Volume 4 | Issue 1 | April 2023 – September 2023 | page: 32-34 | Ankitkumar A. Desai
Authors: Ankitkumar A. Desai 
 Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.
Address of Correspondence
Dr. Ankitkumar A. Desai,
Consultant Spine Surgeon, Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.
Letter to Editor
Henceforth, nowadays demonstrated poor interpreter reliability of imaging interpretation between surgeons of various specialties and radiologists for a variety of pathologic conditions. Particularly in spine surgeons’ practice Discrepancies in radiologic interpretations can lead to diagnostic frustration and difficulty in formulating treatment plans. Moreover, the third-party payee (insurance party) only relies on documented radiology reports rather than surgeons’ independent interpretation of imaging studies (and never reviews the actual images without clinical findings), which can impact insurance authorization for surgery or reimbursement. Ultimately, conflicting Radiological interpretations may negatively impact patient care. The purpose of my letter to the editor and running research design was to evaluate the rate and degree to which radiologists and spine surgeons differ in interpreting magnetic resonance imaging (MRI) studies in the setting of cervical and lumbar spinal stenosis.
Assessment of The MRI:
Magnetic resonance imaging (MRI) is the standard mode of investigation in spine pathology. Stenosis is a disability triggered by a cord or sac compression because of degenerative spine structure changes with its adjacent structure changes. Compression correlates poorly with Quantifiable language and words used for describing compressive pathology in reports aren’t standardized. MRI  is the tool for assessing the extent of cord or sac compromise or injury  and typical features include cord or sac compression, altered cord or signals or MRI myelogram in the lumbar spine, canal stenosis, and altered spinal balancing. Despite an investigation, no standard MRI characteristics consistently representing disease severity in canal stenosis have been found , cord or sac compression is considered a stamp of authority, and its extent correlates poorly with severity. This may be due to the dynamic component of injury mechanics being untraceable by MRI protocol.  or Mechanical stress is the cause of biological differences. Asymptomatic individuals can have a significant cord or sac compression [4, 5]. At present, quantitative measurements such as ‘Spinal Cord Occupation Ratio’, “Maximum spinal cord compression “, ‘Transverse Area’, ‘Compression Ratio’, and ‘Maximum Canal Compromise’ have been used regularly with description. Although their opinions and use of such words, to quantify or qualify the compression are just to provide an objective to the measurements of the cord or sac compression. Standardized terminology exists to describe disc pathology which is a good verse by us, for radiologists aren’t! The nomenclature used by radiologists to report cord or sac compromise impact on clinical management gives the surgeon a drive to extend the surgical plan. I think I will plan to do research with aims to 1) identify terminology used for cord or sac compression 2) compare it 3) From asymptomatic cord compression to symptomatic stenotic features are they able to distinguish between them and 4) Rule out either a language or qualifiers influences spine surgeons opinions.
Do Qualitative or Quantitative Features Identify Spinal Compression Levels?
Maximum Canal Compromise (MCC), Maximum Spinal Cord Compression’ (MSCC) ; ‘Spinal Cord Occupation Ratio ‘(SCOR) (3), and ‘Compression Ratio’ (CR) this four are measurements used to calculate compression based on MRI records I found. These represent the visible compromise and good clinical significance . Greater cord compromise is indicated by a larger MCC, MSCC or SCOR, or smaller CR. Quantitative vocabulary used to understand spinal cord or sac compression are: ‘Compress’, and ‘Indent’. ‘Abut’, ‘Flatten’, ‘Touch’, ‘Mould’, ‘Compromise’, ‘Contact’, ‘Displace’ ‘Distort’ ‘Encroach’ ……. Qualifier Term Greater, Just, Lesser Degree, Mild, Mild-Moderate, Minimal, Minor ….maximum numbers of MRI shows the canal diameter as a sign of canal stenosis. Which are non-compared to Slandered deviation and which vary from patient to patient according to their age, sex, height, weight from which demographic region they belong, etc…Many variable terms are used in MRI reporting of spinal cord involvement, with the overlap in their quantitative features. For example, the term ‘Compressed’ = greater quantifiable compromise meaning is inconsistent. Neither qualitative nor quantitative measures of cord or sac involvement correlated with clinical symptoms, despite it generating referral to spinal surgeons. Some relationships are present between radiological reporting of spinal MRI; findings of the clinician by examination clinicians which generate the requirement for MRI to diagnose canal stenosis although the stage of disease and severity can not be specified. Qualitative versus quantitative descriptors are debatable for a longer period for various conditions [8-9]. However, terms chosen by radiologist has no clear guideline or individual meaning. Clinical decision-making depends on radiological reports & their finds. Research shows Radiologist and their reports are better judges that the majority of clinicians . All to gather, research shows suggests that radiologists’ choice of language may have unintended effects on patient care. This is consistent with our findings suggesting that language choice may influence non-expert clinicians’ decisions about whether to refer patients with canal stenosis. The degree of radiological compromise correlates poorly with disease severity. Patients with cord or sac compression may not suffer from UMN or LMN disease respectively.  and some patients suffer UMN or LMN diseases without visualized compression due to dynamic injury . Henceforth As the ratio of GP (general physician) to spine specialist is very high in India .They are reliable enough to treat basic family diseases but due to this large gap patients has been already undergone an expensive investigation in the form of an MRI and also informed about the report which was made by radiologist .Hence for the very first consultation the spine surgeon force to see the MRI and not to be evaluated as per the standard protocol and go forward accordingly for the patient profile, this also creates misunderstanding between the GP and Spine Specialist in Indian Scenario. Treating any canal stenosis patient is the work of “BHIM” from “MAHABHARATA” rather than “ARJUNA” who sees a tunnel vision rather than a broad spectrum view.
