Comparative Study between Anterior Cervical Discectomy and Fusion by Standalone Polyetheretherketone Cages and Tricortical Bone Graft with Anterior Plate Fixation for Cervical Spondylotic Myeloradiculopathy

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Volume 2 | Issue 2 | October 2021-March 2022 | page: 79-83 | Md. Anowarul Islam, Md. Shohidullah, Rumana Islam, Afia Ibnat Islam, Abu Zaffar Chowdhury

DOI: 10.13107/bbj.2022.v02i02.025

Authors: Md. Anowarul Islam [1], Md. Shohidullah [1], Rumana Islam [1], Afia Ibnat Islam [1], Abu Zaffar Chowdhury [1]

[1] Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Address of Correspondence
Dr. Anowarul Islam,
Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
E-mail: maislam.spine@gmail.com

Abstract

Background: Cervical spondylotic myeloradiculopathy is a common cause of neck pain and radiating arm pain. It develops when one or more of the intervening discs in the cervical spine starts to break down by wear and tear due to its degeneration. Multiple fixation modalities are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), with their positive and negative sides
Objectives: The objective of the study is to compare the safety and efficacy of ACDF by standalone Polyetheretherketone (PEEK) cages with tricortical bone graft with anterior plate fixation for cervical spondylotic myeloradiculopathy.
Methods: This prospective observational study was conducted in the Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2017 to June 2020. Forty patients with cervical spondylotic myeloradiculopathy diagnosed on the basis of presenting complaints, clinical examination, and investigations were enrolled in this study. Modified Odom’s criteria, visual analog scale (VAS), Nurick Grading, and Bridwell criteria for cervical spondylotic myelopathy was used for evaluation of the results.
Result: Male were predominant in this study. Male-female ratio was 2.9: 1. Most of the patients were farmer (30%), C5/6 (55%) was the most commonly involved disc level. Most of the patients had clinical features of neck pain, gait difficulty, and myelopathy sign. Regarding perioperative complications transient dysphagia was seen in 5 (12.5%) patients and transient paraparesis was observed in 2 (5%) patients. Post-operative complications were paresthesia and wound infection seen in significant number of patients of both groups who were recovered within 3–6 months. According to Bridwell’s grade of fusion, Grade I fusion was observed in 16 patients (80%) in cage group and 18 patients (90%) in tricortical Indocyanine Green (ICG) with plate group. According to VAS, postoperatively pain was gradually decline and after 12 months, 12 patients (60%) patients were found in no pain group and 11 patients (55%) were found in no pain group of the tricortical ICG with plate group. There was no significant difference between the two groups (P = 0.04). According to modified Odom’s criteria functional outcome after 12 months was excellent in 18 patients (90%) and good in 2 patients (10%) in cage group and excellent in 17 patients (85%) and good in 3 patients (15%) in tricortical ICG with plate group. There was no statistically significant difference between two groups (P = 0.432).
Conclusion: ACDF is the ideal technique for the treatment of cervical spondylotic myeloradiculopathy with excellent functional outcome and good fusion which could be achieved by either standalone PEEK cage or tricortical ICG with plate and there is no significant difference between two techniques.
Keywords: Cervical spondylotic myeloradiculopathy, Tricortical bone graft, Anterior cervical discectomy and fusion.

References

1. Rao RD, Currier BL, Albert TG. Degenerative cervical Spondylosis clinical syndromes, pathogenesis, and management. J Bone Joint Surg 2007;89:1360-78.
2. Waltz TA. Physical factors in the production of the myelopathy of cervical spondylosis. Brain 1967;90:395-404.
3. Robinson RA, Afeiche N, Dunn EJ, Northrup BE. Cervical spondylotic myelopathy, etiology and treatment concepts. Spine 1977;2:89-99.
4. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg 1993;75:1298-307.
5. Wilkinson M. The morbid anatomy of cervical spondylosis and myelopathy. Brain 1960;83:589-616.
6. Spallone A, Marchione P. Anterior cervical discectomy and fusion with “mini-invasive” harvesting of iliac crest graft versus polyetheretherketone (PEEK) cages: A retrospective outcome analysis. Int J Surg 2014;12:1328-32.
7. Islam MA, Rana MM, Goni MF, Rahman MN. Comparison between anterior cervical discectomy with fusion by polyetheretherketone cages and tricortical iliac crest graft for the treatment of cervical prolapsed intervertebral disc. Bangabandhu Sheikh Mujib Med Univ J 2016;9:169-72.
8. Sharma A, Kishore H. Comparative study of functional outcome of anterior cervical decompression and interbody fusion with tricortical stnad alone iliac crest autograft versus stand-alone polyetheretherketone cage in cervical spondylotic myelopathy. Glob Spine J 2018;8:860-5.
9. Siddiqui AA, Jackowski A. Cage versus tricortical graft for cervical interbody fusion. J Bone Joint Surg Br 2003;85:1019-25.
10. Lee JC, Jang HD, Ahn J, Choi SW, Kang D, Shin BJ. Comparison of cortical ring allograft and plate fixation with autologous iliac bone graft for anterior cervical discectomy and fusion. Asian Spine J 2019;13:258-64.
11. Adam FF, Hasan KM, Meshtaway EM, Refae EH. PEEK cages versus locked plate for multiple levels cervical degenerated disease. J Am Sci 2013;9:100-6.
12. Islam MA, Habib MA, Sakeb N. Anterior cervical discectomy, fusion and stabilization by plate and screw early experience. Bangladesh Med Res Council Bull 2012;38:62-6.
13. Abdallah A, Taha AM. Cages or plates for anterior interbody fusion for cervical radiculopathy: Single and double levels. Egypt Orthop J 2016;51:65-70.
14. Ayman EA, Galhom MD. Comparison between polyetheretherketone cages versus an iliac crest autograft used in treatment of single or double level anterior cervical discectomy. Med J Cairo Univ 2013;81:9-17.
15. Shao MH, Zhang F, Xu HC, Lyu FZ. Titanium cages versus autogenous iliac crest bone grafts in anterior cervical discectomy and fusion treatment of patients with cervical degenerative diseases: A systematic review and meta-analysis. Curr Med Res Opin 2017;33:803-11.
16. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40:607-24.

