Unique Procedure to Remove Pedicle Screw without Compatible Instrumentation: Case Report and Review of Literature.

Introduction: As the number of patients undergoing spine fixation has increased, the requirement for revision surgery has also increased. Difficulty faced while doing revision surgery is mostly in removing polyaxial pedicle screws, especially if we do not have the desired instrumentation.

Case Report: A 55-year-old patient previously operated for D12 fracture presented to us with implant failure due to backing out of pedicle screws.

The Role of Pupillometry in the Assessment of Pain in Children Under General Anesthesia: A Prospective Single-Blinded Observational Study.

Background and objective The management and treatment of nociception remain one of the major challenges in anesthesiology, and hemodynamic variations may occur due to inadequate analgesia, which at times can be injurious. Pupillometry is a new noninvasive tool to assess nociception during anesthesia. The amount of pupillary reflex dilation (PRD) is directly proportional to the intensity of nociceptive stimuli and inversely proportional to the opioid dosage.

Peptidoglycan Remodeling by an L,D-Transpeptidase, LdtD during Cold Shock in Escherichia coli.

Peptidoglycan (PG) is a unique and essential component of the bacterial cell envelope. It is made up of several linear glycan polymers cross-linked through covalently attached stem peptides making it a fortified mesh-like sacculus around the bacterial cytosolic membrane. In most bacteria, including Escherichia coli, the stem peptide is made up of l-alanine (l-Ala), d-glutamate (d-Glu), meso-diaminopimelic acid (mDAP), d-alanine (d-Ala), and d-Ala with cross-links occurring either between d-ala and mDAP or between two mDAP residues.

A LytM-Domain Factor, ActS, Functions in Two Distinctive Peptidoglycan Hydrolytic Pathways in .

Bacterial cell wall contains peptidoglycan (PG) to protect the cells from turgor and environmental stress. PG consists of polymeric glycans cross-linked with each other by short peptide chains and forms an elastic mesh-like sacculus around the cytoplasmic membrane. Bacteria encode a plethora of PG hydrolytic enzymes of diverse specificity playing crucial roles in growth, division, or turnover of PG.

Postoperative Epidural Fibrosis Prevention: Which Is Better-Autologous Fat versus Gelfoam.

Study Design: Prospective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively.

Purpose: To compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery.

Overview Of Literature: EF is a possible sequelae of lumbar disc surgery.

Cleavage of Braun's lipoprotein Lpp from the bacterial peptidoglycan by a paralog of l,d-transpeptidases, LdtF.

The gram-negative bacterial cell envelope is made up of an outer membrane (OM), an inner membrane (IM) that surrounds the cytoplasm, and a periplasmic space between the two membranes containing peptidoglycan (PG or murein). PG is an elastic polymer that forms a mesh-like sacculus around the IM, protecting cells from turgor and environmental stress conditions. In several bacteria, including , the OM is tethered to PG by an abundant OM lipoprotein, Lpp (or Braun's lipoprotein), that functions to maintain the structural and functional integrity of the cell envelope.

Nutritional Osteomalacia-induced Bilateral Neck Femur Fracture in an Elderly Patient: A Case Report.

Introduction: Simultaneous bilateral neck of femur fracture is rare. Majority of them are due to low energy incidents with underlying conditions such as malnutrition, chronic renal failure, cystic fibrosis, celiac disease, seizures, steroid abuse, or osteomalacia.

Case Report: A 68-year-old woman was referred with a 1-year history of bilateral hip pain and a 9-month history of inability to bear weight.

Clinical outcome in Giant cell tumor of cervico-thoracic spine: Our experience with three cases.

Background: Giant cell tumor (GCT) of the spine is uncommon but most aggressive benign tumor of the spine with unpredictable outcome. The purpose of this study was to report on a surgical treatment for the cases of GCT (C2, T4 and C7-T1). The spine is not a common site for a Benign GCT, with a 2.

Abdominal Vascular Injury During Posterior Lumbar Discectomy, Experience from Three Cases and Review of Literature.

Study Design: Case series and review of literature.

