RESUMEN
BACKGROUND: Ligament flavum (LF) hypertropy is the main etiopathogenesis of lumbar canal stenosis (LCS). The purely elastic LF undergoes a morphological adaptation including a reduction in the elastic fibers and a consequent increase in the collagen content, fibrosis, cicatrization, and calcification. However, the morphometric analysis can delineate the LF in patients with LCS from those without LCS, which would help in better understanding LCS pathogenesis. AIM: To compare the histopathological changes in LF between the degenerative LCS and non-stenotic (non-LCS) group. METHODS: The present prospective study was conducted in 82 patients who were divided into two groups, namely LCS and non-LCS. Demographic details of the patients such as duration of symptoms, level of involvement, and number of segments were recorded. The LF obtained from both groups was histopathologically examined for the fibrosis score, elastic fiber degeneration, calcification, and chondroid metaplasia. Morphometrical details included a change in elastin and collagen percentages, elastin/collagen ratio, elastic fiber fragmentation, and ligamentocyte numbers. All parameters were compared between the two groups by using the independent t test, Chi-square test, and Pearson's correlation test. RESULTS: Out of 82 cases, 74 were analysed, 34 in LCS and 40 in non-LCS group. The mean ± SD age of presentation in LCS and non- LCS group was 49.2 ± 8.9 and 43.1 ± 14.3 respectively. The LCS group (n = 34) exhibited significant differences in fibrosis (P = 0.002), elastic fiber degeneration (P = 0.01), % elastic fragmentation (66.5 ± 16.3 vs 29.5 ± 16.9), % elastic, content (26.9 ± 6.7 vs 34.7 ± 8.4), % collagen content (63.6 ± 10.4 vs 54.9 ± 6.4), reduction of elastic/collagen (0.4 ± 0.1 vs 0.6 ± 0.1), and ligamentocyte number (39.1 ± 19.1 vs 53.5 ± 26.9) as compared to non-LCS group (n = 40). The calcification (P = 0.08) and Pearson's correlation between duration and loss of elastin was not significant. The difference in LF morphology is consistent in patient's ≥ 40 years of age among the groups as found in subgroup analysis. Similarly in the patents < 40 and > 40 in the non-LCS group. CONCLUSION: LF is vital in the pathogenesis of LCS. The purely elastic LF undergoes a morphological adaptation that includes a reduction in the elastic fibers with a consequent increase in the collagen content, fibrosis, cicatrization, and calcification. The present study provides a detailed morphometric analysis to semiquantitatively delineate the LF changes in patients with LCS from those in patients without LCS.
RESUMEN
PURPOSE: The spotter's (objectively structured practical examination) is an assessment tool which is widely used to test the practical knowledge of anatomy extensively. In Indian context it is used as an inclusive model in the gross anatomy practical examination and the marks allotted to it varies. The traditional spotter examination often has been blamed for only incorporating the initial levels of revised Bloom's taxonomy. This study retrospectively analysed the pre-professional spotter's examination score and tested its efficacy in terms of reliability, internal consistency, validity, educational impact, and resource intensiveness. METHODS: The summative data of student's score on four different days of unrepeated spotter's examination and final theory examination score was collected and tabulated. These four group of students acted as independent cohorts. The difficulty index (DI), point biserial correlation (PBC), Cronbach α (CA) and descriptive statistics of each cohort were calculated. Revised bloom taxonomy rating was applied to spotter's. RESULTS: We found heterogenous distribution of spotter's in each cohort according to DI. The PBCs and CA of each cohort were acceptable. The majority of spotter's tested the cognitive and comprehension domain of revised bloom's taxonomy. There was nonsignificant difference between mean scores of cohorts but we found low positive significant correlation between theory and spotter's score. CONCLUSION: We concluded that the construct of spotter's was reliable, internally consistent, had fair validity, variable educational impact, and sustainable resource intensiveness. We propose urgent redesigning of spotter's to include higher level of taxonomy to comply with emerging curricular changes.