How to Cite this Article: Islam MA, Shohidullah M, Islam R, Islam AI, Chowdhury AZ| Comparative Study between Anterior Cervical Discectomy and Fusion by Standalone Polyetheretherketone Cages and Tricortical Bone Graft with Anterior Plate Fixation for Cer vical Spondylotic Myeloradiculopathy | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 79-83.

 

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Hemodynamic Neuromonitoring, a Proposed Spino-Cardiac Protective Reflex: Prospective Study in 200 Patients of Lumbar Surgery

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Volume 2 | Issue 2 | October 2021-March 2022 | page: 71-78 | Ajay Krishnan, Devanand Degulmadi, Ravi Ranjan, Shivanand Mayi, Namit Nitherwal, Lingraj Reddy, Ankur Patel, Iboyama Singh, Mirant Dave, Kashyap R Shah, Paresh A Mehta, Shaunak Dudhia, Bharat R Dave

DOI: 10.13107/bbj.2022.v02i02.024

Authors: Ajay Krishnan [1], Devanand Degulmadi [1], Ravi Ranjan [1], Shivanand Mayi [1], Namit Nitherwal [1], Lingraj Reddy [1], Ankur Patel [1], Iboyama Singh [1], Mirant Dave [1], Kashyap R Shah [2], Paresh A Mehta [3], Shaunak Dudhia [3], Bharat R Dave [1]

[1] Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Mithakali, Ahmedabad, Gujarat, India.
[2] Department of Medicine, Stavya Spine Hospital and Research Institute, Mithakali, Ahmedabad, Gujarat, India.
[3] Department of Anaesthesia, Stavya Spine Hospital and Research Institute, Mithakali, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Ajay Krishnan,
Consultant spine surgeon, Stavya Spine Hospital and Research Institute, Mithakali, Ahmedabad , Gujarat, India.
E-mail: drajaykrishnan@gmail.com

Abstract

Background: Parasympathomimetic reflexes are reported in literature in spine surgery. Our primary hypothesis is proposed that nociceptive stimuli can be elicited by various maneuvers of lumbar spinal surgery and the physiological manifestation depends on many patient variables and anesthesia. However, a sympathomimetic pathological response is indicative of potential neural damages, which may or may not be reversible. A spino-cardiac protective reflex (SPR), as a new entity for lumbar spinal surgery, is proposed.
Study Design: This was a prospective single institution.
Materials and Methods: All the patients who were undergoing single motion segment transforaminal lumbar interbody fusion (TLIF) in our institute for lumbar disc herniation or non-discogenic lumbar stenosis lumbar spinal stenosis were included who fitted into inclusion criteria till 200 subjects were recruited. Patients’ pertinent vital data were collected at clinical first pre-operative visit and preoperatively on admission. The intraoperative parameters were recorded: Pre-induction, post-induction, post-positioning, before skin incision, after skin/subcutaneous exposure, pre-screw insertion, after screw insertion, after rod connection and distraction, during central decompression-laminotomy/laminectomy, during lateral recess decompression, discectomy, and segmental compression. Significant pulse rate (PR) and mean arterial pressure (MAP) changes were monitored and correlated.
Results: In the enrolled 200 patients, the change in mean MAP and PR changes in varying steps of TLIF was not significant. The positivity of a significant change in MAP and PR correlating with an evident manipulative/pathological-demographic cause was noted (plausibility), which could revert back to baseline (reversibility) after addressing the culprit in 22 cases. Non-correlating raise was also noted in 35 cases.
Conclusion: Spino-protective reflex exists like any reflex in body. Prospective study on huge database needs to be done to validate these observations. However, this study does make the surgeon think for finding clues to neurological damage or left out residual compressions which can be identified and rectified in real time in many cases. INOM is the standard of care and SPR should be compared with intraoperative neuromonitoring to identify sensitivity and threshold of pathological response in future studies.
Keywords: Lumbar, Protective, Reflex, Spine, Sympathomimetic, Transforaminal lumbar interbody fusion

