Current Issue Volume 5, Number 4 , October-December 2018

ORIGINAL ARTICLE
G Balamurali

Dorsal Root Entry Zone Operation for Brachial Plexus Neuropathic Pain

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:155-161]



Background: We sought to assess efficacy, pain relief, surgical morbidity, and postoperative quality of life in patients who have undergone dorsal root entry zone (DREZ) lesioning for intractable brachial plexus injury and spinal cord injury neuropathic pain.

Methods: We analyzed 16 patients who underwent DREZ lesioning between 2011 and 2016 by a single surgeon. All our patient’s data was analyzed on pre- and post-op visual analog scale (VAS) scores, SF12, normalized dispersion index (NDI) score, questionnaires, and outcome scores. The mean age was 48 years (31-62 years) with 15 males and 1 female. Average follow up was 3.6 years.

Results: Of the 16 patients, 3 (20%) patients experienced “excellent” postoperative (complete) pain relief with another 11 (69%) reporting “good” improvement and 1 (11%) had “good” improvement. Two patients (16%) had objective evidence of a new, mild motor deficit postoperatively. All the 16 patients (100%) stated they would recommend DREZ lesioning procedure to anyone with similar symptoms. There was a statistically significant improvement in VAS scores and quality of life scores at 5 years. Five patients had objective evidence of a new, mild posterior column and motor deficit postoperatively which improved within 6 months and 87% of them did not take any medication further.

Conclusion: With the appropriate patient selection, DREZ lesioning is an efficacious and durable procedure that can be performed with low morbidity and very good patient outcomes for patients with brachial plexus avulsion and spinal cord injury pain. Awareness among doctors and patients is necessary.

Keywords: Brachial plexus injury, Neuropathic pain, Dorsal root entry zone rhyzotomy, Spinal cord Injury pain

How to cite this article: G Balamurali. Dorsal Root Entry Zone Operation for Brachial Plexus Neuropathic Pain. J Spinal Surg 2018;5(4):155-161

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Lekshmi S Bhooshan, Binod P, M Lekshmi

Role of Plastic Surgeon in the Management of Pressure Ulcers during Rehabilitation of Patients with Traumatic Spinal Cord Injury: A Tertiary Hospital Experience

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:162-169]



Background: Pressure ulcers and their management represent one of the most challenging situations following traumatic spinal cord injury (SCI). It requires frequent hospitalizations and hence aggravates the physical, psychological and socioeconomic burden of patients and their caregivers. Early surgical intervention will help in reducing the morbidity as well as improve the quality of life of these patients. In this study,we present a retrospective review of reconstructive surgeries for pressure sores highlighting the role of the plastic surgeon in the rehabilitation of traumatic SCI.

Methods: A three-year retrospective review (January 2014- December 2017) of 25 traumatic SCI patients who underwent reconstructive surgeries for pressure ulcers in the Department of Plastic Surgery in a Tertiary Care Government Hospital in South India was done.Variables like demographic and clinical details, reconstructive procedures done, postoperative complications, duration of hospital stay and relation of wound complication with serum albumin were statistically analyzed and interpreted using statistical package for social sciences (SPSS) software.

Results: Twenty-five male patients with age between 22 and 69 years (mean age = 49.4+/-12.24)were analyzed. 88% of the patients (n = 22) had paraplegia, and 12% had quadriplegia. 12% of patients had a cervical spinal injury, while 88% had a thoracolumbar injury. Mean duration of hospital stay was 36.5 days.Of the 25 patients, 68% (n = 17) had pressure sores at multiple sites while the rest had a single pressure sore. Of the total 49 pressure sores, 30 were ischial, 11 sacral, 7 trochanteric and one perineal pressure sore.Forty-five pressure sores were of grade II/IV and was managed with various flap reconstructions. One sacral pressure sore and one ischial pressure sore (grade II) underwent excision and primary closure. Split skin grafting was done for 2 sacral pressure sores. Postoperative wound complications were analyzed and there was a significant relation between hypoalbuminemia and major wound complications (Fischer exact p = <0.0001)

Conclusion: Plastic surgeons have an important role to play in the rehabilitation phase of traumatic spinal cord injury patients with pressure sores. Early reconstructive surgeries for pressure sores will prevent the development of complications and provide better quality of life (QOL) for these patients.

Keywords: Ischial, Management, Plastic surgeon, Pressure ulcers, Reconstructive surgery, Rehabilitation, Sacral sores, Traumatic spinal cord injury, Trochanteric sores.

Abbreviations

SCI-Traumatic spinal cord injury
QOL-Quality of life

How to cite this article: Bhooshan LS, Binod P, Lekshmi M. Role of Plastic Surgeon in the Management of Pressure Ulcers during Rehabilitation of Patients with Traumatic Spinal Cord Injury: A Tertiary Hospital Experience. J Spinal Surg 2018;5(4):162-169.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Raghavendra Nayak, Nitin Jagdhane, Bhagawati Salgotra

Surgical Outcomes in Patients with Spinal Tuberculosis with Severe Neurological Deficits

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:170-173]



Background: To assess the outcome of surgical interventions in patients with spinal tuberculosis who presented late with severe neurological deficits.

Materials and methods: Thirty-three patients with spinal tuberculosis with severe neurological deficits who underwent neurosurgical intervention at a tertiary care center from 2012 to 2018 were retrospectively analyzed. The data was collected with regards to age, gender, clinical presentations, Frankel grading at presentation, surgery, and outcomes at follow-up.

