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A Comparative Study About Diagnostic Yield of Fluoroscopy Guided Transpedicular Biopsy Done by Orthopaedicians V/S CT Guided Biopsy Done by Radiologists in Cases of Koch’s Spine

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Volume 4 | Issue 1 | April 2023 – September 2023 | page: 28-31 | Meet Shah, Ashok Rathod, Punith K, Rohan Killekar, Kunal Bharadwaj

DOI: https://doi.org/10.13107/bbj.20232.v04i01.057

Authors: Meet Shah, Ashok Rathod, Punith K, Rohan Killekar, Kunal Bharadwaj

[1] Department of Orthopaedics, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Meet Shah,
Department of Orthopaedics, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India.
E-mail: meetkshah29@gmail.com

Abstract

Introduction: Tuberculosis is one of the leading causes of mortality worldwide due to a single infectious agent. Koch’s spine or spinal tuberculosis is one of the most crippling manifestations of extra-pulmonary tuberculosis. Owing to the lack of image-guided biopsy centers and the high prevalence of the disease, most of the patients are diagnosed and treated on clinical grounds. This practice was thought to lead to a delay in the diagnosis of other pathologies and multi-drug-resistant tuberculosis. This study aims to compare the diagnostic yield of fluoroscopy (C-arm) guided transpedicular biopsy done by orthopaedicians v/s CT guided biopsy done by radiologists in cases of Koch’s spine.
Materials and Methods: The study involved 60 consented patients with a clinico-radiological diagnosis of Koch’s spine randomly divided into 2 groups for biopsy 1) CT-guided biopsy to be done by radiologists 2) C-arm guided biopsy to be done by orthopedicians and results were compared.
Results: The use of CT-guided biopsy and C-arm guided biopsy in the diagnosis of Koch’s spine is increasing taking into consideration of increasing MDR TB. We got a positive answer in 70% of cases via CT-guided biopsy and 53.33% via C-arm guided biopsy. Detection of MDR TB on GeneXpert was the commonest diagnostic feature with a comparatively low rate of positive AFB smear and histopathology.
Conclusion: Results of C-arm guided biopsy are similar to CT guided biopsy with the latter being better.
Keywords: Koch’s spine, biopsy, multi-drug resistant tuberculosis

References

1) https://www.who.int/news-room/fact sheets/detail/tuberculosis#:~:text=Worldwide%2C%20TB%20is%20the%2013th,all%20countries%20and%20age%20groups.
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How to Cite this Article: Shah M, Rathod A, Punith K, Killekar R, Bharadwaj K | A Comparative Study About Diagnostic Yield of Fluoroscopy Guided Transpedicular Biopsy Done by Orthopaedicians v/s CT Guided Biopsy Done by Radiologists in Cases of Koch’s Spine| Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 28-31 | https://doi.org/10.13107/bbj.2023.v04i01.057

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Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis

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Volume 3 | Issue 1 | April-September 2022 | page: 20-23 | Subir N. Jhaveri, Shivam K. Kiri, Sharan S. Jhaveri

DOI: https://doi.org/10.13107/bbj.2022.v03i01.035

Authors: Subir N. Jhaveri [1], Shivam K. Kiri [1], Sharan S. Jhaveri [1]

[1] Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Subir N. Jhaveri.
Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.
E-mail: subirjhaveri@yahoo.com

Abstract

Background: Elderly patients with severe osteoporosis are prone to sustain osteoporotic vertebral compression fractures (OVCF’s). Sometimes, they undergo significant vertebral collapse and kyphosis, leading to significant canal compromise and neurological deterioration.
Case Description: We present a case series of three patients, of which two had OVCF’s of L1 and L3, respectively, while one patient had Koch’s spine D12 and L1. All three cases had severe vertebral collapse leading to kyphosis, severe pain, and canal compromise, neurological deterioration with paraparesis, and bowel bladder involvement. Surgery warranted total corpectomy of fractured vertebrae (anterior vertebral column resection) and reconstruction of the anterior column. Due to the significant degree of osteoporosis, fenestrated screws with bone cement (poly methyl acrylate) were used anteriorly along with vertebral body reconstruction with cage, through a purely anterior approach. This is the first instance of fenestrated screws being used anteriorly to reduce screw pull-out. In view of the strong anterior construct, a posterior surgery to supplement the fixation could be avoided in these thoracolumbar junctional cases.
Results: No patient experienced loosening of implants, nor did any patient experience cement-related complications. Although the present follow-up of these patients is short (12 months), the patients are pain free and independently ambulatory.
Conclusion: Using fenestrated screws in an anterior location allow vertebral reconstruction with a single surgery in elderly patients with severe osteoporosis, reducing chances of screw pull-out. Bone plugs at the tip to help prevent cement extravasation from the vertebral body.
Keywords: Anterior fenestrated screws, Bone cement, Corpectomy, Osteoporotic vertebral compression fracture, Koch’s spine, Screw pull-out.

References

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How to Cite this Article: Jhaveri SN, Kiri SK, Jhaveri SS | Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis | Back Bone: The Spine Journal | April-September 2022; 3(1): 20-23.  https://doi.org/10.13107/bbj.2022.v03i01.035

 

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