Sacral tuberculosis: an atypical manifestation

Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated

Deformity correction surgery in adolescent idipathic scoliosis-our early experience

Introduction: Adolescent Idiopathic Scoliosis (AIS) is the most common spinal deformity among teenage girls. It is defined as three dimensional lateral curvature in coronal plane of more than 10 degrees. For those indicated, early surgical intervention allows better surgical correction due to flexibility of the spine during teenage years, hence good functional outcome and better cosmesis can be expected. Materials and Methods: We reported our early experience in managing five patients surgically using the Posterior Spinal Instrumentation and fusion. Pre-operatively patients were examined at IIUM Medical Centre spine clinic, all necessary investigations were carried out. Thorough explanation was done to patient and parents regarding procedure, risk and benefit. All patients were treated using same surgical technique. Neuromonitoring were used throughout the whole surgery until skin closure. All patients were hospitalised around one week. Post-operatively patients were follow-up at two weeks, six weeks, three months, and every six months thereafter. Result: It is important for clinicians to identify patients with AIS as early detection and timely treatment will change the natural history of curve progression. Conclusion: Surgical intervention when necessary will be easier and with less risk of complications when surgery was carried out during teenage years as the spine is more flexible and the deformity is less severe

Early experience in surgical treatment of adolescence idiopathic scoliosis: a report of four cases

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among teenager. For those indicated, early surgical intervention allows better surgical correction due to flexibility of the spine during teenage years, hence good functional outcome and better cosmetic can be expected. In this case report, there is the management of four patients surgically using the posterior spinal instrumentation and fusion. Pre-operatively patients were examined at IIUM Medical Centre spine clinic, all necessary investigations were carried out. A thorough explanation was done to patient and parents regarding procedure, risk and benefit. All patients were treated using the same surgical technique. Neuromonitoring was used throughout the whole surgery until skin closure. All patients were hospitalized around one week. Post-operatively patients were followed up at two weeks, six weeks, three months, and every six months thereafter. It is important for clinicians to identify patients with AIS as early detection and timely treatment will change the natural history of curve progression. Surgical intervention when necessary will be easier and with less risk of complications when surgery was carried out during teenage years as the spine is more flexible and the deformity is less severe

Development of Scoliotic spine severity detection using deep learning Algorithms

According to research conducted by Johns Hopkins' Division of Pediatric Orthopedic Surgery, around three million new instances of Scoliosis are identified each year, with the majority of cases affecting children between the ages of 10 and 12. The current method of diagnosing and treating Scoliosis, which includes spinal injections, back braces, and a variety of other types of surgery, may have resulted in inconsistencies and ineffective treatment by professionals. Other scoliosis diagnosis methods have been developed since the technology's invention. Using Convolutional Neural Network (CNN), this research will integrate an artificial intelligence-assisted method for detecting and classifying Scoliosis illness types. The software model will include an initialization phase, preprocessing the dataset, segmentation of features, performance measurement, and severity classification. The neural network used in this study is U-Net, which was developed specifically for biomedical picture segmentation. It has demonstrated reliable and accurate results, with prediction accuracy reaching 94.42%. As a result, it has been established that employing an algorithm helped by artificial intelligence provides a higher level of accuracy in detecting Scoliosis than manual diagnosis by professionals

Assessment of prognostic factors affecting functional outcome in spinal tuberculosis patients

This study was aimed to determine the favorable prognostic factors in spinal tuberculosis patients with significant neurology for their functional outcome

A case of acute compartment syndrome of upper limb in a dengue haemorrhagic fever patient secondary to intravenous cannula insertion

Dengue fever with its haemorrhagic complications is a common viral illness in Malaysia which can sometimes lead to high morbidity and mortality. We present a case report of a 27-year-old male who was admitted to our hospital with dengue haemorrhagic fever. He developed multiple hematomas and bruising in his right forearm and arm due to intravenous cannula insertion. Due to coexisting thrombocytopenia, the limb progressed to acute compartment syndrome and emergency fasciotomy was done and his limb was salvaged. This case illustrates an important potential complication of dengue fever and the importance of timing of surgery in the event of compartment syndrome

