Should 3D Navigation be the Standard of Care for MIS TLIF?
Volume 4 | Issue 1 | April 2023 – September 2023 | page: 09-13 | Bharat R. Dave, Ajay Krishnan, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan Rai, Mirant B. Dave
DOI: https://doi.org/10.13107/bbj.20232.v04i01.053
Authors: Bharat R. Dave [1], Ajay Krishnan [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan Rai [1], Mirant B. Dave [1]
[1] Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Ravi Ranjan Rai,
Spine Surgeon, Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
E-mail: drravirai84@gmail.com
Abstract
Introduction- Traditionally MIS TLIF is being performed under fluoroscopic guidance, which is technically difficult in few cases, often inaccurate and involves excessive radiation exposure to the surgeon and OR personnel. Navigation promises to be a better tool, however, literature regarding its accuracy is still evolving.
Aims & Objectives- To evaluate the pedicle screw perforation rate in Navigation guided MIS TLIF
Materials and Methods- All consecutive patients undergoing MIS TLIF under 3D Navigation at single institute between January 2019 to January 2021 were included in the study. O-arm and S8 Stealth Navigation was used in all cases. After prone positioning and part preparation, patient tracker was fixed to a bony point nearest to the operative site, and then first CT scan spin was taken. Under Navigation guidance, all four guide wires were placed. Decompression was planned from the side which was more symptomatic. Screws on the opposite side were placed and connected with rod. Decompression was performed, and interbody cage was inserted from the symptomatic side, followed by insertion of remaining two screws under Navigation. A final CT scan spin was taken to determine the accuracy of hardware.
Results- 92 MIS TLIF were performed during the study period under 3D Navigation. 368 screws in 92 patients were analysed for accuracy. The direction and degree of breach was recorded. Four screws were found to breach, two were lateral breach, one superior breach and one medial breach. All breaches were Gr 1 and none of the screws required revision. Overall accuracy was 98.91 percent.
Conclusion- 3D Navigation is a useful tool in guiding placement of pedicle screws with high accuracy. This tool would be particularly indispensable in MISS cases, when tactile feedback is minimal.
Keywords- Surgical Navigation Systems, Computer-Assisted surgery, Minimally Invasive Surgical Procedures, Pedicle Screws.
References
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| How to Cite this Article: Dave BR, Krishnan A, Degulmadi D, Mayi S, Rai RR, Dave MB | Should 3D Navigation be the Standard of Care for MIS TLIF?| Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 09-13 | https://doi.org/10.13107/bbj.2023.v04i01.053 |
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Minimal Invasive Scoliosis Surgery (MISS): Current State of Art for Adolescent Idiopathic Scoliosis
Volume 4 | Issue 1 | April 2023 – September 2023 | page: 04-08 | Udit D. Patel, Rohit A Kavishwar, Seung Woo Suh, Jae Hyuk Yang, Hitesh N. Modi
DOI: https://doi.org/10.13107/bbj.20232.v04i01.052
Authors: Udit D. Patel [1], Rohit A Kavishwar [1], Seung Woo Suh [1], Jae Hyuk Yang [2], Hitesh N. Modi [3]
[1] Department of Orthopaedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea 08308.
[2] Department of Orthopaedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea 02841.
[3] Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India 380054.
Address of Correspondence
Dr. Seung Woo Suh,
Department of Orthopaedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea 08308
E-mail: spine@korea.ac.kr
Abstract
In recent years, minimally invasive spine surgery techniques have grown increasingly popular with both patients and surgeons. MIS have become increasingly feasible, efficient, and popular for the treatment of a variety of spinal pathologies. Minimally invasive scoliosis surgery (MISS) is not a familiar concept among many spine surgeons, but it is a novel technique with demonstration of advantages of MISS over traditional open technique in the final outcomes and will be the future of adolescent idiopathic scoliosis (AIS) surgery.
Keywords: Minimal invasive spine surgery, Minimally invasive scoliosis surgery (MISS), Adolescent idiopathic scoliosis (AIS).
