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Accuracy and safety of free-hand pedicle screw placement in cervical injury patients
Sanjeeb Rijal, Sarvdeep Singh Dhatt, Vishal Kumar, Deepak Neradi, Mahesh Prakash
0, 0(0):0-0
Objectives: The purpose of this study was to describe the free hand method of pedicle screw placement without intraoperative imaging monitors and to evaluate the accuracy of the screw placement in quadriplegics patients. Methods: A free hand screw was inserted in the eleven cervical injury patients with quadriplegia. We studied the preoperative pedicle dimension in all the patients and assessed the clinical and radiological outcome and accuracy of the screw placement. Results: A total of 44 screws were inserted in the cervical pedicles of eleven patients. The postoperative images showed that 28 of the 44 screws had perforated the pedicles but none of them had breached the spinal canal. Among them 16 screws were grade 2 and 12 screws were grade 3. All the screws had penetrated the lateral wall. There were no neurovascular complications related to any malpositioned screw and there was no screw loosening or instrumentation failure in the patients. Conclusion: The free hand screw placement without intraoperative image guidance seems to be safe and effective method of fixation. But this technique requires sound knowledge of the cervical anatomy and experience and is useful in the places where navigation system are not available.
  880 26 -
Small-cell lung carcinoma diagnosed only after cervical intradural metastasis caused hemiparesis
Yoshitaka Hirano, Daichi Fujimori, Fumito Omi, Meitetsu Masawa, Hideo Sakuma, Kazuo Watanabe
0, 0(0):0-0
We present a rare case of intradural extramedullary metastasis of small-cell lung carcinoma in the cervical spine. Optimal treatment strategies, including the indication for decompressive surgery, are discussed. A 70-year-old male who first presented with nuchal region pain suddenly developed right hemiparesis and was referred to our emergency service. Magnetic resonance imaging of his brain was unremarkable, but additional scanning of the cervical spine revealed an intradural tumor at the right C1–C3 levels. Urgent decompressive surgery was carried out, and gross total removal of the tumor was achieved. The histopathological diagnosis was metastasis of small-cell lung carcinoma. Computed tomography of the lung and abdomen revealed a primary tumor in his left lung, with multiple metastases to the mediastinal lymph nodes, liver, and adrenal gland. The patient was being considered for chemotherapy after some improvement of his hemiparesis and pain, but died on the 13th day due to sudden aggravation of the general condition. There was probably no surgical indication for the present case. Careful assessment and management of the primary disease should be considered the top priority even in patients with emergent neuronal insult.
  643 36 -
Adjacent corticocancellous bone graft in anterior cervical interbody fusion: A technical note
J K B C Parthiban
July-September 2016, 3(3):75-78
Autologous bone graft is the gold standard in cervical fusion. Obtaining autologous cancellous bone from adjacent vertebral body is unique and beneficial in anterior cervical interbody fusion. Sufficient amount of cancellous bone graft is curetted from adjacent cervical vertebral bodies and packed in the titanium cages placed in the intervertebral space. Cortical bone obtained from corticectomy and anterior osteophytes add to the volume along with cancellous bone. Fusion achieved is satisfactory and the technique obviates harvesting corticocancellous graft from iliac crest.
[ABSTRACT]   Full text not available  [PDF]
  574 46 -
Current concepts in the management of type II odontoid fractures
Premanand S Ramani
July-September 2017, 4(3):104-112
Introduction: Fracture of the odontoid and particularly type II, is the commonest injury in the upper cervical spine. In the past, it was presumed to cause by high velocity road traffic accidents. But now, with the increase in the number of two-wheeler vehicles and sub-standard conditions of indian roads, this type of injury is common. It is usually caused by hyper-extension of the neck but, can be caused by hyper-flexion. The surgical management has remained controversial. Material and methods: Data was collected from four centres in Maharashtra- India. In one centre, the treatment was posterior C1-C2 stabilization with screws and plate. In centre two, odontoid fracture line was fixed by anterior screws. In the third centre, Magerel technique was used. The fourth centre believed in direct anterior screw and plate fixation of the fracture line. Analysis: The number of patients operated upon, were too less in each centre to analyse and compare with each other. As a result, use of software analysis was not felt necessary which is in fact the need to assess the best technique which can be used to treat this fracture. Results: No definite conclusion could be arrived at by studying the pattern of treatment in these four centres. Conclusion: Way back in 2009, an attempt was made to do a multi-centre retrospective analysis. There was no definite conclusion and even in the present study, no definite conclusion is derived.
