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   2016| April-June  | Volume 3 | Issue 2  
    Online since August 25, 2020

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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]
  325 40 -
Unique case of glass piece injury to cervical spinal cord: A very rare presentation
Rajendran Selvan, R Ramkumar, S Subikshavarthni
April-June 2016, 3(2):63-65
Foreign bodies inside the cervical spinal canal causing injury to spinal cord are seen very rarely. Very few cases of glass fragments in the cervical spinal canal were reported till date. In this report, a 17-year-old boy, who was accidentally injured by a glass piece, which penetrated into the cervical spinal cord, was operated upon and, he recovered dramatically. This case report is to emphasize the morbidity caused by small foreign bodies accidentally introduced by trivial injuries.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  253 36 1
Clinical methods of spinal-level localization in lumbar and lumbosacral spine surgeries through posterior approach
Deepak K Jha, Pranjal Pandey, Mukul Jain, Arvind Arya, Suman Kushwaha, Rima Kumari
April-June 2016, 3(2):34-39
Aims: Clinical methods of palpations of iliac crests and spinous processes for spinal-level localization (SLL) were evaluated for accuracy in lumbar and lumbosacral (LS) spinal surgeries through the posterior approach. Materials and methods: Hundred and seven successive patients operated for lumbar and LS diseases operated through the posterior approach in the last 2 years were evaluated prospectively for the accuracy of clinical methods for SLL. There were 76 males and 31 females. Age ranged from 16 to 70 years (average 43.5 years). Clinical methods for SLL included palpation of iliac crests and spinal processes in correlation with midline sagittal MR images. Surgical incision and further surgery were undertaken after confirmation of spinal level by intraoperative lateral radiograph of LS spine. Accuracy of SLL by clinical methods and surgical findings at various spinal levels was observed. Results: Spinous processes for SLL were accurate in 94.39% (n = 101) cases. The level of iliac crests were seen at or just below L3 and L4 spinous processes in 89.71% (n = 96) and 10.29% (n = 11) cases respectively. Various anatomical features like posterior surfaces of laminae, thecal sac, and positions of roots in the spinal canal were helpful in differentiating L5 to S1 level than levels above. Six errors in SLL in the study included five females with L4 to L5 prolapsed inter-vertebral disk (PIVD) and one male with L5 to S1 PIVD. Conclusion: Spinal-level localization by clinical methods in correlation with MR images is unreliable especially in women and L4 to 5 level. Intraoperative findings of L5 to S1 interspace and S1 lamina show features that may help in SLL during surgery.
[ABSTRACT]   Full text not available  [PDF]
  223 44 -
A case of recurrent cervical spondylolisthesis following cervical laminoplasty
Hiroshi Nomura, Yoshikazu Yanagisawa, Junichi Arima
April-June 2016, 3(2):55-58
We report a case of recurrent cervical spondylolisthesis following cervical laminoplasty. A 77-year-old woman with progressive quadriplegia due to cervical spondylotic myelopathy (CSM) without spondylolisthesis was treated with C3 to 5 French-door laminoplasty. At 15 months postoperatively, anterior slippage of the C4 vertebral body in flexion was prominent. At 20 months postoperatively, slippage had worsened, and C4 to 5 posterior fixation with a lateral mass screw and rod system was performed. At 8 months after C4 to 5 fixation, anterior slippage of the C3 and C5 vertebral bodies was noted, and occipitocervical–upper thoracic posterior fusion was performed. In this case, after laminoplasty, atrophy of the cervical extensor muscles progressed in a time-dependent manner. Therefore, we suggest that progressive atrophy of the cervical extensor muscles might cause isolated neck extensor myopathy with flexible dropped head syndrome, leading to recurrent cervical spondylolisthesis.