References

1. Chowdhury T, Petropolis A, Cappellani RB. Cardiac emergencies in neurosurgical patients. BioMed Res Int 2015;2015:751320.
2. Chowdhury T, Schaller B. The negative chronotropic effect during lumbar spine surgery. Medicine 2017;96:e5436.
3. Doyle DJ, Mark PW. Reflex bradycardia during surgery. Can J Anaesth 1990;37:219-22.
4. Hainsworth R. Reflexes from the heart. Physiol Rev 1991;71:617-58.
5. Matsumura K, Miura K, Takata Y, Kurokawa H, Kajiyama M, Abe I, et al. Changes in blood pressure and heart rate variability during dental surgery. Am J Hypertens 1998;11:1376-80.
6. Deschamps A, Carvalho G. Lumbo-sacral spine surgery and severe bradycardia (Letter). Can J Anesth 2004;51:277.
7. Mandal N. More on lumbo-sacral spine surgery and bradycardia (Letter). Can J Anaesth 2004;51:942.
8. Dooney N. Prone CPR for transient asystole during lumbosacral spinal surgery. Anaesth Intensive Care 2010;38:212-3.
9. Chowdhury T, Sapra H, Dubey S. Severe hypotension in transforaminal lumbar interbody fusion surgery: Is it vasovagal or? Asian J Neurosurg 2017;12:149-50.
10. Chowdhury T, Narayanasamy S, Dube SK, Rath GP. Acute hemodynamic disturbances during lumbar spine surgery. J Neurosurg Anesthesiol 2012;24:80-1.
11. Nash CL Jr., Lorig RA, Schatzinger LA, Brown RH. Spinal cord monitoring during operative treatment of the spine. Clin Orthop Relat Res 1977;126:100-5.
12. Devlin VJ, Schwartz DM. Intraoperative neurophysiologic monitoring during spinal surgery. J Am Acad Orthop Surg 2007;15:549-60.
13. Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU classification for herniated lumbar discs on MRI: Toward developing objective criteria for surgical selection. Eur Spine J 2010;19:1087-93.
14. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 2010;35:1919-24.
15. UK National Institute for Health and Care Excellence. Low Back Pain and Sciatica in Over 16s: Assessment and Management; 2016. Available from: https://www.nice.org.uk/guidance/ng59. [Last accessed on 2017 Nov 07].
16. Swift A. Understanding pain and the human body’s response to it. Nurs Times 2018;114:22-6.
17. Ditunno JF, Little JW, Tessler A, Burns AS. Spinal shock revisited: A four-phase model. Spinal Cord 2004;42:383-95.
18. Krassioukov A. Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol 2009;169:157-64.
19. Wallin BG, Stjernberg L. Sympathetic activity in man after spinal cord injury. Brain 1984;107:183-98.
20. Krassioukov A, Warburton DE, Teasell R, Eng JJ. Spinal cord injury rehabilitation evidence research team. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil 2009;90:682-95.
21. Karlsson AK Autonomic dysreflexia. Spinal Cord 1999;37:383-91.
22. Groen GJ, Baljet B, Drukker J. The innervation of the spinal dura mater: Anatomy and clinical implications. Acta Neurochirur 1988;92:39-46.
23. Bogduk N. The innervation of the lumbar spine. Spine 1983;8:286-93.
24. Bridge CJ. Innervation of spinal meninges and epidural structures. Anat Gec 1959;133:553-61.
25. Pedersen HE, Blunck CF, Gardner E. The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerves (sinu-vertebral nerves). J Bone Joint Surg 1956;38:377-91.
26. Stilwell DL. The nerve supply of the vertebral column and its associated structures in the monkey. Anat Rec 1956;125:139-169.
27. Meglio M, Cioni B, Dei Lago A, De Santis M, Pola P, Serrichio M. Pain control and improvement of peripheral blood flow following spinal cord stimulation. J Neurosurg 1981;54:821-3.
28. Musizza B, Ribaric S. Monitoring the depth of anaesthesia. Sensors 2010;10:10896-935.
29. Kaul H, Bharti N. Monitoring the depth of anaesthesia. Indian J Anaesth 2002;46:323-32.
30. Wiedemayer H, Sandalcioglu IE, Armbruster W, Regel J, Schaefer H, Stolke D. False negative findings in intraoperative SEP monitoring: Analysis of 658 consecutive neurosurgical cases and review of published reports. J Neurol Neurosurg Psychiatry 2004;75:280-6.
31. Cole T, Veeravagu A, Zhang M, Li A, Ratliff JK. Intraoperative neuromonitoring in single-level spinal procedures. Spine 2014;39:1950-9.
32. Prys-Roberts C. Anaesthesia: A practical or impossible construct (editorial). Br J Anaesth 1987;59:1341.
33. Poon KS, Wu KC, Chen CC, Fung ST, Lau AW, Huang CC, et al. Hemodynamic changes during spinal surgery in the prone position. Acta Anaesthesiol Taiwan 2008;46:57-60.
34. Savitha KS, Dhanpal R, Vikram MS. Hemodynamic responses at intubation, change of position, and skin incision: A comparison of multimodal analgesia with conventional analgesic regime. Anaesth Essays Res 2017;11:314-20.
35. Gruenewald M, Ilies C. Monitoring the nociception-anti-nociception balance. Best Pract Res Clin Anaesthesiol 2013;27:235-47.
36. Hu HT, Ren L, Sun XZ, Liu FY, Yu JH, Gu ZF. Contralateral radiculopathy after transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: A case series. Medicine (Baltimore) 2018;97:e0469.
37. Jang KM, Park SW, Kim YB, Park YS, Nam TK, Lee YS. Acute contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion. J Korean Neurosurg Soc 2015;58:350-6.
38. Bärlocher CB, Krauss JK, Seiler RW. Central lumbar disc herniation. Acta Neurochir (Wien) 2000;142:1369-74.
39. Choi JW, Lee JK, Moon KS, Hur H, Kim YS, Kim SH. Transdural approach for calcified central disc herniations of the upper lumbar spine. J Neurosurg Spine 2007;7:370-4.
40. Kim DS, Lee JK, Jang JW, Ko BS, Lee JH, Kim SH. Clinical features and treatments of upper lumbar disc herniations. J Korean Neurosurg Soc 2010;48:119-24.
41. Podnar S. Cauda equina lesions as a complication of spinal surgery. Eur Spine J 2010;19:451-7.
42. Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth 200391:886-904.
43. Schnider TW, Minto CF, Struys MM, Absalom AR. The safety of target-controlled infusions. Anesth Analg 2016;122:79-85.
44. Mahajan S, Swami AC, Kumar A. Cardiovascular changes and lumbar spine surgery: A neglected entity. Asian J Neurosurg 2019;14:1253-5.
45. Chavali S, Das K, Sokhal S, Rath GP. Reflex bradycardia due to traction on filum terminale during detethering of spinal cord. Neurol India 2019;67:889-90.
46. Marie JR, Jennifer S, Alexander PH, Andrew AS, Ronald GE, Carrie G, et al. Hemodynamically significant cardiac arrhythmias during general anesthesia for spine surgery: A case series and literature review. N Am Spine Soc J 2020;2:100010.
47. Morano JM, Tung A. Bradycardic arrest during somatosensory-evoked potential monitoring. A A Pract 2019;13:461-3.

