Paradigm Shift of Interspinous Device Surgery for Degenerative Lumbar Diseases
Volume 3 | Issue 1 | April-September 2022 | page: 04-06 | Jong-Beom Park
DOI: https://doi.org/10.13107/bbj.2022.v03i01.032
Authors: Jong-Beom Park [1]
[1] Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Address of Correspondence
Dr. Jong-Beom Park,
Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Korea.
E-mail: spinepjb@catholic.ac.kr
Guest Editorial
Instrumented fusion surgery is an effective surgery for severe degenerative lumbar diseases and can achieve satisfactory clinical outcomes with a high fusion rate. However, due to extensive nature and loss of segmental motion, instrumented fusion can cause complications and adjacent segment disease, and some patients require second surgery. On the contrary, decompression alone is an effective surgery for moderate degenerative lumbar diseases and can achieve satisfactory clinical outcomes. However, failed back surgery syndrome, such as recurrent lumbar disc herniation or spinal stenosis, can occur at the segment of prior surgery, and some patients also require second surgery. In clinical practice, there are indications for instrumented fusion surgery or decompression alone. However, for some cases, it is difficult to decide which surgery is appropriate for the patients; such a situation is called a grey zone (Fig. 1). Instrumented fusion surgery can be excessive, while decompression alone can involve segmental imbalance or problems postoperatively. Interspinous device surgery (ISD) can be considered for grey zone of degenerative lumbar diseases as new solution.
According to the traditional concepts, diseased lumbar segment with instability is a cause of low back pain and can require fusion. However, in clinical situations, fusion does not always correlate with successful outcomes. While about 10–20% of solid fusion patients complain of persistent low back pain, some non-union patients do not complain of low back pain. These results lead to questions and uncertainty regarding fusion surgery. First, it is unclear if lumbar instability is a cause of low back pain. Second, it must be determined if fusion surgery is necessary for lumbar instability. Recently, the biomechanical concept of the cause of low back pain has changed. Increased load transmission to facet joints and increased intradiscal pressure to the posterior part of a disc are considered important causes of low back pain. Therefore, spine surgeons view degenerative lumbar diseases differently, resulting in a paradigm shift in surgery of degenerative lumbar diseases.
ISD surgery is a dynamic stabilization surgery with an action mechanism of distraction of narrow interspinous space: ISD can widen the spinal canal and neural foramen to achieve indirect decompression of neural structures. In addition, ISD can restore normal lordosis and offset abnormal load shift of facet joints and increased intradiscal pressure to the posterior part of the disc to relieve low back pain. Based on the concept and action mechanism, good indications of ISD surgery are moderate lumbar spinal stenosis (Fig. 2), lumbar disc herniation (Fig. 3), and internal disc derangement (Fig. 4) associated with flexible extension instability or segmental imbalance, such as retrolisthesis or hyperlordosis, which can be reduced in flexion. In contrast, contraindications of ISD surgery are severe lumbar spinal stenosis, flexion instability, degenerative or isthmic spondylolisthesis, rigid extension instability of segmental imbalance that cannot be reduced in flexion, and multilevel degenerative lumbar scoliosis.
In our experiences of about 20 years with primary ISD surgery and revision surgery for failures of ISD surgery, the most common cause of failure of ISD surgery is inappropriate indication or patient selection. Another important cause of failure is incorrect surgical technique such as stand-alone use of ISD without decompression, excessive over-distraction (by over-sized ISD), and supraspinous ligament injury or spinous process fracture. These incorrect surgical techniques cause poor surgical outcomes and might require revision surgery. Based on these outcomes, the following advice is offered for successful ISD surgery for degenerative lumbar diseases. First, ISD surgery should be performed for patients with good indications. Second, ISD implantation should be performed after limited decompression including removal of a hypertrophied ligamentum flavum to preserve segmental stability (Fig. 5).
