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  Citation statistics : Table of Contents
   2017| April-June  | Volume 4 | Issue 2  
    Online since September 2, 2020

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A Rare Case of Dumbbell-shaped Spinal Epidural Capillary Hemangioma

April-June 2017, 4(2):83-86
Study design: A case report and literature review. Summary of background data: Hemangiomas are frequently considered as hamartomatous congenital vascular malformations. Hemangiomas of the spine are usually lesions of the vertebral bodies, but they can occur at other locations, such as the intramedullary or epidural space. Purely epidural hemangiomas are rare and most of them are of cavernous type. Materials and methods: This is a case report of a 70-year-old male with a D6, D7 dumbbell-shaped capillary hemangioma with extraforaminal extension on the left side. Patient underwent D6-8 laminectomy and en bloc resection of the lesion. Results: Microscopic evaluation showed a fibrofatty tissue with a proliferation of small-sized vascular structures with areas of myxoid appearance. To date, there have been nine epidural capillary hemangiomas of the thoracic and lumbar spine reported in the literature. Conclusion: It is important to consider hemangiomas in the differential diagnosis of epidural lesions with dumbbell-shaped appearance in the magnetic resonance imaging study, especially at the thoracic level. These benign lesions usually present as a progressive myelopathy, so early treatment may prevent permanent neurological deficits and result in complete cure.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Lumbar intramedullary abscess and thoracic syrinx secondary to congenital dermal sinus: A rare case of paraplegia

April-June 2017, 4(2):87-88
Congenital dermal sinus (CDS) results from the failure of neuroectoderm separation from the cutaneous ectoderm during the process of neurulation. Although cutaneous markers are frequently associated with CDS, these patients seek medical attention only after an infectious or neurological complication. Common infections secondary to dermal sinus include meningitis and abscess in subcutaneous, extradural, or subdural region. Intramedullary spinal cord abscess (ISCA) in children is an extremely rare infection which may clinically resemble spinal cord neoplasm. We report a rare case of lumbar ISCA and thoracic syrinx secondary to CDS.
[ABSTRACT]   Full text not available  [PDF]
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Malignant nerve sheath tumor with retroperitoneal extension

April-June 2017, 4(2):89-92
Aim: To discuss a rare entity that was encountered along with its findings and outcome. Background: Malignant peripheral nerve sheath tumors (MPNSTs) are sarcomas which originate from peripheral nerves or from cells associated with the nerve sheath, such as Schwann cells, perineural cells, or fibroblasts. These are rare but aggressive neoplasms. The MPNST are frequently seen in the head, neck, and upper extremities. Retroperitoneal cases are fairly rare and clinically difficult to be detected. These tumors have a very aggressive clinical course. The MPNSTs can arise de novo or from malignant transformation of benign nerve sheath tumors. The clinical course is usually short. In most cases, the diagnosis depends on the pathologic and immunohistochemical studies. Case report: Here we report the case of a 42-year-old male patient who presented with swelling over lower back region and paresthesia over anterior aspect of left thigh since last 2 years, which aggravated over last 1 month. It was of pins-and-needle sensation type. Radiologically, the tumor was found extended from retroperitoneum into the spinal canal through the intervertebral foramina of D12–L1 and L1–L2 and compressing dura and its contents. Patient was treated surgically and histopathological examination confirmed MPNSTs. Conclusion: The MPNSTs can arise de novo or from malignant transformation of benign nerve sheath tumors. The clinical course is usually short. In most cases, the diagnosis depends on the pathologic and immunohistochemical studies.
[ABSTRACT]   Full text not available  [PDF]
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A walk to remember

April-June 2017, 4(2):76-78
We present a rare case of thoracic congenital dermal sinus associated with an extramedullary dermoid cyst in an 18-monthold female child, who presented with a 3-month history of motor weakness of both the lower extremities. Magnetic resonance imaging of spine showed an extramedullary dermoid cyst extending from the lower border of T2 to upper border of T5, which was connected with the skin dimple along the sinus tract. Total excision of the dermoid cyst and the sinus tract with T2–T5 laminectomy resulted in excellent functional recovery without any neurological and chemical meningitis.
[ABSTRACT]   Full text not available  [PDF]
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Artificial cervical disk replacement at three levels following multilevel cervical diskectomy

