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HISTORY
Sanjay Behari

The Great Neurosurgeon and Spinal Surgery— Professor Vijendra K Jain: The Innovative Spinal Surgeon

[Year:2017] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:45] [Pages No:33-37][No of Hits : 1386]


ABSTRACT

Dr VK Jain has been one of the most innovative surgeons of this era. His seminal contributions to surgery for spinal diseases, particularly related to the craniovertebral junction (CVJ), have been a great boon for his patients.


 
CASE REPORT
Ashish Shrivastav, Sunit Mediratta

Artificial Cervical Disk Replacement at Three Levels Following Multilevel Cervical Diskectomy

[Year:2017] [Month:April-June] [Volumn:4 ] [Number:2] [Pages:47] [Pages No:79-82][No of Hits : 839]


ABSTRACT

Cervical disk prolapse is a common ailment in young people and has generally been treated by anterior cervical diskectomy and fusion. This has caused restricted movement of the neck at the level of fusion along with adjacent segment changes over a period of time. With the advent of artificial disk, motion preserving techniques are being used for young people with active lifestyles with excellent outcomes. Artificial disk replacement at single level has been used by many surgeons after cervical diskectomy, however, a three level cervical disk replacement or cervical disk arthroplasty surgery has rarely been performed. We report a 46-year-old patient with symptomatic three level cervical disk prolapse treated with anterior cervical diskectomy followed by artificial disk replacement at all three levels as a motion preserving surgery.

Keywords: Cervical disk prolapse, Disk replacement, Motion preserving.

How to cite this article: Shrivastav A, Mediratta S. Artificial Cervical Disk Replacement at Three Levels Following Multilevel Cervical Diskectomy. J Spinal Surg 2017;4(2):79-82.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ajay Kothari, Ketan Khurjekar, Shailesh Hadgaonkar, Navdeep Singh, Himanshu G Kulkarni, Parag Sancheti, Nilay Kumar

Delta Fixation vs Interbody Fusion in Cases of High-grade Spondylolisthesis

[Year:2017] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:45] [Pages No:30-32][No of Hits : 709]


ABSTRACT

High-grade spondylolisthesis is better dealt with surgical methods. There are various methods to achieve solid fusion and decompression in the presence of symptomatic spinal stenosis. In our case report, we have compared delta fixation with interbody fusion methods, especially in high-risk patients (American Society of Anesthesiologists grade III) with its various merits and demerits, and we have attempted to discuss it with respect to the literature available.

Keywords: Delta fixation, High-grade spondylolisthesis, Posterior transsacral interbody fusion.

How to cite this article: Kothari A, Khurjekar K, Hadgaonkar S, Singh N, Kulkarni HG, Sancheti P, Kumar N. Delta Fixation vs Interbody Fusion in Cases of High-grade Spondylolisthesis. J Spinal Surg 2017;4(1):30-32.

Source of support: Nil

Conflict of interest: None


 
TECHNICAL NOTE
Ioannis Siasios, Kunal Vakharia, Joseph M Kowalski, Vassilios G Dimopoulos, John Pollina

C1-C2 Posterior Cervical Fixation by a Harms Technique Modification

[Year:2017] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:45] [Pages No:14-18][No of Hits : 681]


ABSTRACT

Introduction: The unique anatomy of the upper cervical spine in conjunction with its supportive role in the axial stabilization and rotatory function of the head increases the surgical risk and associated complications for corrective surgeries performed in this spinal region. C1-C2 posterior fixation is indicated in the occurrence of instability at the craniocervical junction; and it can be performed by specific surgical techniques, such as the Harms and Magerl techniques. In this technical note, the authors present a simplified modification of the Harms technique that increases the accuracy of screw placement in the lateral mass of the C1 vertebra and in the pedicle of the C2 vertebra. This modification provides a secure path for screw placement by obtaining fluoroscopic images of K-wires inserted in the lateral masses of C1 and the pedicles of C2 as in the original technique. According to this technique, a pin driver is used to guide a K-wire through the initially marked entry point to the lateral mass of C1. After fluoroscopic confirmation of the optimal position of the guide wire, a cannulated hand drill is placed over the guidewire. A pilot hole is drilled in the same trajectory for the screw placement under fluoroscopic control. Then the guidewire and the hand drill are removed and an appropriately sized 3.5 mm polyaxial screw is placed with a hand drill under confirmation of the correct position with anteroposterior and lateral fluoroscopy. The same procedure is followed for the placement of the C2 pedicle screws. Then, a small rod is placed and secured within the polyaxial screw heads of the C1 and C2 screws bilaterally. Decortication of the spinous processes of the involved vertebrae and the occiput is the final step before closure of the fascia, cervical muscle layer, subcutaneous tissue, and skin.

Keywords: Atlantoaxial posterior fixation, C1 lateral mass, C2 pedicle screws, Harms technique.

How to cite this article: Siasios I, Vakharia K, Kowalski JM, Dimopoulos VG, Pollina J. C1-C2 Posterior Cervical Fixation by a Harms Technique Modification. J Spinal Surg 2017;4(1):14-18.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Vinu V Gopal, PT Baburaj, PK Balakrishnan

Caregiver’s Burden in Rehabilitation of Patients with Neurological Deficits following Traumatic Spinal Cord Injury

[Year:2017] [Month:January-March] [Volumn:4 ] [Number:1] [Pages:45] [Pages No:9-13][No of Hits : 543]


ABSTRACT

Introduction: Traumatic spinal cord injury (SCI) is an emerging public health problem reaching epidemic proportions. Reduced functional capacity after SCI not only affects the quality of life (QOL) of the patient, but also creates an added social, financial, and psychological burden on the family. Caregiver is responsible for providing the patient with physical, emotional, and functional support. Therefore, the increasing burden on the caregiver worsens all the domains constituting the QOL of the patient. Thus, the understanding of caregiver burden in terms of demographic profile of caregivers, severity of SCI, cost of care, mode of treatment adopted, and employment and education of the caregiver is important in the rehabilitation of patients with SCI.

Materials and methods: A cross-sectional analytical questionnaire survey was performed with 50 SCI patients and their primary caregivers at a tertiary care institution between June and September 2016. The caregiver burden was assessed using the Zarit burden interview scale, and its relation with severity of injury and type of treatment was analyzed using nonparametric statistics. The demographic variables influencing caregiver burden were also studied.

Results: About 38% of patients had complete SCI. About 34% of caregivers of patients were their own spouse. The mean age of caregiver was 42.9 ± 1.2 years. The majority (44%) of caregivers had moderate burden. Completeness of SCI significantly influenced caregiver burden (p = 0.02). Type of treatment adopted did not influence the caregiver burden (p = 0.52). Employment status and education of caregiver were found to be significantly associated with caregiver burden (p = 0.001 and p = 0.046 respectively).

Conclusion: Caregivers had significant burden of care in terms of severity of SCI. Age, employment status, education, and marital status affect caregiving burden. We hope the results of the study will guide experimental research in this field, motivating the health care professionals in providing early psychological intervention leading to positive belief and attitude change in society. The study will encourage society in focusing on community-based rehabilitation, which can potentially reduce the overall burden.

Keywords: Burden, Caregiver, Spinal cord injury, Traumatic.

How to cite this article: Gopal VV, Baburaj PT, Balakrishnan PK. Caregiver’s Burden in Rehabilitation of Patients with Neurological Deficits following Traumatic Spinal Cord Injury. J Spinal Surg 2017;4(1):9-13.

Source of support: Nil

Conflict of interest: None


 
Original Article
Deepak K Jha, Pranjal Pandey, Mukul Jain, Arvind Arya, Suman Kushwaha, Rima Kumari

Clinical Methods of Spinal-level Localization in Lumbar and Lumbosacral Spine Surgeries through Posterior Approach

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:34-39][No of Hits : 1883]


ABSTRACT

Aims: Clinical methods of palpations of iliac crests and spinous processes for spinal-level localization (SLL) were evaluated for accuracy in lumbar and lumbosacral (LS) spinal surgeries through the posterior approach.

Materials and methods: Hundred and seven successive patients operated for lumbar and LS diseases operated through the posterior approach in the last 2 years were evaluated prospectively for the accuracy of clinical methods for SLL. There were 76 males and 31 females. Age ranged from 16 to 70 years (average 43.5 years). Clinical methods for SLL included palpation of iliac crests and spinal processes in correlation with midline sagittal MR images. Surgical incision and further surgery were undertaken after confirmation of spinal level by intraoperative lateral radiograph of LS spine. Accuracy of SLL by clinical methods and surgical findings at various spinal levels was observed.

Results: Spinous processes for SLL were accurate in 94.39% (n = 101) cases. The level of iliac crests were seen at or just below L3 and L4 spinous processes in 89.71% (n = 96) and 10.29% (n = 11) cases respectively. Various anatomical features like posterior surfaces of laminae, thecal sac, and positions of roots in the spinal canal were helpful in differentiating L5 to S1 level than levels above. Six errors in SLL in the study included five females with L4 to L5 prolapsed inter-vertebral disk (PIVD) and one male with L5 to S1 PIVD.

Conclusion: Spinal-level localization by clinical methods in correlation with MR images is unreliable especially in women and L4 to 5 level. Intraoperative findings of L5 to S1 interspace and S1 lamina show features that may help in SLL during surgery.

Keywords: Herniated lumbar disk, Lumbar spine, Spine, Wrong-level disk surgery, Wrong-level surgery.

How to cite this article: Jha DK, Pandey P, Jain M, Arya A, Kushwaha S, Kumari R. Clinical Methods of Spinal-level Localization in Lumbar and Lumbosacral Spine Surgeries through Posterior Approach. J Spinal Surg 2016;3(2):34-39.

Source of support: Nil

Conflict of interest: None


 
Reflection
Vinu V Gopal

Atlantoaxial Fixation - Anterior or Posterior Approach: Critical Review

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:51-54][No of Hits : 1473]


ABSTRACT

Atlantoaxial facet joints have been proposed as the center of mobility and also center for instability of the atlantoaxial region. Because of the high mobility of the atlantoaxial (C1-C2) motion segment, fusion rates at this level have been substantially lower than those at the subaxial spine. The success of craniovertebral junction surgery depends on adequate reduction, decompression of craniovertebral (CV) junction followed by immediate fixation of atlantoaxial joint followed by bone grafting with compression for solid bony fusion. Current options for atlantoaxial fixation include anterior or posterior approaches. The biomechanical stability and fusion rates of posterior fixation surgery had been proved beyond doubt. The main disadvantages of posterior surgery involve disruption of posterior ligamentous complex which are essential for stability. C2 root denervation also aggravates the paraspinal muscle atrophy leading to instability So now advances in spinal surgery made neurosurgeons to think of an anterior technique which can establish fusion and fixation at the same time avoiding the above mentioned complications. The advantages are that there are no anatomical constraints like posterior approach in reaching C1-C2 joint. The risk of neuralgia, bleeding from venous plexus is avoided along with practically no damage to vertebral artery. Newer techniques of anterior transarticular screw and bilateral atlantoaxial fixation and fusion through unilateral right sided retropharyngeal approach had been described in literature. Anterior approach still needs further randomized controlled trials for level 1 evidence, Further research on along with biomechanical feasibility using anatomical ex vivo and in vivo constructs need to be done to further validate the appropriateness and safety of anterior approach for C1-C2 fixation and fusion.

Keywords: Anterior, Atlantoaxial, Posterior.

How to cite this article: Gopal VV. Atlantoaxial Fixation- Anterior or Posterior Approach: Critical Review. J Spinal Surg 2016;3(2):51-54.

Source of support: Nil

Conflict of interest: None


 
Case Report
Nilesh Jain, Sharadendu Narayan, Harshad Patil, Abhishek Songara

Epidermoid Cyst of the Thoracic Spine: A Rare Case

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:59-62][No of Hits : 1300]


ABSTRACT

Intraspinal epidermoid cyst is a rare tumor. The incidence in adults is lesser than 1% and in children lesser than 3%. Epidermoid cyst is predominantly seen at the dorsal spinal level. A large percentage of epidermoid cysts are intradural extramedullary. Intramedullary epidermal cysts are rarer, with about 70 cases reported in the literature. These may be congenital or acquired with known association with spinal dysraphism. We hereby report a case of thoracic epidermoid cyst in a 22-year-old male with an extramedullary exophytic component and intramedullary cyst with accompanying split cord malformation at the level of lesion.

Keywords: Epidermoid cyst, Intramedullary, Intraspinal, Split cord, Thoracic.

How to cite this article: Jain N, Narayan S, Patil H, Songara A. Epidermoid Cyst of the Thoracic Spine: A Rare Case. J Spinal Surg 2016;3(2):59-62.