[ABSTRACT]   Full text not available  [PDF]
  217 47 -
Victor horsley and spinal surgery
Shanthanam S Mahalingam
April-June 2016, 3(2):68-69
The pioneer of neurological surgery in an era when no radiological investigation was available including X-ray, Sir Victor Horsley has earned recognition as the father of neurosurgery. His intellect, interest, and concern for humanity has earned him the knighthood. His association with Sir William Gowers was very appreciable, which helped in the introduction and progress of spinal surgery. The birth and growth of spinal surgery by Sir Victor Horsley and his contributions are briefly discussed in this article.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  221 37 1
Conservative management in cervical spinal epidural hematoma – A new treatment paradigm: Critical review
Vinu V Gopal, PK Balakrishnan
April-June 2016, 3(2):44-47
Spinal epidural hematomas are rare, and their posttraumatic etiology is still rare. Patients' symptomatology varies from clinically silent to dense neurological deficits. Pathogenesis of progression is unclear. They usually involve multiple spinal segments. Review of the literature showed that early surgical intervention is associated with excellent outcome in patients with significant deficits. Such cases usually require long segment surgical decompression. We present a rare case review of posttraumatic long segment anterior cervical epidural hematoma with significant neurological deficit, which was managed conservatively because the patient was not willing to have any surgical intervention. The patient improved gradually with better functional outcome. Our case shows that conservative treatment may be considered as an alternate management option in the treatment of anterior spinal epidural hematomas, thus avoiding long segment decompressive laminectomy. The mechanism of spontaneous resolution of spinal epidural hematoma is also discussed with a review of the literature.
[ABSTRACT]   Full text not available  [PDF]
  214 40 -
A report on the early results of the bacjac interspinous distraction device: A prospective study in patients with lumbar spinal stenosis
Sriram H Srinivasan, Martyn Newey
April-June 2016, 3(2):40-43
Aims: This is a report on the early clinical outcome of the BacJac interspinous distraction device in patients with lumbar spinal stenosis. Materials and methods: This is a prospective study on a group of patients who underwent surgery from February 2010 to December 2012. There were 21 consecutive patients who had insertion of a BacJac. Data prospectively recorded included Visual Analogue Scores for leg pain (VL), back pain (VB), the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and walking distance (WD). Scores were recorded pre- and postoperatively and at final review. The follow-up period varied from 6 to 40 months. Results: We found all clinical outcome measures improved following surgery. Mean scores for VL improved from 76 to 27, for VB from 49 to 24, and for ODI from 42 to 26 at final follow-up. There were also improvements noted in ZCQ scores and patient-reported WD. We also noted a high rate of osteolysis (76%) around the implant at 1 year from insertion. Conclusion: This small prospective study suggests that there is a role for the use of the BacJac interspinous distraction devices in selected patients. Osteolysis around the implant remains an issue although this did not appear to compromise the early outcome in this study.
[ABSTRACT]   Full text not available  [PDF]
  215 37 -
Atlantoaxial fixation–anterior or posterior approach: Critical review
Vinu V Gopal
April-June 2016, 3(2):51-54
Atlantoaxial facet joints have been proposed as the center of mobility and also center for instability of the atlantoaxial region. Because of the high mobility of the atlantoaxial (C1-C2) motion segment, fusion rates at this level have been substantially lower than those at the subaxial spine. The success of craniovertebral junction surgery depends on adequate reduction, decompression of craniovertebral (CV) junction followed by immediate fixation of atlantoaxial joint followed by bone grafting with compression for solid bony fusion. Current options for atlantoaxial fixation include anterior or posterior approaches. The biomechanical stability and fusion rates of posterior fixation surgery had been proved beyond doubt. The main disadvantages of posterior surgery involve disruption of posterior ligamentous complex which are essential for stability. C2 root denervation also aggravates the paraspinal muscle atrophy leading to instability So now advances in spinal surgery made neurosurgeons to think of an anterior technique which can establish fusion and fixation at the same time avoiding the above mentioned complications. The advantages are that there are no anatomical constraints like posterior approach in reaching C1-C2 joint. The risk of neuralgia, bleeding from venous plexus is avoided along with practically no damage to vertebral artery. Newer techniques of anterior transarticular screw and bilateral atlantoaxial fixation and fusion through unilateral right sided retropharyngeal approach had been described in literature. Anterior approach still needs further randomized controlled trials for level 1 evidence, Further research on along with biomechanical feasibility using anatomical ex vivo and in vivo constructs need to be done to further validate the appropriateness and safety of anterior approach for C1-C2 fixation and fusion.