April-June 2017, 4(2):79-82
Cervical disk prolapse is a common ailment in young people and has generally been treated by anterior cervical diskectomy and fusion. This has caused restricted movement of the neck at the level of fusion along with adjacent segment changes over a period of time. With the advent of artificial disk, motion preserving techniques are being used for young people with active lifestyles with excellent outcomes. Artificial disk replacement at single level has been used by many surgeons after cervical diskectomy, however, a three level cervical disk replacement or cervical disk arthroplasty surgery has rarely been performed. We report a 46-year-old patient with symptomatic three level cervical disk prolapse treated with anterior cervical diskectomy followed by artificial disk replacement at all three levels as a motion preserving surgery.
[ABSTRACT]   Full text not available  [PDF]
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JKBC Parthiban
April-June 2017, 4(2):0-0
Full text not available  [PDF]
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The great neurosurgeon and spine surgery

April-June 2017, 4(2):93-94
Full text not available  [PDF]
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A case of atlantoaxial dislocation surgically fixated with laminar craw hooks, spinous plates, and occipital plate system
Gen Kusaka, Masasru Kanda, Motoi Shoda, Masashi Ikota, Natsumi Soma, Toshiyuki Tsuji, Mutsumi Nagai, Yuichi Tanaka
April-June 2017, 4(2):47-49
Although cervical screw fixation is often demonstrated as biomechanical outstanding instrumentation for the case of upper cervical instability, only few reports have presented the complicated technique and high risk in the surgery. In this article, we show a case of atlantoaxial dislocation successfully fixated without any cervical screws.
[ABSTRACT]   Full text not available  [PDF]
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Idiopathic scoliosis: Anterior approach and fixation from the concavity
Alejandro A Reyes-Sánchez, Carla L García-Ramos, Barón Z Kalfopulus, Armando Alpizar-Aguirre, Luis M R Olivares
April-June 2017, 4(2):50-54
Surgical treatment of idiopathic scoliosis is recommended in curves of 45°, requiring reduction and transpedicular fixation. In 2007, we published our experience in the management of scoliosis using four screws in the construct base, two compression screws at the convexity apex, two cross-links and proximal hooks and sublaminar wires, and we reported satisfactory results. Since 2008, we used pedicle screw in the curve with better correction, balance, and rate of arthrodesis consolidation than the technique we performed before; however, this increased the cost, making the surgery inaccessible for our patients. This is the reason we use new constructions with a lower number of fused levels and with reduction in the number of implants to improve cost. The anterior approach with reduction and fixation has good clinical results and lower cost. We include patients with curves under 70° with the concavitynto the left, performing anterior approach, reduction, and fixation. Ten patients with a 5-year follow-up were without loss of reduction or pseudoarthrosis, conserving sagittal and coronal balance.
[ABSTRACT]   Full text not available  [PDF]
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Anthropometric study of cervical spine in adult Nepalese
Pankaj R Nepal, Suman Rijal, Janam Shrestha, Upendra P Devkota
April-June 2017, 4(2):55-59
Introduction: Anterior cervical discectomy with fusion (ACDF) and cervical corpectomies are commonly performed procedures in the neurosurgery and orthopedic units across the world. The size of the graft or prosthesis used is variable on individual basis. Also, geographical variations seem to play oneof the vital roles in determining the size of the cervical vertebral body and intervertebral disk dimensions. Objective: To study dimension of C3 to C7 vertebral body and C2/3 to C7/T1 intervertebral disk. Inclusion criteria: Nepalese nationality aged between 18 to 60 year old and those with normal cervical spine Magnetic resonance imaging. Exclusion criteria: Traumatic cervical spine and any pathological lesion, such as infection/tumor, destructing the normal morphology of cervical vertebra. Study design: Cross-sectional study. Sample size: Fifty-two cases. Sampling technique: Nonprobability consecutive sampling. Duration: Retrospective 1 year. Results and conclusion: There were a total of 52 patients, 33 female and 19 male. With increasing age of C5 to C7, anterior-posterior (AP) diameter increases significantly. No significant association in different gender was noted. However, vertical height was smaller and AP diameter was in-between the study done at Israel and the US. Thus, there seems to exist geographical variation in the dimension of the cervical spine and may possess a greater clinical impact. The dimensions of the cervical spine may need to be considered while designing the prosthesis used in ACDF for Nepalese population.
[ABSTRACT]   Full text not available  [PDF]
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Surgical technique of excision of lumbar intervertebral disk protrusion
S Kalyanaraman
April-June 2017, 4(2):65-71
Full text not available  [PDF]
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Percutaneous posterior fixation: A unique entity to minimize further damage to patient with traumatic spine
Kaushal R Patel, Jayprakash V Modi, Kirtan V Tankshali
April-June 2017, 4(2):60-64
Introduction: Percutaneous posterior fixation is a novel and unique modality to fix traumatic spine injury. Conventionally, traumatic spine injury severe enough to consider for fixation is approached by open method. However, this method is disadvantageous as there occurs further trauma to the surrounding soft tissue while approaching spine for fixation. Percutaneous technique, on the contrary, offers stable fixation as conventional method and also offers added advantage of minimal soft tissue damage. Study design: This is an original prospective cohort study of 35 patients having traumatic spine injury operated by percutaneous posterior fixation. Aims and objectives: To compare the midterm results of percutaneous posterior fixation vs conventional (open) posterior fixation and to evaluate the role of percutaneous posterior fixation as damage control surgery (DCS). Materials and methods: This is a prospective cohort study of 35 patients operated at a single center from January 2012 to January 2014 with 2 years of follow-up.
  • Inclusion criteria:
– Patients having traumatic thoracic or lumbar spine injury between level T10 and L3 – Age >18 years – Polytrauma patients having associated spine injury – Patients having normal neurology – Patients having A1, A2, or A3 type of injury according to AO classification
  • Exclusion criteria:
– Patients having neurological deficit – A4 type of injury Results: As observed in our study, traumatic spine injury is more common in middle-aged male patients. Percutaneous fixation provides definitive advantage over conventional method of posterior fixation in terms of decreased intraoperative blood loss, decreased postoperative pain, earlier mobilization of the patients, reduced duration of hospital stay, less complications, and better functional outcome as measured by visual analog scale (VAS) score, Oswestry disability index (ODI) score, and SF-36 score, modified MacNab's criteria. JOSS Postoperatively, all the patients had either excellent or good outcome as measured by MacNab's criteria. Conclusion: Midterm results of percutaneous fixation are equivalent to conventional method with added advantage of reduced risk of infection as observed in our study. Percutaneous fixation has more to it rather than only DCS, however, its role in replacing conventional method requires proper surgeon training, steep learning curve, long-term studies and critical evaluation.
[ABSTRACT]   Full text not available  [PDF]
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Outcome of short same-segment fixation in thoracolumbar junction fractures

