Fusion with stabilization for the treatment of post-operative Lumbar spondylodiscitis: Our experience
Volume 3 | Issue 2 | October 2022-March 2023 | page: 84-89 | Md. Anowarul Islam, Wayez Mahbub, Suvradev Saha, Afia Ibnat Islam
DOI: https://doi.org/10.13107/bbj.2022.v03i02.045
Authors: Md. Anowarul Islam [1], Wayez Mahbub [1], Suvradev Saha [1], Afia Ibnat Islam [2]
[1] Department of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
[2] Department of Spine Surgery, Holy Family & Red Crecent Medical College & Hospital, Dhaka, Bangladesh.
Address of Correspondence
Dr. Md. Anowarul Islam ,
Professor of Spine Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
E-mail: maislam.spine@gmail.com
Abstract
Objective: To analyse the outcome of fusion with stabilization for the treatment of postoperative lumbar spondylodiscitis.
Background: Post-operative spondylodiscitis is a dreadful complication following disc surgery. Treatment option is either conservative or operative, but till date, there are no universally accepted treatment protocol. Many studies suggest early surgical intervention provides good outcome. Different mode of surgical interventions can be applied for its treatment like debridement only, debridement followed by fusion with or without stabilization. In this study, we treat all of our patients having post-operative spondylodiscitis by fusion with stabilization.
Materials & methods: Retrospectively we reviewed 20 cases from January 2016 to July 2021 in Bangabandhu Sheikh Mujib Medical University and other private hospitals of Dhaka, Bangladesh. Post-operative spondylodiscitis was diagnosed according to history, specific clinical findings, laboratory and radiographic investigations. Surgery was the treatment of choice in our cases. Pre and postoperative evaluations were done by the Visual Analog scale (VAS), Nurick score for neurological outcome, Modified Kirkaldy–Willis criteria for functional outcome and Modified Lee’s criteria for fusion assessment.
Results: Total number of patients was 20. Mean age was 48 years (range 22-83). Average follow-up period was 12 months. The period between the surgery and the onset of symptoms was 14 to 28 days. Pre-operative VAS score was 8.10±1.7 and post-operatively was 1.7±0.6 at the last follow-up (P< 0.001). Pre & post-operative Nurick score was 2.7 & 0.7. Functional outcome was assessed in our study by Modified Kirkaldy-Willis criteria which shows 90% patient have satisfactory outcome while 10% have unsatisfactory outcome. Modified Lee’s criteria show definitive fusion in 55%, probable fusion in 35% & possible pseudarthrosis in 10% cases.
Conclusion: Early diagnosis and proper management are the keys to successful outcome of postoperative spondylodiscitis. Surgical management in the form of fusion and transpedicular fixation can give excellent results.
Keywords: Sondylodiscitis, Fusion, Stabilizationp
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| How to Cite this Article: Islam MA, Mahbub W, Saha S, Islam AI | Fusion with stabilization for the treatment of postoperative Lumbar spondylodiscitis: Our experience | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 84-89. https://doi.org/10.13107/bbj.2022.v03i02.045 |
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.
A Case Report of Aspergillus Fungal Spinal Infection in Immunocompetent Patient and Review of Literature
Volume 3 | Issue 2 | October 2022-March 2023 | page: 113-118 | Udit D. Patel, Hitesh N. Modi
DOI: https://doi.org/10.13107/bbj.2022.v03i02.049
Authors: Udit D. Patel [1], Hitesh N. Modi [1]
[1] Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Thaltej, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India.
E-mail: modispine@gmail.com
Abstract
Background: Spinal aspergillus infection is rare but can cause significant morbidity and mortality. Sometime it may mis-diagnosed as pyogenic or tuberculous infection in immunocompetent patients. Therefore, it causes delay in diagnosis and leads to spinal instability, neurological deficit, and sometimes death.
Case Report: Here we discussed a case of 68 years old female patient with severe back pain and difficulty in walking which was gradually increased over the period of time of two months. During this, she was diagnosed as koch’s spine based on MRI report and she had been started on empirical anti-tuberculous medication. But her condition was deteriorated. After that patient underwent surgical management and infected tissue sent for culture and sensitivity and histopathological examination. The report was positive for aspergillus fungal infection. she was started with anti-fungal medication and course of treatment was uneventful.