As Matter of fact, MR imaging cannot currently replace the clinical assessment and vice versa but, notably, interpretation of MRI reports by non-expert clinicians may contribute to false reassurances and variable care. To prevent confusion for non-expert clinicians, descriptive terminology could be removed from reporting and replaced by statements of consistency (or non-consistency) with canal stenosis but further investigation is needed to confirm the value of such an approach. There are, of course, limitations to the conclusions with a lack of data from various centers, and patterns of language likely differ across individual centers, different cities, and countries. Nowadays endoscopy spine is the new sunrise in the world of spine surgery which gives different stories and different tale in a different part of the world, some research article shows that patient underwent endoscopy spine surgery goes for a follow-up MRI after a year shows no signs of surgery, I don’t know how things are going to turn in the future.
That disagreements in MRI interpretation between orthopedic spine surgeons and radiologists occur often. The discrepancies were often with some fold, with spine surgeons rating pathology as more severe. why do I hypothesize that? This is due to the spine surgeons also having clinical data, physical examination, and its interpretation and differentials in their mind while interpreting imaging studies. Insurance companies should not only rely on MR imaging and radiologist interpretation but should also be given equal importance to clinicians and clinical findings. I do agree and pushing a thought that doing better research for this problem by doing collaboration of spine surgeon and radiologist, so we can have better reporting of MRI and radiologist can also took in some clinical inputs from surgeons respectively with their expertise.
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9. Fehlings MG, Rao SC, Tator CH, Skaf G, Arnold P, Benzel E, et al. The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: Results of a multicenter study. Spine (Phila Pa 1976). 1999. March 15;24(6):605–13.
10. Bosmans JML, Weyler JJ, De Schepper AM, Parizel PM. The Radiology Report as Seen by Radiologists and Referring Clinicians: Results of the COVER and ROVER Surveys. Radiology. 2011. April 1;259(1):184–95.
11. Witiw CD, Mathieu F, Nouri A, Fehlings MG. Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy. Glob Spine J. 2017. December 18;219256821774551.
|How to Cite this Article: Desai AA | Discrepancies Between Radiologist and Spine Surgeon Interpretations of Cervical and Lumbar Stenosis| Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 32-34 |
Volume 4 | Issue 1 | April 2023 – September 2023 | page: 28-31 | Meet Shah, Ashok Rathod, Punith K, Rohan Killekar, Kunal Bharadwaj
Authors: Meet Shah, Ashok Rathod, Punith K, Rohan Killekar, Kunal Bharadwaj
 Department of Orthopaedics, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Meet Shah,
Department of Orthopaedics, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India.
Introduction: Tuberculosis is one of the leading causes of mortality worldwide due to a single infectious agent. Koch’s spine or spinal tuberculosis is one of the most crippling manifestations of extra-pulmonary tuberculosis. Owing to the lack of image-guided biopsy centers and the high prevalence of the disease, most of the patients are diagnosed and treated on clinical grounds. This practice was thought to lead to a delay in the diagnosis of other pathologies and multi-drug-resistant tuberculosis. This study aims to compare the diagnostic yield of fluoroscopy (C-arm) guided transpedicular biopsy done by orthopaedicians v/s CT guided biopsy done by radiologists in cases of Koch’s spine.
Materials and Methods: The study involved 60 consented patients with a clinico-radiological diagnosis of Koch’s spine randomly divided into 2 groups for biopsy 1) CT-guided biopsy to be done by radiologists 2) C-arm guided biopsy to be done by orthopedicians and results were compared.
