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ORIGINAL ARTICLES
Accuracy and safety of free-hand pedicle screw placement in cervical injury patients
Sanjeeb Rijal, Sarvdeep Singh Dhatt, Vishal Kumar, Deepak Neradi, Mahesh Prakash
January-March 2022, 9(1):20-24
DOI:10.4103/joss.joss_4_20  
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.
  1,859 63 -
CASE REPORTS
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
DOI:10.4103/joss.joss_5_20  
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.
  1,289 61 -
EDITORIAL
Adjacent corticocancellous bone graft in anterior cervical interbody fusion: A technical note
J K B C Parthiban
July-September 2016, 3(3):75-78
DOI:10.5005/jp-journals-10039-1095  
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]
  748 81 -
TECHNICAL NOTE
Endoscopic decompression for lumbar spinal canal stenosis: A technical note
Kangtaek Lim, Jayesh Sardhara
January-March 2022, 9(1):40-46
DOI:10.4103/joss.joss_37_21  
Laminectomy and fusion were surgical options to decompress neural structures and provide more space for the spinal cord in a stenosis patient with severe leg pain and progressive neurologic signs, such as numbness and weakness. The evolution of endoscopic spinal surgery techniques has created advantages for patients who require a laminectomy. The authors present a unique technique for endoscopic access to the central and lateral recess pathology as a minimally invasive procedure, which provides a good visualization. We performed two cases of endoscopic spinal surgery for single-level and consecutive three-level lumbar spinal canal stenosis using an 8 mm outer diameter, 5.5 mm working channel, 10° angled lens spinal endoscopic system (percutaneous stenoscopic lumbar decompression, MaxMore Spine Company, Unterföhring, Germany). Optimized endoscopic drills, forceps, and Kerrison punch were used to remove bony pathology and ligamentum flavum under direct endoscopic visualization. The first case had a narrow canal space in the L4/L5 segment with severe numbness at the same dermatome and did not respond with adequate conventional treatment. The second case had three-level canal stenosis with severe back pain and leg weakness. The purpose of this paper is to describe the technique, the efficacy, and feasibility of unilateral endoscopic laminectomy and bilateral decompression via posterior approach in lumbar spinal canal stenosis. Moreover, in this article, we present the technical details on endoscopic procedures and the prevention of complications and management during operation for spinal canal stenosis.
  771 44 -
REVIEW ARTICLE
Current concepts in the management of type II odontoid fractures
Premanand S Ramani
July-September 2017, 4(3):104-112
DOI:10.5005/jp-journals-10039-1140  
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]
  652 64 -
EDITORíS NOTE
From the desk of editor in chief
J K B C Parthiban
April-June 2022, 9(2):69-69
DOI:10.4103/joss.joss_24_22  
  586 58 -
EDITORIAL
Does cervical laminoplasty cause postoperative kyphosis?
Sachin Anil Borkar
April-June 2022, 9(2):70-72
DOI:10.4103/joss.joss_15_22  
  581 61 -
RESEARCH ARTICLES
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
DOI:10.5005/jp-journals-10039-1024  
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]
  512 98 -
REVIEW ARTICLE
Piriformis Syndrome and Variants – A Comprehensive Review on Diagnosis and Treatment
Anil Pande, Rathipriya Annan Gopinath, Sheena Ali, R Adithyan, Senguttuvan Pandian, Siddhartha Ghosh
October-December 2021, 8(4):7-14
DOI:10.4103/joss.joss_19_21  
Piriformis syndrome (PS) is an entrapment neuropathy caused by the compression of the sciatic nerve by the piriformis muscle (PM). PS pain is described as deep, aching type with tingling and numbness, radiating from the gluteal and perineal area down to the lower limb. Rarely, this nondisc sciatica can present with associated pudendal neuralgia due to added pudendal nerve (PN) Type 1 entrapment. Women are much more likely to develop PS than men. The diagnosis is difficult in the past due to the lack of standardized diagnostic tests. Cases can present with symptoms attributable to PS. They report sciatica, paraesthesia, numbness, and episodic sharp pain in the perineal area, which is exacerbated on prolonged sitting, standing, and walking. Magnetic resonance imaging (MRI) scans of lumbosacral spine and lumbosacral plexus are usually normal. Their clinical symptoms can be misdiagnosed with urinary tract infection. The treatment with antibiotics has no effect on pain and paraesthesia. The urine cultures are negative, consultation with a neurosurgeon is requested due to associated sciatic pain. The compression of sciatic nerve and PN by PM is rare but possible. These symptoms can be misdiagnosed and mistreated. Nondisc sciatica is no longer a rarity with the easy availability of MRI for most patients with lumbago and sciatica. The awareness of possible association of Type 1 pudendal neuralgia with PS is necessary.