In our BMC Musculoskeletal Disorders Publication (Cho et al.) [1], we performed 15-year survivorship analysis of 94 patients with single-level lumbar disc herniation who underwent discectomy and DIAM implantation. We aimed to provide the longest follow-up evidence on the efficacy of DIAM implantation for single-level lumbar disc herniation. The results showed that 8.5% of the patients underwent reoperation at the DIAM implantation level during the 15-year follow-up. The mean time to reoperation was 6.5 years. Kaplan–Meier analysis showed a cumulative survival rate of the DIAM implant of 99% at 1 year, 97% at 5 years, 93% at 10 years, and 92% at 15 years after surgery. Our results showed that DIAM implantation significantly decreased reoperation rate for single-level lumbar disc herniation in 15-year survivorship analysis. This study provides the strongest evidence for the efficacy of DIAM implantation for the treatment of single-level lumbar disc herniation. In our view, this paper, coupled with our previous paper (Sur et al.) [2], settles the debate on the efficacy of DIAM implantation for the treatment of moderate lumbar spinal stenosis or lumbar herniation associated flexible extension instability or segmental imbalance.
References
1. Cho YJ, Park JB, Chang DG, Kim HJ. 15-year survivorship analysis of an interspinous device in surgery for single-level lumbar disc herniation. BMC Musculoskelet Disord 2021;22:1030.
2. Sur YJ, Kong JG, Park JB. Survivorship analysis of 150 consecutive patients with DIAM implantation for surgery of lumbar spinal stenosis and disc herniation. Eur Spine J 2011;20:280-8.
| How to Cite this Article: Park JB Paradigm Shift of Interspinous Device Surgery | for Degenerative Lumbar Diseases | Back Bone: The Spine Journal | April-September 2022; 3(1): 04-06. https://doi.org/10.13107/bbj.2022.v03i01.032
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Lemon Principle and Signaling Quality in Context with Spine Surgery
Volume 3 | Issue 1 | April-September 2022 | page: 01-03 | Hitesh N. Modi
DOI: https://doi.org/10.13107/bbj.2022.v03i01.031
Authors: Hitesh N. Modi [1]
[1] Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., SG Highway, Thaltej, Ahmedabad, Gujarat, India.
E-mail: modispine@gmail.com
Abstract
Medical specialty has been considered as a noble profession related with the service to mankind. However, consumer protection act considers it as a service industry with all its norms and rules applicable. If we consider spine surgery, the majority of patients as well as society advocating non-surgical treatment due to associated misbelieves and complexity of surgeries despite of its obvious benefits. The question arises how can we apply business principles to alleviate the hurdles in the spine surgeries and elevate the perception of the surgical treatment in the minds of the patients. Two famous noble prize-winning principles of business “Lemon principle” and “Signaling” would probably answer these. In this article, I have attempted to touch on these two principles in relation with spine surgeries and I am sure that such principles would help us in improving the health-care quality across all specialties.
Keywords: Medical service, consumer act, lemon principle, signaling, business.
References
1. Varian HR. Microeconomic Analysis. Vol. 3. New York: Norton; 1992.
2. Akerlof GA. Quality uncertainty and the market mechanism. Q J Econ 1970;84:488-500.
3. Spence M. Job market signaling. Q J Econ 1973;87:355-74.
4. Connelly BL, Hoskisson RE, Tihanyi L, Certo ST. Signaling theory: A review and assessment. J Manag 2010;37:39-67.
| How to Cite this Article: Modi HN | Lemon Principle and Signalling Quality in Context with Spine Surgery | Back Bone: The Spine Journal | April-September 2022; 3(1): 01-03. https://doi.org/10.13107/bbj.2022.v03i01.031
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Transforaminal Lumbar Interbody Fusion in Multilevel Lytic Listhesis – A Rare Case Report
Volume 2 | Issue 2 | October 2021-March 2022 | page: 102-104 | Tarak N. Patel, Sandeep A. Purane
DOI: 10.13107/bbj.2022.v02i02.030
Authors: Tarak N. Patel [1], Sandeep A. Purane [1]
[1] Department of Spine Surgery, Indospine Hospital, Navarangpura, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Tarak N. Patel,
Consultant Spine Sergeon, Indospine Hospital, Navarangpura, Ahmedabad Gujarat, India.