Cervical spondylotic radiculopathy - The role of conservative management

Cervical spondylotic radiculopathy is common and most patient experiencing an acute episode of unilateral radiculopathy without major motor deficit and no evidence of cord compression can be managed by non-operative measures

Cauda equina syndrome post epidural steroid injection

We report a case of a 62-year-old lady who developed cauda equina syndrome post- epidural steroid injection. She undergone an epidural injection to relieve her radiculopathy pain caused by underlying lumbar spinal canal stenosis L4/L5 and L5/S1. Post epidural injection she developed an acute bowel and bladder dysfunction, worsening pain and weakness over her bilateral lower limbs with saddle anesthesia which did not resolve after 6 days. Her repeated magnetic resonance imaging (MRI) post- epidural injection shows no evidence of extradural hemorrhage/ collection and is unremarkable as compared to her pre- epidural magnetic resonance images. She undergone emergency laminectomy of L4/ L5 and L5/S1. Post laminectomy, her bilateral lower limb pain resolved, power restored, and she regained her bowel and bladder functions. The development of cauda equina syndrome post epidural injection have been reported as a rare complication and is commonly associated with local anesthetic toxicity, direct trauma of the needle to the spinal cord or the development epidural hematoma post injection. However, in this case there was no evidence of epidural hematoma both on magnetic resonance imaging and intraoperatively. Complete neurological recovery occurs following laminectomy suggesting the likely cause of cauda equina syndrome in this case is more to a mechanical compression

Is religiosity a good predictor of psychological health in patients undergoing major lower limb amputations?

INTRODUCTION: Major lower limb amputation has a huge psychological impact on the patient and has been a concern to treating surgeons. Like with all other medical conditions, prevention is better than cure. Thereby it is of uttermost importance to identify susceptible individuals and early referral to the relevant department to minimize the suffering of these individuals. The aim of this study is to determine if religiosity is associated with psychological health in individuals undergoing major lower limb amputation. MATERIALS AND METHODS: This is a single centre prospective cross sectional observational study involving fifty patients seen in the outpatient department who has undergone a major lower limb amputation (above knee or below knee amputation) in the past two years. They were assessed based on Depression Anxiety Stress Scale- 21 (DASS- 21), Rosenberg Self Esteem Scale and The Duke University Religion Index (DUREL). RESULTS: Final results show that there is a significant difference between the intrinsic religiosity (IR) component of DUREL with the depression (P-value 0.001) and anxiety (P-value 0.011) component of DASS. A collective data from this study shows that these individuals suffers more from anxiety rather than depression, stress or low self- esteem. This information is an important aspect to look into, as relevant parties can do the necessary to reduce the anxiety faced by these individuals. CONCLUSION: The conclusion from this study suggest that individuals with low intrinsic religiosity are more likely to suffer from depression and anxiety following a major lower limb amputation

Correlation study between clinical special tests for myelopathy and static MRI parameters in patients of Malaysian population treated for cervical dysfunction

Introduction: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Magnetic resonance imaging (MRI) remains the imaging modality of choice, but its findings are not completely specific for clinically significant CSM. This cross-sectional study aims to determine the pathoanatomy of CSM in patients and analyze the correlations between clinical key symptoms, myelopathic signs, and MRI findings. Methods: Patients with CSM aged 30 to 80 years old with no previous cervical spine disease or injuries were recruited. Clinical parameters include myelopathic hand signs and other clinical-specific tests. The MRI findings were analyzed for level of compression, underlying degenerative pathology, and parameters for cord compression. Results: Thirty patients were recruited. The most common myelopathic signs observed were positive Hoffmann’s sign and the presence of reverse brachioradialis reflex. All patients had either degenerative or prolapse disc changes on MRI. There was a positive correlation between the clinical key features with MRI parameters for canal and cord diameter. The transverse cord diameter, cord compression ratio, and approximate cord area were the only independent variables related to almost all the positive clinical specific tests. All three have a moderate to strong correlation with the clinical findings. Conclusion: The MRI parameters such as canal and cord size of the cervical spine are an objective reflection of compression on the spinal cord. Correlations observed indicate cord compression that plays a major role in the pathophysiology of CSM. These measurements are sensitive indicators of canal stenosis and play a significant role in predicting the severity and outcome of CSM