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  1. Kow Ren Yi, Ed Simor Khan Mor Japar Khan, Fauziana Abd Jabar, Fauziana Abd Jabar, Low Chooi Leng
    IIUM Medical Journal Malaysia, 2019;18(102):69-0.
    MyJurnal
    Majority of the traumatic spine injuries are located at the thoracolumbar region. They can be compression fractures, burst fractures, flexionextension injuries (Chance fractures), dislocations, or any of the combination. Surgery is indicated for patients with thoracolumbar injury classification scoring (TLICS) of 4 or more. Traditionally, surgical approaches for thoracolumbar spinal injuries involve open surgery, instrumentation with/without decompression. In our previous study, open surgery for traumatic thoracolumbar injuries and history of blood transfusion have been found to be associated with higher risk of deep surgical site infection requiring surgical debridement. With the advent of modern implants and equipments, minimally invasive surgery (MIS) has been made possible for spine surgeries. We report our two-year experience in utilizing MIS to treat traumatic thoracolumbar spinal injuries. Materials and method: Patients who underwent spinal surgeries at Hospital Tengku Ampuan Afzan, Kuantan from July 2017 to July 2019 were screened for suitability to be included in this study. Only patients who underwent spinal minimally invasive surgeries have been included in this study. Patients who underwent open spinal surgeries were excluded. Results: A total of 8 patients were included in this study. There were 3 burst fractures and 5 chance fractures. All patients underwent a minimum of 4-level posterior spinal instrumented fusion with MIS techniques and 2 patients had laminectomy at the injured level for decompression. All but one patient did not require blood transfusion and there was no incidence of surgical site infection among these patients. Conclusion: Minimally invasive surgery (MIS) is a better option compared to open surgery in treating traumatic thoracolumbar spinal injuries. By minimizing the surgical incision, we are able to reduce blood loss and avoid deep surgical site infection.
  2. Kow RY, Mustapha Zakaria Z, Khan ESKM, Low C
    J Orthop Case Rep, 2019 3 28;8(6):65-67.
    PMID: 30915298 DOI: 10.13107/jocr.2250-0685.1262
    Introduction: Fracture of the ulnar coronoid process is uncommon. It is commonly associated with posterior dislocation of the elbow, but it may also present as an isolated fracture. In general, all ulnar coronoid process fractures with elbow joint instability and large fracture fragments are fixed surgically. We report two cases of the rare isolated Regan-Morrey type III ulnar coronoid process fractures and their outcomes.

    Case Report: Case Report 1: Mrs P, a 27-year-old right-hand dominant female, was involved in a motor vehicle accident (MVA) and sustained an isolated Regan-Morrey type III ulnar coronoid process fracture. In view of the large coronoid process fragment causing elbow joint instability, she underwent an open reduction and internal fixation when the elbow swelling had subsided. An anterior approach was used to identify the fracture fragment and it was fixed with two half-threaded cancellous lag screws with washers to achieve an anatomical reduction. Postoperatively, she recovered with excellent outcome based on the Mayo elbow performance score (MEPS).Case Report 2: Mr M, a 23-year-old right-hand dominant gentleman, was involved in a MVA and sustained an isolated Regan-Morrey type III ulnar coronoid process fracture. During examination under general anesthesia, passive range of the movement of his right elbow was noted to be <90°due to the impaction of the fracture fragment. An open reduction through an anterior approach was performed and Kirschner wires were inserted to fix the coronoid process fracture. Kirschner wires were opted for the ease of post-operative removal as the patient was not keen to have a retained implant after recovery. He recovered with good outcome based on the MEPS.

    Conclusion: Isolated fracture of the ulnar coronoid process is rare. Open reduction and internal fixation is mandatory for patients with coronoid process fracture and unstable elbow joint to achieve good functional outcomes.