E-mail: drtarakpatel@gmail.com
Abstract
Spondylolisthesis is a spinal condition that affects the lower vertebrae (spinal bones). This disease causes one of the lower vertebrae to slip forward onto the bone directly beneath it. It is a painful condition but treatable in most cases. We have described an unusual case of multilevel lytic spondylolisthesis in a patient presenting with back pain and neurogenic claudication. The patient underwent an uneventful post-operative recovery. At a recent follow-up, 3 months after the surgery, the symptoms of the patient were significantly improved. The patient was ambulating without aid and did not complain of any leg symptoms.
Keywords: Spondylolisthesis, Vertebrae, Lytic spondylolisthesis, Spinal, Neurogenic, Claudication
References
1. Kilian H. Mannheim: Verlag Von Bosserman; 1854 (2016) Schilderungenneuerbecken formen und ihresverhaltens in lebened Randall RM, Silverstein M, Goodwin R. Review of Pediatric Spondylolysis and Spondylolisthesis. Sports Med Arthrosc Rev 24(4):184-187.
2. Newman PH (1955) Spondylolisthesis, its cause and effect. Ann R Coll Surg Engl 5:305–323.
3. Dandy DJ, Shanon MJ (1971). Lumbo-sacral subluxation (Group I spondylolisthesis) J Bone Joint Surg Br 53:578–595.
4. Ikata T, Miyake R, Katoh S, Morita T, Murase M (1996) Pathogenesis of sports-related spondylolisthesis in adolescents. The American Journal of Sports Medicine 24:94–98.
5. Schuller S, Charles YP, Steib JP (2011) Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J 5:713–719.
6. L’Heureux EA Jr, Perra JH, Pinto MR, Smith MD, Denis F, Lonstein JE (2003) Functional outcome analysis including preoperative and postoperative SF-36 for surgically treated adult isthmic spondylolisthesis. Spine 28:1269–1274.
7. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine 32:120–125.
| How to Cite this Article: Patel TN, Purane SA Transforaminal Lumbar Interbody | Fusion in Multilevel Lytic Listhesis – A Rare Case Report | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 102-104. |
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Periosteal Variety of Sacral Osteoid Osteoma Encroaching into the Spinal Canal – Treatment with a Tubular Retractor System: Case Report
Volume 2 | Issue 2 | October 2021-March 2022 | page: 89-92 | Ravish Patel, Shivam Shah, Naresh Kumar, Shammi Patel
DOI: 10.13107/bbj.2022.v02i02.028
Authors: Ravish Patel [1], Shivam Shah [1], Naresh Kumar [2], Shammi Patel [3]
[1] Department of Orthopaedic Surgery, Sunshine Global Hospital, Vadodara, Gujarat, India.
[2] Department of Orthopaedic Surgery, National University Hospital, Singapore.
[3] Department of Orthopaedic Surgery, Krupa Orthopaedic Hospital, Surat, Gujarat, India.
Address of Correspondence
Dr. Ravish Patel,
Consultant Spine Surgeon, Sunshine Global Hospital, Vadodara, Gujarat, India.
E-mail: ravishspine@gmail.com
Abstract
Background: Osteoid osteomas are benign primary bone tumors with a predilection for posterior elements of the spinal column. Complete surgical excision through a traditional open approach is the treatment of choice for patients not responding to non-steroidal anti-inflammatory medications and patients with contraindications for nidus ablation. The study aims to highlight an alternative minimally invasive technique for complete surgical excision of osteoid osteoma encroaching into the spinal canal.
Methods: We report a case of 22 years-old obese male suffering from left S1 radiculopathy and night pain. Magnetic resonance imaging and computed tomography (CT)-scan of the lumbosacral region revealed a benign bony lesion of size 13 mm × 11 mm × 8 mm encroaching from S1 lamina into the spinal canal and compressing left S1 root. Peri-lesional bony sclerosis and soft tissue edema were absent. In view of obesity and a small size of the lesion, it was decided to remove the lesion with a tubular retractor system under general anesthesia. Complete resection of the lesion was carried out sparing the L5-S1 facet, with a minimally invasive approach.