References
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| How to Cite this Article: Patel UD, Kavishwar RA, Suh SW, Yang JH, Modi HN | Minimal Invasive Scoliosis Surgery (MISS): Current State of Art for Adolescent Idiopathic Scoliosis | Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 04-08 | https://doi.org/10.13107/bbj.2023.v04i01.052 |
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Presumptive Long Rod Technique (PLRT) for Revision Extension Instrumented Spine Surgery: A Technical Note
Volume 3 | Issue 2 | October 2022-March 2023 | page: 119-124 | Ajay Krishnan, Shivakumar A Bali, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan, Vatsal Parmar, Pranav Charde, Vikrant Chauhan, Mirant B Dave, Denish Patel, Preety A Krishnan, Bharat R Dave
DOI: https://doi.org/10.13107/bbj.2022.v03i02.050
Authors: Ajay Krishnan [1], Shivakumar A Bali [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan [1], Vatsal Parmar [1], Pranav Charde [1], Vikrant Chauhan [1], Mirant B Dave [1], Denish Patel [1], Preety A Krishnan [2], 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,
Spine Surgeon, Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
E-mail: drajaykrishnan@gmail.com
Abstract
Background: Revision spine surgery needing extension of fixation either require complete exposure of previously operated levels for rod exchange or can be managed by linking the new surgical construct (NSC) to primary surgical construct (PSC) with dominos. Presumptive long rod technique (PLRT) provides additional length of rod for domino placement.
Case report: 80-year male on conservative management developed acute cauda equina syndrome retention due to pre-existing multilevel lumbar stenosis and acute big sequestrated disc prolapse at L12. Emergent surgical intervention in form of L1 to L4 pedicle screw fixation with postero-lateral bone grafting and fragmentectomy was done. Peri-operative period was uneventful. He was started on Teriperatide 20mcg daily with progressive mobilization and physiotherapy. At 4 months of follow-up, he developed L1 osteoporotic fracture with proximal junctional kyphosis (PJK). Patient underwent T12-L1 interbody fusion with extension of fixation to T10 which required complete opening up of previous incision as it was an Indian implant set. A domino of larger foot print couldn’t be accommodated in the space available between L1- L2 screws. Owing to severe osteoporosis and degenerative changes at proximal levels, presumptive oversized rods were inserted with extra lengths of the rods left at proximal ends. This technique is labelled PLRT(presumptive long rod technique) at our institute. At 6 months of follow up, patient developed T10 osteoporotic fracture with PJK and patient was planned for extension of fixation upto T4. Since the extra lengths of rods were available at proximal ends, only the planned operative levels were exposed and it was connected to previous construct using the larger footprint domino. Patient improved clinically and was ambulatory. The patient expired at 18 months due to cardio-respiratory arrest unrelated to the spinal events.
Conclusion: Additional rod lengths intentionally left at adjacent levels during primary surgery where there is anticipation of PJK and adjacent segment disease (ASD) can be a boon when there is need for extension of fixation. These extra lengths of rod can be used to place dominos and connect PSC to NSC without the need for exposure of PSC levels for rod exchange, preventing complications especially in setups with economic constraints.
Keywords: Complex, Adult Spinal Deformity, Adjacent Segment, Junctional Kyphosis, Osteoporosis, Revision, Surgery, Multirod.
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| How to Cite this Article: Krishnan A, Bali SA, Degulmadi D, Mayi S, Ranjan R, Parmar V, Charde P, Chauhan V, Dave MB, Patel D, Krishnan PA, Dave BR | Presumptive Long Rod Technique (PLRT) for Revision Extension Instrumented Surgery: A Technical Note | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 119-124. https://doi.org/10.13107/bbj.2022.v03i02.050 |
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Hirayama Disease: A Rare Case Report and Literature Review
Volume 3 | Issue 2 | October 2022-March 2023 | page: 109-112 | Sharvin K Sheth, Amit C Jhala, Jay V Shah
DOI: https://doi.org/10.13107/bbj.2022.v03i02.048
Authors: Sharvin K Sheth [1], Amit C Jhala [1], Jay V Shah [2]
[1] Department of Spine Surgery, Chirayu Orthopaedic and Spine Hospital, Ahmedabad, Gujarat, India.
[2] Department of Radiology, Medimax Advance Radio Imaging, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Amit C Jhala,
Consultant Spine Surgeon and Chief of Department of Spine Surgery, Chirayu Orthopaedic and Spine Hospital, Ahmedabad, Gujarat, India.
E-mail: acjhala@gmail.com
Abstract
Hirayama disease is a rare neurological condition and is characterized by a sporadic juvenile muscular atrophy of distal upper extremity in young males. The disease is more prevalent in Japan and other Asian countries, though a few cases have been reported in Western countries as well. It manifests as a self-limiting, gradually progressive atrophic weakness of forearm and hand. The anterior displacement of posterior dura during neck flexion leading to cervical cord atrophy has been hypothesized. We discuss a case of a 21-year-old male patient with progressive distal upper extremity weakness, diagnosed with Hirayama disease, and literature review for the same.