Objective: To report three cases of vascular injury during posterior lumbar disc surgery, two of these occurred during open discectomy, and one during an endoscopic surgery. Aim is to highlight importance of early diagnosis and prompt steps taken to prevent morbidity and mortality.

Spontaneous spinal epidural abscess in a normoglycemic diabetic patient - Keep it as a differential.

Spinal epidural abscess (SEA) is a rare and serious condition which can lead to permanent neurological deficit. Spontaneous SEA is even rarer condition with an incidence of less than 1 per 10,000 person-year. Being spontaneous, it has high chances of being misdiagnosed, more so when the risk factors are not clearly explainable for the condition.

Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions.

We present a technique for anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft with preserved tibial insertions. The tendons, harvested with an open-ended tendon stripper while their tibial insertions are preserved, are looped around to prepare a quadrupled graft. The femoral tunnel is drilled independently through a transportal technique, whereas the tibial tunnel is drilled in a standard manner.

Demographic Trends of Patients with Compressive Myelopathy in a Developing Asian Country.

Study Design: Prospective case series.

Purpose: To analyze the demographic picture of the patients suffering from compression myelopathy due to various spinal problems.

Overview Of Literature: There is a lack of literature depicting demographic picture of such patients with spinal injuries as most of the articles have shown the epidemiology of spinal cord injuries either managed conservatively or operatively.

Tuberculous altantoaxial subluxation: a case report with review of literature.

Involvement of upper cervical and craniovertebral junction is rare but might lead to lethal consequences if the diagnosis is delayed. We present a case of atlantoaxial joint tuberculosis, resulting in gross instability of the joint. The patient was treated with antitubercular medication combined with posterior decompression and transarticular screw fixation.

Outcome of spinal decompression in Cauda Equina syndrome presenting late in developing countries: case series of 50 cases.

The purpose of this study is to find the clinical outcome of decompression of Cauda Equina presenting late in the course of disease. There were 33 males and 17 females with average age of 48 years, ranging from 25 to 85 years. All patients presented to us with a fully developed Cauda Equina syndrome (CES).

Transarticular screw fixation for atlantoaxial instability - modified Magerl's technique in 38 patients.

Background: Symptomatic atlantoaxial instability needs stabilization of the atlantoaxial joint. Among the various techniques described in literature for the fixation of atlantoaxial joint, Magerl's technique of transarticular screw fixation remains the gold standard. Traditionally this technique combines placement of transarticular screws and posterior wiring construct.

Accessory soleus muscle in clubfoot deformity: a report in four feet.

The commonest presentation of accessory soleus muscle is a swelling at the posteromedial aspect of the ankle in adolescents or young adults. Accessory soleus is rarely encountered in children undergoing surgical release for congenital clubfoot, and only a few isolated reports are available in the literature. The purpose of this study is to heighten awareness about the role of accessory soleus muscle in clubfoot deformity.

Management of odontoid fractures with anterior screw fixation.

Type II odontoid fractures are prone to undergo nonunion. Stabilization of such fractures with anterior screw fixation provides rigid internal fixation and preserves C1-C2 motion. During a 5-year period, 17 patients with displaced type II fractures of the odontoid were treated Thirteen were male and four were female with a mean age of 38.

Monteggia fracture dislocation in a neonate resulting from birth trauma: a case report.

Birth-related injuries in an uncommon location may be missed initially and may result in significant morbidity. We report for the first time a case of a Monteggia fracture dislocation in a neonate resulting from birth trauma. The delayed presentation at 7 days made open reduction necessary in this otherwise nonoperatively managed injury because of the accelerated rate of bony union in infants.

Pregnancy complicated by paraplegia due to Pott's spine.

Pott's paraplegia associated with pregnancy is a serious problem and is difficult to treat, as not much literature is available regarding its management. Such a case, where the multidisciplinary team approach gave good neonatal and maternal outcome, is reported here.

Fracture of the posterior process of talus.

Fracture of posterior process of talus is quite rare, but is associated with significant morbidity as it involves two articular surfaces. We report two such cases in which open reduction and internal fixation were done with good functional results. One of the cases had a concomitant medial malleolus fracture which to the best of our knowledge has not been reported so far.