[ABSTRACT]   Full text not available  [PDF]
  504 38 -
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]
  309 39 1
Knee spine syndrome: Common clinical correlation and its management algorithm
Jayprakash V Modi, Harshil R Patel, Hriday P Acharya
January-March 2019, 6(1):6-10
Introduction: Various studies have been carried out proposing the concept of knee spine syndrome measuring simultaneous changes in knee flexion and sacral inclination, but none regarding its management. Here in this study, we put forward the management and diagnostic algorithm for the knee and spine disease operated by the same surgeon. Materials and methods: This is a prospective study of 10 patients having knee spine syndrome operated by the same surgeon from January 2016 to January 2018. They were selected and treated as per the treatment protocol put forward and clino-radiological outcomes were evaluated with visual analog scale (VAS), oswestry disability index (ODI) scoring, and radiographs. Results: Age of the patients included in this study ranged from 55–80 years. In 6 patients, the spine was operated first and in others, knee replacement was done as an index procedure. Average pre-operative ODI score was 28.9 which decreased to 7.5 postoperatively at 2-year follow-up. VAS score decreased from 7.4 preoperatively to 1.5. Conclusion: Knee spine syndrome is one of those entities which need to be identified and treated as a whole and not as two different symptomatic diseases. According to our proposed algorithm, radicular symptoms (spinal pathology) should be treated first. In cases of predominant back pain which could be either due to loss of lumbar lordosis or precipitated by deformity caused by malalignment in osteoarthritis knee, knee replacement was considered first. Despite the proposed algorithm, the clinical acumen of the surgeon in determining the leading cause of morbidity may help prevent unnecessary further staged surgeries.
[ABSTRACT]   Full text not available  [PDF]
  290 49 -
Reverse latissimus dorsi turnover muscle flap for coverage of a secondary midline lumbar defect following spinal surgery
Darshansingh U Rajput, Sudhir Beglihosahalli Muniswamy
January-March 2016, 3(1):12-14
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.
[ABSTRACT]   Full text not available  [PDF]
  278 60 -
Vacuum-assisted closure dressing in Spine: An emerging trend
Sanjay K Tripathi, Saurav N Nanda, CR Reddy, Sachin T Ranvir, Sawan K Pawar, Amit Kohli, Shahrookh Vatchha
April-June 2016, 3(2):48-50
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.
[ABSTRACT]   Full text not available  [PDF]
  301 37 -
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]
  280 57 -
Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in a South Indian population for guiding pedicular mass fixation
Nithin Asadhi, Narayan Gudi, Anil K Sakalecha, Arun Shanthappa, Hariprasad Seenappa
July-September 2016, 3(3):96-102
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.