Results: Patient had complete symptomatic improvement after the surgery. Histopathology showed interconnected trabeculae of woven bone matrix rimmed by osteoclasts consistent with the diagnosis of osteoid osteoma. Post-operative CT scan showed that the nidus was removed completely and important structures such as facet, pedicle, and midline posterior ligament complex were preserved. The patient resumed his daily activities and remained symptoms-free at the end of 6 months of follow-up.
Conclusion: Minimally invasive surgery using a tubular retractor system can be safe and effective alternative to traditional open surgery for excision of osteoid osteoma from the posterior elements. Faster recovery, minimal tissue damage, and early return to work are added advantages for an obese patient undergoing minimally invasive total surgical excision.
Keywords: Benign bone tumors, Sacral spine, Osteoid osteoma, Periosteal osteoid osteoma, Minimally invasive spine surgery, Tubular retractor system
References
1. Gasbarrini A, Cappuccio M, Bandiera S, Amendola L, van Urk P, Boriani S. Osteoid osteoma of the mobile spine: Surgical outcomes in 81 patients. Spine (Phila Pa 1976) 2011;36:2089-93.
2. Jackson RP, Reckling FW, Mants FA. Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories. Clin Orthop Relat Res 1977;128:303-13.
3. Janin Y, Epstein JA, Carras R, Khan A. Osteoid osteomas and osteoblastomas of the spine. Neurosurgery 1981;8:31-8.
4. Kirwan EO, Hutton PA, Pozo JL, Ransford AO. Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment. J Bone Joint Surg Br 1984;66:21-6.
5. Zileli M, Cagli S, Basdemir G, Ersahin Y. Osteoid osteomas and osteoblastomas of the spine. Neurosurg Focus 2003;15:E5.
6. Noordin S, Allana S, Hilal K, Nadeem N, Lakdawala R, Sadruddin A, et al. Osteoid osteoma: Contemporary management. Orthop Rev (Pavia) 2018;10:7496.
7. Kadhim M, Binitie O, O’Toole P, Grigoriou E, De Mattos CB, Dormans JP. Surgical resection of osteoid osteoma and osteoblastoma of the spine. J Pediatr Orthop B 2017;26:362-9.
8. Albisinni U, Facchini G, Spinnato P, Gasbarrini A, Bazzocchi A. Spinal osteoid osteoma: Efficacy and safety of radiofrequency ablation. Skeletal Radiol 2017;46:1087-94.
9. Kneisl JS, Simon MA. Medical management compared with operative treatment for osteoid-osteoma. J Bone Joint Surg Am 1992;74:179-85.
10. Etemadifar MR, Hadi A. Clinical findings and results of surgical resection in 19 cases of spinal osteoid osteoma. Asian Spine J 2015;9:386-93.
11. Pourfeizi HH, Tabrizi A, Bazavar M, Sales JG. Clinical findings and results of surgical resection of thoracolumbar osteoid osteoma. Asian Spine J 2014;8:150-5.
12. Tsoumakidou G, Thenint MA, Garnon J, Buy X, Steib JP, Gangi A. Percutaneous image-guided laser photocoagulation of spinal osteoid osteoma: A single-institution series. Radiology 2016;278:936-43.
13. Santiago E, Pauly V, Brun G, Guenoun D, Champsaur P, Le Corroller T. Percutaneous cryoablation for the treatment of osteoid osteoma in the adult population. Eur Radiol 2018;28:2336-44.
14. Nzokou A, Weil AG, Shedid D. Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor. J Neurosurg Spine 2013;19:708-15.
15. Nakamura Y, Yabuki S, Kikuchi S, Konno S. Minimally invasive surgery for osteoid osteoma of the cervical spine using microendoscopic discectomy system. Asian Spine J 2013;7:143-7.
16. Xie T, Xiu P, Song Y, Zeng J, Huang S. Percutaneous endoscopic excision and ablation of osteoid osteoma of the lumbar spine and sacrum: A technical note and outcomes. World Neurosurg 2020;133:121-6.
