Case Series of the Management of Surgical Site Infection Following Thoracic Spinal Surgeries During COVID Pandemic

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Volume 3 | Issue 1 | April-September 2022 | page: 24-31 | Neetin Mahajan, Sunny Sangma, Jayesh Mhatre, Pritam Talukder

DOI: https://doi.org/10.13107/bbj.2022.v03i01.036

Authors: Neetin Mahajan [1], Sunny Sangma [1], Jayesh Mhatre [1], Pritam Talukder [1]

[1] Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Sunny Sangma,
Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India.
E-mail: Sunnysangma11@gmail.com

Abstract

Introduction: Post-operative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and post-operative care, wound infection continues to compromise patient outcome after spinal surgery. This kind of infection places the patient at risk for pseudoarthrosis, adverse neurologic sequelae, chronic pain, deformity, and even death. In spite of all preventive measures, the SSI following spinal surgeries are 1% among operated spinal instrumentation.
Case Series: Here, we present a series of three patients who presented to us with post-operative surgical site infection (SSI) in spine surgery in the form of wound, discharge, and other complaints. Out of all, two of them were operated with debridement and skin closure followed by broad spectrum IV antibiotics and one of them managed with vacuum-assisted closure dressing and high antibiotics sensitive to organisms found in wound culture. Optimization by building up hemoglobin, supplementing micronutrients including Vitamin C, D, and B12 and high protein diet was started as adjuvant therapy and all of them was discharged with healthy wound.
Conclusion: SSI in spine surgery is a common but challenging complication, particularly after instrumental spinal arthrodesis. Using meticulous aseptic technique, intra-operative irrigation, prophylactic antibiotics, and optimizing patient factors preoperatively are key to preventing a SSI. In patients who still develop an infection despite efforts at prevention, timely diagnosis and treatment are critical. Instrumentation can be retained while still successfully clearing an early infection, although following fusion, instrumentation can be removed if lifetime oral antibiotic suppression is either not indicated or undesirable.
Keywords: Spine surgery, Postoperative infections, Surgical site infection, Spinal instrumentation.

References

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How to Cite this Article: Mahajan N, Sangma S, Mhatre J, Talukder P | Case Series of the Management of Surgical Site Infection Following Thoracic Spinal Surgeries During COVID Pandemic | Back Bone: The Spine Journal | April-September 2022; 3(1): 24-31.    https://doi.org/10.13107/bbj.2022.v03i01.036

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Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis

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Volume 3 | Issue 1 | April-September 2022 | page: 20-23 | Subir N. Jhaveri, Shivam K. Kiri, Sharan S. Jhaveri

DOI: https://doi.org/10.13107/bbj.2022.v03i01.035

Authors: Subir N. Jhaveri [1], Shivam K. Kiri [1], Sharan S. Jhaveri [1]

[1] Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Subir N. Jhaveri.
Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.
E-mail: subirjhaveri@yahoo.com

Abstract

Background: Elderly patients with severe osteoporosis are prone to sustain osteoporotic vertebral compression fractures (OVCF’s). Sometimes, they undergo significant vertebral collapse and kyphosis, leading to significant canal compromise and neurological deterioration.
Case Description: We present a case series of three patients, of which two had OVCF’s of L1 and L3, respectively, while one patient had Koch’s spine D12 and L1. All three cases had severe vertebral collapse leading to kyphosis, severe pain, and canal compromise, neurological deterioration with paraparesis, and bowel bladder involvement. Surgery warranted total corpectomy of fractured vertebrae (anterior vertebral column resection) and reconstruction of the anterior column. Due to the significant degree of osteoporosis, fenestrated screws with bone cement (poly methyl acrylate) were used anteriorly along with vertebral body reconstruction with cage, through a purely anterior approach. This is the first instance of fenestrated screws being used anteriorly to reduce screw pull-out. In view of the strong anterior construct, a posterior surgery to supplement the fixation could be avoided in these thoracolumbar junctional cases.
Results: No patient experienced loosening of implants, nor did any patient experience cement-related complications. Although the present follow-up of these patients is short (12 months), the patients are pain free and independently ambulatory.
Conclusion: Using fenestrated screws in an anterior location allow vertebral reconstruction with a single surgery in elderly patients with severe osteoporosis, reducing chances of screw pull-out. Bone plugs at the tip to help prevent cement extravasation from the vertebral body.
Keywords: Anterior fenestrated screws, Bone cement, Corpectomy, Osteoporotic vertebral compression fracture, Koch’s spine, Screw pull-out.

References

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14. Afathi M, Mansouri N, Farah K, Benichoux V, Blondel B, Fuentes S. Use of cement-augmented percutaneous pedicular screws in the management of multifocal tumoral spinal fractures. Asian Spine J 2019;13:305-12.
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19. Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine 2007;7:47-53.
20. Access O. Clinical therapeutic effects of anterior decompression on spinal osteoporotic fracture and inflammatory cytokines. Pak J Med Sci 2014;30:931-5.

