Dr SAMRAT SMRUTIRANJAN SAHOO, MS ORTHO, DNB - All India Institute of Medical Sciences, Nagpur - Assistant Professor

Dr SAMRAT SMRUTIRANJAN SAHOO

MS ORTHO, DNB

All India Institute of Medical Sciences, Nagpur

Assistant Professor

Nagpur, MAHARASHTRA | India

Main Specialties: Adult Reconstructive Orthopaedics, Orthopaedic Surgery of the Spine, Orthopaedic Trauma, Orthopaedics

Dr SAMRAT SMRUTIRANJAN SAHOO, MS ORTHO, DNB - All India Institute of Medical Sciences, Nagpur - Assistant Professor

Dr SAMRAT SMRUTIRANJAN SAHOO

MS ORTHO, DNB

Introduction

Primary Affiliation: All India Institute of Medical Sciences, Nagpur - Nagpur, MAHARASHTRA , India

Specialties:

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Letter to the Editor: The "Cough Trick" Reduces Pain During Removal of Closed-suction Drains after Total Knee Arthroplasty: A Randomized Trial.

Clin Orthop Relat Res 2020 05;478(5):1133-1134

V. Tiwari, S. Dwidmuthe, S. S. Sahoo, All India Institute of Medical Sciences-Nagpur, Nagpur, Maharashtra, India.

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http://dx.doi.org/10.1097/CORR.0000000000001204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170684PMC
May 2020
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Role of Autologous Fibula Strut Graft in Surgical Management of Tubercular Spondylitis by Anterior Approach: A Prospective Study

https://doi.org/10.14444/6058

International Journal of Spine Surgery

Abstract

Background Decompression of cord in tubercular paraplegia is a mainstay treatment with favorable neurological improvement. Anterior decompression and stabilization with autologous bone grafts promotes fusion of affected segment of spine and prevents further progression of deformity. The objective of this study is to assess the role of autologous fibula strut graft in correction of tubercular kyphosis without instrumentation.

Methods Twenty patients of tubercular spine (Gulhane Askeri Tip Akademisi type II or III) with paraplegia were treated with anterior decompression, debridement, and stabilization with various autologous bone graft in combination without instrumentation. Patients were further grouped as follows (10 in each group): group A includes patients where autologous fibula strut, rib, and iliac crest grafts were used in combination; group B includes patients where only autologous rib and iliac crest grafts were used. Results were analyzed in terms of neurological recovery (Frankel grade), graft union time (graft uptake), correction and progression of kyphotic deformity, and graft subsidence.

Results Patients in both groups A and B show similar neurological recovery from Frankel grade A/B to E. Group A (fibula strut group) patients show mean correction of 6.7° (3°–22°) in kyphosis with no loss of correction after a 2-year follow-up, whereas patients in group B (nonfibular strut group) show increase in kyphosis in immediate postoperative period without further progression on follow up. Graft uptake was good in all 19 cases, and graft subsidence was seen in 1 patient of group A.

Conclusions Bone grafting is indispensable in surgical management of tubercular spine. It allows fusion of affected segment and prevents further progression of deformity. However, the neurological recovery of patient depends upon the adequate decompression of cord, debridement, and adequate stabilization of anterior and middle column vertebral body height loss. The use of autologous fibular strut graft along with cancellous graft is superior to only cancellous grafts in terms of kyphosis correction.

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October 2019
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Samir Dwidmuthe
Samir Dwidmuthe

Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (M)

1
Vivek Tiwari
Vivek Tiwari

Gandhi Medical College

1