17. Kim CW, Siemionow K, Anderson DG, Phillips FM. The current state of minimally invasive spine surgery. Instr Course Lect 2011;60:353-70.
18. Kim YB, Hyun SJ. Clinical applications of the tubular retractor on spinal disorders. J Korean Neurosurg Soc 2007;42:245-50.
19. Hikata T, Fujita N, Iwanami A, Watanabe K, Nakamura M, Matsumoto M, et al. Remodeling of the cervical facet joint after minimally invasive microendoscopic resection for cervical osteoid osteoma. Spine (Phila Pa 1976) 2016;41:E1191-4.
20. Jeong DM, Paeng SH. Enchondroma of the cervical spine in young woman: A rare case report. Asian J Neurosurg 2015;10:334-7.
21. Harish S, Saifuddin A. Imaging features of spinal osteoid osteoma with emphasis on MRI findings. Eur Radiol 2005;15:2396-403.
22. Gamba JL, Martinez S, Apple J, Harrelson JM, Nunley JA. Computed tomography of axial skeletal osteoid osteomas. AJR Am J Roentgenol 1984;142:769-72.
23. Barlow E, Davies AM, Cool WP, Barlow D, Mangham DC. Osteoid osteoma and osteoblastoma: Novel histological and immunohistochemical observations as evidence for a single entity. J Clin Pathol 2013;66:768-74.
24. Ilyas I, Younge DA. Medical management of osteoid osteoma. Can J Surg 2002;45:435-7.
| How to Cite this Article: Patel R, Shah S, Kumar N, Patel S Periosteal Variety of Sacral | Osteoid Osteoma Encroaching into the Spinal Canal – Treatment with a Tubular Retractor System: Case Report | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 93-97. |
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A Case of C 3 Aneurysmal Bone Cyst Managed by Staged Surgery
Volume 2 | Issue 2 | October 2021-March 2022 | page: 89-92 | Bharat Dave, Ajay Krishnan, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan Rai, Vatsal N. Parmar
DOI: 10.13107/bbj.2022.v02i02.027
Authors: Bharat Dave [1], Ajay Krishnan [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan Rai [1], Vatsal N. Parmar [1]
[1] Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Vatsal N. Parmar,
Consultant Spine Surgeon, Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India.
E-mail: vatsalparmar1992@gmail.com
Abstract
Aneurysmal bone cysts are often mistaken as malignant tumors such as lesions or another benign bony lesion because of their proliferative component. Treatment of spinal aneurysmal bone cyst is challenging because of its proximity to the spinal cord, unique pathology, and complex growth characteristics. The treatment options are curettage and bone grafting, irradiation, embolization, intralesional injection of calcitonin, and steroid. We present a case of cervical aneurysmal bone cysts operated in a staged procedure: arterial embolization followed by surgical resection and stabilization.
Keywords: Aneurysmal bone cyst, Arterial embolization, Bone grafting
References
1. Boriani S, De Iure F, Campanacci L, Gasbarrini A, Bandiera S, Biagini R, et al. Aneurysmal bone cyst of the mobile spine: Report on 41 cases. Spine 2001;26:27-35
2. Ruiter DJ, Van Rijssel TG, Van Der Velde EA. Aneurysmal bone cysts: A clinicopathological study of 105 cases. Cancer 1977;39:2231-9.
3. Pennekamp W, Peters S, Schinkel C, Kuhnen C, Nicolas V, Muhr G, et al. Aneurysmal bone cyst of the cervical spine. Eur Radiol 2008;18:2356-60.
4. Sanerkin NG, Mott MG, Roylance J. An unusual intraosseous lesion with fibroblastic, osteoclastic, osteoblastic, aneurysmal and fibromyxoid elements: “Solid” variant of aneurysmal bone cyst. Cancer 1983;51:227.
