canal from 0.5cm2 to 1.5cm2, lumbosacral motion of 15.4°, lumbar lordosis of 30.7°, and with 8.7° loss of segmental L4-S1 lordosis as compared to the immediate postoperative period. In this case of an isolated L5 burst fracture with radiculopathy treated with MIS, there was clinical improvement and motion preservation, with partial remodeling although there was some residual loss of lordosis

Irreducible Atlanto-Axial Dislocation in Neglected Odontoid Fracture Treated with Single Stage Anterior Release and Posterior Instrumented Fusion

It is a well-know fact that type 2 odontoid fractures frequently go into nonunion. If left untreated, patients may develop irreducible atlantoaxial dislocation (AAD). We describe the surgical management of two patients with neglected odontoid fractures and irreducible AAD treated with single stage anterior release followed by posterior instrumented fusion. Both patients presented with history of neglected trauma and progressive myelopathy. Traction under anesthesia failed to achieve reduction of AAD. Anterior release was done by trans-oral approach in one patient and retrophayngeal approach in the other. Posterior fixation was performed with transarticular screws in both the patients. Both patients had full neurological recovery and demonstrated fusion at follow-up. Anterior release followed by posterior instrumented correction may be an effective alternative to the traditional means of treating irreducible dislocations associated with neglected odontoid fractures

Conus medullaris syndrome due to an intradural disc herniation: A case report

A 70-year-old male patient developed acute paraplegia due to conus medullaris compression secondary to extrusion of D12-L1 disc. After negative epidural examination intraoperatively, a durotomy was performed and an intradural disc fragment was excised. Patient did not regain ambulatory status at two-year follow-up. Intraoperative finding of negative extradural compression, tense swollen dura and CSF leak from ventral dura should alert the surgeon for the possibility of intradural disc herniation. A routine preoperative MRI is misleading and a high index of suspicion helps to avoid a missed diagnosis

Complex multilevel lumbar spine fractures with transverse sacral fracture

We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation

Paraplegia due to recurrent multiple hydatid cyst of the spine: A case report

Recurrence after surgical treatment of hydatid cyst of the spine is extremely common. Preexisting fibrosis, fragility of the cyst wall, confluent cysts and proximity to vital structures makes radical excision difficult and repeated recurrences are inevitable. This case report describes a recurrent hydatid cyst presenting as three separate cysts in the dorsal spine in a middle-aged male. The extradural cyst caused paraplegia. The extraspinal cyst presented as an extrapleural mass in relation with the eighth, ninth and the tenth ribs near the costo-vertebral junction. The three cysts were resected en masse. Complete neurological recovery occurred with no recurrence at four years follow-up. Resection of the hydatid cyst en masse offers the best chance of cure and must be attempted in all cases. A prolonged chemotherapy should be administered in all cases

Metachronous multicentric giant cell tumour of bone in a 12-year-old girl: A case report and review of literature

While giant cell tumour of bone is a relatively common tumour in adults, it is exceedingly rare in children. Multicentric metachronous giant cell tumour is an even rarer presentation of this tumour in skeletally immature patients. We present here the challenges in management of this rare tumour. A 12-year-old girl presented with a giant cell tumour affecting four different bones sequentially, three times within a 3-year period. The disease first appeared in the right distal fibula, then a year later in ipsilateral talus and calcaneus and finally a year later, in the T5 vertebral body, all requiring surgical treatment. Our strategy was to manage this lesion aggressively based on the limited literature available and present our own long-term surveillance strategy. Our patient responded well to treatment each time and has remained disease-free for 24 months from her last surgery. This is a rare case of metachronous multicentric giant cell tumour of bone in a skeletally immature patient requiring aggressive treatment and surveillance

Intradural tumor and concomitant disc herniation of cervical spine

We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies

Assessment of pedicle screw malposition in uniplanar versus multiplanar spinal deformities in children

Background: Spinal deformities can either be uniplanar or multiplanar. The current study aims to compare mal-positioned pedicle screw assessment on radiographs versus CT in children <12 years with multiplanar and uniplanar spinal deformities. Methods: A cohort of 15 children, mean age 10.1 years, who underwent posterior spinal fusion using free-hand pedicle screw insertion for multiplanar (M) or uniplanar (U) deformities with post-operative radiograph and CT evaluation of 154 screws. The outcome measures included the assessment of malpositions detected on plain radiographs versus CT scans in U and M deformities. The overall breaches in post-operative plain radiographs and CT in each group were compared and analyzed by two independent observers.The mal-positioned screws were graded on extent of cortical breach on CT. Inter and intra-observer variability was calculated with Kappa(k) method. Sensitivity, Specificity and Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated by comparing breaches on radiographs versus CT considered the gold standard. Results: In total,154 pedicle screws were analyzed, 65 in U group and 89 in M group. There were 23 (14.9%) malpositioned screws identified on plain radiographs and 43 (27.9%) on CT (p = 0.008). There were 17/154 (11.03%) Grade 1 breaches, 16/154 (10.38%) Grade 2 breaches and 10/154(6.49%) Grade III breaches.Among the 43 CT breaches, 12/65 (18.46%) were in U group, 31/89 (34.83%) were in M group (p = 0.013).The overall Sensitivity, Specificity and PPV of plain radiographs compared to CT in detecting malpositions were 32.56%, 91.89% and 60.87% respectively. Conclusions: There was a significant discrepancy in identification of pedicle screw malposition based on plain radiographic versus CT based assessment, more so in multiplanar deformities. The ability to detect a breach on plain radiographs is lesser in multiplanar versus uniplanar deformities