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An unusual case of dorsally sequestrated disk mimicking tumor with cauda equina syndrome
Batuk Damjibhai Diyora, Sachin Giri, Deepali Giri, Nitin Kotecha, Swapnil Patil
January-March 2016, 3(1):15-17
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  4 448 68
Orientation of C1-2 joints in congenital atlantoaxial dislocation
Pravin Salunke
July-September 2014, 1(3):115-120
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  3 391 46
Spinal intramedullary tubercular abscess
Saravanan Natesan, R Raghavendran, Vidya Narasimman, Deiveegan Kunjithapatham
January-March 2014, 1(1):39-40
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 386 46
Epidermoid cyst of the thoracic spine: A rare case
Nilesh Jain, Sharadendu Narayan, Harshad Patil, Abhishek Songara
April-June 2016, 3(2):59-62
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 361 59
A Rare Case of Dumbbell-shaped Spinal Epidural Capillary Hemangioma

April-June 2017, 4(2):83-86
Study design: A case report and literature review. Summary of background data: Hemangiomas are frequently considered as hamartomatous congenital vascular malformations. Hemangiomas of the spine are usually lesions of the vertebral bodies, but they can occur at other locations, such as the intramedullary or epidural space. Purely epidural hemangiomas are rare and most of them are of cavernous type. Materials and methods: This is a case report of a 70-year-old male with a D6, D7 dumbbell-shaped capillary hemangioma with extraforaminal extension on the left side. Patient underwent D6-8 laminectomy and en bloc resection of the lesion. Results: Microscopic evaluation showed a fibrofatty tissue with a proliferation of small-sized vascular structures with areas of myxoid appearance. To date, there have been nine epidural capillary hemangiomas of the thoracic and lumbar spine reported in the literature. Conclusion: It is important to consider hemangiomas in the differential diagnosis of epidural lesions with dumbbell-shaped appearance in the magnetic resonance imaging study, especially at the thoracic level. These benign lesions usually present as a progressive myelopathy, so early treatment may prevent permanent neurological deficits and result in complete cure.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 348 60
Bilateral symmetric dumbbell C1-C2 ganglioneuroma in neurofibromatosis type 1 patient causing spastic quadriparesis
Bipin Chaurasia, Dhiman Chowdhury, Ayub Ansari, Robert A Khan, Raushan Chaurasia, Akhlaque H Khan, Ranjit K Chaurasiya, Kanak K Barua, Ramesh Chaurasia, Nazmin A Lopa, Sweta K Chaurasia, Pulak Biswas, Md. Mainul Islam
July-September 2018, 5(3):138-143
Introduction: Ganglioneuroma is a very rare tumor and rarely found bilaterally in association with neurofibromatosis patient. Very few cases of dumbbell ganglioneuroma in the cervical region have been reported in the literature. Materials and methods: A 36-year young male presented to us with a complaint of progressive spastic quadriparesis for 4 years. We did MRI of the cervical spine with contrast and found bilateral symmetrical dumbbell mass at the C1-C2 level severely compressing the spinal cord. Rest of the spine and brain imaging showed normal findings. Result: We operated the patient. Bilateral decompression of the cervical spine at the corresponding level was achieved by complete removal of tumor. Patient's motor power of all limbs gradually improved. Histopathology was done which revealed ganglioneuroma of both the resected tumors. Conclusion: Bilateral symmetric dumbbell ganglioneuroma is extremely rare in C1-C2 region and can be associated with neurofibromatosis Type 1.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 464 69
Combined C1-C2 transarticular with C1 lateral mass screw fixation for the treatment of atlantoaxial instability: A single center experience
Murtuza Sikander, Sean Martin, Bassam Dabbous, Stewart Griffiths, Sumit Karia, Erlick Pereira, Thomas Cadoux-Hudson
October-December 2016, 3(4):133-139
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' 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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 473 72
Prospective study of spectrum of lumbar disk herniation and its surgical outcome
Vishwanath Sidram, PC Chandrakumar, Raghavendra Bellara
October-December 2016, 3(4):144-150