[ABSTRACT]   Full text not available  [PDF]
  284 47 -
Role of kinematic magnetic resonance imaging for evaluation of cervical spondylotic myeloradiculopathy: diagnostic accuracy and surgical planning
Sachin Chemate, Chandrasekar Kalavakonda, CV Shankar Ganesh, Shailendra Markad, Prasad Temkar, Bagatheesh Sugathan, Ratnika Joshi, Anandkumar Shah, Mayank Nakipuriya, Harshal Agrawal, Mangaleswaran Balamurugan
April-June 2018, 5(2):53-56
Objective: The dynamic part of cervical spondylotic myeloradiculopathy (CSM) is conventionally being evaluated usingstatic magnetic resonance imaging (MRI), which does not address dynamic changes in flexion and extension of the cervical vertebral column. The objective of the study is to evaluate the utility of kinematic MRI imaging indiagnostic accuracy and surgical planning of evaluation of CSM. Materials and methods: In a prospective study, 30 patients with CSM were evaluated with conventional standard MRcervical spine and kinematic MRI cervical spine with flexion and extension. Morphometric measurements were compared between neutral, flexion, and extension images. Results: The cervical cord length and cervical canal length were significantly longer in flexion and significantly shorter in extension in all cervical cord sagittal lines. Flexion was associated with decrease in spinal cordcompression in 40% of patients, whereas extension caused increase in compression (increase in the size of T2 hyperintensivity) in 75% of patients.Extension identified new subtle T2 hyperintensities. Interpretationof standardMRI findings and the clinical level of radiculopathyis poor, which improves when the neck is extended. Conclusion: Our results suggest that integration of kinematic MRI with standard static MRI provides additional information in diagnostic accuracy and surgical planning.
[ABSTRACT]   Full text not available  [PDF]
  288 41 -
Role of plastic surgeon in the management of pressure ulcers during rehabilitation of patients with traumatic spinal cord injury: A tertiary hospital experience
Lekshmi S Bhooshan, P Binod, M Lekshmi
October-December 2018, 5(4):162-169
Background: Pressure ulcers and their management represent one of the most challenging situations following traumatic spinal cord injury (SCI). It requires frequent hospitalizations and hence aggravates the physical, psychological and socioeconomic burden of patients and their caregivers. Early surgical intervention will help in reducing the morbidity as well as improve the quality of life of these patients. In this study,we present a retrospective review of reconstructive surgeries for pressure sores highlighting the role of the plastic surgeon in the rehabilitation of traumatic SCI. Methods: A three-year retrospective review (January 2014–December 2017) of 25 traumatic SCI patients who underwent reconstructive surgeries for pressure ulcers in the Department of Plastic Surgery in a Tertiary Care Government Hospital in South India was done.Variables like demographic and clinical details, reconstructive procedures done, postoperative complications, duration of hospital stay and relation of wound complication with serum albumin were statistically analyzed and interpreted using statistical package for social sciences (SPSS) software. Results: Twenty-five male patients with age between 22 and 69 years (mean age = 49.4+/-12.24)were analyzed. 88% of the patients (n = 22) had paraplegia, and 12% had quadriplegia. 12% of patients had a cervical spinal injury, while 88% had a thoracolumbar injury. Mean duration of hospital stay was 36.5 days.Of the 25 patients, 68% (n = 17) had pressure sores at multiple sites while the rest had a single pressure sore. Of the total 49 pressure sores, 30 were ischial, 11 sacral, 7 trochanteric and one perineal pressure sore.Forty-five pressure sores were of grade II/IV and was managed with various flap reconstructions. One sacral pressure sore and one ischial pressure sore (grade II) underwent excision and primary closure. Split skin grafting was done for 2 sacral pressure sores. Postoperative wound complications were analyzed and there was a significant relation between hypoalbuminemia and major wound complications (Fischer exact p = <0.0001) Conclusion: Plastic surgeons have an important role to play in the rehabilitation phase of traumatic spinal cord injury patients with pressure sores. Early reconstructive surgeries for pressure sores will prevent the development of complications and provide better quality of life (QOL) for these patients.
[ABSTRACT]   Full text not available  [PDF]
  274 47 -
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]
  269 46 -
Lumbar stenosis: Oblique coronal images in MRI for assessment of ligamentum flavum
Satishchandra Gore
July-September 2016, 3(3):117-117
Though axial views at lumbar disk level in the plane of the disk and sagittal views at lumbar foramen level are routinely used in assessing the canal stenosis, lateral extent of thickened ligamentum flavum which is truly causing symptoms is well demonstrated in oblique coronal views in magnetic resonance imaging (MRI). Emphasis on this view in addition to the routine views will improve our understanding of lumbar canal stenosis, particularly in and around superior facet and axilla of the nerve root close to neural foramen.