Source of support: Nil

Conflict of interest: None


 
History
Anil Kumar Peethambaran, Thomas Varghese

The Great Neurosurgeon and Spinal Surgery

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:66-67][No of Hits : 1284]


ABSTRACT

Padmashree Dr. A Marthanda Pillai: A Neurosurgeon Par Excellence

Padmashree (Dr.) Ananthanarayanan Marthanda Pillai is the current Chairman and Managing Director of Ananthapuri Hospitals and Research Institute, a 300-bedded superspecialty hospital in Thiruvananthapuram, the capital city of Kerala. He was awarded the Padmashree award for his excellence in the field of neurosurgery and social work by IMA, in the year 2011.


 
Spine Image
G Murugesan

Dysphagia caused by Anterior Cervical Osteophytes at C2-C3: Unusual Location and Presentation

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:70-71][No of Hits : 1104]


ABSTRACT

Anterior cervical osteophytes are common in old age due to degenerative process; it is usually asymptomatic in elderly people. Due to mechanical compressions, few patients may present with multiple complications, such as dysphagia, dysarthria, and dyspnea. The osteophytes commonly involve lower cervical spine and usually present with neurological symptoms.
This case is unusual as it presented with C2-C3 osteophyte with dysphagia, which was completely relieved by excision.

Keywords: Anterior cervical osteophytes, Complete excision, Compression of pharynx, Dysphagia.

How to cite this article: Murugesan G. Dysphagia caused by Anterior Cervical Osteophytes at C2-C3: Unusual Location and Presentation. J Spinal Surg 2016;3(2):70-71.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Anantha Gabbita, Mohamed M Usman, Anantha Kishan, DN Varadaraju, Shivalinge G Patil, Amrut V Hosmath

Pedicle Screw Placement in the Thoracic and Lumbar Spine by the C-arm Guided Navigation and the Free Hand Method: A Technical and Outcome Analysis

[Year:2016] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:43] [Pages No:90-95][No of Hits : 1093]


ABSTRACT

Introduction: The use of pedicle screws in stabilizing all three columns of the spine is a well-known but technically demanding procedure. Various assisted techniques like intraoperative fluoroscopy and stereotaxy-guided techniques have marginally increased placement accuracy along with increased radiation exposure to the surgeon and the patient, with an increased operative time.

Over the last two decades, a detailed understanding of the anatomy of the thoracolumbar pedicles has led to the emergence of the “free-hand” technique.

Objectives: To analyze the pedicle screw placement in thoracic, lumbar, and sacral spine over a 3-year period in terms of the intraoperative and immediate postoperative procedural results using navigation-guided and free hand techniques.

Materials and methods: A retrospective study was done over a period of 3 years from November 2012 to December 2015 in a tertiary care center by a single surgeon, involving 118 cases that were done using the C-arm navigation and the free hand technique.

Results: The study involved a total of 118 patients and 546 screws over a period of 3 years. The indications consisted of degenerative diseases (72%), infection (12.7%), trauma (12.7%), and malignancy (2.54%). The initial 77 cases were done by image guidance under C arm navigation and the later 41 cases with free hand techniques. Among these, there were eight breaches noted (6.72%), five (6.49%) in the image-guided technique vs three (7.3%) in the freehand technique. The direction of breach was lateral in one case (12.5%) and medial in seven cases (87.5%). Three patients (37.5%) with suboptimal screw placement underwent revision surgery. Four patients (3.36%) in the present study had postoperative neurological deficit in the form of foot drop and preoperative durotomies noted in nine patients (7.62%). Postoperative surgical site infections were noted in four cases (3.38%).

Conclusion: Free hand pedicle screw placement based on external anatomy alone can be performed with acceptable safety and accuracy in experienced hands and allows avoidance of radiation exposure encountered in fluoroscopic techniques.

Keywords: A ccuracy, B reach, F ree h and, I mage g uided, Lumbar, Pedicle screw, Sacral, Thoracic.

How to cite this article: Gabbita A, Usman MM, Kishan A, Varadaraju DN, Patil SG, Hosmath AV. Pedicle Screw Placement in the Thoracic and Lumbar Spine by the C-arm Guided Navigation and the Free Hand Method: A Technical and Outcome Analysis. J Spinal Surg 2016;3(3):90-95.

Source of support: Nil

Conflict of interest: None


 
Original Article
Sriram H Srinivasan, Martyn Newey

A Report on the early Results of the BacJac Interspinous Distraction Device: A Prospective Study in Patients with Lumbar Spinal Stenosis

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:40-43][No of Hits : 1024]


ABSTRACT

Aims: This is a report on the early clinical outcome of the BacJac interspinous distraction device in patients with lumbar spinal stenosis.

Materials and methods: This is a prospective study on a group of patients who underwent surgery from February 2010 to December 2012. There were 21 consecutive patients who had insertion of a BacJac. Data prospectively recorded included Visual Analogue Scores for leg pain (VL), back pain (VB), the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and walking distance (WD). Scores were recorded pre- and postoperatively and at final review. The follow-up period varied from 6 to 40 months.

Results: We found all clinical outcome measures improved following surgery. Mean scores for VL improved from 76 to 27, for VB from 49 to 24, and for ODI from 42 to 26 at final follow-up. There were also improvements noted in ZCQ scores and patient-reported WD. We also noted a high rate of osteolysis (76%) around the implant at 1 year from insertion.

Conclusion: This small prospective study suggests that there is a role for the use of the BacJac interspinous distraction devices in selected patients. Osteolysis around the implant remains an issue although this did not appear to compromise the early outcome in this study.

Keywords: Clinical outcome, Interspinous distraction device, Lumbar spinal stenosis, Surgical treatment.

How to cite this article: Srinivasan SH, Newey M. A Report on the early Results of the BacJac Interspinous Distraction Device: A Prospective Study in Patients with Lumbar Spinal Stenosis. J Spinal Surg 2016;3(2):40-43.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Darshansingh U Rajput, Sudhir Beglihosahalli Muniswamy

Reverse Latissimus Dorsi Turnover Muscle Flap for Coverage of a Secondary Midline Lumbar Defect following Spinal Surgery

[Year:2016] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:28] [Pages No:12-14][No of Hits : 938]


ABSTRACT

The reconstruction of defects located in the midline lumbar region area is difficult, especially when occurring following a neurosurgical procedure. They display a high level of complexity with respect to dural exposure, exposure of implants, deep irregular contours and bacterial contamination of the wound. The difficulty is made more challenging by the fewer possible options of regional flaps available in the vicinity. In order to obtain a well-vascularized tissue, with good resistance to bacterial contamination and easy to shape into such defects, the reverse latissimus dorsi turnover muscle flap is a useful surgical option. In this article, we are reporting a case of post-traumatic spine surgery wound complication resulting in a midline lumar defect that was reconstructed with a reverse latissimus dorsi (LD) turnover muscle flap.

Keywords: Midline lumbar defect, Reverse LD, Turnover flap.

How to cite this article: Rajput DU, Muniswamy SB. Reverse Latissimus Dorsi Turnover Muscle Flap for Coverage of a Secondary Midline Lumbar Defect following Spinal Surgery. J Spinal Surg 2016;3(1):12-14.

Source of support: Nil

Conflict of interest: None


 
Original Article
Gopalakrishnan Balamurali, Vishal C Gala, Jean-Marc Voyadzis, David Rosen, Apazra Burks, Laurie Rice, Richard G Fessler

Presence of Undiagnosed Cervical Myelopathy in Patients referred for Surgical Evaluation of Lumbar Stenosis

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:29-33][No of Hits : 792]


ABSTRACT

Introduction: Lumbar stenosis is a common clinical entity, i.e., being diagnosed with increasing frequency in our aging population in the United States. The process of spondylitic degeneration that causes lumbar stenosis may also give rise to concurrent cervical stenosis, resulting in so-called tandem stenosis. Symptomatic tandem spinal stenosis is characterized clinically by a combination of claudication and progressive gait disturbance with signs of mixed myelopathy and polyradiculopathy in both the upper and lower extremities.

Materials and methods: A retrospective review of 361 patients, referred to our clinic for evaluation of lumbar stenosis over a period of 4 years, was conducted. Data collection consisted of detailed chart review and tabulation of the duration of symptoms, course of nonsurgical therapy, sensory and motor deficits, gait/ balance disturbances, upper motor neuron signs, and diagnostic imaging studies. Patients with signs and symptoms suggestive of cervical spondylitic myelopathy underwent confirmatory diagnostic imaging studies.

Results: Twenty-one of the 361 patients (5.8%) were found to have symptomatic tandem stenosis with clear clinical evidence of cervical myelopathy. Twelve of the 21 patients underwent cervical decompression; of these four underwent cervical decompression followed by lumbar decompression, and one patient underwent cervical decompression followed by thoracic decompression. Eight of the 21 patients underwent lumbar decompression only. One patient underwent lumbar decompression followed by cervical decompression.

Conclusion: The possibility of concurrent disease in both the cervical and lumbar spines reinforces the need for a thorough history and physical examination. Recognition and diagnosis of tandem stenosis is critical in determining the correct surgical sequencing and technique for treatment as spinal cord compression from cervical stenosis has significant associated morbidity and mortality. The 5.8% rate of tandem stenosis in this series places it in the lower end of the range from previous reports. Furthermore, only 3% of all patients referred for surgical evaluation of lumbar stenosis were ultimately found to have cervical stenosis requiring surgical decompression.

Keywords: Cervical myelopathy, Lumbar stenosis, Tandem stenosis.

How to cite this article: Balamurali G, Gala VC, Voyadzis J-M, Rosen D, Burks A, Rice L, Fessler RG. Presence of Undiagnosed Cervical Myelopathy in Patients referred for Surgical Evaluation of Lumbar Stenosis. J Spinal Surg 2016;3(2):29-33.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Jayprakash V Modi, Kaushal R Patel, Zulfikar Patel, Shardul V Soman, Kirtan V Tankshali

Spinal Decompression using Ultrasonic Bone Scalpel: A Novel Ultrasonic Surgical Device

[Year:2016] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:39] [Pages No:140-143][No of Hits : 776]


ABSTRACT

Introduction: The ultrasonic bone scalpel (UBS) is an ultrasonic device that cuts the bone, but does not harm the surrounding soft tissue and duramater. Such a type of selectivity of bone scalpel, particularly for bone destruction, makes the bone scalpel ideal for spine surgeries where there is the need to remove only bone adjacent to the duramater and neural structures, with the sparing of the duramater. Moreover, dural tear is the most common unintended complication of spinal surgeries nowadays.

Materials and methods: This is a retrospective study of 35 patients operated for spinal decompression – cervical, thoracic, or lumbar – between January 2015 and June 2016 at BJ Medical College, Ahmedabad.

Aim: To analyze the result of the use of UBS in spinal decompression over the conventional method of decompression, such as using the Kerrison Rongeur, high-speed burr drills, and conventional osteotome.

Observation and results: Out of the 35 patients in our study, 21 patients (60%) had cervical, 3 patients (8.6%) had thoracic, and 11 patients (31.4%) had lumbar pathologies. There is significant reduction in duration of surgery and need for blood transfusion. We considered the neck disability index (NDI) and oswestry disability index (ODI) scores to measure the clinical outcomes of using bone scalpel at the end of 1 year. Both the scores were significantly improved. We had one case of dural tear (2.9%) in a patient with lumbar canal stenosis. No neurological worsening in any patients was present.

Conclusion: The UBS is a unique surgical device that reduces heat production and decreases the chances of dural tear, which makes it a suitable instrument for different spinal surgeries in recent days.

Keywords: Dural tear, High-speed drill, Spinal decompression, Ultrasonic bone scalpel.

How to cite this article: Modi JV, Patel KR, Patel Z, Soman SV, Tankshali KV. Spinal Decompression using Ultrasonic Bone Scalpel: A Novel Ultrasonic Surgical Device. J Spinal Surg 2016;3(4):140-143.

Source of support: Nil

Conflict of interest: None


 
HISTORY
Deepu Banerji

The Great Neurosurgeon and Spinal Surgery

[Year:2016] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:28] [Pages No:25-26][No of Hits : 754]


ABSTRACT

Educationist and an Inspirational Guru in Neurosurgery: Prof Anil K Singh

It is a great privilege and honor to write a few words for our dear teacher and friend Prof AK Singh, who continues to inspire generations of neurosurgeons and neuroscientists till date. I credit him for bringing forth our traditional “Guru Shishya Parampara” in modern perspective.


 
REFLECTION
S Balaji Pai

Microscopic Lumbar Diskectomy vs Endoscopic Diskectomy

[Year:2016] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:28] [Pages No:5-7][No of Hits : 750]


ABSTRACT

Lumbar diskectomy is a routinely performed surgery by neurosurgeons, orthopedic surgeons and lately by the spinal surgeons.