  536 38 -
ORIGINAL ARTICLES
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
DOI:10.5005/jp-journals-10039-1106  
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]
  486 81 1
CASE REPORTS
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
DOI:10.5005/jp-journals-10039-1077  
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]
  460 104 -
ORIGINAL ARTICLES
Anterior fixation of atlantoaxial joints: Technique and pitfalls
Sushil Patkar
April-June 2014, 1(2):60-68
DOI:10.5005/jp-journals-10039-1013  
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]
  459 95 1
REVIEW ARTICLES
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
DOI:10.5005/jp-journals-10039-1086  
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]
  485 67 -
CASE REPORTS
Sympathetic conjoined lumbosacral nerve root in kambin's triangle during transforaminal endoscopy
Prasad Patgaonkar, Kiran Dhole, Vaibhav Goyal, Nandan Marathe
January-March 2022, 9(1):62-64
DOI:10.4103/joss.joss_24_21  
Kambin's triangle is a safe corridor for transforaminal endoscopic approach as it is devoid of any neurovascular structure. We came across an interesting case where we encountered a large conjoined lumbosacral nerve root (CNR) in Kambin's triangle during transforaminal endoscopic spine surgery. Patient had intraoperative sympathetic shock which recovered after administering atropine. A 50-year-old female presented with low back pain with bilateral lower limb radiculopathy for 3 years. Magnetic resonance imaging revealed left L4-5 foraminal annular fissure. Radiculopathy was in L5 dermatomal pattern which was confirmed by diagnostic discography and lateral recess block. Left-sided L4-5 transforaminal endoscopic lumbar discectomy was done where we encountered a large CNR in safe zone of Kambin's triangle. Transforaminal endoscopic spine surgery done under monitored anesthesia care with patient in awake and aware state allows identification, diagnosis, and prevention of injury to anomalous neural structure in Kambin's triangle to avoid incidence of failed back syndrome.
  530 19 -
RESEARCH ARTICLE
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
DOI:10.5005/jp-journals-10039-1099  
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]
  464 79 -
ORIGINAL ARTICLE
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
DOI:10.5005/jp-journals-10039-1098  
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]
  465 75 1
ORIGINAL ARTICLES
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]
  452 84 -
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
DOI:10.5005/jp-journals-10039-1170  
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]
  458 78 -
REVIEW ARTICLES
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
DOI:10.5005/jp-journals-10039-1061  
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]
  454 77 1
CASE REPORTS
Split cord malformation type 2 complicated by presence of tuberculous arachnoiditis
Tarang Kamalkishore Vora, RR Ravi
April-June 2015, 2(2):55-57
DOI:10.5005/jp-journals-10039-1057  
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]
  422 90 -
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
DOI:10.5005/jp-journals-10039-1051  
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]
  428 84 -
ORIGINAL ARTICLES
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
DOI:10.5005/jp-journals-10039-1192  
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]
  439 71 -
Utility of the annular closure device in the treatment of degenerative disc disease: A Meta-Analysis with trial sequential analysis
Akshay Ganeshkumar, Priya Narwal, Manoj Phalak, Varidh Katiyar, Ravi Sharma, Sachin Anil Borkar, Shashank Sharad Kale
April-June 2022, 9(2):82-93
DOI:10.4103/joss.joss_35_21  
Lumbar degenerative disc disease is a common etiology of lower backache and resulting morbidity, severe disease can even result in neurological deficits. Recurrence occurs even after surgical treatment and results in poor prognosis, loss of productivity, and increased healthcare costs. Novel methods to tackle this based on countering plausible biomechanical reasons for recurrence have emerged including the recently investigated Annular Closure Device (ACD). Few RCTs and numerous comparative studies and post-hoc analyses have evaluated its safety, efficacy, and health economics; this review aims to provide an objective overview of the ACD. It was observed that ACD use was associated with significantly lower reoperations and re-herniations while having comparable or slightly higher complication rates and significantly saving direct and indirect costs. Leg pain and Back pain at follow-up were comparable between ACD and control groups. TSA objectively reveals the need for more data to ascertain ACD safety and efficacy. ACD usage has been shown to reduce re-herniations, reoperations while having comparable back pain and complication rates; thus having a positive health economics benefit. This should encourage more widespread adoption of ACD which would function to reduce the data gap.
  457 53 -
REFLECTION ARTICLE
My reflection as neuro- and spinal surgeon at 80 years
Premanand S Ramani
April-June 2018, 5(2):73-77
DOI:10.5005/jp-journals-10039-1174  
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]
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REVIEW ARTICLES
Concepts in the Management of Syringomyelia
Abhidha Shah, Abhinandan Patil, Shashi Ranjan, Atul Goel
July-September 2018, 5(3):120-127
DOI:10.5005/jp-journals-10039-1184  
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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