How to Cite this Article: Jhaveri SN, Kiri SK, Jhaveri SS | Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis | Back Bone: The Spine Journal | April-September 2022; 3(1): 20-23.  https://doi.org/10.13107/bbj.2022.v03i01.035

 

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Clinical and Radiological Outcome following MIS-TLIF and Open-TLIF between Asian and African Population- A Comparative Retrospective Analysis in 104 Patients

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Volume 3 | Issue 1 | April-September 2022 | page: 14-19 | Hitesh N. Modi, Utsab Shreshtha

DOI: https://doi.org/10.13107/bbj.2022.v03i01.034

Authors: Hitesh N. Modi [1], Utsab Shreshtha [1]

[1] Department of Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Hitesh N. Modi,
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India.
E-mail: drmodihitesh@gmail.com

Abstract

Purpose: This study aimed to evaluate pre-operative and post-operative sagittal parameters using pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis (SL) between Asian and African population who underwent minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) and open-TLIF surgeries. Study compares blood loss, operative time, and hospital stay; and evaluates disability and pain by Oswestry disability index (ODI) and visual analog scale (VAS) score, respectively, in both groups.
Methods: This retrospective study included 104 patients with an average age of 52.1 ± 12.9 years. All were operated for open-TLIF and MIS-TLIF for one- or two-level lumbar canal stenosis or spondylolisthesis. Patients were divided into two groups according to race: Asian and African. Clinical improvements were evaluated using VAS and ODI scores. Modified MacNab’s criteria were used to evaluate outcome. Estimated blood loss, hospital stay, operative time, perioperative morbidity, and complications were reviewed. On radiological parameters, patients’ LL, PI, and SL were compared between two groups.
Results: Average follow-up was 40.6 ± 13.9 months. Both groups showed significant post-operative improvement in their VAS and ODI scores in both open- and MIS-TLIF (P < 0.0001); however, comparing clinical improvement between Asian and African groups, it did not show significant difference in VAS (P = 0.103) and ODI (P = 0.077). Both groups showed significant improvement in LL and SL in both open- and MIS-TLIF (P < 0.0001); however, there was no change in PI. It did not show any significant difference in improvement in LL (P = 0.156), PI (P = 0.798), and SL (P = 0.179) between Asian and African groups. Regarding post-operative complications, there were 4 (6.9%) and 3 (6.5%) complications occurred in Asian and African population, respectively. There were no difference in complication rates in both groups (P = 0.939).
Discussion: TLIF (MIS and open) gives similar clinical outcome between Asian and African population. Sagittal parameters were higher in African population than the Asian population. Attention should be paid to predetermine the value of LL to achieve during surgery.
Keywords: Transforaminal lumbar interbody fusion, Asian versus African, Sagittal parameters, Clinical outcome.

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How to Cite this Article: Modi HN, Shreshtha U |  Clinical and Radiological Outcome following MIS-TLIF and Open- TLIF between Asian and African Population- a Comparative Retrospective Analysis in 104 Patients | Back Bone: The Spine Journal | April-September 2022; 3(1): 14-19.  https://doi.org/10.13107/bbj.2022.v03i01.034

 

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Spine Surgery: A Narrative Review About Recent Updates and Future Directions

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Volume 3 | Issue 1 | April-September 2022 | page: 07-13 | Nandan A. Marathe, Pauras P. Mhatre, Sudeep Date, Ayush Sharma
DOI: https://doi.org/10.13107/bbj.2022.v03i01.033

Authors: Nandan A. Marathe [1], Pauras P. Mhatre [1], Sudeep Date [2], Ayush Sharma [3]

[1] Department of Orthopaedics, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Cumberland Infirmary, Newtown Road, Carlisle CA2 7HY, United Kingdom.
[3] Consultant Spine Surgeon and Head of Spine unit, Railway Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Pauras P. Mhatre,
Seth G.S. Medical College & KEM Hospital, Mumbai, India.
E-mail: paurasmhatre@gmail.com

Abstract

Background: Advances in case selection, operative methods, and postsurgical care have facilitated spine surgeons to manage complex spine cases with short operative times, decreased hospital stay and improved outcomes.
Methods: This is an overview of recent updates and future directions in the field of spine surgery. All the articles were obtained through a literature review on PubMed.
Results: Minimally invasive spine procedures like Endoscopic spine surgeries, Oblique Lumbar Interbody Fusion, use of retractor systems, etc. are emerging in rapidly in modern world. Fusion surgeries are associated with adjacent level disease hence, motion preservation surgeries that mimic the natural biomechanics of the spine are being explored as alternatives. In view of risks to vital structures, nerve injury due to mal-positioning, etc.; robotic spine surgery has paved a way to allow surgeons real-time procedural manipulation along with instrument control, real-scale magnification. Many high-impact discoveries in cancer research, stereotactic radiotherapy, newer combinations of chemotherapy, and tumor-specific antibodies have increased our understanding of spine oncology. Past two decades have seen many advancements in treatment of spine deformities right from initial radiographic assessment, surgical planning to postoperative care.
Conclusion: All in all, all stakeholders in innovation including the industry, scientists and surgeons must work in an open and honest collaboration to benefit the future patients and continue the evolution in Spine Surgery.
Keywords: Spine surgery, Recent updates, Minimally invasive surgery, Artificial disc replacement, Artificial intelligence.

References

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How to Cite this Article: Marathe NA, Mhatre PP, Date S, Sharma A | Spine Surgery: A Narrative Review About Recent Updates and Future Directions | Back Bone: The Spine Journal | April-September 2022; 3(1): 07-13. https://doi.org/10.13107/bbj.2022.v03i01.033

 

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Paradigm Shift of Interspinous Device Surgery for Degenerative Lumbar Diseases

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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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