[ABSTRACT]   Full text not available  [PDF]
  261 52 -
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]
  260 48 1
Surgical outcome of spinal intradural extramedullary tumors: A Single-center prospective study of 92 cases— Assessment using nurick's grade and visual analog scale
Vivek K Kankane, Neha Gupta, Vivek Sharma
April-June 2018, 5(2):63-68
Introduction: To account the surgical outcome of 92 patients who underwent an entire removal of intradural extramedullary tumors (IDEMs) and evaluate the factors that have an influence on the neurological symptoms and prospects of spinal IDEM tumors. Materials and methods: Ninety-two cases of histopathologically confirmed IDEM tumors were treated surgically between July 2008 and July 2016. There were 32 females and 60 males with a mean age of 41.52 years. The mean postoperative follow-up period was 40.27 months. The histopathological result, locations of the tumors, and clinical outcome were analyzed. Backache was assessed by the visual analog scale (VAS) and the neurologic purpose was evaluated by Nurick's grade. The preoperative symptoms duration and the proportion of mass hold of the intradural space were evaluated. In adding up, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the magnetic resonance imaging (MRI) evaluated the tumor recurrence. Results: The histopathological outcomes are as follows: 28 cases of meningioma, 48 cases of nerve sheath tumors (40 cases schwannoma and 8 cases neurofibroma) (in our study, we included only non-dumbbell-shaped with no extracanalicular extended, posteriorly situated nerve sheath tumors, so these groups of tumors were excised completely with only posterior approach with preservation of facet), 10 cases of an arachnoid cyst, 2 case of Tarlov cyst, 1 case of benign cystic teratoma, and 3 cases were metastasis, and our study included only posteriorly situated tumors. The locations of the tumors were as follows: 64 cases in the thoracic region, 16 cases in the cervical region, and 12 cases in the lumbar region; postoperatively, there were two cases of cerebrospinal fluid (CSF) leakage; the majority of diagnosis consisted of nerve sheath tumors (52.1%), followed by meningioma (30.40%). The proportion of mass occupying the intradural space was 81.65 ± 9.01%. The VAS score was reduced in all cases from 7.56 ± 0.72 to 1.30 ± 0.47 (p = 0.001) and the Nurick's grade improved in all cases from 3.69 ± 0.92 to 1.35 ± 0.57 (p = 0.001). The preoperative symptoms were correlated with only the proportion of mass occupying the intradural space (VAS; r = 0.496, p = 0.016, Nurick's grade; r = 0.431, p = 0.040). The Statistical Package for the Social Sciences (SPSS) version 22 was used for statistical study, and the Spearman correlation test and paired Student's t-test were performed. Two cases of schwannoma recurred. Conclusion: The IDEM tumors detected by MRI are frequently benign, and excellent clinical outcome can be obtained when treated surgically. The extent of neurologic symptoms was associated with the proportion of mass occupying the intradural space. All the tumors were capable of being excised through the posterior approach. The 'postoperative neurological improvement was outstanding in the entire cases. Consequently, violent surgical excision is suggested even for cases with a long period of symptoms or a rigorous neurologic deficit.