Results: Thirty-three patients (25 male, 8 female) with the mean age group of 32.2 years were studied. At presentation, all patients had spasticity, 26 (78 %) had bladder involvement. Thirty-two patients showed significant improvement (Frankel D/E) at 1 year follow-up. There was a remarkable improvement in the other symptoms such as pain (95%), spasticity (92%) and bladder symptoms (88%). Only one patient in Frankel grade A showed no good recovery. He had extensive multidrug-resistant systemic tuberculosis with HIV positivity and he expired 9 months post-surgery. Fourteen patients showed recovery in 3 months follow-up and rest showed improvements in 9 to 12 months follow-up.

Conclusion: There was a remarkable improvement in the neurological outcome following the surgical decompression. Surgical decompression and fusion is a good option in patients with severe deficits unless the patient is medically unfit. Old age, cord changes, and bladder involvements are the factors which might delay the recovery.

Keywords: Paraplegia, Potts’ spine, Severe neurological deficits, Tuberculous spine.

How to cite this article: Nayak R, Jagdhane N, Salgotra B. Surgical Outcomes in Patients with Spinal Tuberculosis with Severe Neurological Deficits. J Spinal Surg 2018;5(4):170-173.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Anil Kumar, Lokesh Nehete, Jitender Chaturvedi, Nighat Hussain

Large Giant Cell Tumor at Dorsal Spine with Spinal Instability

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:174-177]



Giant cell tumors (GCTs) are rare in the mobile spine above the sacrum that most frequently presents with pain and neurologic deficit depending on the site of involvement. Complete excision of GCTs with appropriate reconstruction for the preservation of spinal integrity is the treatment of choice. We report a case of GCT involving dorsal vertebrae of a female patient, who was treated by wide local excision of the tumor, reconstruction of spinal integrity with expandable interbody cage and posterior instrumentation for large D2 and D3 giant cell tumor. Histopathology confirmed it as GCT. After 1 year of follow-up, the patient is doing well without any evidence of local and distant tumor recurrence.

Keywords: Dorsal, Giant cell tumor, Spinal Instability, Spine.

How to cite this article: Kumar A, Nehete L, Chaturvedi J, Hussain N. Large Giant Cell Tumor at Dorsal Spine with Spinal Instability. J Spinal Surg 2018;5(4):174-177.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Vivek Agrawal, Rajendra B Aher

A Common Pathology in Rare Location: Spinal Hemangioma

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:178-180]



Hemangioma of spinal column is a common pathology but purely epidural spinal hemangioma, especially in pediatric age group, is rare and there are very few case reports available in English medical literature. We are reporting a case of cervicodorsal epidural arterio-venous hemangioma without vertebrae involvement in a pediatric patient to highlight difficulty in interpretation and importance of preoperative radiological diagnosis.

Keywords: Epidural lesions, Hemangioma, Spinal hemangioma.

How to cite this article: Agrawal V, Aher RB. A Common Pathology in Rare Location: Spinal Hemangioma. J Spinal Surg 2018;5(4):178-180.

Source of support: Nil

Conflict of interest: None


LETTER TO THE EDITOR
Philip Sell

Evidence for the Treatment of Low Back Pain and Radicular Pain

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:181]



Effective and economic delivery of healthcare is a societal goal. Low back pain causes more disability, worldwide than any other condition. Prevalence and burden increase with age until around the sixth decade and worldwide prevalence has been reported to be highest in western Europe. High levels of psychological distress have been associated with back pain onset as has lifestyle factors. The persistence of an episode of back pain is related to clinical factors, lifestyle, and psychosocial factors -including distress and fear-avoidance beliefs.

How to cite this article: Sell P. Evidence for the Treatment of Low Back Pain and Radicular Pain. J Spinal Surg 2018;5(4):181

Source of support: Nil

Conflict of interest: None


SPINE IMAGE
Irphan Muhammed, Vinu V Gopal

Multilevel Dorsal Transverse Process Fracture

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:182]



Transverse process fractures are considered minor injuries under the classification of spine fractures.1 They occur following high energy direct trauma or violent muscle contraction, usually following road traffic accidents.2-4 They are usually associated with pelvic hip fractures, blunt injury abdomen, and haemothorax.

How to cite this article: Muhammed I, Gopal VV. Multilevel Dorsal Transverse Process Fracture. J Spinal Surg 2018;5(4):182.

Source of support: Nil

Conflict of interest: None


SPINE IMAGE
Geo Paul, Vinu V Gopal

Bilateral Pars Interarticularis Fracture following Trauma in Children

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:183]



Spondylolysis1 is a term used to describe anatomic defects in pars interarticularis with adjacent bone sclerosis. Spondylolysis in children as a result of a stress fracture is described in the literature, but spondylolysis following trauma is rare.

How to cite this article: Paul G, Gopal VV. Bilateral Pars Interarticularis Fracture following Trauma in Children. J Spinal Surg 2018;5(4):183.

Source of support: Nil

Conflict of interest: None


HISTORY
Vinu V Gopal

Professor Dr Anil Peethambaran—A Great Neurosurgeon, My Teacher, and Mentor

[Year:2018] [Month:October-December] [Volumn:5 ] [Number:4] [Pages:38] [Pages No:184-193]



It is indeed an honor and privilege to write about a neurosurgical teacher par excellence, my mentor and guru. Being a good artist with creative skills his contributions are remarkable milestones in the development of spine surgery in Kerala


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