April-June 2017, 4(2):72-75
Background: Short same-segment posterior fixation (SSPF) minimizes the number of vertebral levels involved in fixation of a spine fracture. Short same-segment posterior fixation with pedicle fixation at the level of the fracture suggests biomechanical advantages toward maintenance of kyphosis correction, reducing failure rates with the aim of improving spinal motion and early rehabilitation.[1],[2],[3],[4] Materials and methods: All patients with thoracolumbar junction fractures included in our study were evaluated between 2014 and 2016 with biomechanical criteria and clinical outcome. The immediate postoperative radiographs were compared with radiographs of each follow-up, evaluating any loss of correction by measuring kyphotic angle using Cobb's method, also at each follow-up, clinical outcome was measured using Oswestry disability index. The intraobserver and interobserver reliability were analyzed. Results: There were 35 patients with unstable thoracolumbar fractures in our study who were operated using posterior spinal fixation system during 2014 to 2016 with pedicle screw insertion at the level of the fractured vertebrae. The average follow-up was 18 months. The average preoperative kyphotic angle as measured by Cobb's method in all the cases was 17.2°, which improved to 5.9°, achieving a mean of 65% correction immediately postoperatively. At final follow-up, average postoperative Cobb's angle was 7.7°, maintaining 55% correction at final follow-up. Disability improved from 78% mean preoperatively to 47.27% mean postoperatively at final follow-up. Conclusion: Short same-segment posterior fixation decreases implantation failure rate and has better biomechanical stability compared with traditional SSPF; however, long-term kyphosis correction to a greater extent was not maintained, which was also statistically insignificant. Despite this loss of kyphosis correction, clinical pain and disability improved at long-term follow-up.
[ABSTRACT]   Full text not available  [PDF]
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