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Background: Low back pain and sciatic pain are some of the most common and infuriating pains. The prevalences are about 18-29%. The minimally invasive technique of spine decompression offers several advantages. One of the methods is percutaneous endoscopic lumbar discectomy (PELD) using the transforaminal approach. This study aimed to evaluate the needle angle and sleeve placement based on skin entry point using 3-dimensional (3D) computed tomography morphometric measurements. Methods: The data were collected using 3D computed tomography morphometric measurements on the 4th – 5th lumbar. The parameters comprised several aspects of the vertebral morphometry. The vertebral AP length, spinous to skin length, AP vertebral body length, 30% of vertebral body length, and angle of the needle insertion data were collected. All the data were then analyzed using SPSS. Results: There were 50 patients enrolled in this study. From vertebral morphometry, the average angle for the needle insertion for 4th lumbar spine in the coronal plane was 48.224 (± 4.138)°. The average distance of the needle insertion was 8.185 (±1.709) cm. The average twice the distance of the needle insertion was 16.370 (±3.417) cm and the average angle with the length doubled was 22.268 (±0.953)°. The average angle for 4th lumbar in the sagittal plane was 78.169 (±1.445)°. Conclusion: We found the angle in the coronal plane for PELD in the 4th vertebra lumbar was 48.224°. The angle of insertion was 22.268° when the distance was doubled. The angle in the sagittal plane for PELD in the 4th lumbar spine was 78.169°.

Background Anterior Cruciate Ligament (ACL) is the most common ligament injury during sports activities that was treated with ACL reconstruction. Nowadays, peroneus longus is used in ACL reconstruction. However, it is difficult to predict the peroneus longus graft diameter for ACL reconstruction. Thus, preoperative measurements are very important to predict peroneus longus autograft for ACL reconstruction. Methods A cohort retrospective study was conducted using consecutive sampling method from February 2016 until October 2017 in our center. We recorded patients’ characteristics include gender, age, body weight, height, and Body Mass Index (BMI) preoperatively. We measured peroneus longus graft diameter intraoperatively, and analysed data using Spearman correlation. Results Thirty-nine patients met inclusion criteria. There were 28 males and 11 females in the peroneus group. From the patients' mean characteristics, age was 25.10 ± 9.16, body weight 71.23 ± 14.17, height 169.13 ± 8.81, and BMI 20.96 ± 3.44. Intraoperative peroneus longus diameter measurement was 8.56 ± 0.82. Spearman correlation showed significant correlation between intraoperative peroneus longus diameter with patient's height, body weight, and BMI with p, Highlights • Gender. • Height. • Weight. • Body Mass Index. • Peroneus longus tendon diameter. • Patients' characteristics in preoperative measurements can predict graft diameter intraoperatively.

Objective: This research aimed to developing customized pedicle screw based on Indonesian vertebral anatomy and compare the insertion time, pull-out strength, and screw-media interface area of different screw design. We have developed 3 different types of pedicle screws (v-thread cylinder-core, square-thread cylinder-core and square-thread conical-core). The thread diameter was calculated from pedicle width of Indonesian population (6 mm). We used commercially available pedicle screw as control group (6.2 mm). Result: The insertion time were significantly difference between v-thread cylinder-core pedicle screw (22,94 s) with commercially available pedicle screw (15.86 s) (p2). The data comparison showed that the square-thread conical-core customized pedicle screw group has comparable insertion time and has better pull-out strength than commercially available pedicle screw.