[ABSTRACT]   Full text not available  [PDF]
  257 51 -
A Study comparing open and minimally invasive surgery for one- or two-level thoracolumbar intradural extramedullary spine tumors
Sreenath Kuniyil1, Bijukrishnan Rajagopalawarrier, Vijayan Peettakkandy
April-June 2019, 6(2):53-59
Background: The era of modern minimally invasive spine (MIS) surgery begins in the early 1990s with the report of the first case of tubular discectomy. Later, intradural tumor excision was reported in 2006. But most of us are still reluctant in accepting this new corridor due to lack of studies from India. Aim: The aim of this study is to compare various aspects of minimally invasive resection of one- or two-spinal level thoracolumbar intradural extramedullary (IDEM) tumors with conventional open surgery. Materials and methods: This study was conducted in patients admitted with a diagnosis of IDEM spinal tumor during the period of January 2016 January 2019. We compared 19 cases of one- or two-spinal level thoracolumbar IDEM tumors operated through MIS with 19 similar cases operated through open surgery. Results: The mean intraoperative blood loss was 115 mL in the MIS group and 530 mL in the open group and the duration of surgery was 229.74 minutes for the MIS group and 230.26 minutes for the open group. The mean C arm exposure was 6.04 in the MIS group and 2.63 in the open group. Ten cases in the MIS group and eight cases in the open group were operated in one spinal level and 9 in the MIS group and 11 in the open group were operated in two spinal levels. One patient in both groups developed cerebrospinal fluid (CSF) leak and one patient in the MIS group and two patients in the open group had a postoperative wound infection. The mean postoperative pain score was 2 in the MIS group and 3.58 in the open group (assessed by the visual analog scale). Sensory and motor symptoms improved in all cases in both groups. The mean hospital stay was 5.16 days in the MIS group and 8.42 days in the open group. The mean size of incision was 2.73 in the MIS group and 8.18 in the open group. The patient satisfaction index (PSI 1–4) in terms of overall satisfaction was 1 (68.4%) and 2 (31.6%) in the MIS group and 1 (47.4%), 2 (31.6%), and 3 (21.1%) in the open group. Conclusion: We conclude that MIS procedures are a safe and better alternative for one- or two-level thoracolumbar IDEM spinal tumors but its usefulness in tumors with more than two-level needs further studies.
[ABSTRACT]   Full text not available  [PDF]
  258 47 -
Split cord malformation type 2 complicated by presence of tuberculous arachnoiditis
Tarang Kamalkishore Vora, RR Ravi
April-June 2015, 2(2):55-57
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.
[ABSTRACT]   Full text not available  [PDF]
  248 55 -
My reflection as neuro- and spinal surgeon at 80 years
Premanand S Ramani
April-June 2018, 5(2):73-77
Introduction: Most surgeons today do not retire at the stipulated age as dictated by the government. Reasons for continuing to work: (1) Updating knowledge. (2) Mix with the students. (3) Continue having interactions with the patients. (4) Pleasure of pursuing surgical art that has been mastered. (5) Monetary gains. Guidelines for retirement: Author has explained in detail the guidelines. Briefly if the assistants, the nurse, and the anesthetist feel that the surgeon's dexterity has come down, then the surgeon has to retire irrespective of age. Conclusion: Today's pattern of medical practice is such that surgeons can carry on performing operative procedures much after their retirement age, provided their dexterity is not compromised.
[ABSTRACT]   Full text not available  [PDF]
  261 42 -
A common pathology in rare location: Spinal hemangioma
Vivek Agrawal, Rajendra B Aher
October-December 2018, 5(4):178-180
Hemangioma of spinal column is a common pathology but purely epidural spinal hemangioma, especially in pediatric age group, is rare and there are very few case reports available in English medical literature. We are reporting a case of cervicodorsal epidural arterio-venous hemangioma without vertebrae involvement in a pediatric patient to highlight difficulty in interpretation and importance of preoperative radiological diagnosis.