Objectives: To study the surgical outcome of lumber disk herniation and factors influencing the surgical outcome. Materials and methods: A case series study of 200 patients with herniated lumbar disk were studied in setting of tertiary hospital in the Department of Neurosurgery at Vijayanagara Institute of Medical Sciences, Bellary, Karnataka during the period of June 2013 to January 2015. Among the selected patients, the sociodemographic profile, clinical profile, radiological profile, and the surgical interventions were undertaken and the outcome was noted. The MacNab scale was used to determine the clinical outcome after surgery. All patients were followed for a period 6 months postoperatively for the presence of complications. Results: Mean age of the patients was 45.63 ± 18.54 years with 61% of males and 39% of them were females. L4-L5 interspace was involved in 138 cases (68.0%), disk was protruded in 54% of the cases, and extruded in 28% of the cases. According to MacNab's criteria, in this study “Excellent” outcome was seen in 146 patients (73%), outcome was “Good” in 45 (22.5%) patients, “Fair” in 7 (3.5%) patients, and “Poor” in 2 cases (1%). Better surgical outcomes were associated with younger patients (p = 0.002), disk prolapse at the level of L4-L5 (p < 0.001), extruded and protruded type of disk prolapse (p = 0.034), and disk prolapse precipitated by lifting inappropriate weight (p = 0.002). Conclusion: The outcome of lumbar discectomy depends more on patient's age, level and type of disk prolapse, factors precipitating disk prolapse, and patient selection than on surgical technique.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2 361 58
Giant cell tumor of dorsal spine
Shivender Sobti, Paul S John, Amit Kumar, Sarvpreet S Grewal
July-September 2016, 3(3):112-113
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 375 61
Unique case of glass piece injury to cervical spinal cord: A very rare presentation
Rajendran Selvan, R Ramkumar, S Subikshavarthni
April-June 2016, 3(2):63-65
Foreign bodies inside the cervical spinal canal causing injury to spinal cord are seen very rarely. Very few cases of glass fragments in the cervical spinal canal were reported till date. In this report, a 17-year-old boy, who was accidentally injured by a glass piece, which penetrated into the cervical spinal cord, was operated upon and, he recovered dramatically. This case report is to emphasize the morbidity caused by small foreign bodies accidentally introduced by trivial injuries.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 423 52
Primary ewing sarcoma of the body of cervical spine
Hemant V Savant, Srikant Balasubramaniam, Zafar Ahmed Sheikh, Vijay Mahajan
January-March 2016, 3(1):22-24
Primitive neuroectodermal tumors (PNETs) are malignant neoplasm originating from neural crest cells that generally affects children and young adults (4–15 years). Ewing sarcoma family of tumors occurs most commonly in the long bones of the extremity and less commonly in the spine. We present a case of a 21 years old male with acute onset neck and left upper extremity pain which rapidly progressed to spastic paraplegia without bladder bowel involvement. He underwent a C7 corpectomy and titanium cage fixation. Immunohistochemistry clinched the diagnosis of PNET/ Ewing sarcoma. Our case was unique in the primary involvement of the body of cervical vertebra in a young adult which was very similar to Kochs spine.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 375 52
Hemorrhage within the schwannoma of thoracic spinal cord presenting as acute rapidly progressive paraplegia: A rare case
N Vaibhav, S Shanthanam Mahalingam, J K B C Parthiban
October-December 2016, 3(4):160-162
Spinal schwannomas are benign, slow-growing nerve sheath tumors presenting as insidious lesions. Acute presentation is rare with spinal schwannomas. An intratumoral bleed causing acute presentation with paraplegia and its recovery after surgical intervention is rarely reported in the literature. We report one such case and discuss the possible mechanism for such presentation and the available literature on the subject.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 364 68
Cervical myelopathy secondary to combined ossification of ligamentum flavum and posterior longitudinal ligament
Sourabh Chachan, Niraj S Kasat, Paul K L Thng