Anterior Cruciate Ligament (ACL) is a knee ligament that is very important in maintaining the stability of the knee joint. The incidence of isolated ACL tears remain a common orthopaedic injury with significant increase in the rate of ACL reconstruction over time. Several types of autografts used for ACL reconstruction have some potential occurrence of donor site morbidity, including Bone-Patellar Tendon-Bone (BPTB), hamstring tendon, and quadriceps tendon. Peroneus longus tendon can be an option as a graft donor because it has biomechanical characteristics that are not significantly different from the hamstring tendon. Purpose: The aim of the study was to evaluate the functional outcome and donor site morbidity of anterior cruciate ligament (ACL) reconstruction using peroneus longus tendon autograft. Methods: This study was an observational analytical with retrospective cohort design using medical record. The functional outcomes were assessed with IKDC, Modified Cincinnati, Tegner-Lysholm, and KSS scoring system 12 months after surgery. Donor site morbidity was assessed with AOFAS and FADI scoring system, eversion strength, and plantarflexion strength. Results: Seventy five patients fulfilled the inclusion criteria (59 males and 16 females). Mean of peroneus longus tendon graft diameters were 8.39 ± 0.69 mm (range 6.5-10 mm). Significant increase of functional score (p0.05) between donor and contralateral side ankle. There was neurapraxia in 3 (4%) patients at six months postoperative. Conclusion: The peroneus longus tendon can be an ideal source of graft for ACL reconstruction because it has good functional outcome and minimal donor site morbidity.

Introduction: Combination between SCIWORA and Brown-Sequard syndrome in a patient is a rare condition. In SCIWORA, there is usually a delay in neurologic deficits which can potentially lead to misdiagnosis. Therefore, the clinician should have a good understanding of the course of the disease to make a good diagnosis and treatment. Case report: Reporting a case of female 20 years old with chief complaint of severe neck pain and delayed limbs weakness. The mechanism of injury was fall with the head hit the ground in left lateral flexion position. The physical examination showed zero motor power of the right limbs and contralateral pain and temperature deficit 1 h after the injury. We diagnosed the patient with incomplete spinal cord injury at C4 level with associated Brown-Sequard syndrome. We gave soft collar neck for immobilization, medication with NSAID for analgetic and Methylprednisolon. We found dramatic improvement in 10 h after the injury with motor improvement from 0 to 5 and normal sensory function. The patient then was discharged with good functional outcome and with no sequelae. Conclusion: Incomplete cervical spinal cord injury without radiological abnormality that manifested as Brown-Sequard syndrome is a rare case and potentially confusing condition. Better understanding of the course of the disease may help the clinician to make a right diagnosis and plan for management. Keywords: SCIWORA, Brown-Sequard syndrome, Spinal cord injury

A peroneus longus tendon autograft is used in many orthopaedic procedures and it is biomechanically comparable to a hamstring tendon autograft. Despite its potential, there are few studies that have evaluated the use of the peroneus longus tendon in ACL reconstruction. The aim of this study was to compare the clinical outcome and donor site morbidity of ACL reconstruction with hamstring tendon autografts versus peroneus longus tendon autografts in patients with an isolated ACL injury. Patients who underwent isolated single-bundle ACL reconstruction were allocated to two groups (hamstring and peroneus longus) and observed prospectively. Graft diameter was measured intraoperatively. Functional scores (IKDC, modified Cincinnati and Lysholm scores) were recorded preoperatively and 1 year after surgery. Donor site morbidities were assessed with thigh circumference measurements and ankle scoring with the AOFAS and FADI. Fifty-two patients (hamstring n = 28, peroneus n = 24) met the inclusion criteria. The peroneus longus graft diameter (8.8 ± 0.7 mm) was significantly larger than the hamstring diameter (8.2 ± 0.8 mm) (p = 0.012). There were no significant differences between the pre- and 1-year postoperative score between the hamstring and peroneus longus groups in the IKDC (n.s), modified Cincinnati (n.s), and Lysholm (n.s). The mean for the AOFAS was 97.3 ± 4.2 and for the FADI 98 ± 3.4 in the peroneus longus group, with a significant decrease in thigh circumference in the hamstring group (p = 0.002). Anterior cruciate ligament reconstruction with peroneus longus autografts produces a functional score (IKDC, modified Cincinnati, Lysholm) comparable to that of hamstring autografts at a 1-year follow-up, with the advantages of larger graft diameter, less thigh hypotrophy and excellent ankle function based on AOFAS and FADI scores. Prospective cohort study, Level II.