Conclusion: Early diagnosis of spinal fungal infection is often delayed in immunocompetent patients and it lead to delayed in anti-fungal management which lead to increase in morbidity and mortality.
Keywords: Aspergillus, Spinal fungal infection, Case Report
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| How to Cite this Article: Patel UD, Modi HN | A Case Report of Aspergillus Fungal Spinal Infection in Immunocompetent Patient and Review of Literature | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 113-118. https://doi.org/10.13107/bbj.2022.v03i02.049 |
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Patient and Parent’s Knowledge, Emotion and Expectation Evaluation in Conservatively Treated Adolescent Idiopathic Scoliosis: A Prospective Randomized Study in 200 Children by a Simple Questionnaire
Volume 3 | Issue 2 | October 2022-March 2023 | page: 96-108 | Hitesh N. Modi, Seung-Woo Suh, Jae-Young Hong, Jae-Hyuk Yang
DOI: https://doi.org/10.13107/bbj.2022.v03i02.047
Authors: Hitesh N. Modi [1, 2], Seung-Woo Suh [1], Jae-Young Hong [1], Jae-Hyuk Yang [1]
[1] Scoliosis Research Institute, Department of Orthopaedics, Korea University Guro Hospital, Seoul, South Korea.
[2] Department of Orthopaedics, Zydus Hospital and Healthcare Research Pvt Ltd, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr Seung-Woo Suh,
Scoliosis Research Institute, Department of Orthopaedics, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul, South Korea.
E-mail: spine@korea.ac.kr
Abstract
Objectives: To find out if any disparity of the knowledge regarding the scoliosis, treatment, psychological status and treatment satisfaction between different groups of children based on age, follow-up or treatment modality (bracing or observation) and, between patients and their parents.
Summary of Background Data. There are numerous questionnaires available in scoliosis which specifically measures either operative outcome or bracing outcomes in terms of general appearance, psychological appearance or pain scores. There is no questionnaire available that evaluate the overall general knowledge, their psychological status regarding the treatment, knowledge regarding future such as progression of curve, marriage, pregnancy and health status as well as their expectations and choices from the treatment in conservatively treated AIS patients.
Methods: Study was conducted in 200 children with adolescent idiopathic scoliosis (AIS) with age between 10 and 16 years. All 30 questions were divided into four subgroups to evaluate 1) General knowledge (Q 1-9); 2) Emotional and psychological status (Q 10-16); 3) Treatment knowledge (Q 17-25); and 4) Treatment satisfaction (Q 26-30). Results were evaluated based on treatment modality (bracing or observation); duration of follow-up (less than or more than 12 months), and age (less than or more than 13 years), and also between patients and parents.
Results: General knowledge remains the same (p>0.05) in all subgroups, while treatment knowledge was higher in parents (p<0.0001) and in patients with follow-up more than 12 months (p=0.0009) while age of patients didn’t show any difference (p=0.083). Psychological disturbances were found more in parents (p=0.046), and patients with longer follow-up (p=0.001) and higher age (p=0.002). Similarly, parents (p<0.0001), and patients with follow-up more than 12 months (0.011) and age more than 13 years (p=0.009) had higher treatment dissatisfaction. However, the treatment modality (bracing or observation) didn’t exhibit any difference (p>0.05) in any questionnaire.
Conclusion: We evaluated general and treatment knowledge, psychological and mental status and treatment satisfaction from a single and simple questionnaire in conservatively treated AIS subjects, which would provide useful information to handle the different issues involved with the disease.
Keywords: Adolescent idiopathic scoliosis, Conservative treatment, Questionnaire, Evaluation.