October-December 2016, 3(4):157-159
In the cervical spine, the combined ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. Patients are usually treated with cervical laminectomy or laminoplasty with OLF resection. In most of the cases, OLF is adhered to the dura and there is a risk of dural tear or cerebrospinal fluid (CSF) leakage during its resection. In this case report, authors present results of laminectomy with debulking instead of complete excision of OLF for spinal cord decompression in a cervical myelopathy case where OLF was adhered to the dura. A 69-year-old man presented with insidious-onset weakness in bilateral lower limbs and unsteady gait since 1 month. He had a history of neck pain with left upper limb radiation for 2 years. Magnetic resonance imaging (MRI) showed C5 to C6 severe central canal stenosis with underlying myelomalacia. Computed tomography (CT) showed OPLL and OLF contributing to severe central canal stenosis at C5 to C6 level. Patient underwent C4 to C6 laminectomy, debulking of OLF, posterior instrumentation, and fusion with autogenous bone graft from C3 to C6. Histological specimen showed osseous tissue within the ligamentum flavum. After surgery, patient's symptoms improved, and no recurrence was observed at 4 years after surgery. The symptoms of myelopathy were successfully treated with debulking instead of complete excision of OLF, thus reducing the risk of dural tear or CSF leakage.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 370 52
Idiopathic spinal cord herniation
Jay Kotecha, Makarand Kulkarni
January-March 2014, 1(1):46-48
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 405 50
An unusual case of conus nonfunctioning paraganglioma
Batuk Damjibhai Diyora, Sachin Ashokrao Giri, Nitin Kotecha, Deepali Giri
October-December 2015, 2(4):148-150
Paragangliomas are neuroendocrine tumors with differentiation of chromaffin cells originated from neural crests. Paragangliomas most commonly occur in the head and neck regions (more than 90% of cases). Spinal paragangliomas are uncommon and difficult to diagnose preoperatively due to the absence of any specific radiological and clinical findings. A 39-year male patient presented with severe back pain with inability to lie down for 2 days. Neurological examination revealed paraparesis with brisk lower limb reflexes. His magnetic resonance imaging (MRI) lumbosacral spine suggestive of homogeneously contrast enhancing intradural mass confined to L1 to L2 level. The patient underwent laminectomy with excision of the highly vascular intradural lesion. Histopathological examination confirmed as paraganglioma. Lumbar spinal paragangliomas are diagnostic dilemma not only due to the rarity of these lesions, but also due to radiological features mimicking other common lesions at this location like ependymoma and schwannomas. Characteristic features on T2-weighted MRI and gradient echo imaging can help in preoperative diagnosis, though these features are not specific of these lesions. Preoperative consideration of these lesions helps in taking precautions during excision as these tumors can be functioning paragangliomas.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 314 51
Victor horsley and spinal surgery
Shanthanam S Mahalingam
April-June 2016, 3(2):68-69
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 399 61
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
Anantha Gabbita, Mohamed M Usman, Anantha Kishan, DN Varadaraju, Shivalinge G Patil, Amrut V Hosmath
July-September 2016, 3(3):90-95
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 517 84
Anterior fixation of atlantoaxial joints: Technique and pitfalls
Sushil Patkar
April-June 2014, 1(2):60-68
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Utility of 99mTc-MDP bone scan in comparison to MRI and plain radiographs for the diagnosis of early spondyloarthropathy
Ajit S Shinto, KK Kamaleshwaran, M Anjali, V Rajamani, SG Thirumalaisamy, N Sreedharan
January-March 2014, 1(1):12-15
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 403 60
Spinal decompression using ultrasonic bone scalpel: A novel ultrasonic surgical device
Jayprakash V Modi, Kaushal R Patel, Zulfikar Patel, Shardul V Soman, Kirtan V Tankshali
October-December 2016, 3(4):140-143
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 538 84
Anterior cervical surgery: Drain needed or not?
