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   2014| January-March  | Volume 1 | Issue 1  
    Online since August 24, 2020

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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]
  261 48 -
Recurrent hemangioendothelioma of the spine
Singh Arwinder Gill, Alexander Cahyadi, Sudhendoo Babhulkar, Sumeet Pawar, PS Ramani
January-March 2014, 1(1):28-31
Introduction: Hemangioendotheliomas are vascular neoplasms that rarely involve the neuraxis. Case report: A 50-year-old male patient complaining of severe pain and weakness on both his legs. Patient had history of spinal tumor operation 13 years ago. On examination, patient showed tenderness on his back and no localizing signs. Investigations: X-ray and 3D reconstructive CT scan of the dorsal spine showed involvement of D11 and L1 with collapsed D12. MRI showed kyphosis deformity and significant cord compression. Treatment: Preoperative embolization was performed followed by transthoracic removal of the tumor and D12 vertebral body which was followed interbody vertebral cage. A second surgery was undertaken to further excise the tumor and stabilize the spine. Results: Patient was relieved of his symptoms and neurological deficit postoperatively. Conclusion: A rare case of spinal hemangioendothelioma was treated with embolization and two step surgery requiring stabilization.
[ABSTRACT]   Full text not available  [PDF]
  241 42 -
Alveolar soft part sarcoma presenting as cauda equina syndrome
Rakesh Gupta, Akshat Kayal
January-March 2014, 1(1):41-45
Background: Alveolar soft-part sarcoma (ASPS) is a rare soft tissue sarcoma often affecting adolescents and young adults. Though the tumor has as indolent clinical course, the ultimate prognosis is poor characterized by late metastasis. Histopathological evaluation is the crucial to a correct diagnosis. Case report: A 30-year-old Indian woman presented with paraplegia and a persistent mass over the back. A thorough histological examination alongside imaging techniques shaped a reliable diagnosis. Conclusion: Alveolar soft tissue sarcoma of the spine is a rare tumor and a very high index of suspicion is required to make an early diagnosis and achievement of complete microscopic resection is critical for successful outcome.
[ABSTRACT]   Full text not available  [PDF]
  234 37 -
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]
  229 29 1
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]
  220 38 -
A rare complication of cirrhosis: Hepatic myelopathy
Sofiene Bouali, Adenane Boubaker, Asma Bouhoula, Jalel Kallel, Aoiuj Lassaad, Hafedh Jemel
January-March 2014, 1(1):49-51
Introduction: Hepatic myelopathy is characterized by spastic paraparesis and minimal sensory abnormalities in patients with cirrhosis, particularly those with portosystemic shunts that have been created surgically or have occurred spontaneously. Materials and methods: We described a patient who presented with spastic paraparesis and diagnosed as hepatic myelopathy when all the other possible diagnoses were ruled out with a review of literature in the goal of promoting prompt recognition and enhancing understanding of HM. Results: We reported a patient aged 51 years who presented with spastic paraparesis with insidious onset and progressive course and diagnosed as hepatic myelopathy. Conclusion: Unlike hepatic encephalopathy, hepatic myelopathy is usually considered irreversible.
[ABSTRACT]   Full text not available  [PDF]
  219 30 -
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]
  218 28 2
Dilemma in the surgical management of lumbar canal stenosis
PS Ramani, Sumeet Pawar, Sudhendoo Babhulkar
January-March 2014, 1(1):1-11
For a long time wide decompressive laminectomy, direct visualization and decompression of affected nerve roots, foraminotomy and when necessary discectomy had remained the gold standard to operate patients with lumbar canal stenosis. There was confusion in the literature concerning the role of fusion even in the presence of instability in degenerative lumbar canal stenosis due to absence of prospective randomized clinical trials. This has led to uncertainty about the correct choice of surgical strategy as no evidence based recommendations on the role of instrumented PLIF in older patients. Such thoughts have compelled some to try minimally invasive instrumentation with micro decompression, transforaminal interbody fusion and percutaneous pedicle screws. It has the advantage of short incision, less morbidity, shortened bed rest and early ambulation which is so essential in older patients with comorbid conditions. In this study we discuss the pathogenesis of development of spinal conditions and their treatment options through the history of spinal surgery. Also discussed is the dilemma that exists in spinal surgeons regarding the selection of appropriate treatment strategy for stenosis amongst the elderly.
[ABSTRACT]   Full text not available  [PDF]
  203 32 -
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]
  192 41 1
Reliability of the column theory to evaluate thoracolumbar spinal instability
Tarek Aly, El-Sayed
January-March 2014, 1(1):25-27
The concept of spinal instability is still evolving. Instability is mechanical terms means decreased stiffness of the functional spinal unit, increased mobility, or abnormal motion, and alterations in spinal mechanics place the neurological structures at risk. The column theory was used to evaluate the spinal instability. Aim: in this study, we try to correlate the column theory of the spine with the preoperative and postoperative clinical and radiological findings. Patients and methods: One hundred and twenty-two patients with unstable thoracolumbar or lumbar spine treated surgically were studied. The patients were classified according to their pathogenesis into three groups (trauma, 75 patients, tumor, 30 patients and infection, 17 patients, groups). All patients were also classified according to the three column theory. Detailed radiographic analysis of the vertebra (e) involved was done at admission, at mobilization, and at follow-up. Neurologic assessment was performed using modified Frankel grading scale. Results: The results of this study did not support the column theory for evaluation of spinal instability. Comparing each group separately does not reveal any significant relationship between the number of the columns involved and radiographic or neurologic findings either before or after surgery. Conclusion: Spine instability concept is still dilemma and evolving matter. More research is required for better understanding of the nature of the spine and its loading characters.
[ABSTRACT]   Full text not available  [PDF]
  200 29 -
JKBC Parthiban
January-March 2014, 1(1):0-0
Full text not available  [PDF]
  182 47 -
Progressive quadriplegia from kyposis in pediatric patient after laminectomy for cervical intramedullary tumor excision: Case report and literature review in short
Hossain Forhad Chowdhury, Mohammod Raziul Haque, Khandkar Ali Kawsar, A FM Momtazul Haque
January-March 2014, 1(1):35-38
Cervical spinal deformities with progressive neurological deficit after laminectomy is relatively uncommon. But, it can happen more commonly after resection of intramedullary spinal cord lesions than other spinal lesion. Postlaminectomy cervical spinal deformity is most common in children with an immature skeletal system. Many factors such as the extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, postoperative radiation therapy, etc. can precipitate such deformities. We report a pediatric patient with who underwent successful complete removal of long segment cervical intramedullary spinal tumor. Postoperatively he developed progressive kyphosis in cervical spine with progressive neurological deficit. We went for second operation (anterior cervical spinal cord decompression by two segments corpectomy followed by iliac crest strut graft fusion and stabilization). Postoperatively patient recovered well. He had loss of cervical spinal lordosis with mild kyphosis before first operation. Such a case report in the literature is relatively uncommon. Here, we also go for short review of literature on this topic.
[ABSTRACT]   Full text not available  [PDF]
  184 22 -
Establishment of simulation surgical training lab in spinal surgery
Suryapratap Singh Tomar, Mohammad Akheel
January-March 2014, 1(1):52-52
Full text not available  [PDF]
  156 27 -