Journal of Pakistan Orthopaedic Association
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The Future is Here
Munawar Shah, Danial Shah
We live in an amazing world at amazing times as we are in the evolutionary stages of Orthobiologics. Now we are increasingly looking for biological solutions of biological problems and the best news is that it has gone from science fiction to a very real entity. Similarly access to investigations for previously impossible tasks have become a reality. Imagine a scenario when one is playing sports and hurts his shoulder and we would like to investigate him after a thorough clinical assessment. We would like to order a Magnetic Resonance Imaging (MRI) to exclude soft tissue injuries and we run into a well as the patient is claustrophobic, has a pacemaker or is overweight or has metal inside his body.1,2 Although clinical examination and MRI play a key role in diagnosis, sometimes interpretation can be unclear or even wrong.3,4 Nothing is more accurate than direct visualization, particularly when we have to determine if the patient need surgery.5,6With forward thinking and innovation technology there is now a real solution Office -Based Needle Arthroscopy.7 It is a small Gadget that will make a Big Difference to the clinical practice.8 (Fig IA, IB, IC, ID) Clinic or of?ce based arthroscopy is by no means a new idea but it has previously failed to become widely used. This is probably due the dif?culties in transferring the type of required equipments (which closely mirrored that used in operating theatres) to the clinic environment.
Selective Spinal Fusion for Lenke Type 5C Adolescent Idiopathic Scoliosis: Short Term Radiographic Follow Up.
Latif Khan, Ashfaq Ahmad, Abdullah Shah, Muhammad Kashif, Ijaz Ahmad, Amer Aziz
Objective: To determine the short term radiological outcomes of Lenke type 5C adolescent idiopathic scoliosis in terms of Cobb angle correction and coronal balance after selective posterior segmental spinal instrumentation with pedicle screws. Methods: This retrospective cohort study was conducted in Department of Orthopedic and Spine Surgery Ghurki Trust Teaching Hospital/ Lahore Medical and Dental College Lahore. The medical records of patients from 17th April 2015 to 29th October 2019 who underwent selective spinal fusion with pedicle screws for Lenke type 5C adolescent idiopathic scoliosis were reviewed. Pre-operative radiographs were evaluated for Cobb angle of lumbar or thoracolumbar curve as well as sagittal and lumbar modifier on anteroposterior and lateral standing films. The curve correction, implant density, number of segment fused and coronal balance was assessed on post operative radiographs. The pre and post operative comparison of important study variables were done and P value was calculated with the help of Chi-square test. P value < 0.05 was considered statistically significant. Results: The total number of patients were 34. Majority (94.1%,n=32) were females while only 2(5.9%) were males. The mean age at the time of operation was 14.35±2.19 years (range 8 to 19 years). Mean pre-operative and post-operative Cobb angles were 61.790±13.120 (range 400 to 850) and 10.550±8.710 (range 00 to 300) respectively (P value 0.00). The mean percentage of curve correction and percentage of fulcrum flexibility was 83.35±13.07 % (range 55% to 100%) and 59.56%±15.07 (range 28.57% to 84.60%) respectively (P value 0.469). Mean implant density and fusion mass was 66.03±7.94% (range 53 to 79%) and 10.32±2.8 (range 7 to 15%) segments respectively. The coronal balance was achieved in all patients. No major complication was noted. Conclusion: Near normal Cobb angle correction and coronal balance was achieved in all patients of Lenke type 5C adolescent idiopathic scoliosis treated with posterior segmental spinal instrumentation utilizing pedicle screws.