Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult Male Football Player: Case Report
Volume 2 | Issue 1 | April-September 2021 | page: 43-47 | Umesh Srikantha, Yadhu K Lokanath, Akshay Hari, Ravi Gopal Varma
Authors: Umesh Srikantha [1], Yadhu K Lokanath [1], Akshay Hari [1], Ravi Gopal Varma [1]
[1] Department of Neurosurgery, Centre of Excellence: Brain & Spine Aster CMI, Bengaluru, Karnataka, India.
Address of Correspondence
Dr. Yadhu K Lokanath,
Consultant Neurosurgeon, Department of Neurosurgery, Centre of Excellence: Brain & Spine Aster CMI, Bengaluru, Karnataka, India.
E-mail: dryadhu2498@gamil.com
Abstract
Interbody fusion is preferred surgical treatment for various symptomatic pathologies of lumbar spine and spondylolisthesis is one of the commonest indication. Goal is to achieve adequate bony and neural decompression, disc height restoration, deformity correction and good interbody fusion. Numerous techniques and approaches have been designed, minimal invasive tubular transforminal interbody fusion is widely accepted among them. In any case pre-operative planning and identifying any anatomical variation is prerequisite before surgery. In this article, we report, 22-year male football player, presenting with worsening low back pain, left radicular pain with neurogenic claudication. Radiographs revealed a L5-S1 Meyerding grade I isthmic spondylolisthesis with L5-S1 left sub articular disc protrusion with narrowing of lateral recess on left side and no evidence of lumbosacral nerve root anomalies on magnetic resonance imaging. Patient was planned for minimal invasive L5-S1 transforaminal interbody fusion, intraoperatively, Type 3 Neidre and Macnab root anomaly was identified, patient successful underwent interbody fusion with no acute intraoperative or postoperative complications. In follow up period, patient had no radicular pain. In our article, we summarize the incidence, classification of nerve root anomaly along with intra operative strategy for interbody fusion in presence of root anomaly and report this rare twin anomaly.
Keywords: Isthmic spondylolisthesis, nerve root anomaly, MIS TLIF, young football player.
References
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| How to Cite this Article: Srikantha S, Lokanath YK, Hari A, Varma RG | Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult Male Football Player: Case Report | Back Bone: The Spine Journal | April-September 2021; 2(1): 43-47. |
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Common Lumbar and Sacral Interventional Pain Procedures
Volume 2 | Issue 1 | April-September 2021 | page: 33-42 | Milan Mehta, Bharat J Shah, Palak Chudasama
Authors: Milan Mehta [1], Bharat J Shah [1], Palak Chudasama [1]
[1] Department of Pain Management, Zydus Hospital, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Milan Mehta,
Interventional Pain Specialist, Zydus Hospital, Ahmedabad, Gujarat, India.
E-mail: milan.aaryen@gmail.com
Abstract
Interventional pain specialists perform all pain procedures under live fluoroscopic guidance and with use of a contrast agent to deliver cortisone as close to the disc herniation or nerve root impingement, as determined by MRI or at the pain generators. Image-guided technique reduces morbidity. Dye spread in AP, lateral and oblique view is to be documented in real-time to reduce catastrophic complications. It outlines the area surrounding exiting and traversing nerve roots along with epidural space and also delineates the perimeter of the joint.
All these procedures help in identifying pain generators by means of diagnostic techniques which helps in conservative management as well as it’s very useful before radio-frequency ablative procedures and before surgery.
Keywords: Lumbar and sacral pain; Non operative treatment; Intervention pain speciality.
References
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| How to Cite this Article: Mehta M, Shah BJ, Chudasama P | Common Lumbar and Sacral Interventional Pain Procedures | Back Bone: The Spine Journal | April-September 2021; 2(1): 33-42. |
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Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up
Volume 2 | Issue 1 | April-September 2021 | page: 27-32 | Hitesh N. Modi, Shakti A. Goel, Utsab Shrestha
Authors: Hitesh N. Modi [1], Shakti A. Goel [1] , Utsab Shrestha [1]
[1] Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Senior Consultant, Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., SG Highway, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: drmodihitesh@gmail.com
Abstract
Objective: There is controversy in surgical management of cervical spondylotic myelopathy (CSM); a few group encourage only laminectomy or laminoplasty while the others emphasize on lateral mass fixation along with laminectomy. Cervical lordosis is an important factor for maintaining posture neck and preventing postoperative axial neck pain. Literature has reported that cervical lordosis less than -20 degrees is often responsible for neck pain. The purpose of this study was to evaluate clinical outcome and radiological parameters after posterior cervical laminectomy and fixation in CSM.
Material and Methods: This retrospective study included 37 patients operated with posterior cervical decompression and lateral mass screw fixation with minimum two-year follow-up. All patients were operated for CSM. All were operated by a single surgeon and followed up at six weeks, twelve weeks, six months, one year and yearly afterwards. Clinical outcome and radiological parameters were analyzed for clinical improvement [European Myelopathy Score (EMS)] and cervical lordotic angle.