Keywords: Hirayama Disease, Juvenile muscular atrophy, Monomelic amyotrophy
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28. MARIE, P., and FOIX, c.: L’atrophie isolhe non pro- gressive des petits muscles de la main (Tephromala- cie antCieure). Nouv. iconogr. de la SalpbriBre 25: 353 and 427, 1912.
| How to Cite this Article: Sheth SK, Jhala AC , Shah JV | Hirayama Disease: A Rare Case Report and Literature Review | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 109-112. https://doi.org/10.13107/bbj.2022.v03i02.048 |
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New Development and Progression of Ossification of the Posterior Longitudinal Ligament (OPLL) after Cervical Disc Arthroplasty: A Case Report
Volume 3 | Issue 2 | October 2022-March 2023 | page: 47-50 | Jong-Beom Park
DOI: https://doi.org/10.13107/bbj.2022.v03i02.040
Authors: Jong-Beom Park [1]
[1] Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, 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, Seoul, Korea.
E-mail: spinepjb@gmail.com
Abstract
Purpose: To report an extremely rare case of new development and progression of ossification of posterior longitudinal ligament (OPLL) after cervical disc arthroplasty (CDA).
Background: To our knowledge, new development and progression of ossification of OPLL after CDA have not been reported.
Methods: A 44-year-old female with cervical disc herniation at C5-6 presented with radiculopathy. The patient had no evidence of preexisting OPLL on plain radiographs and magnetic resonance imaging. She underwent CDR at C5-6 and her symptoms were significantly improved after surgery.
Results: New development of OPLL at C5-7-T1 was identified for the first time at 6 years after CDA at C5-6, and progression of OPLL was observed at 3 & 13 years’ follow-up. Due to new development and progression of OPLL, there was no segmental motion at C5-6 with CDA. The patient continued to follow up without further surgery because there was no deterioration in clinical symptoms.
Conclusion: Our study demonstrated an extremely rare case of new development and progression of OPLL after CDA with a long term follow-up. Our case suggests potential clues for discovering the complex pathological mechanism of OPLL.
Keywords: Ossification of the posterior longitudinal ligament, New development, Progression, Cervical disc arthroplasty
References
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| How to Cite this Article: Park JB | New Development and Progression of Ossification of the Posterior Longitudinal Ligament (OPLL) after Cervical Disc Arthroplasty | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 47-50. https://doi.org/10.13107/bbj.2022.v03i02.040 |
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Post-Discectomy Pyogenic Lumbar Discitis- A Literature Review
Volume 3 | Issue 2 | October 2022-March 2023 | page: 55-64 | Udit D. Patel1, Hitesh N. Modi1
DOI: https://doi.org/10.13107/bbj.2022.v03i02.042
Authors: Udit D. Patel [1], Hitesh N. Modi [1]
[1] Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India 380054.
Address of Correspondence
Dr. Udit D. Patel
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: uditpatel27@gmail.com
Abstract
Introduction: Post-disctectomy pyogenic lumbar discitis is not common condition in contrast to postoperative wound infection but its presentation is typically non-specific, which can lead to delay in diagnosis and its treatment. In this condition, patients present with low back pain after symptoms free interval. The diagnosis can be established with symptoms, examination, laboratory studies and radiological investigations.
Purpose: The aim of this literature review is to evaluate available articles about post- discectomy lumbar spondylodiscitis. we analyse the incidence, risk factors, causative organisms, diagnosis modalities (including clinical features, blood and radiological investigations), management strategies (conservative and surgical) and prevention for postoperative lumbar spondylodiscitis in the published literature.
Material and methods: We have reviewed literature articles available on topic of post-discectomy lumbar discitis in PubMed, MEDLINE and Google scholar only in English language; and have been published from the year 2000 onwards.
Results: This incidence rate of post-operative discitis is 0.94%. The age range was 38-56 years with a mean age of 45.18±4.17 years. Mean interval between discectomy and establishment of diagnosis was 2-8 weeks. Of all the patients included 61.93% were males and 38.07% were females. The most common organism isolated is staph. aureus (including methicillin sensitive and resistant staph. aureus). Majority of patients were initially treated conservatively. The surgical treatment in patients who fail to respond to conservative management has been demonstrated. Our study showed 40.1% excellent results, 56% good result and 3.9% fair and poor result at final follow up.
Conclusion: Although the incidence of post-operative lumbar discitis is rare, it’s associated with morbidity and mortality. The true challenge of post-operative discitis is to diagnose the condition timely. Majority of patients can be treated conservatively and operative management is rarely necessary in the patients with failed conservative treatment.
Keywords: Lumbar discectomy, Postoperative pyogenic discitis, Literature review, Treatment
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| How to Cite this Article: Patel UD, Modi HN | Post-Discectomy Pyogenic Lumbar Discitis- A Literature Review | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 55-64. https://doi.org/10.13107/bbj.2022.v03i02.042 |
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