[ABSTRACT]   Full text not available  [PDF]
  261 41 -
Dynamic computed tomography myelography including the prone position as a reliable preoperative imaging method for osteoporotic vertebral fracture with neurological deficits: A preliminary report of three cases
Toru Funayama, Toshinori Tsukanishi, Kentaro Mataki, Tetsuya Abe, Hiroshi Noguchi, Hiroshi Kumagai, Katsuya Nagashima, Kousei Miura, Masao Koda, Masashi Yamazaki
April-June 2018, 5(2):57-62
Aims: Delayed paralysis after osteoporotic vertebral fracture (OVF) in the elderly is caused by severe compression on the spinal cord or the cauda equina from the collapsed vertebral fragment that is retropulsed into the spinal canal. Patients with retropulsion of the vertebral fragment that occupies approximately 40% or more of the spinal canal likely develop delayed paralysis, suggesting that narrowing of 40% is the critical point. However, whether or not a neural decompression procedure during posterior instrumentation surgery, such as laminectomy should be performed during the surgery is still controversial. We performed dynamic computed tomography myelography (CTM) including the prone (surgical) position with OVF to investigate if the severity of spinal cord and cauda equina compression during the surgery could be estimated in advance. Materials and methods: The CTM was examined in 3 OVF patients (1 man and 2 women; mean age, 84 years) with neurological deficit in the supine and prone (surgical) positions to accurately estimate the necessity of decompression during surgery. Results: The spinal narrowing was 50% or higher in the supine position, but was less than 40% in the prone position in two patients (fracture at the T11 and L1 vertebrae), indicating that decompression was not necessary. Decompression was required in one patient (fracture at the L2 vertebra) with a high narrowing rate of 57% in the supine position and 56% in the prone position. Conclusion: Diagnostic imaging in the supine position alone will not help estimate the severity of intraoperative spinal cord or cauda equina compression because the degree of vertebral instability varies in each patient with OVF.
[ABSTRACT]   Full text not available  [PDF]
  264 35 -
Concepts in the Management of Syringomyelia
Abhidha Shah, Abhinandan Patil, Shashi Ranjan, Atul Goel
July-September 2018, 5(3):120-127
Objective: The authors analyze their experience with syringomyelia. The treatment was focused on identification of the primary etiological factor and its treatment. Methods: Depending on the etiological factors and treatment considerations the series was classified into three groups. Group 1 had cases where there was no definite demonstrable etiological factor. Group 2 cases had basilar invagination and/or Chiari malformation, and Group 3 consisted of cases where the syrinx was secondary to an obvious aetiology, such as a mass lesion either in the posterior cranial fossa or in the spine or a severe kyphotic spinal deformity. Post-traumatic syringomyelia and syrinx in association with spina bifida were not studied. There is a significant subgroup where no cause is identified when evaluated by conventional radiological parameters. However, atlantoaxial dislocation was identified when assessed by Goel classification of facetal alignment. Results: In general, in Group 1 (or in idiopathic group), atlantoaxial instability was identified and was accordingly treated. In Group II, atlantoaxial instability was considered to be defining phenomenon. Accordingly atlantoaxial fixation was the treatment. In Group III the treatment was focused on the etiological factor. It was identified that direct syrinx drainage was not only not useful, but was harmful. It was observed that clinical outcome rather than radiological improvement is the reliable indicator of the surgical result. Conclusion: Syringomyelia is ‘never’ a primary pathological event but is secondary to a known or unknown (or unidentified) pathology. Treatment of the primary etiology is the goal in management of this condition
[ABSTRACT]   Full text not available  [PDF]
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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]
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Concurrent miller fisher syndrome variant in ossification of posterior longitudinal ligament
Alexander Cahyadi, Arwinder Singh, PS Ramani, Sudhendoo Babhulkar, Sumeet Pawar, Amrita Shenoy
January-March 2014, 1(1):32-34
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.
[ABSTRACT]   Full text not available  [PDF]
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Old and neglected odontoid fracture with C1-C2 dislocation: An approach
Ankit Arunbhai Desai, Adarsh Trivedi, BL Chandrakar, Ritesh Soni
January-March 2015, 2(1):27-29
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.
[ABSTRACT]   Full text not available  [PDF]
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