B. Vijayalakshmi Devi

Clinical, radiological, and functional evaluation of surgical treatment in degenerative lumbar canal stenosis

BACKGROUND Lumbar spinal stenosis is a frequent indication for spinal surgery. The clinical symptoms may not be accurately reflected on radiological studies. Treatment is aimed at not only obtaining immediate pain relief but also in preventing its long-term disabling sequelae. The walking ability needs to be correlated with functional outcome measures in assessing patients with symptomatic lumbar canal stenosis (LCS). AIMS AND OBJECTIVES To study and evaluate the outcome of surgery for degenerative LCS on a clinical, radiological, and functional basis, and to establish an association between various factors that may be influencing the development of LCS. MATERIALS AND METHODS A prospective study of 48 patients was carried out at the Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupathi, in whom the LCS was confirmed and measured on magnetic resonance imaging images by thecal sac cross-sectional area (CSA). Their functional assessment was done by motorized treadmill test for assessment of the time of appearance of first symptom and the maximum walking distance. The visual analog scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association (JOA) score, and Short Form-36 (SF-36) score were also evaluated. CONCLUSIONS The post-operative VAS, ODI, JOA, SF-36 scores showed a significant improvement from the preoperative ones. Postoperative thecal sac measurements showed a significant neural decompression substantiating the results of improvement in the functional assessment scores after surgery. The treadmill test is a quantifiable means of dynamic function. It may be considered as a useful tool for the assessment of functional impairment and for the correlation of thecal sac CSA with lumbar canal stenosis. A combination of functional scores, treadmill test, and thecal sac CSA may be included in the preoperative assessment of outcome in patients with LCS.

Atypical parathyroid adenoma with multiple brown tumors as initial presentation: A rare entity

Brown tumors seen in hyperparathyroidism are rare, non-neoplastic lesions because of abnormal bone metabolism, and they can mimic benign bone tumors or malignancy. Although biopsy is considered as the gold standard for diagnosis, it can be inconclusive. As the diagnosis of brown tumors is often challenging, a high index of suspicion is essential for diagnosis. We present a case of 21-year-old woman who presented with multiple painful bony lesions, which were initially misdiagnosed as fibrous dysplasia. Due to persistent bone pain and deterioration in her physical mobility, she was referred to tertiary care centre. After thorough clinical workup, she underwent Tc-99m methylene diphosphonate bone scintigraphy that raised strong clinical suspicion of hyperparathyroidism and brown tumors. Subsequently, Tc-99m-methoxy isobutyl isonitrile (MIBI) parathyroid scintigraphy revealed a solitary MIBI avid focal lesion, suggestive of left inferior parathyroid adenoma. Later parathyroidectomy was performed and histopathological examination confirmed it as atypical parathyroid adenoma.

Hemorrhage from lumbar artery following percutaneous renal biopsy.

We present a 58-year-old lady who underwent ultrasound-guided renal biopsy for suspected acute glomerulonephritis. Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes. Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra. The bleeding vessel was occluded with gelfoam.