Results: The use of CT-guided biopsy and C-arm guided biopsy in the diagnosis of Koch’s spine is increasing taking into consideration of increasing MDR TB. We got a positive answer in 70% of cases via CT-guided biopsy and 53.33% via C-arm guided biopsy. Detection of MDR TB on GeneXpert was the commonest diagnostic feature with a comparatively low rate of positive AFB smear and histopathology.
Conclusion: Results of C-arm guided biopsy are similar to CT guided biopsy with the latter being better.
Keywords: Koch’s spine, biopsy, multi-drug resistant tuberculosis
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|How to Cite this Article: Shah M, Rathod A, Punith K, Killekar R, Bharadwaj K | A Comparative Study About Diagnostic Yield of Fluoroscopy Guided Transpedicular Biopsy Done by Orthopaedicians v/s CT Guided Biopsy Done by Radiologists in Cases of Koch’s Spine| Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 28-31 | https://doi.org/10.13107/bbj.2023.v04i01.057
Volume 4 | Issue 1 | April 2023 – September 2023 | page: 24-27 | Muluem O.K, Bissou M, Fonkoue L, Ndongmoui N.G, Chifen U, Haman N.O, Djientcheu V.P
Authors: Muluem O.K , Tsiagadigui J.G , Fonkoue L , Ndongmoui N.G , Chifen U , Haman N.O , Djientcheu V.P 
 Department of Orthopaedics, General Hospital, Yaounde, Cameroon.
 Department of Medicine and Biomedical Sciences, Yaounde, Cameroon.
Address of Correspondence
Dr. Muluem Olivier Kennedy,
Department of Orthopaedics, General Hospital, Yaounde, Cameroon.
Motor Cervical spine injuries during the practice of judo rarely occur. When they occur, they can be responsible for serious injuries such as fractures, dislocations and sprains. The objective of our work was to evaluate the factors favoring the occurrence of these lesions, the diagnostic approach, the emergency management and the medium-term prognosis in two Cameroonian judokas.
Keywords: Cervical spine, Injury, Judo, Risk factor, Prognosis
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|How to Cite this Article: Muluem OK, Bissou M, Fonkoue L, Ndongmoui NG, Chifen U, Haman NO, Djientcheu VP | Cervical Spine Trauma in Cameroonian Judokas: Risk Factors and Prognosis in Two Cases in Yaounde| Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 24-27 | https://doi.org/10.13107/bbj.2023.v04i01.056
Volume 4 | Issue 1 | April 2023 – September 2023 | page: 20-23 | Meeta Agarwala, Hitesh N Modi, Deep J. Patel
Authors: Meeta Agarwala , Hitesh N Modi , Deep J. Patel 
 Department of Anaesthesia, Zydus Hospitals, Ahmedabad, Gujarat, India.
 Department of Spine Surgery, Zydus hospital, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Meeta Agarwala,
Department of Anaesthesia, Zydus Hospitals, Ahmedabad, Gujarat, India.
Background & Aims: Motor evoked potentials (MEP) have been widely used as intraoperative neuromonitoring in patients undergoing spine surgery to prevent neurological complications. The present study aims to show the significance of 6% desflurane as an effective agent in maintaining anaesthesia at a minimum alveolar concentration (MAC) of 0.8–1.0 in patients undergoing spine surgery with neuromonitoring.
Methods: This retrospective, cohort, single-centre study was conducted between 2016 and 2018. Patients who underwent spinal surgery along with intraoperative neuromonitoring were included. Anaesthesia was given with weight adjusted intravenous propofol (2-3 mg/kg) and maintained with Oxygen and air with inhalation desflurane (6%) with MAC of 0.8-1.0 and Bispectral index of 40-60. The data of MEP signals were collected at baseline, after instrumentation, decompression, and closure. The MEP data were correlated using Spearman correlation test and Wilcoxon rank test with minimum alveolar concentration, mean arterial pressure, temperature and bispectral index at different time intervals. P value <0.05 was considered statistically significant.
Results: A total of 37 patients (26 females and 11 males) were included in the study with the mean of 52.46±12.85 years. There was no statistically significant correlation between the variables at different time intervals. Although, a statistically significant negative correlation was observed between bispectral index and latency after decompression (p=0.006). A significant difference was observed in visual analogue scale and Oswestry disability index before and after procedure (p< 0.001).
Conclusion: Anaesthesia with 6% desflurane in 0.8-1.0 MAC does not alter MEP signals in patients undergoing spinal surgery without any complication and with adequate recovery rate from anaesthesia.