Results: Average age 68±8.3 years. The cervical lordotic angle of -23.02±4.19 degrees was maintained in patients operated with lateral mass screw fixations along with laminectomy at final follow-up. The EMS and VAS score showed significant improvement postoperatively from 15.7 to 13.6 (p<0.05) and 8.1 to 1.5 (p<0.05), respectively. Three patients had postoperative C5 palsy that recovered completely within three months. Two patients expired within a few months after surgery due to acute myocardial infarction and respiratory arrest, respectively. There were three patients who had postoperative C5 palsy, which recovered completely within three months postoperatively. There was no permanent postoperative neurological deficit noticed in the series.
Conclusion: Posterior cervical lateral mass screw fixation for CSM gives satisfactory clinical outcome and maintains cervical lordosis. Lateral mass fixation with decompression helps preventing postoperative progressive kyphotic deformity of cervical spine after multilevel cervical laminectomy.
Keywords: Cervical Spondylotic Myelopathy, Lateral Mass Screws, Cervical Lordosis, European Myelopathy Score.
References
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| How to Cite this Article: Modi HN, Goel SA, Shrestha U | Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up | Back Bone: The Spine Journal | April-September 2021; 2(1): 27-32. |
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SARS-CoV-2 (COVID-19) and Spine Surgeries in Tertiary-care Hospital of India
Volume 2 | Issue 1 | April-September 2021 | page: 23-26 | Bharat R. Dave, Ajay Krishnan, Ravi Ranjan Rai, Devanand Degulmadi, Shivanand Mayi, Kirit Jadhav
Authors: Ghanshyam Kakadiya [1], Kalpesh Saindane [1], Prashant Gedam [1], Nitin Pothare [1]
[1] Department of Orthopedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Ghanshyam Kakadiya,
Department of Orthopedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
E-mail: drghanshyam89@gmail.com
Abstract
The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on spine surgery worldwide. India, with its large population and limited health resources, will be overwrought due to the number of cases of critically ill patients with COVID-19. It is important to understand the challenges for spine surgeons in India when dealing with patients during the COVID-19 pandemic. In India, elective spine surgeries stand cancelled whilst trauma and emergency surgeries have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines.
This article highlights the challenges in the triaging of patients, care in dealing with a patient with COVID-19 in spine surgery, and the effects on academics and research activities; it also suggests immediate measures and recommendations that also apply to other specialties.
Keywords: COVID-19, coronavirus disease, Spine surgery, India.
References
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| How to Cite this Article: Kakadiya G, Saindane K, Gedam P, Pothare N | SARS- CoV-2 (COVID-19) and Spine Surgeries in Tertiary-care Hospital of India | Back Bone: The Spine Journal | April-September 2021; 2(1): 23-26. |
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Drain Tip Culture: Would It Help Us Predict and Prevent Surgical Site Infection After Spinal Surgery?
Volume 2 | Issue 1 | April-September 2021 | page: 19-22 | Bharat R. Dave, Ajay Krishnan, Ravi Ranjan Rai, Devanand Degulmadi, Shivanand Mayi, Kirit Jadhav
Authors: Bharat R. Dave [1], Ajay Krishnan [1], Ravi Ranjan Rai [1],
Devanand Degulmadi [1], Shivanand Mayi [1], Kirit Jadhav [1]
[1] Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Ravi Ranjan Rai,
Consultant Spine Surgeon, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
E-mail: drravirai84@gmail.com
Abstract
Background: Systematic cultures of drain tips or drainage fluids are commonly used by surgical teams for the early detection of Surgical Site Infection (SSI), even in the absence of clinical suspicion of infection. However, their prognostic values are controversial.
Method: This was a prospective study of patients undergoing spine surgery at our institute during the study period. Patients already diagnosed with spine infection were excluded from the study. At the time of drain removal, the drain tip was cut and sent to microbiology laboratory for bacterial culture. All patients were treated with antimicrobial prophylaxis based on evidence-based guidelines and were monitored for at least 6 months after surgery for the development of Surgical Site Infection (SSI). SSI was defined according to Centers for Disease Control and Prevention criteria.
Results: The study comprised of 183 patients including 85 males and 98 females. The rate of Surgical Site Infection in our study was 2.73 % (5 patients). Drain Tip Culture (DTC) was positive in 4 patients (2.18 %). Association of DTC with SSI was found to have high Specificity (98.31 %) and Negative Predictive Value (97.76 %) but low Sensitivity (20 %) and Positive Predictive Value (25 %).
Conclusion: Culture of drain tip after spine surgery does not conclusively predict the presence or absence of surgical site infection. However, statistical significance was observed between drain tip culture and surgical site infection with high specificity, high negative predictive value, low sensitivity and low positive predictive value.
Keywords: Drain tip culture; Spinal Surgery; Surgical site infection.
References
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[7]. Reiffel AJ, Barie PS, Spector JA. A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection. Surg Infect 2013; 14:244-269. https://doi.org/10.1089/sur.2011.126.