How to Cite this Article: Krishnan A, Degulmadi D, Ranjan R, Mayi S, Nitherwal N, Reddy L, Patel A, Singh I, Dave M, Shah KR, Mehta PA, Dudhia S, Dave BR Hemodynamic | Neuromonitoring, a Proposed Spino- Cardiac Protective Reflex: Prospective Study in 200 Patients of Lumbar Surgery | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 71-78.

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Clinical and Radiological Outcome of Minimally Invasive- Transforaminal Lumbar Interbody Fusion in Patients with Single or Double-Level Involvement with Minimum 2-Year Follow-up

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Volume 2 | Issue 2 | October 2021-March 2022 | page: 65-70 | Hitesh N. Modi, Utsab Shrestha , Udit D. Patel
DOI: 10.13107/bbj.2022.v02i02.023

Authors: Hitesh N. Modi [1], Utsab Shrestha [1], Udit D. Patel [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. Hitesh N. Modi,
Department of Spine Surgery, Zydus Hospitals and healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, India.
E-mail: drmodihitesh@gmail.com

Abstract

Purpose: The objective of this study is to analyze the clinical and radiological outcome of Minimally Invasive-Transforaminal Lumbar Interbody Fusion (MIS-TLIF) in terms of estimated blood loss (EBL), operative time, length of stay (LOS) in the hospital, complication, Oswestry disability index (ODI) score, visual analog scale (VAS) score, and parameters of sagittal spinal balance before and after surgery. The parameters of sagittal spinal balance included in this study were pelvic Incidence (PI), lumbar lordosis, focal lordosis at the index level.
Materials and Methods: All cases were retrospectively followed up. Single-level and double-level MIS-TLIF procedures for back pain and leg pain operated between 2015 and 2018 were included in the study. PI, Lumbar lordosis, Focal lordosis at index level was measured on preoperative, post-operative, and final follow-up lateral lumbosacral X-ray in the supine position. Demographic data, intraoperative blood loss, operative time, LOS, ODI score, and VAS score at different times were reviewed and analyzed.
Results: Fifty-four patients were included among them 24 were male and 30 were female. The average age of the patients was 51.6 ± 12.1 years. Sixteen double-level surgery and 38 single-level surgeries. The average value of follow-up was found to be 39.6 ± 12.4 months. The average value of operative time, the EBL and the LOS were 170.8 ± 19.8 min, 132.1 ± 34.8 mL, and 4.8 ± 0.8 days, respectively. The average PI was 54.9 ± 11.2° preoperatively, 55.0 ± 10.7° postoperatively and 54.8 ± 10.9° at the final follow-up. Pre-operative lumbar lordosis and focal lordosis were 44.55 ± 12.9° and 7.76 ± 5.2°, respectively with postoperatively and final follow-up to 48.88 ± 13.1° and 10.62 ± 5.1°, respectively. VAS score and ODI scales were improved significantly from preoperative 8.4 ± 0.9 and 56.3 ± 4.9, respectively, to postoperatively and final follow-up 2.0 ± 0.8 and 21.6 ± 5.4, respectively. The postoperative complications and revision occurred in 8 (14.8%) and 4 (7.4%) patients, respectively.
Conclusion: MIS-TLIF is a novel technique with the good radiological and clinical outcome with decreased perioperative morbidity. It is also superior to open TLIF in terms of EBL, hospital LOS, operative time, perioperative morbidity, and surgical complications.
Keywords: Minimally invasive-transforaminal lumbar interbody fusion, Clinical improvement, Pelvic incidence, Lumbar lordosis, Focal lordosis

