We describe the surgical technique of the periumbilical anterior retroperitoneal approach for lumbar disc replacement (LDR) and the initial clinical experience, emphasizing relevant anatomical landmarks, exposure techniques, and key technical considerations for anterior exposure during LDR. The operative workflow of the periumbilical anterior retroperitoneal approach was described, including pre-operative planning, design of the periumbilical incision, entry into the retroperitoneal space, mobilization of vascular structures, and exposure of lumbar disc levels. Essential steps of disc removal, trial placement, and prosthesis implantation under fluoroscopic guidance were outlined. Post-operative care and early clinical experience were also summarized, with a representative operative case demonstrating important anatomical landmarks and procedural stages. The approach provided adequate exposure for single- and multilevel LDR while preserving the integrity of the abdominal wall. In our initial case, no major vascular, urologic, or neurologic complications were encountered, and the patient showed satisfactory early post-operative recovery with an acceptable cosmetic result. The periumbilical anterior retroperitoneal approach appears to be a technically feasible alternative to traditional anterior lumbar exposure techniques for LDR. It facilitates multilevel access while minimizing soft-tissue disruption and preserving abdominal wall structures. Although early outcomes are encouraging, further studies with larger cohorts and long-term follow-up are needed to validate its safety and durability.
Objectives: This study aimed to identify the genetic cause of bone dysplasia in a patient with fibro-osseous bone dysplasia. Methods: We performed longitudinal clinical, radiographic, biochemical, and molecular characterization (whole-exome sequencing) of a 20-year-old male presenting with an atypical severe sclerosing and fibro-osseous bone phenotype. Results: Over a 15-year clinical window, the patient demonstrated diffuse, mixed lytic and sclerotic lesions across the axial and appendicular skeleton, accelerated skeletal maturation, structural bone fragility resulting in an early pathological fracture, and marked metabolic osseous remodeling, as evidenced by chronically elevated alkaline phosphatase. A novel, de novo start-loss mutation in the PHYKPL gene (NM_153373.4:c.2T>C (p.?) was identified in this patient. Conclusion: This study describes a novel candidate dominant phenotype associated with a de novo PHYKPL variant. These findings introduce a novel candidate gene-disease association that warrants future confirmatory studies to define its role in skeletal metabolic matrix health.
Objectives: The article aimed to examine the outcome of bipolar hemiarthroplasty (BHA) in the treatment of displaced femoral neck fractures in Nigeria. Methods: A retrospective study of all cases of BHA performed for displaced femoral neck fracture in three tertiary health hospitals from January 01 st , 2010, to December 31 st , 2024. The inclusion criteria are patients with femoral neck fractures aged 60 or older, who underwent BHA and have a minimum follow-up of 2 years. The outcome variables were surgical site infection (SSI), length of hospital stay (LHS), and functional outcome, assessed using the Harris Hip score (HHS) for pain, and the patients’ ambulatory status at the consultant outpatient clinic attendance. Results: A total of 73 patients met the inclusion criteria. The mean age was 75 years with a male-to-female ratio of 1:1.03. The majority of patients were aged 70–79 years. Domestic fall was the predominant cause of injury in 71.2% (52 patients), with female preponderance. SSI occurred in 19.2% (14 patients). The HHSs for pain were good to excellent in 63% (46 patients) of the patients, and the ambulatory status of the patient at last attendance showed that 24.7% (18 patients) and 39.7% (29 patients) were walking without the use of a walking stick as an assistive device, respectively. There was a statistically significant difference between age group and ambulatory status ( p = 0.001) and between LHS and SSI ( p = 0.001). Conclusion: BHA is a viable option for the treatment of displaced femoral neck fractures in a low-resource environment.