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[9]. Tschudin-Sutter S, Meinke R, Schuhmacher H, Dangel M, Eckstein F, Reuthebuch O, et al. Drainage days-an independent risk factor for serious sternal wound infections after cardiac surgery: a case control study. Am J Infect Control 2013; 41:1264-1267. https://doi.org/10.1016/j.ajic.2013.03.311.
[10]. Ahn J-S, Lee H-J, Park E, Park I-Y, Lee JW. Suction Drain Tip Culture after Spine Surgery: Can It Predict a Surgical Site Infection? Asian Spine J 2015; 9:863-868. https://doi.org/10.4184/asj.2015.9.6.863.
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[16]. Overgaard S, Thomsen NO, Kulinski B, et al. Closed suction drainage after hip arthroplasty. Prospective study of bacterial contamination in 81 cases. Acta Orthop Scand. 1993; 64:417–420.
[17]. Girvent R, Marti D, Mun˜ oz JM. The clinical significance of suction drainage cultures. Acta Orthop Belg. 1994; 60:290–292.
[18]. Sankar B, Ray P, Rai J. Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations. Int Orthop. 2004; 28:311–314.
[19]. Nakayama Y, Tsuji T, Asazuma T, et al. Evaluation of the usefulness of bacterial culture of drainage tube tip in spinal instrumentation surgery. Natl Defense Med J. 2005; 52:79–82.
[20]. Nagashima H, Yamane K, Nishi T, et al. Recent trends in spinal infections: retrospective analysis of patients treated during the past 50 years. Int Orthop. 2010; 34:395–399.
[21]. Chen AF, Chivukula S, Jacobs LJ, et al. What is the prevalence of MRSA colonization in elective spine cases? Clin Orthop Relat Res. 2012; 470:2684–2689.
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| How to Cite this Article: Dave BR, Krishnan A, Rai RR, Degulmadi D, Mayi S, Jadhav K | Drain Tip Culture: Would It Help Us Predict and Prevent Surgical Site Infection After Spinal Surgery? | Back Bone: The Spine Journal | April-September 2021; 2(1): 19-22. |
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Conservative Management of Thoracolumbar Spinal Tuberculosis in The Tertiary Care Hospital of India
Volume 2 | Issue 1 | April-September 2021 | page: 12-18 | Ghanshyam Kakadiya, Yogesh Soni, Kalpesh Saindane, Kushal Gohil, Kshitij Chaudhary, Akash Shakya
Authors: Ghanshyam Kakadiya [1], Yogesh Soni [1], Kalpesh Saindane [1], Kushal Gohil [1], Kshitij Chaudhary [1, 3], Akash Shakya [1]
[1] Department of Orthopaedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, SSIMS, Bhilai, Chhattisgarh, India.
[3] PD Hinduja Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Ghanshyam Kakadiya,
Department of Orthopaedics, TNMC & BYL Nair Hospital, Mumbai-400008
E-mail: drghanshyam89@gmail.com
Abstract
Introduction: Spinal tuberculosis is a leading cause of non-traumatic paraplegia in a developing country like India. There is an emerging trend to operate on patients early with spinal TB. A study aim was to reiterate the importance of conservative management in Spinal Tuberculosis. The study aim was to assess the clinical and radiological outcomes of the conservative management of thoracolumbar spine tuberculosis and reiterate the importance of conservative management.
Methods: A prospective study with 188 thoracolumbar tuberculosis patients included from May 2016 to April 2019. All the patients were subjected to computed tomography-guided biopsy followed by anti-tuberculous therapy (ATT) for 12-months. Indications for surgery included patients in which biopsy either failed and persistent/worsening of neurology. Preoperative and postoperative clinical and functional outcomes Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and ASIA scale were measured.
Results: 160 patients had a neurological deficit of ASIA-C and ASIA-D in 28. A failed performed biopsy was in 18 patients. Out of 170 successful biopsies,18 patients had persistent/worsening of neurology, these 18 (10.58%) patients required surgery. VAS was significantly improved from mean value preoperative 7.90±0.60 to 4.0±0.54 postoperative 1 month and 2.90±0.54 at the final follow‐up. ODI was improved from mean value preoperative 77.10±6.90 to 30.50±6.50 postoperative 1 month and 21.30±6.70 at final follow‐up. Pre-treatment mean kyphosis was 5.68±3.84 that improved to 6.51±3.88 post-treatment.
Conclusions: The results of conservative treatment consisting of biopsy and ATT for at least 12 months in compliant patients are excellent. A combined approach using clinical staging, biopsy, and ATT can minimize surgical intervention in most patients. Early diagnosis and early treatment lead to a good prognosis. Periodic evaluation is a must to look for evidence of improvement and the adverse effect of ATT.
Keywords: Spinal tuberculosis; biopsy; Conservative Management; ATT.
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| How to Cite this Article: Kakadiya G, Soni Y, Saindane K, Gohil K, Chaudhary K, Shakya A | Conservative Management of Thoracolumbar Spinal Tuberculosis in The Tertiary Care Hospital of India | Back Bone: The Spine Journal | April-September 2021; 2(1): 12-18. |
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