References

1. Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg 2002;49:499-517.
2. Goldstein CL, Phillips FM, Rampersaud YR. Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion: A systematic review. Spine (Phila Pa 1976) 2016;41 Suppl 8:S74-89.
3. Guan J, Bisson EF, Dailey AT, Hood RS, Schmidt MH. Comparison of clinical outcomes in the national neurosurgery quality and outcomes database for open versus minimally invasive transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 2016;41:E416-21.
4. Lin Y, Chen W, Chen A, Li F. Comparison between minimally invasive and open transforaminal lumbar interbody fusion: A meta-analysis of clinical results and safety outcomes. J Neurol Surg A Cent Eur Neurosurg 2016;77:2-10.
5. Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 2012;70:707-21.
6. Seng C, et al. Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: A matched-pair comparison study. Spine (Phila Pa 1976) 2013;38:2049-55.
7. Wong AP, Smith ZA, Stadler JA 3rd, Hu XY, Yan JZ, Li XF, et al. Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF): Surgical technique, long-term 4-year prospective outcomes, and complications compared with an open TLIF cohort. Neurosurg Clin North Am 2014;25:279-304.
8. Wu RH, Fraser JF, Hartl R. Minimal access versus open transforaminal lumbar interbody fusion: Meta-analysis of fusion rates. Spine (Phila Pa 1976) 2010;35:2273-81.
9. Kim CH, Lee CH, Kim KP. How high are radiation-related risks in minimally invasive transforaminal lumbar interbody fusion compared with traditional open surgery? A meta-analysis and dose estimates of ionizing radiation. Clin Spine Surg 2016;29:52-9.
10. Nandyala SV, Fineberg SJ, Pelton M, Singh K. Minimally invasive transforaminal lumbar interbody fusion: One surgeon’s learning curve. Spine J 2014;14:1460-5.
11. Ng CL, Pang BC, Medina PJ, Tan KA, Dahshaini S, Liu LZ. The learning curve of lateral access lumbar interbody fusion in an Asian population: A prospective study. Eur Spine J 2015;24 Suppl 3:361-8.
12. Park Y, Lee SB, Seok SO, Jo BW, Ha JW. Perioperative surgical complications and learning curve associated with minimally invasive transforaminal lumbar interbody fusion: A single-institute experience. Clin Orthop Surg 2015;7:91-6.
13. Ryang YM, Villard J, Obermüller T, Friedrich B, Wolf P, Gempt J, et al. Learning curve of 3D fluoroscopy image-guided pedicle screw placement in the thoracolumbar spine. Spine J 2015;15:467-76.
14. Silva PS, Pereira P, Monteiro P, Silva PA, Vaz R. Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus 2013;35:E7.
15. Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review. J Neurosurg Spine 2016;24:416-27.
16. Styf JR, Willen J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976) 1998;23:354-8.
17. Berthonnaud E, Dimnet J, Roussouly P, Labelle H. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Technol 2005;18:40-7.
18. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005;30:2024-9.
19. Hioki A, Miyamoto K, Kodama H, Hosoe H, Nishimoto H, Sakaeda H, et al. Two-level posterior lumbar interbody fusion for degenerative disc disease: Improved clinical outcome with restoration of lumbar lordosis. Spine J 2005;5:600-7.
20. Marty C, Boisaubert B, Descamps H, Montigny J, Hecquet J, Legaye J, et al. The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J 2002;11:119-25.
21. Singh R, Yadav SK, Sood S, Yadav RK, Rohilla R, et al. Spino-pelvic radiological parameters in normal Indian population. SICOT J 2018;4:14.
22. Sudhir G, Acharya S, Kalra KL, Chahal R. Radiographic analysis of the sacropelvic parameters of the spine and their correlation in normal asymptomatic subjects. Glob Spine J 2016;6:169-75.
23. Tian NF, Wu YS, Zhang XL, Xu HZ, Chi YL, Mao FM. Minimally invasive versus open transforaminal lumbar interbody fusion: A meta-analysis based on the current evidence. Eur Spine J 2013;22:1741-9.
24. Hu W, Tang J, Wu X, Zhang L, Ke B. Minimally invasive versus open transforaminal lumbar fusion: A systematic review of complications. Int Orthop 2016;40:1883-90.
25. Sulaiman WA, Singh M. Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis grades 1-2: Patient-reported clinical outcomes and cost-utility analysis. Ochsner J 2014;14:32-7.
26. Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 2010;19:1780-4.
27. Adogwa O, Carr K, Thompson P, Hoang K, Darlington T, Perez E, et al. A prospective, multi-institutional comparative effectiveness study of lumbar spine surgery in morbidly obese patients: Does minimally invasive transforaminal lumbar interbody fusion result in superior outcomes? World Neurosurg 2015;83:860-6.
28. Ahn J, Tabaraee E, Singh K. Minimally invasive transforaminal lumbar interbody fusion. J Spinal Disord Tech 2015;28:222-5.
29. Choi WS, Kim JS, Ryu KS, Hur JW, Seong JH. Minimally invasive transforaminal lumbar interbody fusion at L5-S1 through a unilateral approach: Technical feasibility and outcomes. Biomed Res Int 2016;2016:2518394.
30. Datta G, Gnanalingham KK, Peterson D, Mendoza N, O’Neill K, Van Dellen J, et al. Back pain and disability after lumbar laminectomy: Is there a relationship to muscle retraction? Neurosurgery 2004;54:1413-20; discussion 1420.
31. Alamin TF, Kim MJ, Agarwal V, Provocative lumbar discography versus functional anesthetic discography: A comparison of the results of two different diagnostic techniques in 52 patients with chronic low back pain. Spine J 2011;11:756-65.
32. Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F. Open versus minimally invasive TLIF: Literature review and meta-analysis. J Orthop Surg Res 2019;14:229.
33. Jhala A, Singh D, Mistry M. Minimally invasive transforaminal lumbar interbody fusion: Results of 23 consecutive cases. Indian J Orthop 2014;48:562-7.

How to Cite this Article: Modi HN, Shrestha U, Patel UD Clinical | and Radiological Outcome of Minimally Invasive- Transforaminal Lumbar Interbody Fusion in Patients with Single or Double-Level Involvement with Minimum 2-Year Follow-up | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 65-70.

 

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Minimally Invasive Trans-foraminal Lumbar Interbody Fusion (MI-TLIF): Technique, Tips and Tricks.