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| How to Cite this Article: Modi HN, Suh SW, Hong JY, Yang JH | Patient and Parent’s Knowledge, Emotion and Expectation Evaluation in Conservatively Treated Adolescent Idiopathic Scoliosis: A Prospective Randomized Study in 200 Children by a Simple Questionnaire | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 96-108. https://doi.org/10.13107/bbj.2022.v03i02.047 |
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Gorham Stout Disease- A Rare Disorder with Ambiguous Recommendations: A Systematic Review of literature.
Volume 3 | Issue 2 | October 2022-March 2023 | page: 65-77 | Ajay Krishnan, Preethesh Agrawal, Vatsal Parmar, Vikrant Chauhan, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan, Shiv Kumar Bali, Prartham C Amin, Pranav R Charde, Preety A Krishnan, Mirant R Dave, Bharat R Dave
DOI: https://doi.org/10.13107/bbj.2022.v03i02.043
Authors: Ajay Krishnan [1], Preethesh Agrawal [1], Vatsal Parmar [1], Vikrant Chauhan [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan [1], Shiv Kumar Bali [1], Prartham C Amin [1], Pranav R Charde [1], Preety A Krishnan [2], Mirant R Dave [1], Bharat R Dave [1]
[1] Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
[2] Department of Radiology, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Ajay Krishnan,
Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
E-mail: drajaykrishnan@gmail.com
Abstract
Background: Vanishing bone disease / Gorham-Stout disease (GSD) is a condition that produces deformity and instability of bone. The fibro lympho-vascular tissue replaces the bone leading to massive osteolysis and its sequelae, but the exact cause is yet unknown. The disease involves the spine infrequently, but due to the proximity of the spinal cord it can seriously affect the patient. The aim of this study is to report as a review to contribute to the diagnosis, and treatment modalities in GSD affection of spine with the reported literature available from 1983 till March 2022.
Materials & Method: This metanalysis study is focused on GSD involving the spine. The search was done in two databases PubMed and Google scholar from 1983 up to March 2022. The Study selection was done to study the demographic pattern of GSD in spine and its outcome with conservative and surgical treatment and to determine the best suitable medical treatment for stopping disease progression and achieving remission.
Results: We retrieved 72 articles from Google scholar and PubMed out of which 5 articles were excluded (90 reported cases). Heffez criteria was followed for diagnosis in all these cases (n=86, 95.5%). 57 patients (64%) were operated and 33 patients (36%) were managed conservatively. Per-operative failure to achieve a fixation/reconstruction were reported in 2 (2.53%) cases. Number of surgeries till follow-up were average 1.70+ 1.23 (1-5) surgeries. The average follow-up of cases reported was 47.1+ 48.9 (3-240 months). Union was documented in 10 cases (3.4%). 9 of these cases needed additional bone graft/substitute. Bisphosphonates(n=40), sirolimus (n=5), interferon (n=17), radiotherapy (n= 31) and beta-blockers (n=4) were given in medications. 23 patients had remission. Death occurred in 17 patients (18.88%).
Conclusion: Surgery is needed frequently. Failure of fixations, achieving union and remission are daunting and ’off label” therapies are the dictum. Radiotherapy has been used more frequently with or without bisphosphonates. Though promising medical treatment are evolving and focus of treatment is directed towards anti-angiogenic, anti-osteolytic and anabolic therapy, but no standard treatment recommendations can be made out from existing literature.
Keywords: Vanishing bone disease, Gorham stout, Osteolysis, Spine, Deformity, Sirolimus, TNF
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| How to Cite this Article: Krishnan A, Agrawal P, Parmar V, Chauhan V, Degulmadi D, Mayi S, Ranjan R, Bali SK, Amin PC, Charde PR, Krishnan PA, Dave MR, Dave BR | Gorham Stout Disease- A Rare Disorder with Ambiguous Recommendations: A Systematic Review of literature | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 65-77. https://doi.org/10.13107/bbj.2022.v03i02.043 |
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Application of Intra Operative Ultrasound in Spine Surgery
Volume 3 | Issue 2 | October 2022-March 2023 | page: 51-54 | Rakeshkumar C. Luhana, Jinil N. Doshi
DOI: https://doi.org/10.13107/bbj.2022.v03i02.041
Authors: Rakeshkumar C. Luhana [1], Jinil N. Doshi [1]
[1] Department of Spine Surgery, Venus Superspeciality Hospital, Vadodara, Gujarat, India.