How to cite this article: Pai SB. Microscopic Lumbar Diskectomy vs Endoscopic Diskectomy. J Spinal Surg 2016;3(1):5-7.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Farid Yudoyono, Rossa Avrina, Farida Arisanti, Vitriana Noormeita, Benny Atmadja Wirjomartani

Cervical Spondylotic Myelopathy Release by Unilateral Open-Door Laminoplasty with Miniplate Alone: Three Years Follow-up

[Year:2016] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:28] [Pages No:18-21][No of Hits : 703]


ABSTRACT

Objective: Cervical spondylotic myelopathy (CSM) is a common degenerative spine disease that requires surgical intervention if conservative failed. Currently, there is interest in various technical of laminoplasty. To review outcome of patients who underwent single-door cervical laminoplasty using titanium miniplates alone.

Materials and methods: The author performed surgery in patients with CSM by unilateral open-door laminoplasty, which allows through decompression of the cervical spinal canal. Pain was measured with a visual analog scale (VAS). Surgical outcome was analyzed with the modified Japanese Orthopaedic Association (mJOA) score.

Results: Visual analog scale scores and mJOA were significantly improved at 1, 2 and 3 years follow-up compared to preoperative levels. Recovery rate mJOA score 27,7%, excellent pain relief (100% of initial VAS score).

Conclusion: Open-door laminoplasty is easily applied for young spine surgeon, allows good field visualization and decompression, single-door cervical laminoplasty using miniplates alone is a safe technique and achieves a high hinge union rate, good canal decompresion and neurological recovery.

Keywords: Cervical spondylotic myelopathy, Laminoplasty, Modified Japanese Orthopaedic Association, Visual analog scale.

How to cite this article: Yudoyono F, Avrina R, Arisanti F, Noormeita V, Wirjomartani BA. Cervical Spondylotic Myelopathy Release by Unilateral Open-Door Laminoplasty with Miniplate Alone: Three Years Follow-up. J Spinal Surg 2016;3(1):18-21.

Source of support: Nil

Conflict of interest: None


 
Review Article
Sanjay K Tripathi, Saurav N Nanda, CR Reddy, Sachin T Ranvir, Sawan K Pawar, Amit Kohli, Shahrookh Vatchha

Vacuum-assisted closure Dressing in Spine: An Emerging Trend

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:48-50][No of Hits : 646]


ABSTRACT

Vacuum-assisted closure (VAC) is a negative pressure therapy for the closure of wounds as it accelerates secondary wound healing and may reduce the need of serial debridement. It is emerging as a therapy for the management of acute, subacute, and chronic wounds. As the number and indications of spine surgery have increased in the past 20 years, the number of complications has also increased. Wound infection is one of the most commonly encountered complications. Vacuumassisted closure has emerged as a very cost-effective and alternative new technique for the management of dead space and wound conditioning in wound infection in spine. This article presents information about VAC and its studies with respect to the spine.

Keywords: Negative pressure therapy, Vacuum-assisted closure, Wound infection in spine.

How to cite this article: Tripathi SK, Nanda SN, Reddy CR, Ranvir ST, Pawar SK, Kohli A, Vatchha S. Vacuum-assisted closure Dressing in Spine: An Emerging Trend. J Spinal Surg 2016;3(2):48-50.

Source of support: Nil

Conflict of interest: None


 
Research Article
Shardul Madhav Soman, Jayprakash Vrajlal Modi

Management Protocol of Patients with Lumbar Spinal Stenosis, using the Qualitative Grading as a Tool

[Year:2016] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:28] [Pages No:1-4][No of Hits : 627]


ABSTRACT

Objectives: Several parameters exist for assessment of lumbar spinal stenosis (LSS) but these parameters lack clinical correlation. To formulate a protocol for management of these group of patients using the qualitative grading as a tool.

Materials and methods: A prospective study was undertaken using the qualitative grading on magnetic resonance imaging (MRI) to assess the clinical outcome of LSS at a single level. Irrespective of the grade every patient underwent a minimum 3 months period of conservative management after which depending on the oswestry disability index (ODI) and visual analog scale (VAS) for pain he was grouped into success or failure and the failed patients were advised for decompression surgery at the involved level. These patients were then further assessed after a period of 3 months after surgery. A decrease in ODI by 10 points and a 20 points decrease in VAS was considered as a success.

Results: Out of the 90 patients, there were 61 failures in conservative group, out of these 57 were operated of which only nine did not match the success criteria, while the other four either refused surgery or were lost to follow-up. In grades A1 to 3, only two patients failed conservative trial while from A4 to D, there was a gradual decline in success of conservative trial.

Conclusion: Qualitative grading is a useful tool in LSS and correlates with the clinical outcome and to decision making of these patients.

Keywords: Lumbar spinal stenosis, Magnetic resonance imaging, Neurogenic claudication, Spine decompression.

How to cite this article: Soman SM, Modi JV. Management Protocol of Patients with Lumbar Spinal Stenosis, using the Qualitative Grading as a Tool. J Spinal Surg 2016;3(1):1-4.

Source of support: Nil

Conflict of interest: None


 
HISTORY
Gopalakrishnan Madhavan Sasidharan, Indiradevi Bhagavatula

The Great Neurosurgeon and Spinal Surgery

[Year:2016] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:39] [Pages No:169-172][No of Hits : 620]


ABSTRACT

An anonymous green lawn under my knees, in one of those conference parties the name I am not able to recall now, just as I squeezed the shutter button, I felt a pat on my shoulder “So, you are interested in photography?” I looked up to find the friendly inquiring face of one of the pioneering leaders of neurosurgery in India towering over me.


 
History
Shanthanam S Mahalingam

Victor Horsley and Spinal Surgery

[Year:2016] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:45] [Pages No:68-69][No of Hits : 578]


ABSTRACT

The pioneer of neurological surgery in an era when no radiological investigation was available including X-ray, Sir Victor Horsley has earned recognition as the father of neurosurgery. His intellect, interest, and concern for humanity has earned him the knighthood. His association with Sir William Gowers was very appreciable, which helped in the introduction and progress of spinal surgery. The birth and growth of spinal surgery by Sir Victor Horsley and his contributions are briefly discussed in this article.

Keywords: Sir Victor Horsley, Sir William Gowers, Spinal cord tumor, Spinal surgery.

How to cite this article: Mahalingam SS. Victor Horsley and Spinal Surgery. J Spinal Surg 2016;3(2):68-69.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Murtuza Sikander, Sean Martin, Bassam Dabbous, Stewart Griffiths, Sumit Karia Erlick Pereira, Thomas Cadoux-Hudson

Combined C1-C2 Transarticular with C1 Lateral Mass Screw Fixation for the Treatment of Atlantoaxial Instability: A Single Center Experience

[Year:2016] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:39] [Pages No:133-139][No of Hits : 570]


ABSTRACT

Aim: To study the outcome of a cohort of patients with atlantoaxial instability (AAI) treated with a combination of C1-C2 transarticular screws and C1 lateral mass fixation.

Background: Several surgical techniques have been described for stabilization of the atlantoaxial complex. Each technique differs in its biomechanical properties, advantages, and disadvantages. In this series, we describe our experience with a combined four-point fixation technique that combines C1-C2 transarticular screws with C1 lateral mass fixation for AAI. Materials and methods: We present a single-center retrospective case series of 30 patients who were surgically treated for AAI over one decade. All patients presented with symptoms and signs of AAI and consequently underwent extensive clinical and radiological evaluation prior to surgery.
The median follow-up of our cohort was 8.3 months (3.143) with three patients lost to follow-up. Pre and postoperative symptoms were compared, including the visual analog scale (VAS) scores for neck and C2 radicular pain. All patientsf preand postoperative lateral dynamic cervical radiographs were evaluated and the posterior atlantodental interval (PADI) was measured. Ranawat functional disability score was used for pre and postoperative evaluation.

Results: Of the 30 patients, 8 were male and 22 female. The mean age was 60.4 years (18-78 years). The median hospital stay following surgery was 5 days (2.25 days). The mean preoperative VAS score for neck pain was 6.3 vs 4.3 at the first postoperative review (p ≤ 0.001) on paired comparison. Ranawat scores were available for 26 out of 30 patients. The scores improved following surgery in 8/26 (30.7%) patients, did not change in 17 (65.4%) patients, and deteriorated in only one patient (3.8%). Like the VAS score, improvement in Ranawat score following surgery was significant (p = 0.02).
Complications in this series included two unilateral intraoperative vertebral artery injuries associated with placement of C1-C2 transarticular screws, another patient had worsening C2 pain following surgery, and three patients had numbness in the C2 distribution following the procedure. Radiologically, two patients had suboptimal unilateral C2 screw placement despite satisfactory intraoperative fluoroscopic imaging. There were no infections and no implant failure.

Conclusion: The addition of C1 lateral mass screws to C1-C2 transarticular screw fixation for the treatment of AAI is an effective and safe procedure worthy of note. Our results and experience prove that this method is extremely beneficial where decompression of the posterior elements of C1 is required and may obviate the need of additional posterior wiring traditionally described. Further studies are necessary to look at the longterm fusion rates and compare them with other procedures.

Keywords: Atlantoaxial fixation, Atlantoaxial instability, Atlantoaxial joint, Neck pain.

How to cite this article: Sikander M, Martin S, Dabbous B, Griffiths S, Karia S, Pereira E, Cadoux-Hudson T. Combined C1-C2 Transarticular with C1 Lateral Mass Screw Fixation for the Treatment of Atlantoaxial Instability: A Single Center Experience. J Spinal Surg 2016;3(4):133-139.

Source of support: Nil

Conflict of Interest: None


 
CASE REPORT
Shivender Sobti, Paul S John, Amit Kumar, Sarvpreet S Grewal

Giant Cell Tumor of Dorsal Spine

[Year:2016] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:43] [Pages No:112-113][No of Hits : 570]


ABSTRACT

Giant cell tumor (GCT) is a low-grade malignant tumor that commonly involves ends of the long bone. The most common site for GCT of the spine is sacrum. These are rare above the sacrum. We present a case of GCT involving dorsal vertebral body and review regarding the treatment modalities.

Keywords: Giant cell tumor, Sacral giant cell tumor, Spinal giant cell tumor.

How to cite this article: Sobti S, John PS, Kumar A, Grewal SS. Giant Cell Tumor of Dorsal Spine. J Spinal Surg 2016;3(3):112-113.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Batuk Damjibhai Diyora, Sachin Giri, Deepali Giri, Nitin Kotecha, Swapnil Patil

An Unusual Case of Dorsally Sequestrated Disk Mimicking Tumor with Cauda Equina Syndrome

[Year:2016] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:28] [Pages No:15-17][No of Hits : 558]


ABSTRACT

A 44-year-old male presented with acute onset retention of urine and low back pain. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated an extradural mass extending from the lower border of the L3 vertebra to upper border of L5 vertebra. Axial imaging showed the posterolaterally located mass lesion on left side, producing significant compression and displacement of thecal sac and exiting nerve root. Following contrast administration, there was a peripheral ring enhancement. Diagnosis of extradural mass lesion was made. In view of urinary retention, urgent laminectomy was performed. The massive sequestrated lumbar disk was found on an exploration that was excised completely. This resulted in prompt relief of backache. Bladder took 2 weeks for complete recovery. Here, an unusual case of sequestrated dorsally placed lumbar disk mimicking tumor is presented.

Keywords: Lumbar disk, Sequestrated disk, Spinal tumor.

How to cite this article: Diyora BD, Giri S, Giri D, Kotecha N, Patil S. An Unusual Case of Dorsally Sequestrated Disk Mimicking Tumor with Cauda Equina Syndrome. J Spinal Surg 2016; 3(1):15-17.

Source of support: Nil

Conflict of interest: None


 
CASE SERIES
Srikant Balasubramaniam, Devendra K Tyagi, Hemant V Savant, Zafar Ahmed Sheikh

Solitary Symptomatic Spinal Extradural Arachnoid Cyst Needing Surgical Treatment: A Series of Three Cases

[Year:2016] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:28] [Pages No:8-11][No of Hits : 511]


ABSTRACT

Extradural arachnoid cysts are rare lesions which may produce symptoms by compressing the spinal cord or nerve roots. Surgery is the treatment of choice in such lesions but asymptomatic patients can be managed conservatively. We present three cases of symptomatic extradural arachnoid cysts managed at our institute. Magnetic resonance imaging (MRI) done in all cases showed an extradural arachnoid cyst at Dorsal (2 cases) and cervical (1 case) level. All patients were operated with successful result. The pathophysiology, symptomatology, investigations and treatment options of this rare condition are described in relation to our cases.

Key messages: Extradural arachnoid cysts are rare lesions which may produce symptoms by compressing the spinal cord or nerve roots. Surgery is the treatment of choice in such lesions but asymptomatic patients can be managed conservatively. Symptomatic patients have good results with surgical excision of the cyst.

Keywords: Arachnoid cyst, Dorsal cord, Extradural cyst, Meningeal cyst.