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Volume 2 | Issue 2 | October 2021-March 2022 | page: 60-64 | Sanjeev Asati, Saijyot Raut, Vishal Kundnani, Amit Chugh, Ameya Rangekar, Praveen VNR Goparaju
DOI: 10.13107/bbj.2022.v02i02.023

Authors: Sanjeev Asati [1], Saijyot Raut [1], Vishal Kundnani [1], Amit Chugh [1], Ameya Rangekar [1], Praveen VNR Goparaju [1]

[1] Department of Spine Surgery, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
[2] Mumbai Spine Scoliosis and Disc Replacement Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Saijyot Raut,
Clinical spine fellow, Bombay Hospital & Medical Research Centre & Mumbai Spine Scoliosis and Disc Replacement Centre, Mumbai, Maharashtra, India.
E-mail: saijyotraut@gmail.com

Abstract

Surgical interbody fusion is the main stay of treatment in many lumbar pathologies. Of these, transforaminal lumbar interbody fusion has progressively gained popularity among fusions due to its safety and satisfactory results. With the ever-ending evolution of technological advancements enabled spine surgeons to embrace minimally invasive surgeries mainly due to focal nature of the pathology. Tubular retractors have been tried and tested with very good results when used with microscopic magnification. They helps in surgical decompression and fusion through transforaminal approach with minimal footprint and have proven their versatility by delivering excellent outcomes. Near total bloodless surgery, better cosmesis, decreased hospital stay, lower pain score, early return to work, are some other proven advantages with minimally invasive transforaminal interbody fusion MIS-TLIF. However, high procedural costs and longer trajectory of learning is restraining many surgeons from adapting this technique over time tested open procedures. In this report the authors discuss about the nuances of the surgical procedure, tips and tricks to provide a comprehensive insight and better understanding.

Keywords: MIS-TLIF, Minimally invasive spine surgery, Transforaminal lumbar interbody fusion.

References

1. Stonecipher T, Wright S (1989) Posterior lumbar interbody fusion with facet screw fixation. Spine 14:468–47.
2. Fraser RD (1995) Interbody, posterior, and combined lumbar fusions. Spine 20:S167–S177.
3. Harms J, Jeszenszky D (1998) The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88–99.
4. Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 15(suppl):26–35.
5. Jin-Tao Q, Yu T, MeiW, et al. Comparison of MIS vs. open PLIF/ TLIF with regard to clinical improvement, fusion rate, and incidence of major complication: a meta analysis. Eur Spine J. 2015;24:1058-1065.
6. Khan NR, Clark AJ, Lee SL, Venable GT, Rossi NB, Foley KT. Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and metaanalysis. Neurosurgery. 2015;77:847-874.
7. Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24:479-484.
8. Gu G, Zhang H, Fan G, et al. Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease. Int Orthop. 2014;38:817-824.
9. Kulkarni AG, Patel RS, Dutta S. Does minimally invasive spine surgery minimize surgical site infections? Asian Spine J. 2016;10: 1000-1006.
10. Kim KT, Lee SH, Suk KS, Bae SC. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976) 2006;31:712-6.
11. Kim DY, Lee SH, Chung SK, Lee HY. Comparison of multifidus muscle atrophy and trunk extension muscle strength: Percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976) 2005;30:123-9.
12. Shunwu F, Xing Z, Fengdong Z, Xiangqian F (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 35:1615–1620.
13. Wang HL, Lu FZ, Jiang JY, Ma X, Xia XL, Wang LX (2011) Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J (Engl) 124:3868–3874.
14. Kim CW, Lee YP, Taylor W, Oygar A, Kim WK (2008) Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery. Spine J 8:584–590.
15. Tjardes T, Shafizadeh S, Rixen D, Paffrath T, Bouillon B, Steinhausen ES, Baethis H (2010) Image-guided spine surgery: state of the art and future directions. Eur Spine J 19:25–45.

How to Cite this Article: Asati S, Raut S, Kundnani V, Chugh A, Rangekar A, Goparaju P VNR | Minimally Invasive Trans-foraminal Lumbar Interbody Fusion (MI-TLIF): Technique, Tips and Tricks. | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 60-64.

 

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Integrated Operation Theater Spine Suite (IOTSS) History of Spine Surgery: Lord Krishna the First Eternal Spine Surgeon

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Volume 2 | Issue 2 | October 2021-March 2022 | page: 56-59 | Bharat R Dave
DOI: 10.13107/bbj.2022.v02i02.021

Authors: Bharat R Dave [1]

[1] Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Bharat R Dave,
Consultant Spine Surgeon, Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India.
E-mail: Brd_172@yahoo.com

Abstract

The Mission has been to improve the quality of human life and do no harm. The significant change experienced during the training at England 1991 to 1996. Saga to be the best, be different and be unique continued. Necessary equipment installed like C Arm for fluoroscopy, radiolucent operation table and Anaesthesia machine. Safety increased due to optimisation of the operating room by implementation of available gadgets.
Many of us have witnessed the transition of an era, from handwritten Operation schedule call books to smartphone apps., from manual typewriters to high tech computers for research, from manual slide carousel to virtual presentations, from written high-risk consent to video consent and now from high radiation and lead aprons to Zero radiation exposure with O-Arm and navigation.
Integrated Operation Theatre Spine Suite– Enabling Technology – IOTSS is the latest version in optimising and additionally maximising the advantage of the surgery.
Keywords: Integrated spine suite, Optimizing results, Spine surgery

References

1. Brahmavaivarta Purana Sri-Krishna Janma Khanda (Fourth Canto) Chapter 72 English translation by Shantilal Nagar Parimal Publications. Available from: https://www.archive.org/details/brahma-vaivarta-purana-all-four-kandas-english-translation.
2. Bhishagratna K, Kaviraj KL. An English Translation of the Sushruta Samhita in Three Volumes. Vol. 1. Toronto: Archived by University of Toronto; 1907.
3. Carstensen K, Jensen EK, Madsen ML, Thomsen AM, Løvschall C, Dehbarez NT, et al. Implementation of integrated operating rooms: how much time is saved and how do medical staff experience the upgrading? A mixed-methods study in Denmark. BMJ Open 2020;10:e034459.
4. Gen ZT. Nikhil Raval. Available from: http://www.healthcaredesignmagazine.com/architecture/integrated-operating-room.