[ABSTRACT]   Full text not available  [PDF]
  214 38 -
Epidermoid cyst of the thoracic spine: A rare case
Nilesh Jain, Sharadendu Narayan, Harshad Patil, Abhishek Songara
April-June 2016, 3(2):59-62
Intraspinal epidermoid cyst is a rare tumor. The incidence in adults is lesser than 1% and in children lesser than 3%. Epidermoid cyst is predominantly seen at the dorsal spinal level. A large percentage of epidermoid cysts are intradural extramedullary. Intramedullary epidermal cysts are rarer, with about 70 cases reported in the literature. These may be congenital or acquired with known association with spinal dysraphism. We hereby report a case of thoracic epidermoid cyst in a 22-year-old male with an extramedullary exophytic component and intramedullary cyst with accompanying split cord malformation at the level of lesion.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  210 35 1
Postoperative meningocele spurious
Abhishek Songara, Harshad Patil
April-June 2016, 3(2):72-73
Lumbar meningocele spurious is a rare complication after lumbar spine surgeries. This results following a breach in the dural-arachnoid layer and extradural encapsulated cerebrospinal fluid collection. On review of the literature, less than 60 cases have been reported so far. Diagnosis of meningocele spurious is confirmed by magnetic resonance imaging. Herein, the authors have described a case of meningocele spurious after lumbar spine surgery and its management.
[ABSTRACT]   Full text not available  [PDF]
  196 34 -
Presence of undiagnosed cervical myelopathy in patients referred for surgical evaluation of lumbar stenosis
Gopalakrishnan Balamurali, Vishal C Gala, Jean-Marc Voyadzis, David Rosen, Apazra Burks, Laurie Rice, Richard G Fessler
April-June 2016, 3(2):29-33
Introduction: Lumbar stenosis is a common clinical entity, i.e., being diagnosed with increasing frequency in our aging population in the United States. The process of spondylitic degeneration that causes lumbar stenosis may also give rise to concurrent cervical stenosis, resulting in so-called tandem stenosis. Symptomatic tandem spinal stenosis is characterized clinically by a combination of claudication and progressive gait disturbance with signs of mixed myelopathy and polyradiculopathy in both the upper and lower extremities. Materials and methods: A retrospective review of 361 patients, referred to our clinic for evaluation of lumbar stenosis over a period of 4 years, was conducted. Data collection consisted of detailed chart review and tabulation of the duration of symptoms, course of nonsurgical therapy, sensory and motor deficits, gait/ balance disturbances, upper motor neuron signs, and diagnostic imaging studies. Patients with signs and symptoms suggestive of cervical spondylitic myelopathy underwent confirmatory diagnostic imaging studies. Results: Twenty-one of the 361 patients (5.8%) were found to have symptomatic tandem stenosis with clear clinical evidence of cervical myelopathy. Twelve of the 21 patients underwent cervical decompression; of these four underwent cervical decompression followed by lumbar decompression, and one patient underwent cervical decompression followed by thoracic decompression. Eight of the 21 patients underwent lumbar decompression only. One patient underwent lumbar decompression followed by cervical decompression. Conclusion: The possibility of concurrent disease in both the cervical and lumbar spines reinforces the need for a thorough history and physical examination. Recognition and diagnosis of tandem stenosis is critical in determining the correct surgical sequencing and technique for treatment as spinal cord compression from cervical stenosis has significant associated morbidity and mortality. The 5.8% rate of tandem stenosis in this series places it in the lower end of the range from previous reports. Furthermore, only 3% of all patients referred for surgical evaluation of lumbar stenosis were ultimately found to have cervical stenosis requiring surgical decompression.
[ABSTRACT]   Full text not available  [PDF]
  192 34 -
J K B C Parthiban
April-June 2016, 3(2):0-0
Full text not available  [PDF]
  184 36 -
Dysphagia caused by anterior cervical osteophytes at C2-C3: Unusual location and presentation
G Murugesan
April-June 2016, 3(2):70-71
Anterior cervical osteophytes are common in old age due to degenerative process; it is usually asymptomatic in elderly people. Due to mechanical compressions, few patients may present with multiple complications, such as dysphagia, dysarthria, and dyspnea. The osteophytes commonly involve lower cervical spine and usually present with neurological symptoms. This case is unusual as it presented with C2-C3 osteophyte with dysphagia, which was completely relieved by excision.
[ABSTRACT]   Full text not available  [PDF]
  187 28 -
The great neurosurgeon and spinal surgery
Anil Kumar Peethambaran, Thomas Varghese
April-June 2016, 3(2):66-67
Full text not available  [PDF]
  174 29 -