Address of Correspondence
Dr. Rakeshkumar Luhana,
Department of Spine Surgery, Venus Superspeciality Hospital, Vadodara, Gujarat, India.
E-mail:rcluhana@gmail.com
Abstract
Objective: Intraoperative ultrasound is a real time imaging modality. Though was introduced in 1980s, not widely used. It is applicable for Intradural lesions as well as pathology ventral to cord, while doing posterior approach and helps us to make surgery safer. Our objective is to share technique as well as our experience of intra operative ultrasound by sharing illustrative cases.
Method: our Surgical cases were reviewed and identified cases where we used intraoperative ultrasound. Illustrative cases were selected and compiled.
Results: This article describes technique of intra operative ultrasound and several illustrative cases were demonstrated.
Conclusion: Intraoperative ultrasound is a real time imaging tool and can be used for various indications especially for intradural lesions and addressing ventral pathology from posterior routes.
Keywords: Intra operative ultrasound, Real time imaging, Intra operative adjunct
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| How to Cite this Article: Luhana R, Doshi J | Application of Intra Operative Ultrasound in Spine Surgery | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 51-54. https://doi.org/10.13107/bbj.2022.v03i02.041 |
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A Prospective Study to Find Out the Association between Supine Lying Low Back Pain and Retrolisthesis
Volume 3 | Issue 1 | April-September 2022 | page: 42-46 | Bharat R. Dave, Shivanand C. Mayi, Ajay Krishnan, Ramneesh Kohli, Devanand Degulmadi, Ravi Ranjan Rai, Mirant B. Dave
DOI: https://doi.org/10.13107/bbj.2022.v03i01.039
Authors: Bharat R. Dave [1], Shivanand C. Mayi [1], Ajay Krishnan [1], Ramneesh Kohli [1], Devanand Degulmadi [1], Ravi Ranjan Rai [1], Mirant B. Dave [1]
[1] Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakali, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Shivanand C. Mayi,
Consultant Spine Surgeon, Stavya Spine Hospital & Research Institute, Mithakali, Ahmedabad, Gujarat, India.
E-mail: drshivanandmayi@gmail.com
Abstract
Objectives: The objectives of this study was to test the primary hypothesis that “retrolisthesis causes supine lying low back pain (LBP).”
Methods: Patients with history of chronic back pain (>12 weeks) who presented to the hospital outpatient department were evaluated. Patients with history of supine lying exaggeration of symptoms were specifically asked for duration, for which they can comfortably lie in supine position. Retrolisthesis in this study was measured on MRI mid sagittal image by measuring the slip percent. Slip percent of more than 8% was labeled as retrolisthesis. Statistical analysis was done using SPSS software.
Results: Average age of the study population was 41.46 ± 10.82 years. All the study participants had the history of supine lying LBP for 50 ± 54.51 weeks. About 94.78% (n = 115) of the study subjects had retrolisthesis on MRI. About 46.08% (n = 115) were house wives. L5-S1 was the most commonly involved level, three patients had no instability, and three patients had anterolisthesis. Duration of time up to which the patients can lie down in supine position was not statistically significant when analyzed with the VAS values for supine lying LBP and the slip percent.
Conclusion: The presence of supine lying LBP in an individual should be strongly considered for the underlying subtle instability at the lumbar intervertebral segments and diagnostic evaluation should be performed to rule out retrolisthesis.
Keywords: Retrolisthesis, Low back pain, supine lying, Lumbar instability, Vertebral slippage, Lateral stenosis, Dynamic radiograph.
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| How to Cite this Article: Dave BR, Mayi SC, Krishnan A, Kohli R, Degulmadi D, Rai RR, Dave MB | A Prospective Study to Find Out the Association Between Supine Lying Low Back Pain and Retrolisthesis | Back Bone: The Spine Journal | April-September 2022; 3(1): 42-46. https://doi.org/10.13107/bbj.2022.v03i01.039 |
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