Keywords: Anaesthesia, Desflurane, Motor evoked potentials, Propofol
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|How to Cite this Article: Agarwala MS, Modi HN, Patel DJ Desflurane | as an Effective Anaesthetic Agent for Intra- Operative Neuro-Monitoring in Spine Surgeries| Back Bone: The Spine Journal | April 2023- September 2023; 4(1): 20-23 | https://doi.org/10.13107/bbj.2023.v04i01.055
Volume 4 | Issue 1 | April 2023 – September 2023 | page: 14-19 | Ankitkumar A. Desai, Siddharth Patel, Kamlesh Jain, Keyur Buddhdev, Shubhdeepsingh Chugh
Authors: Ankitkumar A. Desai , Siddharth Patel , Kamlesh Jain , Keyur Buddhdev , Shubhdeepsingh Chugh 
 Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.
Address of Correspondence
Dr. Ankitkumar Arunbhai Desai,
Consultant Spine Surgeon, Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.
Introduction: In resource limited Hospital in rural and urban city where microscopes are not readily available, I hypothesize that if properly used, good magnifying loupes could offer comparable results to the microscope in relieving rediculpathy which is the primary goal of discectomy.
Material and Methods: Prospective cohort study was conducted on 49 single level lumbar disc prolapsed patients with ridiculer leg pain between January 2017 and March 2021. The microscope was used in 15 patients (29.9%) and loupe in 34 cases (70.1%). Pre-operative assessment clinical examination with spine assessment. Surgical indications included failure of at least 6 weeks medical , physio treatment, pain or progressive neurological deficits. Micro lumbar discectomy was done in all patients. Per-and post operative parameters recorded included: length of the incision, operative time, blood loss, the presence of a wound drain, length of hospital stay, leg and back pain before discharge and in follow up visits and complications. visual analogue scale (VAS) used as a tool.
Results: The demographic, clinical characteristic , radiological characteristics and surgical technique were similar and comparable (p>0.05). The mean length of the incision was 2.5 cm for the microscope group and 3 to 3.5 cm for the loupes group (P value =0.0007).There wasn’t any statistically significant difference in both groups as regard the blood loss (p=1), complication rate and length of hospital stay (p=0.21). There wasn’t any statistically significant difference in VAS score for leg pain (p=0.32) and low back pain (p=0.46). Radicular pain recurred in equal proportion in both groups (p=0.17). 13 (86.2%) in the microscope and 32 (92.6%) in the loupe group had a 3 months post-operative VAS of zero (p=0.32).
Conclusion: Operative microscope and loupes are both justifiable alternative device in lumbar micro discectomy since both have similar and comparable outcome. In rural n urban city hospitals with less resources & less access to microscopes and other minimally invasive equipment such as the endoscope, MLD system or tubular with proven safety and effectiveness over macro disectomy , loupes are safe and effective tools for in lumbar discectomy. Operating Microscopes is more surgeon friendly as it’s gives good viewing angle without or less Work-related Musculoskeletal Disorders (WMSD).
Keywords: Microdiscectomy, Loupe, Microscope, Work-related Musculoskeletal Disorders (WMSD) Rapid Upper Limb Assessment (RULA).
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|How to Cite this Article: Desai AA, Patel S, Jain K, Buddhdev K, Chugh S Prospective | Cohort Study for Discectomy for Herniated Lumbar Disc in Resource Limited Hopital in Rural and Urban City : Loupe Vs Microscope | Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 14-19 | https://doi.org/10.13107/bbj.2023.v04i01.054
Volume 4 | Issue 1 | April 2023 – September 2023 | page: 01-03 | Hitesh N. Modi
Authors: Hitesh N. Modi 
 Department of Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd, Thaltej, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Spine Surgeon, Department of Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd, Thaltej, Ahmedabad, Gujarat, India.
Competition is rapidly increasing across all specialties in the field of medicine due to increase in the number of doctors as well as developing technological and marketing changes. It is mandatory to develop and sustain the advantage of surgical skill in particular specialty for the long-term to take advantage of the experience and skills. Fierce competition in turn decreases the overall practice if we do not sustain the competitive advantage which we have in the beginning. It is imperative that we develop sustained competitive advantage to sustain and grow our professional journey for the long-term. In this article we have focussed on how to develop a sustained competitive advantage in the field of spine surgery which can be also applied to other surgical or medical specialties like the other business industries.
Keywords: Medical Profession, Fierce competition, Sustained competitive advantage, Grow professional competence.
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|How to Cite this Article: Modi HN | Developing Sustained Competitive Advantages in Spine Practice| Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 01-03 | https://doi.org/10.13107/bbj.2023.v04i01.051