5. Di Caprio MR, Murphy MJ, Camp RL. Aneurysmal bone cyst of the spine with familial incidence. Spine 2000;25:1589-92.
6. Bertoni F, Bacchini P, Capanna R, Ruggieri P, Biagini R, Ferruzzi A, et al. Solid variant of aneurysmal bone cyst. Cancer 1993;71:729-34.
7. Hay MC, Paterson D, Taylor TK. Aneurysmal bone cysts of the spine. J Bone Joint Surg Br 1978;60:406-11.
8. Capanna R, Albisinni U, Picci P, Calderoni P, Campanacci M, Springfield DS. Aneurysmal bone cyst of the spine. J Bone Joint Surg Am 1985;67:527-31.
9. Dickman CA, Fehlings M, Gokaslan ZL. Spinal Cord and Spinal Column Tumors: Principles and Practice. Thieme; 2006.
10. Caro PA, Mandell GA, Stanton RP. Aneurysmal bone cyst of the spine in children. Mri imaging at 0.5 Tesla. Pediatr Radiol 1991;21:114-6.
11. Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ. From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: Radiologic-pathologic correlation. Radiographics 2001;21:1283-309.
12. Suzuki M, Satoh T, Nishida J, Kato S, Toba T, Honda T, et al. Solid variant of aneurysmal bone cyst of the cervical spine. Spine 2004;29:E376-81.
13. Sanerkin NG, Mott MG, Roylance J. An unusual intraosseous lesion with fibroblastic, osteoclastic, osteoblastic, aneurysmal and fibromyxoid elements: “Solid” variant of aneurysmal bone cyst. Cancer 1983;51:227.
14. Cottalorda J, Bourelle S. Current treatments of primary aneurysmal bone cysts. J Pediatr Orthop B 2006;15:155-67.
15. Gladden ML Jr., Gillingham BL, Hennrikus W, Vaughan LM. Aneurysmal bone cyst of the first cervical vertebrae in a child treated with percutaneous intralesional injection of calcitonin and methylprednisolone. A case report. Spine 2000;25:527-30.
16. Cybulski GR, Anson J, Gleason T, Homsi MF, Reyes MG. Aneurysmal bone cyst of the thoracic spine: Treatment by excision and segmental stabilization with Luque rods. Neurosurgery 1989;24: 273-6.
17. Garneti N, Dunn D, El Gamal E, Williams DA, Nelson IW, Sandemon DR. Cervical spondyloptosis caused by an aneurysmal bone cyst. Spine 2003;28:E68-70.
| How to Cite this Article: Dave B, Krishnan A, Degulmadi D, Mayi S, Rai R, Parmar VN | A Case of C 3 Aneurysmal Bone Cyst Managed by Staged Surgery | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 89-92.
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A Novel Technique for the Management of AtlantoAxial OsteoArthritis (AAOA)
Volume 2 | Issue 2 | October 2021-March 2022 | page: 84-88 | Mirant B Dave, Ravi Ranjan Rai, Shivanand Mayi, Devanand Degulmadi, Ajay Krishnan, Payal Mehta, Akruti Dave, Bharat R Dave
DOI: 10.13107/bbj.2022.v02i02.026
Authors: Mirant B Dave [1], Ravi Ranjan Rai [1], Shivanand Mayi [1], Devanand Degulmadi [1], Ajay Krishnan [1], Payal Mehta [1], Akruti Dave [1], Bharat R Dave [1]
[1] Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Mirant Dave,
Stavya Spine Hospital and Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
E-mail: mirantdave172@gmail.com
Abstract
Purpose: This study presents a conservative approach and a novel technique for managing Atlantoaxial Osteoarthritis (AAOA). The subaxial cervical joints have a five joint complex, while C1-C2 joint is a three joint structure which makes it undergo biomechnaically increased stress. Atlantoaxial Osteoarthritis (AAOA) is more commonly associated with the elderly age group, especially women. Most of these patients improve with conservative treatment, while few require surgical fixation.