  3. Kow Ren Yi, Ed Simor Khan Mor Japar Khan, Mohd Jumaidi Md Hashim, Anas Nazhar, Low Chooi Leng
    IIUM Medical Journal Malaysia, 2019;18(102):61-0.
    MyJurnal
    Solat or prayer, as one of the five pillars of Islam, and it is associated with bio-psycho-social benefits in Muslim patients. Â Many Muslim patients neglected solat while being hospitalized as they are unaware of the convenience (rukhsoh) available for them. Ibadah Friendly Hospital Courses have been conducted in different states of Malaysia to impart knowledge to the hospital staff who can in turn educate their patients. This study aims to construct a content-validated assessment tool and to assess the effectiveness of a state-level Hospital Mesra Ibadah course. Materials and methods: A self-administered questionnaire was constructed and content-validated by a panel of three experts (two religious teachers and one consultant spine surgeon). All 15 questions achieved item-level content validity index (I-CVI) of 1.00 after two rounds of validation. The questionnaires were distributed to participants of a state-level Hospital Mesra Ibadah course to compare the participants’ pre-course test score and post-course test score. Results: A total of 88 participants (48.9%) were included in this study. There was a significant difference in the pre-course test mean score and post-course test mean score among the participants. There was also a significant reduction of unsure answer after the course. There was no significant association found between the gender, place of working and occupations with the pre-post test score difference. Conclusion: This study demonstrates that the Hospital Mesra Ibadah course is effective in imparting as well as consolidating the knowledge among participants, hence it should be routinely organized to benefit more participants.
  4. Kow, Ren Yi, Hazwan Ab Wahid, Ed Simor Khan Mor Japar Khan, Colin Komahen, Low, Chooi Leng, Ruben Jaya Kumar
    MyJurnal
    Cervical spine injury is commonly associated with
    road-traffic accidents. The true incidence of cervical
    spine injuries is unknown due to under-reporting of
    such injuries. Cervical spine injury is associated with
    high morbidity and mortality if it is missed. With the
    advancement of imaging modalities, the number of
    missed cervical injuries has reduced. Nevertheless, some
    clinicians are dependent solely on imaging tools to rule
    out cervical spine injury in a trauma victim. We report
    two cases of “near miss” C6 fracture to highlight the
    importance of a detailed clinical history and clinical
    examination with imaging as an adjunct to rule out
    cervical injury.
  5. Muhammad Wafiuddin Ahmad, Ed Simor Khan, Rajandra Kumar, Zamzuri Zakaria, Ahmad Faiza, Haidar Nusuruddin, et al.
    MyJurnal
    Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among teenager. For those indicated, early surgical intervention allows better surgical correction due to flexibility of the spine during teenage years, hence good functional outcome and better cosmetic can be expected. In this case report, there is the management of four patients surgically using the posterior spinal instrumentation and fusion. Pre-operatively patients were examined at IIUM Medical Centre spine clinic, all necessary investigations were carried out. A thorough explanation was done to patient and parents regarding procedure, risk and benefit. All patients were treated using the same surgical technique. Neuromonitoring was used throughout the whole surgery until skin closure. All patients were hospitalized around one week. Post-operatively patients were followed up at two weeks, six weeks, three months, and every six months thereafter. It is important for clinicians to identify patients with AIS as early detection and timely treatment will change the natural history of curve progression. Surgical intervention when necessary will be easier and with less risk of complications when surgery was carried out during teenage years as the spine is more flexible and the deformity is less severe.
  6. Khan ESKBM, Thean CAP, Zakaria ZB, Awang MSB, Karupiah RK, Awang MB
    J Orthop Case Rep, 2020;10(2):101-105.
    PMID: 32953668 DOI: 10.13107/jocr.2020.v10.i02.1718
    Introduction: Spinal schwannoma can occur anywhere along the spinal cord but is predominantly seen in the cervical and thoracic region.It composes mainly of well-differentiated schwann cell and is benign in nature. It is typically seen in the peripheral nerves and is commonly associated with neurofibromatosis. Up to 80% of cases, spinal schwannoma is reported to be intradural in location and 15% of cases have both intradural and extradural components. Spinal schwannoma rarely causes conus medullaris syndrome.

    Case Report: In this case series, all three female patients in their 4th and 5th decades of life presented with conus medullaris syndrome. Lower back pain, radiculopathy, lower limb weakness, and urinary incontinence are their main clinical presentation. Magnetic resonance imaging shows a well-defined intradural, extramedullary mass compressing onto the conus medullary region. These patients undergone microscopic assisted excision of the tumor and had remarkably good early outcome despite the advanced presentation of neurological deficit.

    Conclusion: Despite the late presentation with significant neurological deficit, surgical excision of spinal schwannomas carries a good prognosis postoperatively due to their benign nature and extramedullary location.

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