How to Cite this Article:  Dave BR Integrated Operation Theater Spine Suite | (IOTSS) History of Spine Surgery: Lord Krishna the First Eternal Spine Surgeon| Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 56-59.

 

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Rare Case of a Solitary Spinal Osteochondroma with Myelopathy Treated by a Minimally Invasive Technique

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Volume 2 | Issue 2 | October 2021-March 2022 | page: 98-101 | Umesh Srikantha, Akshay Hari, Yadhu Lokanath, Ravi Gopal Varma, Nandeesh BM

Authors: Umesh Srikantha [1], Akshay Hari [1], Yadhu Lokanath [1], Ravi Gopal Varma [1], Nandeesh BM [1]

 

[1] Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India.
[2] Department of Neuropathology, NIMHANS, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Akshay Hari,
Consultant Spine Surgeon, Aster CMI Hospital, Bangalore, Karnataka, India.
E-mail: aksayhari@gmail.com

Abstract

Among primary bone tumors, osteochondroma or osteocartilaginous exostosis is a common occurrence. However, solitary spinal osteochondromas are quite rare, seen in only in 1–4% of all reported cases. Only few symptomatic cases have been reported so far in the literature. Recurrence and malignant transformation are also known, thereby necessitating wide surgical excision as the treatment of choice. We would like to report one such a case of a solitary cervical osteochondroma presenting with myelopathy that was excised surgically using a minimally invasive tubular approach.
Keywords: Spinal, Osteochondroma, Solitary, Myelopathy, Minimally invasive, Tubular.

 

References

1. Gille O, Pointillart V, Vital JM. Course of spinal solitary osteochondromas. Spine (Phila Pa 1976) 2005;30:E13-9.
2. Albrecht S, Crutchfield JS, SeGall GK. On spinal osteochondromas. J Neurosurg 1992;77:247-52.
3. Orguc S, Arkun R. Primary tumors of the spine. Semin Musculoskelet Radiol 2014;18:280-99.
4. Srikantha U, Bhagavatula ID, Satyanarayana S, Somanna S, Chandramouli BA. Spinal osteochondroma: Spectrum of a rare disease: Report of 3 cases. J Neurosurg Spine 2008;8:561-6.
5. Bess RS, Robbin MR, Bohlman HH, Thompson GH. Spinal exostoses: Analysis of twelve cases and review of the literature. Spine (Phila Pa 1976) 2005;30:774-80.
6. Gürkanlar D, Aciduman A, Günaydin A, Koçak H, Celik N. Solitary intraspinal lumbar vertebral osteochondroma: A case report. J Clin Neurosci 2004;11:911-3.
7. Sharma MC, Arora R, Deol PS, Mahapatra AK, Mehta VS, Sarkar C. Osteochondroma of the spine: An enigmatic tumor of the spinal cord. A series of 10 cases. J Neurosurg Sci 2002;46:66-70; discussion 70.
8. Ratliff J, Voorhies R. Osteochondroma of the C5 lamina with cord compression: Case report and review of the literature. Spine (Phila Pa 1976) 2000;25:1293-5.
9. Anantharamaiah H, Kalyani R, Kumar ML, Manohar PV. Secondary chondrosarcoma of the lumbosacral region: Are any bones spared in the multiple hereditary exostoses? J Clin Diagn Res 2012;6:1778-80.
10. Ruivo C, Hopper MA. Spinal chondrosarcoma arising from a solitary lumbar osteochondroma. JBR-BTR 2014;97:21-4.
11. Strovski E, Ali R, Graeb DA, Munk PL, Chang SD. Malignant degeneration of a lumbar osteochondroma into a chondrosarcoma which mimicked a large retropertioneal mass. Skeletal Radiol 2012;41:1319-22.
12. Chow WA. Update on chondrosarcomas. Curr Opin Oncol 2007;19:371-6.
13. Yukawa Y, Kato F, Sugiura H. Solitary osteochondroma of the lower cervical spine. Orthopedics 2001;24:292-3.
14. Celli P, Trillò G, Ferrante L. Spinal extradural schwannoma. J Neurosurg Spine 2005;2:447-56.
15. Lu DC, Chou D, Mummaneni PV. A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors. J Neurosurg Spine 2011;14:758-64.
16. Lu DC, Dhall SS, Mummaneni PV. Mini-open removal of extradural foraminal tumors of the lumbar spine. J Neurosurg Spine 2009;10:46-50.
17. Ozawa H, Kokubun S, Aizawa T, Hoshikawa T, Kawahara C. Spinal dumbbell tumors: An analysis of a series of 118 cases. J Neurosurg Spine 2007;7:587-93.
18. Seppälä MT, Haltia MJ, Sankila RJ, Jääskeläinen JE, Heiskanen O. Long-term outcome after removal of spinal schwannoma: A clinicopathological study of 187 cases. J Neurosurg 1995;83:621-6.
19. Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Giant invasive spinal schwannomas: Definition and surgical management. J Neurosurg Spine 2001;94:210-5.