How to cite this article: Balasubramaniam S, Tyagi DK, Savant HV, Sheikh ZA. Solitary Symptomatic Spinal Extradural Arachnoid Cyst Needing Surgical Treatment: A Series of Three Cases. J Spinal Surg 2016;3(1):8-11.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Nithin Asadhi, Narayan Gudi, Anil K Sakalecha, Arun Shanthappa, Hariprasad Seenappa

Computerized Tomographic Morphometric Analysis of Subaxial Cervical Spine Pedicles in a South Indian Population for guiding Pedicular Mass Fixation

[Year:2016] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:43] [Pages No:96-102][No of Hits : 505]


ABSTRACT

Introduction: Our hospital Sri RL Jalappa Hospital is located on the national highway in South India. We receive many patients with history of trauma following road traffic accidents and fall from height. Most of the patients have sustained injuries to head and spine including cervical spine. The general population also presents with neck pain of various etiologies (e.g., cervical myelopathy).

Aim: To assess the morphometry of the subaxial cervical spine pedicles through computerized tomography and to determine the frequency of neurovascular injuries in patients who undergo pedicular mass fixation in cervical spine.

Materials and methods: This study was a hospital-based prospective intervention study centered at RL Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar, from November 2013 to July 2015 in which data of 200 patients who underwent computerized tomographic scans of the cervical spine and neck for various pathologies were collected and assessed.

Results: The mean values of pedicle lengths and widths were found to be progressively increasing for both males and females from C3 to C6 vertebrae level and then slightly decreasing at C7 level. Also, it can be seen that the mean values for females are smaller than those for males, for both left and right side. We found that transverse and sagittal plane angulations were significantly dependent on spinal level. Transverse angulation was approximately 45° at C3 through C5 and decreased caudally to approximately 33°at C7 for both sexes.

Conclusion: Through this study we found that there is less significance in the demographic profile. There was a progressive increase in the lengths, widths, and height of the pedicles from C3 to C7 vertebra pedicle transverse angle. Though the literature describes the use of 3.5 mm cervical pedicular screws, Indian population will require a smaller size.

Keywords: Cervical spine pedicles, Computerized tomography, Morphometric analysis, Pedicular mass fixation.

How to cite this article: Asadhi N, Gudi N, Sakalecha AK, Shanthappa A, Seenappa H. Computerized Tomographic Morphometric Analysis of Subaxial Cervical Spine Pedicles in a South Indian Population for guiding Pedicular Mass Fixation. J Spinal Surg 2016;3(3):96-102.

Source of support: Nil

Conflict of interest: None


 
Review Article
Gopalakrishnan Balamurali, Ajay Ramesh Kothari, Amjad Nasr Anaizi, Jean-Marc Voyadzis, John O’toole, Richard G Fessler

Minimally Invasive Techniques for the Treatment of Primary Spinal Column Lesions

[Year:2015] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:40] [Pages No:132-140][No of Hits : 1525]


ABSTRACT

Minimally invasive spine surgery is becoming more prevalent as surgeons seek to provide definitive treatment without the morbidity and dysfunction associated with traditional, open surgical procedures. Minimally invasive surgery has been applied with success to the treatment of degenerative disease and traumatic injuries of the spine. Approaches to metastatic and primary spinal column tumors have also evolved rapidly as clinicians seek to minimize tissue disruption, postoperative pain and blood loss in these susceptible patient populations who may also require adjuvant therapies. The various noninvasive and minimally invasive techniques available for the treatment of these primary spinal tumors are reviewed, and their indications, benefits, and limitations discussed.

Keywords: Corpectomy, Minimally invasive spinal surgery, Percutaneous, Vertebral tumors.

How to cite this article: Balamurali G, Kothari AR, Anaizi AN, Voyadzis JM, O’toole J, Fessler RG. Minimally Invasive Techniques for the Treatment of Primary Spinal Column Lesions. J Spinal Surg 2015;2(4):132-140.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ankit Arunbhai Desai, Adarsh Trivedi, Bl Chandrakar, Ritesh Soni

Old and Neglected Odontoid Fracture with C1-C2 Dislocation: An Approach

[Year:2015] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:32] [Pages No:27-29][No of Hits : 1441]


ABSTRACT

In Indian health setup with short of précised expertize, the nonunion with C1-C2 instability of odontoid fractures usually results from delayed diagnosis and its inappropriate treatment. Our patient had kyphotic deformities at the C1-C2 joint complex secondary to neglected odontoid fractures. Patient was asymptomatic for a long period of time before appearance of symptoms, neck pain and instability, despite being obvious subluxation and kyphotic deformities at C1-C2 joint complex. The reactive new bone formation around the odontoid fracture plays a chief role in preventing further movement and development of myelopathy or instability. However, the treatment options available for neglected odontoid fractures remain controversial. Patient was operated by us without posterior C1 decompression, occipital-to-C2 fusion and spinal instrumentation with two lateral mass screws.

Keywords: Atlantoaxial joint, Bone, Dislocations, Fractures, Odontoid process.

How to cite this article: Desai AA, Trivedi A, Chandrakar BL, Soni R. Old and Neglected Odontoid Fracture with C1-C2 Dislocation: An Approach. J Spinal Surg 2015;2(1):27-29.

Source of support: Nil

Conflict of interest: None


 
HISTORY
Manoj K Tewari

The Great Neurosurgeon and Spinal Surgery—Vijay Kumar Kak

[Year:2015] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:33] [Pages No:61-64][No of Hits : 1126]


ABSTRACT

Prof Vijay Kumar Kak was born on 15 October 1938 at Saharanpur in Uttar Pradesh. He had his initial schooling in DAV institutions at Muzaffarnagar, Kanpur and Allahabad. He joined SN Medical College, Agra, in 1955, and graduated in 1960 with distinctions in seven subjects, several gold medals and first position at all the three professional examinations. He was awarded the Chancellor’s Medal for the best graduate in Faculty of Medicine of Agra University.


 
Research Article
Rajesh Kumar Barooah, Zakir Hussain

Timing of Surgery in Bladder Functional Outcome of Cauda Equina Syndrome of Lumbar Disk Disease: A Prospective Study

[Year:2015] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:40] [Pages No:125-131][No of Hits : 1043]


ABSTRACT

Objectives: Cauda equina syndrome (CES) is a complex of clinical symptoms/signs secondary to prolapsed intervertebral disk. The clinical presentation depends on varying combinations of lower extremity weakness, sensory loss in the lower extremities and/or saddle area, pain in the low back and/or lower extremities, and visceral impairment of bladder, rectal and/or sexual function. Although CES is sometimes used to describe a syndrome without impairment of bladder and bowel function, generally in the literature the term ‘cauda equina syndrome’ means a syndrome that includes impairment of urinary function and saddle sensory deficits.

Materials and methods: We have taken all the discogenic CES cases that presented to the Department of Neurosurgery at Gauhati Medical College and Hospital for a period of 2 years. All the patients were subjected to thorough clinical evaluation and requisite investigations specifically magnetic resonance imaging (MRI). All underwent surgery followed by analysis of the surgical outcome.

Results: Out of the total of 30 patients, male outnumber female, maximum incidence being 4th decade, age incidence ranging from 17 to 70 years. Clinically, patients presented with history of recent onset and an earlier less well-defined history of pre-existing symptoms. Low backache being the most common symptoms followed by radiculopathy, saddle anesthesia. Urinary straining/retention was the most common autonomic disturbance followed by incontinence urinary function outcome was poor in two patients, fair 10 patients, normal 18 patients. Time interval to surgery after autonomic involvement range from 5 to 200 days, mainly due to delayed referral. The most common level was L4-L5 followed by L5-S1, laminectomy single level done in 17 cases, fenestration one cases followed by discectomy.

Conclusion: Surgical intervention should be done in CES irrespective of the duration and severity of clinical symptom and autonomic symptoms. Timing of surgical intervention from autonomic involvement does not affect outcome. It is the severity of deficit which is the major determinant of outcome.

Keywords: Autonomic, Cauda equina syndrome, Discogenic.

How to cite this article: Barooah RK, Hussain Z. Timing of Surgery in Bladder Functional Outcome of Cauda Equina Syndrome of Lumbar Disk Disease: A Prospective Study. J Spinal Surg 2015;2(4):125-131.

Source of support: Nil

Conflict of interest: None


 
Original Article
Anil Chander Vodur Chandrasekar, Vignesh Jayabalan, Karthik Kailash Kannan, Sitsabesan Chokkalaingam

Percutaneous Posterior Stabilization with Vertebroplasty in Painful Thoracolumbar Spinal Metastatic Disease: A Retrospective Study

[Year:2015] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:40] [Pages No:113-117][No of Hits : 1042]


ABSTRACT

Objective: To do a retrospective evaluation of clinical outcome of the patients with spinal metastases treated with minimally invasive posterior spinal stabilization and vertebroplasty.

Methods and results: We retrospectively analyzed 22 patients with biopsy proven metastatic thoracolumbar spinal lesion treated with percutaneous posterior stabilization with pedicle screws and vertebroplasty operated in Ramachandra Medical University from June 2006 to May 2012. Neurologically intact patients with Tokuhashi’s score of 9 or and Spine instability neoplastic score of more than 6 were included. Average age group was 61.8 years with 14 males and eight females. Clinical outcome was assessed using pre- and postoperative visual analog score (VAS), intraoperative blood loss, duration of surgery, time taken to mobilize the patients after surgery and length of hospital stay.
The average VAS decreased from 9.2 preoperatively to 4.1 postoperatively (p < 0.001) and 2.2 (< 0.04) at 3 months postoperative period. The mean Karnofsky’s performance index increased from 45% preoperatively to 70% postoperatively. Average blood loss was 80 ml and the average duration of surgery was 85 minutes. Fifteen patients were mobilized on the second postoperative day with most patients discharged on 4th day. No patients had evidence of implant loosening and failure. Three patients had radiological evidence of cement extravasation. No patient had neurological deficit postoperatively and none had radiological evidence of deformity or adjacent level fracture in follow-up X-rays.

Conclusion: Percutaneous pedicle screw stabilization with vertebroplasty provided good pain relief and short-term clinical improvement in patients with thoracolumbar spinal metastasis with minimal postoperative morbidity.

Keywords: Metastasis, Pedicle screws, Percutaneous, Stabilization, Vertebroplasty.

How to cite this article: Chandrasekar ACV, Jayabalan V, Kannan KK, Chokkalaingam S. Percutaneous Posterior Stabilization with Vertebroplasty in Painful Thoracolumbar Spinal Meta- static Disease: A Retrospective Study. J Spinal Surg 2015;2(4): 113-117.

Source of support: Nil

Conflict of interest: None


 
Review Article
Chiazor Udochukwu Onyia, Sajesh K Menon

Surgical Techniques for Managing Intradural Spinal Tumors: An Overview and Update

[Year:2015] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:45] [Pages No:85-96][No of Hits : 925]


ABSTRACT

Background: Over the past decades, significant progress has been made in our understanding of the basics and techniques of surgical treatment for intradural tumors. However, the management which is most ideal for these lesions has remained a controversial topic.

Objectives: To review previous work on the available operative options for intradural tumors with focus on both the advantages and disadvantages in each case, the outcomes and also highlight on the current trends in this aspect of spine surgery.

Materials and methods: A systematic literature review of previous publications on the various techniques employed in the surgical treatment of intradural tumors. We discuss their presentation, basic concepts and practical aspects of their management with emphasis on the techniques of operative treatment.

Results: Different outcomes following the application of various techniques in the surgical management of intradural spinal tumors have been well-documented in the literature. However, there are currently no algorithms to guide the surgeon on surgical care for intradural spinal tumors. The choice of which surgery to do in each case is a function of each surgeon’s philosophy, knowledge and cummulative experience as well as a clear understanding of the anatomy of the lesion in each patient, the available facilities and equipment.

Keywords: Hemilaminectomy, Intradural extramedullary, Intradural Intramedullary, Laminectomy, Laminoplasty, Laminotomy.

How to cite this article: Onyia CU, Menon SK. Surgical Techniques for Managing Intradural Spinal Tumors: An Overview and Update. J Spinal Surg 2015;2(3):85-96.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
MA Naveen, Vikas Naik, GC Keshav, SA Santhosh Kumar, Sanjeev Balaji Pai

Aneurysmal Bone Cyst of C2, C3 Cervical Spine: A Rare Case Report and Review of Literature

[Year:2015] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:33] [Pages No:52-54][No of Hits : 737]


ABSTRACT

Aneurysmal bone cysts (ABCs) are benign lesions occurring predominantly in metaphysis of long bones. Lesions involving the cervical spine comprise 1% of all spinal ABCs. We report a rare case of C2, C3 ABC in a 39-year-old male patient, who presented with progressive weakness of all four limbs since 8 months. Magnetic resonance imaging (MRI) of spine showed an expansile osteolytic mixed intensity lesion with fluid level involving the body of axis and left pedicle causing significant compression on thecal sac posteriorly suggestive of ABC. Decompression of the cyst along with occipitocervical stabilization with iliac crest bone grafting by combined anterior and posterior approach was done. Histopathological examination revealed trabeculated, dilated vascular beds consistent with the diagnosis of ABC. The patient’s neurological status improved immediately after surgery and he continues to do well 6 months postoperatively.

