Imaging of Calcifying and Ossifying Disorders of the Spine

Substantial advances in the availability of spinal imaging have led to the increasing use of spinal imaging in the evaluation of patients with neck and back pain. This has resulted in the recognition of a diverse collection of spinal disorders, characterized by heterotopic calcification and ossification. Despite the increasing frequency at which these conditions are being diagnosed, there still exists a lack of awareness of the imaging characteristics of some of these calcifying and ossifying spinal disorders. Here, we review the imaging characteristics of ankylosing spondylitis, arachnoiditis ossificans, calcific discitis, calcific tendonitis of the longus colli, calcium pyrophosphate dihydrate deposition, crowned dens syndrome, diffuse idiopathic skeletal hyperostosis, ossification of the ligamentum flavum, and ossification of the posterior longitudinal ligament. Radiologists and clinicians alike should be familiar with these calcifying and ossifying spinal disorders to aid in an accurate diagnosis and to guide clinical management.Learning Objectives: Recognize the clinical features and imaging findings of various calcifying and ossifying disorders of the spine.

Removal of locked intramedullary nails with the aid of bolts

Background: Removal of an intramedullary nail would require the extraction system of the inserted nail to be available. Sometimes the system is not available, and an alternative system would have to be utilised. Aim of the study was to document the removal of interlocked nails using bolts in the absence of appropriate fitting extraction system.Methods: A prospective study of consecutive patients seen by the authors between September 2016 and September 2018 in private clinics in Port Harcourt where the authors were invited to remove intramedullary nails. Bolts fitted to the proximal tips of the nails were utilized. With the aid of plier applied to the bolts and mallet, the nails were extracted. The patients’ socio-demographic and information relevant to the injury were obtained. Data was analysed using SPSS version 23.Results: Fifteen patients were seen. Ages ranged from 29 to 72 years, consisting of 10 males and five females. The tibia was affected in six and the femur in nine. There were five united tibial fractures and one non-united tibial fracture, six united femoral fractures and three non-united femoral fractures. Indication for removal was mostly patients’ request. Duration of surgery ranged from 1 to 4 hours. All the nails were extracted. Complications included broken nail, heterotopic calcification, bony overgrowth/ ingrowth/ongrowth around the nail and interlocking screws. There was no mortality.Conclusions: In the absence of conventional intramedullary nail extraction system, appropriate size bolts can be applied to the threaded proximal tip of nails and used for nail extraction.