 

How to Cite this Article: Srikantha U, Hari A, Lokanath Y, Varma RG, Nandeesh BM | Rare Case of a Solitary Spinal Osteochondroma with Myelopathy Treated by a Minimally Invasive Technique | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 98-101.

 

(Abstract Text HTML)      (Download PDF)

.

Rare Case of a Solitary Spinal Osteochondroma with Myelopathy Treated by a Minimally Invasive Technique

/in /by

Volume 2 | Issue 2 | October 2021-March 2022 | page: 98-101 | Umesh Srikantha, Akshay Hari, Yadhu Lokanath, Ravi Gopal Varma, Nandeesh BM

DOI: 10.13107/bbj.2022.v02i02.029

Authors: Umesh Srikantha [1], Akshay Hari [1], Yadhu Lokanath [1], Ravi Gopal Varma [1], Nandeesh BM [2]

[1] Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India.
[2] Department of Neuropathology, NIMHANS, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Akshay Hari,
Consultant Spine Surgeon, Aster CMI Hospital, Bangalore, Karnataka, India.
E-mail: aksayhari@gmail.com

Abstract

Among primary bone tumors, osteochondroma or osteocartilaginous exostosis is a common occurrence. However, solitary spinal osteochondromas are quite rare, seen in only in 1–4% of all reported cases. Only few symptomatic cases have been reported so far in the literature. Recurrence and malignant transformation are also known, thereby necessitating wide surgical excision as the treatment of choice. We would like to report one such a case of a solitary cervical osteochondroma presenting with myelopathy that was excised surgically using a minimally invasive tubular approach.
Keywords: Spinal, Osteochondroma, Solitary, Myelopathy, Minimally invasive, Tubular

 

References

1. Gille O, Pointillart V, Vital JM. Course of spinal solitary osteochondromas. Spine (Phila Pa 1976) 2005;30:E13-9.
2. Albrecht S, Crutchfield JS, SeGall GK. On spinal osteochondromas. J Neurosurg 1992;77:247-52.
3. Orguc S, Arkun R. Primary tumors of the spine. Semin Musculoskelet Radiol 2014;18:280-99.
4. Srikantha U, Bhagavatula ID, Satyanarayana S, Somanna S, Chandramouli BA. Spinal osteochondroma: Spectrum of a rare disease: Report of 3 cases. J Neurosurg Spine 2008;8:561-6.
5. Bess RS, Robbin MR, Bohlman HH, Thompson GH. Spinal exostoses: Analysis of twelve cases and review of the literature. Spine (Phila Pa 1976) 2005;30:774-80.
6. Gürkanlar D, Aciduman A, Günaydin A, Koçak H, Celik N. Solitary intraspinal lumbar vertebral osteochondroma: A case report. J Clin Neurosci 2004;11:911-3.
7. Sharma MC, Arora R, Deol PS, Mahapatra AK, Mehta VS, Sarkar C. Osteochondroma of the spine: An enigmatic tumor of the spinal cord. A series of 10 cases. J Neurosurg Sci 2002;46:66-70; discussion 70.
8. Ratliff J, Voorhies R. Osteochondroma of the C5 lamina with cord compression: Case report and review of the literature. Spine (Phila Pa 1976) 2000;25:1293-5.
9. Anantharamaiah H, Kalyani R, Kumar ML, Manohar PV. Secondary chondrosarcoma of the lumbosacral region: Are any bones spared in the multiple hereditary exostoses? J Clin Diagn Res 2012;6:1778-80.
10. Ruivo C, Hopper MA. Spinal chondrosarcoma arising from a solitary lumbar osteochondroma. JBR-BTR 2014;97:21-4.
11. Strovski E, Ali R, Graeb DA, Munk PL, Chang SD. Malignant degeneration of a lumbar osteochondroma into a chondrosarcoma which mimicked a large retropertioneal mass. Skeletal Radiol 2012;41:1319-22.
12. Chow WA. Update on chondrosarcomas. Curr Opin Oncol 2007;19:371-6.
13. Yukawa Y, Kato F, Sugiura H. Solitary osteochondroma of the lower cervical spine. Orthopedics 2001;24:292-3.
14. Celli P, Trillò G, Ferrante L. Spinal extradural schwannoma. J Neurosurg Spine 2005;2:447-56.
15. Lu DC, Chou D, Mummaneni PV. A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors. J Neurosurg Spine 2011;14:758-64.
16. Lu DC, Dhall SS, Mummaneni PV. Mini-open removal of extradural foraminal tumors of the lumbar spine. J Neurosurg Spine 2009;10:46-50.
17. Ozawa H, Kokubun S, Aizawa T, Hoshikawa T, Kawahara C. Spinal dumbbell tumors: An analysis of a series of 118 cases. J Neurosurg Spine 2007;7:587-93.
18. Seppälä MT, Haltia MJ, Sankila RJ, Jääskeläinen JE, Heiskanen O. Long-term outcome after removal of spinal schwannoma: A clinicopathological study of 187 cases. J Neurosurg 1995;83:621-6.
19. Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Giant invasive spinal schwannomas: Definition and surgical management. J Neurosurg Spine 2001;94:210-5.

 

How to Cite this Article: Srikantha U, Hari A, Lokanath Y, Varma RG, Nandeesh BM | Rare Case of a Solitary Spinal Osteochondroma with Myelopathy Treated by a Minimally Invasive Technique | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 98-101.

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