Conclusion: Aneurysmal bone cyst of the cervical spine is very rare. It requires thorough neural decompression and 360° fusion for better stability and outcome.

Keywords: Aneurysmal bone cyst, C2, C3 vertebrae, 360° fusion.

How to cite this article: Naveen MA, Naik V, Keshav GC, Kumar SAS, Pai SB. Aneurysmal Bone Cyst of C2, C3 Cervical Spine: A Rare Case Report and Review of Literature. J Spinal Surg 2015;2(2):52-54.

Source of support: Nil

Conflict of interest: None


 
History
Harjinder S Bhatoe

The Great Neurosurgeon and Spinal Surgery—Col (Dr) Vijay Sagar Madan

[Year:2015] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:45] [Pages No:106-107][No of Hits : 726]


ABSTRACT

The 60s and 70s were the period of post-independence pioneers and visionaries, and the Armed Forces Medical Services was no exception. The spark of Neurosurgery that was lit in post-independence Indian Army Medical Corps by Col AC Ray was nurtured and carried forward by officers like Col (Dr) Vijay Sagar Madan.


 
Case Report
Sachin Ashok Giri, Deepali Giri, Manish Tapase, Swapnil Patil, Batuk Damjibhai Diyora, Alok Sharma

Spinal Tuberculosis Mimicking Metastasis in a Case of Basal Cell Carcinoma

[Year:2015] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:40] [Pages No:144-147][No of Hits : 619]


ABSTRACT

Spinal tuberculosis (TB) is a common problem in developing countries. Among the bone tuberculosis spine is the most common site. If there are atypical spinal lesions associated with a primary lesion elsewhere in the body, this can mislead the diagnosis and management of disease. We report a case of 63-year-male patient presented with sudden onset of weakness in both lower limbs associated with back pain. Magnetic resonance imaging (MRI) of thoracic spine showed multiple noncontiguous lesions involving thoracic vertebral bodies. The patient had a rapidly growing blackish lesion over the left submandibular region. So clinicoradiological diagnosis considered as melanoma with metastasis. The patient underwent emergency laminectomy with gross total resection of epidural lesion. Histopathology confirmed it as tuberculous lesion. Excisional biopsy of submandibular lesion suggestive of basal cell carcinoma. Multiple vertebral lesions can sometimes be misleading if these are associated with primary lesion. In developing countries like India, where TB is prevalent, TB of the spine should be considered as differential diagnosis even if it is associated with a primary lesion as subsequent treatment protocol has significant impact on the outcome.

Keywords: Basal cell carcinoma, Melanoma, Spinal tuberculosis.

How to cite this article: Giri SA, Giri D, Tapase M, Patil S, Diyora BD, Sharma A. Spinal Tuberculosis Mimicking Metastasis in a Case of Basal Cell Carcinoma. J Spinal Surg 2015;2(4):144-147.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Sanjitha Sivasubramanian, Mathew Cherian, Pankaj Mehta, JKBC Parthiban

Imaging of Spinal Cord Compression: Magnetic Resonance Imaging and Beyond

[Year:2015] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:33] [Pages No:48-51][No of Hits : 601]


ABSTRACT

Imaging plays a crucial role in spinal cord compression. Routine magnetic resonance imaging (MRI) sequences often detect pathological changes occurring in the cord only in the late stages of the disease process. Diffusion tensor imaging (DTI) is a novel imaging technique which has the potential to identify the course of nerve fiber tracts and detect early microstructural changes occurring in the cord ahead of the other techniques. Cord changes occur in the form of altered DTI values, such as fractional anisotropy, mean diffusivity, which add functional information to the imaging report.

Keywords: diffusion tensor imaging, magnetic resonance imaging, spinal cord, spondylosis.

How to cite this article: Sivasubramanian S, Cherian M, Mehta P, Parthiban JKBC. Imaging of Spinal Cord Compression: Magnetic Resonance Imaging and Beyond. J Spinal Surg 2015;2(2):48-51.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
S Balaji Pai, G Raghuram, BG Srihari

Posterior Cervical Microdiscectomy

[Year:2015] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:33] [Pages No:33-36][No of Hits : 585]


ABSTRACT

Background: Posterior cervical foraminotomy was first described by Spurling and Scoville. With the incorporation of the operating microscope and microsurgical techniques, there has been renewed interest in this approach for laterally placed cervical disk prolapse.

Materials and methods: Twenty-nine patients (20 males and 9 females) with ages varying from 31 to 55 years underwent posterior cervical microdiscectomy for laterally placed cervical disk prolapse at 30 levels. Surgical procedure employed by us for the posterior cervical microdiscectomy is described in the article.

Results: All the patients had relief from radiculopathy following the surgery. No major complication was noted in our series. One patient developed transient nerve root deficit which improved, over 6 weeks. No fusion was required in any case. Hence, all the complications of anterior approach and fusion could be avoided.

Conclusion: Posterior cervical microdiscectomy is a safe and effective approach for the treatment of laterally placed cervical disk prolapse. In selected cases, this approach provides excellent results with minimal complications.

Keywords: Cervical disk, Cervical radiculopathy, Laminoforaminotomy, Minimally invasive, Posterior cervical microdiscectomy.

How to cite this article: Pai SB, Raghuram G, Srihari BG. Posterior Cervical Microdiscectomy. J Spinal Surg 2015;2(2):33-36.

Source of support: Nil

Conflict of interest: None


 
Original Article
Vivek Kumar Kankane, Gaurav Jaiswal, Tarun Kumar Gupta

Surgical Outcome of Intradural Extramedullary Tumors: Single Institutional Experience— Assessment using Frankel Grading

[Year:2015] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:40] [Pages No:118-124][No of Hits : 575]


ABSTRACT

Background: To report the surgical outcome of intradural extramedullary (IDEM) tumors in 52 patients. Clinical effect was evaluated based on Frankel grade.

Purpose: The results of a single neurosurgery institution are reported to highlight the peculiarities and pitfalls of the management of this disease. Tumors are analyzed from the point of view of their localization, histology, surgical technique and outcome was evaluated in term of Frankle classification.

Methods: Fifty-two cases of histopathologically confirmed IDEM were treated laminectomy with complete resection of tumors between January 2011 and February 2014. There were 34 males and 18 females with an average age of 41.53 years. The mean postoperative follow-up period was 22.44 months. The histopathological findings, locations of the tumors, and clinical results were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up was evaluated according to the Frankel grading.

Results: The histopathological results are as follows: 14 cases of a meningioma, 30 cases of nerve sheath tumors (28 cases schwannoma and 2 cases neurofibroma), 4 cases of an arachnoid cyst, 3 cases of tarlov cyst, and one case of benign cystic teratoma. The locations of the tumors were as follows: 40 cases in the thoracic region, eight cases in the cervical region, and two cases in the lumbar and two cases of sacral region. The most common diagnosis was nerve sheath tumors (57.69%), followed by meningioma (26.92%). At the final follow-up, a 3-grade, 2-grade and 1-grade improvement was observed in 6, 22 and 24 cases, respectively. There were changes in the Frankel grade in every case. The preoperative neurological deficit improved within 6 postoperative weeks in most cases. Postoperatively, there were one case of cerebrospinal fluid leakage.

Conclusion: intradural extramedullary tumors detected by magnetic resonance imaging (MRI) are mostly benign and good clinical results can be obtained when treated surgically. Therefore, more dynamic surgical approaches by neurosurgeons are suggested to decline morbidity.

Keywords: Extramedullary, Frankel grading, Intradural, Tumor.

How to cite this article: Kankane VK, Jaiswal G, Gupta TK. Surgical Outcome of Intradural Extramedullary Tumors: Single Institutional Experience-Assessment using Frankel Grading. J Spinal Surg 2015;2(4):118-124.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Tarang Kamalkishore Vora, RR Ravi

Split Cord Malformation Type 2 Complicated by Presence of Tuberculous Arachnoiditis

[Year:2015] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:33] [Pages No:55-57][No of Hits : 565]


ABSTRACT

We present a rare case of split cord malformation (SCM) type II complicated by presence of tuberculous arachnoiditis without any history of systemic tuberculosis or vertebral body lesions. Diagnosis was made based on intraoperative findings and was confirmed by histopathology. Surgical decompression along with a combination of steroid and antitubercular therapy resulted in a good outcome. Clinical features, magnetic resonance imaging (MRI), intraoperative findings, pathology and the relevant literature are herein discussed.

Keywords: spinal arachnoiditis, Split cord malformation, Tuberculous radiculomyelopathy.

How to cite this article: Vora TK, Ravi RR. Split Cord Malformation Type 2 Complicated by Presence of Tuberculous Arachnoiditis. J Spinal Surg 2015;2(2):55-57.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shivalingegouda Rayagouda Patil, Anantha Kishan, Anantha Gabbita, DN Varadharaju, PM Jagannath

Anterior Cervical Surgery: Drain Needed or Not?

[Year:2015] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:33] [Pages No:37-41][No of Hits : 563]


ABSTRACT

Study design: Retrospective cohort study.

Objective: To recognize the factors that influence drain output and based on the results to formulate certain guidelines which help in deciding drain placement in patients who have undergone anterior cervical discectomy (ACD) surgeries.

Summary of background data: The common worry of operating surgeon after anterior cervical discectomy and fusion (ACDF) surgery is postoperative neck hematoma. To avoid this, there has been a traditional practice to keep the drain postoperatively. Drain placement has got inherent complications, like infection risk, postoperative pain, increased analgesic use and increased length of hospital stay.

Materials and methods: All patients who underwent elective ACD surgeries with surgical drain placement in our institution between from Jan 2011 and July 2014 were identified using operation theater (OT) records. Patient information was abstracted from the medical records section. Patients were categorized on the basis of normal or increased total drain output, with increased drain output defined as total drain output 50th percentile (20 ml) or more. A multivariate logistic regression was used to determine which factors were independently associated with increased drain output.

Results: A total of 161 patients with ACDF met inclusion criteria. Total drain output was in the range from 0 to 300 ml. Among all patients in the study, 67 patients had increased drain output (drain output ≥ 50th percentile or 20 ml). Multivariate analysis identified three independent predictors of increased drain output: BMI, number of levels (≥ 2 levels) and implants.

Conclusion: Patients with the factors, like increased BMI, two or more level surgery and implants placed may benefit from surgical drain placement after ACD surgeries.

Keywords: Anterior cervical discectomy, Drain output, Postoperative drain.

How to cite this article: Patil SR, Kishan A, Gabbita A, Varadharaju DN, Jagannath PM. Anterior Cervical Surgery: Drain Needed or Not? J Spinal Surg 2015;2(2):37-41.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Vinu V Gopal, K Mahadevan

Importance of Hyaline Material in Herniated Lumbar Disk Pathology: Predicting the Presence of Hyaline from Preoperative Magnetic Resonance Imaging and its Clinical Significance

[Year:2015] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:33] [Pages No:42-47][No of Hits : 517]


ABSTRACT

Aim: To conduct a prospective study to assess whether we can predict the presence of hyaline material in the extruded disk from preoperative magnetic resonance imaging (MRI) in patients with lumbar disk herniations and its clinical significance.

Materials and methods: Hundred patients posted for microlumbar discectomy were included in the study. They were assessed preoperatively for severity of symptoms using visual analog scale (VAS). Detailed radiological assessment was done using MRI. Following surgery, extruded disk specimens were sent for histopathological examination. The presence of hyaline material in biopsy was correlated with specific MRI findings and postoperative outcome assessed based on the VAS score.

Results: Out of the 100 patients, there were 58 males and 42 females between the age of 18 and 55 years. Histopathology of herniated disk material showed annulus fibrosis in 15% of patients, nucleus pulposus in 78% and a combination of both in 7%. Hyaline cartilage was found in 24% of patients. Extend of Modic changes more than 50% of vertebral end plate in MRI was indicative of the presence of hyaline in biopsy (p < 0.001). Preoperative MRI finding of vertebral end plate defect (VEPD) was associated with the presence of hyaline in 92.8% of cases. Presence of hyaline was correlated with the improvement in mean VAS score postoperatively.

Conclusion: In this study, the importance of hyaline in the extruded disk with its clinical significance is emphasized. We conclude that the presence of hyaline, as predicted from MRI findings like VEPD and extend of Modic changes, is a predictor of good postoperative outcome.

Keywords: Hyaline, Modic, Vertebral end plate.

How to cite this article: Gopal VV, Mahadevan K. Importance of Hyaline Material in Herniated Lumbar Disk Pathology: Predicting the Presence of Hyaline from Preoperative Magnetic Resonance Imaging and its Clinical Significance. J Spinal Surg 2015;2(2):42-47.