Materials and Methods: Three hundred thirty-eight patients were analysed from the database (2009 to 2018) with a minimum follow up of 18 months. All patients presented with unilateral sub-occipital neuralgia, unilateral restricted movement, C2 radiculopathy and no myelopathy. Diagnosis of AAOA with an open mouth AP radiograph is confirmatory. Dynamic radiographs were used to diagnose instability. CT Scan was done for pre-operative evaluation, and MRI was done to rule out sinister pathologies.
Results: The average age of the patients was 65.2 years (41-84 years). The majority of the patients (177) were females working as housewives. Our study didn’t have any correlation with the lifting of heavy objects on the head. The majority of the patients were treated conservatively with a soft cervical collar, and they were asked to wear it throughout the day and night, every day for two months. Patients with no symptomatic relief after conservative treatment with collar were given an intra-articular injection or greater occipital nerve block (BR Dave’s Technique). Patients not responding to conservative management with persistent instability were treated with Surgical Fixation (Trans-articular/Harms-Goel).
Conclusion: The primary management is with a cervical collar; Greater Occipital Nerve Block (BR Dave’s technique) or Intra-articular block provides excellent symptomatic relief.
Keywords: Arthritis, Atlantoaxial, Nerve block, C1C2 instability, C1C2 fusion
References
1. Standring S, editor. Gray’s Anatomy E-Book: The Anatomical Basis of Clinical Practice. Amsterdam, Netherlands: Elsevier Health Sciences; 2020.
2. Bogduk N. Cervical causes of headache and dizziness. In Grieve GP, editor. Modern Manual Therapy of the Vertebral Column. London: Churchill Livingston; 1987. p. 289-302.
3. Harata S, Tohno S, Kawagishi T. Osteoarthritis of the atlanto-axial joint. Int Orthop 1982;5:277-82.
4. Schaeren S, Jeanneret B. Atlantoaxial osteoarthritis: Case series and review of the literature. Eur Spine J 2005;14:501-6.
5. Zapletal J, de Valois JC. Radiologic prevalence of advanced lateral C1-C2 osteoarthritis. Spine 1997;22:2511-3.
6. Halla JT, Hardin JG Jr. Atlantoaxial (C1‐C2) facet joint osteoarthritis: A distinctive clinical syndrome. Arthritis Rheum 1987;30:577-82.
7. Mixter SJ, Osgood RB. Traumatic lesions of the atlas and axis. Ann Surg 1910;51:193.
8. Dreyfuss P, Michaelsen M, Fletcher D. Atlanto-occipital and lateral atlanto-axial joint pain patterns. Spine 1994;19:1125-31.
9. Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia 2002;22:15-22.
10. Elliott RE, Tanweer O, Smith ML, Frempong-Boadu A. Outcomes of fusion for lateral atlantoaxial osteoarthritis: Meta-analysis and review of literature. World Neurosurg 2013;80:e337-46.
11. Falco FJ, Erhart S, Wargo BW, Bryce DA, Atluri S, Datta S, et al. Systematic review of diagnostic utility and therapeutic effectiveness of cervical facet joint interventions. Pain Physician 2009;12:323-44.
12. Manchikanti L, Singh V, Falco FJ, Cash KM, Fellows B. Cervical medial branch blocks for chronic cervical facet joint pain: A randomized, double-blind, controlled trial with one-year follow-up. Spine 2008;33:1813-20.
13. Narouze SN, Casanova J, Mekhail N. The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache. Pain Med 2007;8:184-8.
14. Glémarec J, Guillot P, Laborie Y, Berthelot JM, Prost A, Maugars Y. Intraarticular glucocorticosteroid injection into the lateral atlantoaxial joint under fluoroscopic control. A retrospective comparative study in patients with mechanical and inflammatory disorders. Joint Bone Spine 2000;67:54-61.
15. Dach F, Éckeli ÁL, Ferreira KD, Speciali JG. Nerve block for the treatment of headaches and cranial neuralgias a practical approach. Headache 2015;55:59-71.
| How to Cite this Article: Dave MB, Rai RR, Mayi S, Degulmadi D, Krishnan A, Mehta P, Dave A, Dave BR| A Novel Technique for the Management of AtlantoAxial OsteoArthritis (AAOA) | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 84-88. |
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