Shivalingegouda Rayagouda Patil, Anantha Kishan, Anantha Gabbita, DN Varadharaju, PM Jagannath
April-June 2015, 2(2):37-41
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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 369 56
Posterior cervical laminoforaminotomy: A comparative study between open vs minimally invasive approach
Nirmala Subramanian, Umesh Srikantha, Aniruddha Tekkatte Jagannatha, Kiran Khanapure, Ravi Gopal Varma, Alangar Sathyaranjandas Hegde
January-March 2015, 2(1):8-12
Objectives: Minimally invasive spine surgery is gradually being preferred over conventional techniques due to several advantages. Our study was conducted to compare the persistent cervical symptoms and the surgical outcomes between open cervical laminoforaminotomy (O-CLF) and minimally invasive cervical laminoforaminotomy (MI-CLF). Materials and methods: Between June 2011 and 2013, 14 patients with radicular pain in the upper limb with magnetic resonance imaging (MRI) proven posterolateral cervical disk prolapse and failed conservative treatment were assigned to either O-CLF or MI-CLF. Neurological examination and visual analog scale (VAS) for upper limb and neck pain was done. Follow-up was done on day 1, 4 weeks and 6 months. Results: Out of the 14 patients, seven underwent O-CLF and seven underwent MI-CLF. Demographic characteristics and operating time were comparable between the two groups. The mean follow-up duration was 3 months. Mean blood loss was higher in O-CLF group (150 ml) as compared to MI-CLF (30 ml). Postoperative analgesic requirement was also significantly high in the O-CLF group. Length of hospital stay was more in the O-CLF (4.85 days) as against MI-CLF (1.28 days). Visual analog scale scores for radicular pain did not differ between the two groups. However, VAS scores for neck pain was significantly higher in O-CLF at 6 weeks follow-up as compared to the MI-CLF group. Patients who underwent MI-CLF returned to work faster (2.28 weeks) than their O-CLF counterparts (3.42 weeks). Conclusion: Minimally invasive cervical laminoforaminotomy results in reduction of postoperative analgesic requirements, hospital stay, blood loss, decreased incidence of postoperative axial neck pain and early return to work.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 378 66
Laminoplasty for cervical spondylotic myelopathy
Patrick Fransen
April-June 2014, 1(2):77-80
Cervical spondylotic myelopathy (CSM) is a commonly treated either by uninstrumented laminectomy, carrying the risk of postoperative instability, or by anterior or posterior decompression 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.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1 339 55
Scaffolds for cell transplantation in neurology—The suitability of a thermoreversible gelation polymer: Our perspectives
Vidyasagar Devaprasad Dedeepiya, Justin Benjamin William, Jutty KB C Parthiban, Hiroshi Yoshioka, Yuichi Mori, Satoshi Kuroda, Masaru Iwasaki, Senthilkumar Preethy, Samuel J K Abraham
January-March 2014, 1(1):16-24
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 NIPAAm-co-BMA) and polyethylene glycol (PEG)-based thermoreversible gelation polymer for cell therapy applications in neurology.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Nanotechnology in spinal cord injury: A new hope for overcoming barriers to treatment
Vinu V Gopal, K Mahadevan
July-September 2015, 2(3):78-84
Incidence of spinal cord injury (SCI) is on the rise affecting the young strata of the society leading to permanent disability in majority of cases with limited treatment to offer. Treatment of sci has many challenges due to the complex blood spinal cord barrier (BSCB). Nanotechnology presents a substantial solution in neuroprotective treatment by enabling targeted delivery of drugs to the site of injury by overcoming BSCB. Nanofiber scaffolds which are built of biodegradable nanofibers forms structural support for injured spinal cord, guiding and supporting cell growth thereby favoring neural regeneration. Common concerns with nanotechnology include the health hazards due to the difficult degradation and immunomodulation. The lack of proper clinical trials and the lack of centralized monitoring agency are the serious ethical concerns regarding nanotechnology. Nanotechnology is still a developing field and it is unclear exactly what effects it will have on the body or the environment. This fact leads to the greater regulation imposed on nanotechnology, making the process of drug development even more expensive and time consuming. Application of nanotechnology in stem cell research and nanorobotics are promising future research that can revolutionize the treatment strategies in SCI.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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