Source of support: Nil

Conflict of interest: None


 
Review Article
Vidyasagar Devaprasad Dedeepiya, Justin Benjamin William, Jutty KBC Parthiban, Hiroshi Yoshioka, Yuichi Mori, Satoshi Kuroda, Masaru Iwasaki, Senthilkumar Preethy, Samuel JK Abraham

Scaffolds for Cell Transplantation in Neurology — The Suitability of a Thermoreversible Gelation Polymer: Our Perspectives

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:16-24][No of Hits : 2379]


ABSTRACT

Clinical translation of cell-based therapies in neurology, especially the spinal cord injury and damage to the brain, have been marred by several hurdles [Dedeepiya VD et al Expert Opinion on Biological Therapy (In print)] and one significant among them is the need for a suitable biocompatible scaffold, which can retain the transplanted cells, give an active or passive support to the cells, enable their proliferation, differentiation when needed and integration into the local niche until the restoration of the damage are complete, without any adverse reactions to the vicinity or to any of the systems of the animal or human being where it is applied. Scaffolds for neurological applications need to be biocompatible, biodegradable, non-immunogenic, must provide contact guidance for neurite outgrowth, should have porosity for vascularization and cell migration. Several natural scaffolds like collagen, alginate, silk fibroin, hyaluronic acid, chitosan, etc. and synthetic scaffolds like poly (lactic acid) (PLA), poly (glycolic acid) (PGA), poly (lactic-co-glycolic acid) (PLGA), polyethylene glycol (PEG), poly (lactide-co-caprolactone) (PLCL) have been employed for cell transplantation in neurology primarily for nerve injuries and stroke. In this review, we briefly outline the different studies utilizing these scaffolds employed for cell transplantation in neurology and we document the suitability of a unique poly (N-isopropylacrylamide-co-n-butyl methacrylate) (poly NIPAAmco- BMA) and polyethylene glycol (PEG)-based thermoreversible gelation polymer for cell therapy applications in neurology.

Keywords: Scaffolds, Neurology, Regenerative medicine, Cell therapy, Thermoreversible gelation polymer (TGP).

How to cite this article: Dedeepiya VD, William JB, Parthiban JKBC, Yoshioka H, Mori Y, Kuroda S, Iwasaki M, Preethy S, Abraham SJK. Scaffolds for cell Transplantation in Neurology- The Suitability of a Thermoreversible Gelation Polymer: Our Perspectives. J Spinal Surg 2014;1(1):16-24.

Source of support: Nil

Conflict of interest: Prof Yuichi Mori, Dr Hiroshi Yoshioka and Dr Samuel JK Abraham are applicants to and/or assignees of patents on the Thermoreversible gelation polymer.


 
Original Article
PS Ramani, Sumeet Pawar, Sudhendoo Babhulkar

Dilemma in the Surgical Management of Lumbar Canal Stenosis

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:1-11][No of Hits : 2106]


ABSTRACT

For a long time wide decompressive laminectomy, direct visualization and decompression of affected nerve roots, foraminotomy and when necessary discectomy had remained the gold standard to operate patients with lumbar canal stenosis. There was confusion in the literature concerning the role of fusion even in the presence of instability in degenerative lumbar canal stenosis due to absence of prospective randomized clinical trials. This has led to uncertainty about the correct choice of surgical strategy as no evidence based recommendations on the role of instrumented PLIF in older patients. Such thoughts have compelled some to try minimally invasive instrumentation with micro decompression, transforaminal interbody fusion and percutaneous pedicle screws. It has the advantage of short incision, less morbidity, shortened bed rest and early ambulation which is so essential in older patients with comorbid conditions. In this study we discuss the pathogenesis of development of spinal conditions and their treatment options through the history of spinal surgery. Also discussed is the dilemma that exists in spinal surgeons regarding the selection of appropriate treatment strategy for stenosis amongst the elderly.

Keywords: Lumbar canal stenosis, elderly, surgical management, IDSS, PLIF.

How to cite this article: Ramani PS, Pawar S, Babhulkar S. Dilemma in the Surgical Management of Lumbar Canal Stenosis. J Spinal Surg 2014;1(1):1-11.

Source of support: Nil

Conflict of interest: None


 
Original Article
Sushil Patkar

Anterior Fixation of Atlantoaxial Joints: Technique and Pitfalls

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:60-68][No of Hits : 1917]


ABSTRACT

Both the atlantoaxial joints can be exposed adequately by an unilateral extrapharyngeal approach from the right side. The atlantoaxial dislocation can be reduced, joints can be decorticated and bone graft can be introduced into the joint. The odontoid process can be drilled and removed. The C1-C2 joint can be fixed either by (1) C1 lateral mass and C2 body screw plate bilaterally, or (2) bilateral anterior C2-C1 transarticular screws.

Keywords: Atlantoaxial fusion, Anterior transarticular screws, Anterior screw plate fixation, Atlantoaxial dislocation.

How to cite this article: Patkar S. Anterior Fixation of Atlantoaxial Joints: Technique and Pitfalls. J Spinal Surg 2014;1(2):60-68.

Source of support: Nil

Conflict of interest: None


 
Prospective Study
Patrick Fransen

Laminoplasty for Cervical Spondylotic Myelopathy

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:77-80][No of Hits : 1755]


ABSTRACT

Cervical spondylotic myelopathy (CSM) is a commonly treated either by uninstrumented laminectomy, carrying the risk of postoperative instability, or by anterior or posterior decompres- sion with fusion resulting in postoperative stiffness and possibly adjacent segment degeneration.
Cervical laminoplasty, initially developed for pediatric or OPLL patients could be an interesting surgical alternative to decompress and reconstruct cervical anatomy without fusion.
Sixteen patients, mean age 63, who presented with CSM were treated surgically using multilevel laminoplasty, and reviewed after 1 month, 6 months, 1 and 2 years. Clinical evaluation was performed based on the Benzel-JOA and Nurick scores. The preoperative mean Benzel-JOA score was 13.43; preoperative mean Nurick score was 1.81. Intramedullary hyperintensity in T2 MRI was observed in five patients. The operation was performed on 2 levels (19%) 3 levels (69%) and 4 levels (12%).
We used the open-door hinged laminoplasty technique, using metallic implants, without bone graft. At one month FU, mean JOA score was 15.44, and Nurick dropped to 1.05. At 6 months, mean JOA was 16.36 and Nurick was 0.72. At one year, the mean JOA score was 16.16, and Nurick was 0.83. At 2 years, mean JOA was 17.5 and Nurick was 0.25.
We reviewed the possible advantages and complications of spinal cord decompression by open-door laminoplasty for CSM. We conclude that this technique allows significant clinical improvement observed progressively in the two years following surgery without increased rigidity or instability.

Keywords: Cervical spine, Cervical spondylosis, Laminoplasty, Myelopathy.

Abbreviations: ASD: Adjacent segment degeneration; CSM: Cervical spondylotic myelopathy; FU: Follow-up; JOA: Japanese orthopedic association; ROM: Range of motion.

How to cite this article: Fransen P. Laminoplasty for Cervical Spondylotic Myelopathy. J Spinal Surg 2014;1(2):77-80.

Source of support: Nil

Conflict of interest: None


 
Case Report
Alexander Cahyadi, Arwinder Singh, PS Ramani, Sudhendoo Babhulkar, Sumeet Pawar, Amrita Shenoy

Concurrent Miller Fisher Syndrome Variant in Ossification of Posterior Longitudinal Ligament

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:32-34][No of Hits : 1575]


ABSTRACT

Introduction: Miller fisher syndrome (MFS) could be found in coincidence with ossification of posterior longitudinal ligament. High index of suspicion is required that lead to further investigation.

Case report: A 56-year-old male presented with four days history of loss of sensation on both lower and upper extremity. The complaint was felt more on the lower than upper extremity. The patient felt imbalance during walking. Muscle strengh of all extremity was normal, but sensory lost was found in all extremity. Deep tendon reflexes were absent in all extremity.

Investigations: Computed tomography (CT) scan and MRI showed canal stenosis due to of the posterior longitudinal ligament. Nerve conduction velocity suggested peripheral neuropathy on both upper and lower extremity. Antibody anti GQ1b was positive. Cerebrospinal fluid examination showed cytoalbuminemic dissociation.

Treatment: Patient was treated conservatively.

Results: Improvement was achieved in 5 days, and progressively return to normal condition.

Conclusion: Peripheral polineuropathy could be found in coincident with of the posterior longitudinal ligament and required specific management.

Keywords: Ossification, posterior longitudinal ligament, Miller fisher syndrome.

How to cite this article: Cahyadi A, Singh A, Ramani PS, Babhulkar S, Pawar S, Shenoy A. Concurrent Miller Fisher Syndrome Variant in Ossification of Posterior Longitudinal Ligament. J Spinal Surg 2014;1(1):32-34.

Source of support: Nil

Conflict of interest: None


 
Case Report
Vinod Agrawal, Sanjay Tripathi, Saurav Narayan Nanda, Himanshu Parmar

Osteoid Osteoma of Cervical Spine: A Rare Presentation

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:107-109][No of Hits : 1568]


ABSTRACT

Osteoid osteoma of cervical spine is rare, and only few cases are reported in scientific literature. We report a case of osteoid osteoma of cervical spine treated at our tertiary care hospital in Mumbai.

Keywords: Osteoid osteoma, Cervical spine, Benign bone tumor.

How to cite this article: Agrawal V, Tripathi S, Nanda SN, Parmar H. Osteoid Osteoma of Cervical Spine: A Rare Presentation. J Spinal Surg 2014;1(2):107-109.

Source of support: Nil

Conflict of interest: None


 
Case Report
Forhad Hossain Chowdhury, Mohammod Raziul Haque, Khandkar Ali Kawsar, AFM Momtazul Haque

Progressive Quadriplegia from Kyposis in Pediatric Patient after Laminectomy for Cervical Intramedullary Tumor Excision: Case Report and Literature Review in Short

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:35-38][No of Hits : 1523]


ABSTRACT

Cervical spinal deformities with progressive neurological deficit after laminectomy is relatively uncommon. But, it can happen more commonly after resection of intramedullary spinal cord lesions than other spinal lesion. Postlaminectomy cervical spinal deformity is most common in children with an immature skeletal system. Many factors such as the extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, postoperative radiation therapy, etc. can precipitate such deformities. We report a pediatric patient with who underwent successful complete removal of long segment cervical intramedullary spinal tumor. Postoperatively he developed progressive kyphosis in cervical spine with progressive neurological deficit. We went for second operation (anterior cervical spinal cord decompression by two segments corpectomy followed by iliac crest strut graft fusion and stabilization). Postoperatively patient recovered well. He had loss of cervical spinal lordosis with mild kyphosis before first operation. Such a case report in the literature is relatively uncommon. Here, we also go for short review of literature on this topic.

Keywords: Cervical spinal deformity, neurological deterioration, post laminectomy, intramedullary spinal tumor, pediatric patient.

How to cite this article: Chowdhury FH, Haque MR, Kawsar KA, Haque AFMM. J Spinal Surg 2014;1(1):35-38.

Source of support: Nil

Conflict of interest: None


 
Case Report
Sofiene Bouali, Adenane Boubaker, Asma Bouhoula, Jalel Kallel, Aoiuj Lassaad, Hafedh Jemel

A Rare Complication of Cirrhosis: Hepatic Myelopathy

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:49-51][No of Hits : 1521]


ABSTRACT

Introduction: Hepatic myelopathy is characterized by spastic paraparesis and minimal sensory abnormalities in patients with cirrhosis, particularly those with portosystemic shunts that have been created surgically or have occurred spontaneously.

Materials and methods: We described a patient who presented with spastic paraparesis and diagnosed as hepatic myelopathy when all the other possible diagnoses were ruled out with a review of literature in the goal of promoting prompt recognition and enhancing understanding of HM.

Results: We reported a patient aged 51 years who presented with spastic paraparesis with insidious onset and progressive course and diagnosed as hepatic myelopathy.

Conclusion: Unlike hepatic encephalopathy, hepatic myelopathy is usually considered irreversible.

Keywords: Hepatic myelopathy, Cirrhosis, Spastic paraparesis.

How to cite this article: Bouali S, Boubaker A, Bouhoula A, Kallel J, Lassaad A, Jemel H. A Rare Complication of Cirrhosis: Hepatic Myelopathy. J Spinal Surg 2014;1(1):49-51.

Source of support: Nil

Conflict of interest: None


 
Original Article
Ajit S Shinto, KK Kamaleshwaran, M Anjali, V Rajamani, SG Thirumalaisamy, N Sreedharan

Utility of 99mTc-MDP Bone Scan in Comparison to MRI and Plain Radiographs for the Diagnosis of Early Spondyloarthropathy

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:12-15][No of Hits : 1474]


ABSTRACT

Introduction: Spondyloarthropathy as a cause of inflammatory lower back ache often goes undiagnosed for long. Though various clinical criteria have been developed, evidence of sacroiliitis is considered the basis for diagnosis. As sacroiliitis may become apparent on plain radiographs after a long duration, it is important to evaluate the efficacy of other imaging techniques to make an early diagnosis. Magnetic resonance imaging (MRI) and development of various specific sequences have helped in picking up structural changes as well as inflammation in sacroiliitis. The present study is to assess the role of MRI and radionuclide bone scan in patients with early SpA of less than 3 years.

Materials and methods: Patients with inflammatory LBA, defined according to the Calin criteria and satisfying the European Spondyloarthropathy Study Group (ESSG) criteria for SpA of less than 3 years duration, were included. Controls had mechanical LBA. A detailed clinical assessment and assessment of disease activity and functional impairment was done with validated measures. Radiological assessment included conventional radiograph of the pelvis, radionuclide scan and MRI of sacroiliac joints (SI joints). The sensitivity, specificity and predictive value of each modality in contributing to the diagnosis of SpA were assessed.

Results: Assessment of 136 SI joints in 42 patients [(Age 29 (± 5.6) and 26 controls (Age 32.1 (± 8.91)] was done. The mean disease duration of cases was 12.5 (± 10.2) months. Conventional radiograph failed to pick up sacroiliitis in any of the cases. Positive bone scan was present in 34 cases (28 bilateral sacroiliitis, 6 unilateral sacroiliitis). Bone scan had a sensitivity of 81.8% and a specificity of 87%. Magnetic resonance imaging abnormality was present in 37/42 (88%) (bilateral in 27 and unilateral in 10) and in none of the controls. This accounted for a sensitivity of 87% and a specificity of 100%. The MRI changes included bone marrow edema (82%), synovial enhancement (60%), subchondral edema (42%), erosions (46%) and sclerosis (38%).

Conclusion: In patients with early SpA of less than 3 years duration, conventional radiographs did not pick up sacroiliitis; however, both the radionuclide scan and MRI were useful.

Keywords: Sacroiliitis, Bone scan, Spondyloarthropathy, MRI, 99mTc-MDP, SPECT CT, Two phase.

How to cite this article: Shinto AS, Kamaleshwaran KK, Anjali M, Rajamani V, Thirumalaisamy SG, Sreedharan N. Utility of 99mTc-MDP Bone Scan in Comparison to Mri and Plain Radiographs for the Diagnosis of Early Spondyloarthropathy. J Spinal Surg 2014;1(1):12-15.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Rakesh Gupta, Rahul Awasthi, Apoorva Pauranik

Salmonella Vertebral Osteomyelitis of Thoracic Spine

[Year:2014] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:34] [Pages No:135-137][No of Hits : 1376]


ABSTRACT

Salmonella spondylitis is a rare illness and may present as pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis and epidural abscess. The diagnosis depends on clinical, radiological, blood and tissue cultures and histopathological findings. We describe a rare case of 63-year-old male, with diagnosis of pyogenic salmonella vertebral osteomyelitis of thoracic spine. Timely surgical intervention and appropriate antibiotic treatment resulted in complete cure.

Keywords: Pyogenic, Vertebral osteomyelitis, Spondylodiscitis, Epidural abscess, Salmonella.

How to cite this article: Gupta R, Awasthi R, Pauranik A. Salmonella Vertebral Osteomyelitis of Thoracic Spine. J Spinal Surg 2014;1(3):135-137.

Source of support: Nil

Conflict of interest: None


 
Original Article
Anil Pande, Daniel Rajesh Babbu, Siddhartha Ghosh

Anterior Deformity Correction in Cervical Spondylotic Myelopathy

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:53-59][No of Hits : 1360]


ABSTRACT

Deformity in the cervical spine is ascribed to congenital, degene- rative, traumatic, infective, neoplastic, iatrogenic causes. The deformity can be in the sagittal and coronal plane and is an important factor in the generation of symptoms in cervical spondylotic myelopathy (CSM). Better understanding of the etiopathogenesis, imaging and improving instrumentation allows for the tackling of these deformities. Correction requires to be tailored to each patient and may require anterior, posterior or combined approaches.

Keywords: Cervical, Spondylotic myelopathy, Deformity correction.

How to cite this article: Pande A, Babbu DR, Ghosh S. Anterior Deformity Correction in Cervical Spondylotic Myelopathy. J Spinal Surg 2014;1(2):53-59.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Vineesh K Varghese, Manmeet S Chhabra, Ashis K Chand, M Vinayaka

Tuberculosis of Spine with Spastic Paraparesis in Pregnancy: A Case Report and Review of the Literature

[Year:2014] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:43] [Pages No:166-168][No of Hits : 1343]


ABSTRACT

Tuberculous paraparesis as a consequence of spinal infiltration in pregnancy is reported to be rare. Analysis of existing literature generates is inconclusive regarding the time and extent of surgical intervention. A potential implication of progression is paraplegia and a significant associated morbidity to the fetus, if delivered premature. A case of spinal tuberculosis in third trimester of pregnancy is reported with description of clinical presentation, neuroradiography findings and successful treatment. Patient was managed by cesarean section followed by immediate spinal decompression. Patient showed complete healing with neurological recovery. Baby suffered no deleterious effect from treatment of the mother. A treatment strategy to successfully treat pregnant women with spinal tuberculosis in the third trimester is recommended. Cesarean section followed by immediate spinal cord decompression is suggested as safe and effective procedure for both mother and child.

Keywords: Tuberculosis of spine, Pregnancy, Third trimester, Cesarean section, spinal cord decompression.

How to cite this article: Varghese VK, Chhabra MS, Chand AK, Vinayaka M. Tuberculosis of Spine with Spastic Paraparesis in Pregnancy: A Case Report and Review of the Literature. J Spinal Surg 2014;1(4):166-168.

Source of support: Nil

Conflict of interest: None


 
REFLECTION
S Balaji Pai

Recurrent Lumbar Disk Herniation

[Year:2014] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:34] [Pages No:121-122][No of Hits : 1316]


ABSTRACT

Management of lumbar disk prolapse varies from observation, aggressive medical management, physiotherapy, percutaneous procedures on the disk, minimally invasive spinal surgery (microscopic and endoscopic discectomy) to more aggressive surgical procedures, like laminectomy and discectomy, anterior lumbar discectomy and fusion procedures. Single level discectomy is associated with good outcome, especially in properly selected cases. Success rates of 76 to 93% have been reported. However, discectomy-related complications too have been reported varying from 15 to 30%. The rate of recurrent disk herniation after lumbar discectomy is 5 to 15% and is the commonest reason for re-surgery. With an increasing incidence of disk herniations and surgery for the same, spinal surgeons are increasingly called upon to address the issue of recurrence.

How to cite this article: Pai SB. Recurrent Lumbar Disk Herniation. J Spinal Surg 2014;1(3):121-122.


 
Case Report
Saravanan Natesan, R Raghavendran, Vidya Narasimman, Deiveegan Kunjithapatham

Spinal Intramedullary Tubercular Abscess

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:39-40][No of Hits : 1249]


ABSTRACT

Spinal intramedullary tubercular abscess is very rare. We present a 3-year-old boy, with subacute paraparesis and incontinence for 1 day. His MR imaging showed a contrast ring enhancing intramedullary lesion at D10-D12 with central T1-hypointense, T2-hyperintense core and cord expansion. He underwent laminectomy, evacuation of abscess, with antituberculous drugs and steroids postoperatively. There was pus evacuated intraoperatively showing positive acid fast bacilli, and the wall biopsy showed inflammatory cell infiltrate and no giant cell or granuloma formation. Child improved well and discharged well. This is a very rare case of intramedullary spinal tubercular abscess satisfying all of Whitner’s criteria.

Keywords: Intramedullary abscess, Spinal, Tuberculous abscess, TB spine.

How to cite this article: Natesan S, Raghavendran R, Narasimman V, Kunjithapatham D. Spinal Intramedullary Tubercular Abscess. J Spinal Surg 2014;1(1):39-40.

Source of support: Nil

Conflict of interest: None


 
Review Article
P Sai Sudarsan, I Dinakar

Odontoid Fractures: Management

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:69-76][No of Hits : 1241]


ABSTRACT

Odontoid fractures account for approximately 20% of all cervical fractures, majority of them being type II. Treatment of odontoid fractures is determined by multiple factors, including fracture type, presence of associated injuries, patient’s age and comorbidities. Majority of type I and III fractures do not warrant surgical correction. However, management of type II fractures still remains controversial. Of late internal fixation has become an accepted treatment. Multiple surgical options have been proposed. This article reviews various alternatives of treating odontoid fractures.

Keywords: Odontoid fractures, Transverse atlantal ligament, Posterior fixation, Trans articular screws, Odontoid screws.

How to cite this article: Sudarsan PS, Dinakar I. Odontoid Fractures: Management. J Spinal Surg 2014;1(2):69-76.

Source of support: Nil

Conflict of interest: None


 
Case Report
Vishwanath Sidram, PC Chandrakumar, M Varunkumar, Bellara Raghavendra

A Rare Case of Extraforaminal Schwannoma in Lumbar Region in an Elderly Male without Neurofibromatosis Operated by Transparaspinal Approach

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:98-100][No of Hits : 1200]


ABSTRACT

Introduction: Schwannoma is a benign tumor arising from the neural crest-derived Schwann cells. These tumors usually grow within the spinal canal and produce compression of spinal cord and nerve root of origin.

Aim: To report a rare case of extraforaminal schwannoma in lumbar region in an elderly male operated by transparaspinal approach.

Case: A 65-year-old male, presented with pain which is characterized by radiation to right thigh and associated with pins and needles sensation, intermittent type.

Investigation: MRI scan demonstrated mixed intensity lesion in right paravertebral region L345 suggestive of extraforaminal schwannoma and disc bulge L3-4, L4-5 compressing anterior thecal sac and bilateral traversing nerve roots. Histology showed a tumor with features of schwannoma. The stroma at places shows myxoid change and hyalinization. Mononuclear cell infiltration is seen into the stroma.

Treatment: Complete removal of the mass done by transparaspinal approach.

Results: No residual tumor on follow-up scan and pain disappeared.

Conclusion: Extraforaminal schwannoma in lumbar region in an elderly male ia a rare condition. The rarity of extraforaminal schwannoma and transparaspinal excision was highlighted. Transparaspinal approach is the most feasible and directly accessible approach to remove tumor and relieve pressure symptoms and rare possibility of malignancy.

Keywords: Extraforaminal, Schwannoma, Transparaspinal.

How to cite this article: Sidram V, Chandrakumar PC, Varunkumar M, Raghavendra B. A Rare Case of Extraforaminal Schwannoma in Lumbar Region in an Elderly Male without Neurofibromatosis Operated by Transparaspinal Approach. J Spinal Surg 2014;1(2):98-100.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rakesh Gupta, Akshat Kayal

Alveolar Soft Part Sarcoma Presenting as Cauda Equina Syndrome

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:41-45][No of Hits : 1200]


ABSTRACT

Background: Alveolar soft-part sarcoma (ASPS) is a rare soft tissue sarcoma often affecting adolescents and young adults. Though the tumor has as indolent clinical course, the ultimate prognosis is poor characterized by late metastasis. Histopathological evaluation is the crucial to a correct diagnosis.

Case report: A 30-year-old Indian woman presented with paraplegia and a persistent mass over the back. A thorough histological examination alongside imaging techniques shaped a reliable diagnosis.

Conclusion: Alveolar soft tissue sarcoma of the spine is a rare tumor and a very high index of suspicion is required to make an early diagnosis and achievement of complete microscopic resection is critical for successful outcome.

Keywords: Alveolar soft-part sarcoma, cauda equina syndrome, immunohistochemistry.

How to cite this article:Gupta R, Kayal A. Alveolar Soft Part Sarcoma presenting as Cauda Equina Syndrome. J Spinal Surg 2014;1(1):41-45.

Source of support: Nil

Conflict of interest: None


 
Case Report
A Shiju Majeed, Y Sherafudeen

Missed Chance Fracture of Lumbar Vertebra presenting as Cauda Equina Syndrome: A Case Report and Review of Literature

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:81-83][No of Hits : 1190]


ABSTRACT

Chance fractures of the thoracolumbar spine are being increasingly reported due to the increase in motor vehicle accidents. These are often missed injuries unless careful attention is paid to clinical examination and analysis of various imaging modalities. This can result in grave neurological complications. Here, we report a case of missed Chance fracture in a 55-year-old male which went on to develop cauda equina syndrome. A review of literature and radiological signs which should be looked into for avoiding missing such injuries are presented.

Keywords: Chance fractures, Cauda equina syndrome, kyphosis.

How to cite this article: Majeed AS, Sherafudeen Y. Missed Chance Fracture of Lumbar Vertebra presenting as Cauda Equina Syndrome: A Case Report and Review of Literature. J Spinal Surg 2014;1(2):81-83.

Source of support: Nil

Conflict of interest: None declared


 
Case Report
Jay Kotecha, Makarand Kulkarni

Idiopathic Spinal Cord Herniation

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:46-48][No of Hits : 1185]


ABSTRACT

History: A 54-year-old female presented with complaints of backache since 6 to 8 months, weakness in both lower limbs and difficulty in walking. She had past history of cervical and lumbar decompression surgery.

Imaging findings: On MRI, a focal kink was seen in the dorsal spinal cord at T8-T9 level. Anterior displacement of the spinal cord was also seen at this level with prominent posterior subarachnoid spaces. Along with other findings described, it was suggestive of idiopathic spinal cord herniation.

Management: Management strategy along with the etiopathogenesis and differential diagnosis is described in the text.

Conclusion: Despite the fact that MR imaging appearances of this entity are pathognomonic, missed diagnosis and misdiagnosis are common. Careful imaging study would avoid this.

Keywords: Idiopathic spinal cord herniation, thoracic spine, MRI features.

How to cite this article: Kotecha J, Kulkarni M. Idiopathic Spinal Cord Herniation. J Spinal Surg 2014;1(1):46-48.

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Tarek Aly, El-Sayed

Reliability of the Column Theory to Evaluate Thoracolumbar Spinal Instability

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:25-27][No of Hits : 1148]


ABSTRACT

The concept of spinal instability is still evolving. Instability is mechanical terms means decreased stiffness of the functional spinal unit, increased mobility, or abnormal motion, and alterations in spinal mechanics place the neurological structures at risk. The column theory was used to evaluate the spinal instability.

Aim: In this study, we try to correlate the column theory of the spine with the preoperative and postoperative clinical and radiological findings.

Patients and methods: One hundred and twenty-two patients with unstable thoracolumbar or lumbar spine treated surgically were studied. The patients were classified according to their pathogenesis into three groups (trauma, 75 patients, tumor, 30 patients and infection, 17 patients, groups). All patients were also classified according to the three column theory. Detailed radiographic analysis of the vertebra (e) involved was done at admission, at mobilization, and at follow-up. Neurologic assessment was performed using modified Frankel grading scale.

Results: The results of this study did not support the column theory for evaluation of spinal instability. Comparing each group separately does not reveal any significant relationship between the number of the columns involved and radiographic or neurologic findings either before or after surgery.

Conclusion: Spine instability concept is still dilemma and evolving matter. More research is required for better understanding of the nature of the spine and its loading characters.

Keywords: Column, Theory, Spine, Instability-3.

How to cite this article: Aly T, Sayed E. Reliability of the Column Theory to evaluate Thoracolumbar Spinal Instability. J Spinal Surg 2014;1(1):25-27.

Source of support: Nil

Conflict of interest: None


 
Case Report
Arwinder Singh Gill, Alexander Cahyadi, Sudhendoo Babhulkar, Sumeet Pawar, PS Ramani

Recurrent Hemangioendothelioma of the Spine

[Year:2014] [Month:January-March] [Volumn:1 ] [Number:1] [Pages:52] [Pages No:28-31][No of Hits : 1025]


ABSTRACT

Introduction: Hemangioendotheliomas are vascular neoplasms that rarely involve the neuraxis.

Case report: A 50-year-old male patient complaining of severe pain and weakness on both his legs. Patient had history of spinal tumor operation 13 years ago. On examination, patient showed tenderness on his back and no localizing signs.

Investigations: X-ray and 3D reconstructive CT scan of the dorsal spine showed involvement of D11 and L1 with collapsed D12. MRI showed kyphosis deformity and significant cord compression.

Treatment: Preoperative embolization was performed followed by transthoracic removal of the tumor and D12 vertebral body which was followed interbody vertebral cage. A second surgery was undertaken to further excise the tumor and stabilize the spine.

Results: Patient was relieved of his symptoms and neurological deficit postoperatively.

Conclusion: A rare case of spinal hemangioendothelioma was treated with embolization and two step surgery requiring stabilization.

Keywords: Hemangioendothelioma, dorsal spine, stabilization.

How to cite this article: Gill AS, Cahyadi A, Babhulkar S, Pawar S, Ramani PS. Recurrent Hemangioendothelioma of the Spine. J Spinal Surg 2014;1(1):28-31.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
S Syed Ali, P Dhivya, M Balamurugan

Hirayama Disease-Dynamic Cervical Compressive Myelopathy: An Indian Perspective

[Year:2014] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:34] [Pages No:123-125][No of Hits : 1017]


ABSTRACT

Introduction: Hirayama disease is a rare form of dynamic cervical flexion myelopathy. The incidence is more in Asian countries, like Japan, India, etc. Early diagnosis and treatment is the mainstay for the prognosis for this disease.

Materials and methods: Our aim is to assess the outcome of anterior cervical stabilization in this disease. We had six patients who was diagnosed to have Hirayama disease in our center and underwent anterior cervical stabilization.

Results: All six patients had fair to good outcome according to Odom’s criteria.

Conclusion: Early diagnosis and prompt treatment is the mainstay for better outcome. Mode of treatment depends on surgeons preference.

Keywords: Cervical compressive myelopathy, Dynamic myelopathy, Hirayama.

How to cite this article: Ali SS, Dhivya P, Balamurugan M. Hirayama Disease-Dynamic Cervical Compressive Myelopathy: An Indian Perspective. J Spinal Surg 2014;1(3):123-125.

Source of support: Nil

Conflict of interest: None


 
Case Report
Don Mathew, Tinu Ravi Abraham, Ajith R Nair

Microsurgical Management of Intraspinal Tumors in the Lumbar Spine: Hemilaminectomy as an Alternative to Laminectomy

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:84-90][No of Hits : 1008]


ABSTRACT

Introduction: Laminectomy is the classical surgical technique done for exposure of the spinal cord in the removal of intraspinal lesions. Here, we report a case where multilevel hemilaminectomy has been done to remove a long segment intraspinal tumor extending from D11 to L5.

Case report: A 47-year-old lady who had backache for 5 years, difficulty in walking for 6 month. She came to us with paraplegia (grade 0 power of both lower limbs), decreased sensation of both lower limbs and bladder incontinence. MRI revealed an intradural mass lesion extending from D11 to L5 level. multilevel hemilaminectomy was performed from D11 to L5 and near total resection of the tumor was done. Postoperatively, patient showed improvement with grade 1-2 power in lower limbs at the end of 3 months.

Advantages of hemilaminectomy: The main advantage of hemilaminectomy is the complete preservation of dorsal static structures of the vertebral column; such as the spinous process, the interspinous and supraspinous ligaments, and the unilateral preservation of the intervertebral joints, laminae, ligamentum flavae and the paraspinal muscles.

Conclusion: It is without doubt that patient morbidity and spine stability is better when surgery is performed through a narrow corridor. It can be concluded that hemilaminectomy is a safe and better alternative to laminectomy in the removal of long segment intradural tumors.

Keywords: Hemilaminectomy, Long segment tumors, Instability.

How to cite this article: Mathew D, Abraham TR, Nair AR. Microsurgical Management of Intraspinal Tumors in the Lumbar Spine: Hemilaminectomy as an Alternative to Laminectomy. J Spinal Surg 2014;1(2):84-90.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Pravin Salunke

Orientation of C1-2 Joints in Congenital Atlantoaxial Dislocation

[Year:2014] [Month:July-September] [Volumn:1 ] [Number:3] [Pages:34] [Pages No:115-120][No of Hits : 987]


ABSTRACT

Aim: To study the C1-2 facets in patients with congenital atlantoaxial dislocation and their bearing on the presentation and management.

Materials and methods: Thirty-six patients of congenital AAD were studied in the last 2 years. Twenty-four patients had irreducible AAD (not reducing on traction) and remaining 12 had reducible AAD. Computed tomography (CT) scans were obtained and the C1-2 joints were studied in axial, sagittal and coronal planes. The obliquity of (C1-2) joints was measured using the novel inferior C1 coronal and sagittal angles. The relationship of obliquity of joints, age and reducibility was studied and these were compared with normal subjects. The amount of facet to be drilled was decided by these angles. Direct posterior reduction was attempted by drilling the facets flat in all. Anomalous vertebral arteries (VA) were detected with preoperative CT angiograms and addressed appropriately intraoperatively.

Results: The inferior C1 sagittal and coronal angles were significantly acute in patients with IrAAD as compared to those with RAAD and normal spine. An inferior sagittal angle more than 150° predicted reducibility. More acute the angle, younger was the age of presentation. Relatively acute coronal angles were noticed in patients with telescoping (central or vertical dislocation). Intraoperative reduction could be achieved after drilling the facets nearly flat. Anomalous VA were found in over 70% of the patients with CAAD and were appropriately addressed. The fusion rates were over 90%.

Conclusion: The congenital AAD appears to be a dynamic process, progressing with time. The acuteness of the inferior C1 sagittal facet angles possibly determines the age at presentation and reducibility. Coronal angle determines the telescoping of C2 within C1. Intraoperative reduction through a direct posterior approach can be achieved in patients with IrAAD by drilling the wedge of C1-2 facets to make the joints relatively flat. Comprehensive facetal drilling also increases the fusion rates.

Keywords: Atlantoaxial dislocation, Facets, Orientation, Surgery.

How to cite this article: Salunke P. Orientation of C1-2 Joints in Congenital Atlantoaxial Dislocation. J Spinal Surg 2014;1(3): 115-120.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rully H Dahlan, Farid Yudoyono, Sevline E Ompusunggu, Akhmad Y Pramatirta, Agung B Sutiono, Ahmad Faried, Muhammad Z Arifin

Langerhan's Cell Histiocytosis of the Lumbar Spine during Pregnancy: A Rare Case with Literature Review

[Year:2014] [Month:April-June] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:94-97][No of Hits : 932]


ABSTRACT

Background: Langerhan’s cell histiocytosis (LCH), previously known as histiocytosis X, is a reactive proliferative dendritic cells of unknown pathogenesis characterized by the proliferation of Langerhan’s cells and is extremely rare in the lumbar spines of adults. This condition is most common among young males under the age of 15 years old (with a peak incidence at 2-4 years old), and the most frequent site of these osteolytic bony lesions of the spine is the thoracic region.

Purpose: To highlight an interesting and rare presentation for Langerhans cell histiocytosis of the spinal cord in pregnant woman.

Study design: This is a case report of a single patient in whom a Langerhans cell histiocytosis was resected from the lumbal spine in pregnant woman with return to normal functioning.

Patient sample: A 26-year-old pregnant woman at 20 to 22 weeks presenting with acute cauda equina syndrome, a 1-month history of pain and numbness and paraparese of right limb had gradually progressed to involve all the lower limbs.

Outcome measures: Frankel grading of neural function and Visual Analogue Score are included to evaluate the therapeutic efficiency.

Methods: Magnetic resonance imaging revealed the widespread involvement of an extradural contrast-enhancing mass in the lumbar spine of L2-L5.

Results: The patient underwent decompression and surgical resection of the tumor in a three-quarters prone position, fetal heart monitoring was performed by our obstetrician; there was no fetal distress during the surgery. The diagnosis was confirmed by histological analysis. She entered spontaneous labor at 36 to 37 weeks and birthed a baby weighing 3000 gm. The child began crying immediately and had Apgar scores of 8 and 10 in the 1st and 5th minutes respectively. No residual disease or recurrence was noted at follow-up longer than 1 year.

Conclusion: Our case’s unique presentation involves LCH in an adult pregnant patient at the lumbar spine with no osteolytic activity. The management of pregnant women and maintenance of fetal well-being should be coordinated among the spinal neurosurgeon, obstetrician and anesthesiologist.

Keywords: Langerhan’s cell histiocytosis, Pregnancy, Cauda equina syndrome, Three quarter prone position.

How to cite this article: Dahlan RH, Yudoyono F, Ompusunggu SE, Pramatirta AY, Sutiono AB, Faried A, Arifin MZ. Langerhan’s Cell Histiocytosis of the Lumbar Spine during Pregnancy: A Rare Case with Literature Review. J Spinal Surg 2014;1(2):94-97.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Ganesan Ram Ganesan, Rajkumar Jayachandran Sundarapandian, Karthik Kailash Kannan, Faraz Ahmed, Vijayaraghavan Phagal Varthi

Does Pelvic Incidence vary between Different Ethnicity? An Indian Perspective

[Year:2014] [Month:October-December] [Volumn:1 ] [Number:4] [Pages:43] [Pages No:151-153][No of Hits : 930]


ABSTRACT

Background: The importance of sagittal plane alignment in adults involves both spinal and pelvic parameters. Most papers published in this field have studied white people and, to the best of our knowledge, there are only few studies on Asians and none in south Indian population.

Materi