Removal of Intradural Extramedullary Schwannoma at Lumbar Level by Doing Laminoplasty in Paediatric Patient- A Case Report and Review of Literature

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Volume 2 | Issue 1 | April-September 2021 | page: 52-55 | Rohit Thaker, Arvind Gosai, Pratik Shah

Authors: Rohit Thaker [1], Arvind Gosai [1], Pratik Shah [1]

[1] Department of Spine Surgery, OrthoPlus Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Rohit Thaker,
Consultant Spine Surgeon, OrthoPlus Hospital, Ahmedabad, Gujarat, India.
E-mail: thakerrohit@gmail.com

Abstract

Intradural Extramedullary tumour of thoracolumbar spine has been mainly treated with laminectomy till date. Other approach has been of treating this pathology by doing laminoplasty. Objective of this case presentation is that laminoplasty is better option for IDEM in selected cases. Laminectomy has been associated with many complications which can be avoided by doing laminoplasty such as postoperative spinal instability, epidural fibro¬sis, kyphotic deformity, excessive blood loss, hematoma invasion, progressive myelopathy, persistent back pain and prolonged hospital stay. So laminoplasty has clearly advantage compared to laminectomy in preserving posterior arch of the spine. Revision surgery is also easier when primary surgery has been done by laminoplasty. In our case of 13-year-old boy having Intradural Extramedullary Schwannoma at L3 level, he was treated with flipping laminoplasty and tumour excision. At final follow up he was having complete clinical recovery and fully healed laminoplasty assessed with CT scan without any recurrence of tumour or any spinal deformity. It proves our purpose of doing laminoplasty with better outcome compared to laminectomy.
Keywords: Laminoplasty; Laminectomy; Intradural Extramedullary; Spinal Cord Tumour.

 

 

References

1. Arnautovic K, Arnautovic A. Extramedullary intra¬dural spinal tumors: a review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci 2009;9 Suppl 1:40-5.
2. Aghayev K, Vrionis F, Chamberlain MC. Adult in¬tradural primary spinal cord tumors. J Natl Compr Canc Netw 2011;9:434-47.
3. Iida Y, Kataoka O, Sho T, et al. Postoperative lumbar spinal instability occurring or progressing secondary to laminectomy. Spine (Phila Pa 1976) 1990;15:1186- 9.
4. Mayfield FH. Complications of laminectomy. Clin Neurosurg 1976;23:435-9.
5. Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminecto¬my in children and adults. J Neurosurg 1982;57:441- 5.
6. Kumar R, Debbarma I, Boruah T, et al. Flipped Reposition Laminoplasty for Excision of Intradural Extramedullary Tumors in the Thoracolumbar Spine: A Case Series of 14 Patients. Asian Spine J. 2020;14(3):327-335. doi:10.31616/asj.2019.0034
7. Liu XY, Zheng YP, Li JM. Laminoplasty for the treat¬ment of extramedullary intradural tumors in the tho¬racic and lumbar spine: greater than two-year follow-up. Orthop Surg 2009;1:275-9.
8. Wiedemayer H, Sandalcioglu IE, Aalders M, et al. Reconstruction of the laminar roof with miniplates for a posterior approach in intraspinal surgery: technical considerations and critical evaluation of follow-up results. Spine, 2004, 29: E333–E342.
9. Papagelopoulos PJ, Peterson HA, Ebersold MJ, et al. Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine, 1997, 22: 442–451.
10. Yeh JS, Sgouros S, Walsh AR, et al. Spinal sagittal malalignment following surgery for primary intramedullary tumours in children. Pediatr Neurosurg, 2001, 35: 318–324.
11. Yücesoy K, Crawford NR. Increase in spinal canal area after inverse laminoplasty: an anatomical study. Spine, 2000, 25: 2771–2776.
12. Onyia, Chiazor & Menon, Sajesh. (2018). Laminectomy Versus Laminoplasty in the Surgical Management of Long-Segment Intradural Spinal Tumors: Any Difference in Neurological Outcomes?. Asian Journal of Neurosurgery. 13. 1128. 10.4103/ajns.AJNS_67_18.

How to Cite this Article: Thaker R, Gosai A, Shah P | A Removal of Intradural Extramedullary Schwannoma at Lumbar Level by Doing Laminoplasty in Paediatric Patient- A Case Report and Review of Literature | Back Bone: The Spine Journal | April-September 2021; 2(1): 52-55.

 

 

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Atypical Fracture of Axis With False Localising Sign

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Volume 2 | Issue 1 | April-September 2021 | page: 48-51 | G D Tharadara

Authors: G D Tharadara [1]

[1] Department of Orthopaedics, Saviour Hospital, Navrangpura, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. G.D. Tharadara,
EX. Professor of Orthopaedics, Spine Consultant, Saviour Hospital, Navrangpura, Ahmedabad, Gujrat, India.
E-mail: drtharadara@rediffmail.com

Abstract

Introduction: Injuries of upper cervical spine many times associated with false localizing signs as a neurological deficit means there is a no clinic-radiological correlation. Purpose of this case report is to diagnose rare clinical presentation due to injury of pyramidal tract decussating at lower medulla.
Method and Materials: A 21 years old male patient presented with traumatic quadriplegia (Frankel-A). Primary treatment was given along with immobilization of neck with collar. Routine X-ray of cervical spine was taken. X-ray was showing shear fracture of C 2 vertebra with intact dens. Crucified tong was inserted. Methyl Prednisolon injection in proper dose within 8 hours was given. (NASCIS II)
CT SCAN was done to know exact fracture geometry. It was showing a fracture of C2 body in an oblique plane shearing off in one piece with the dens tilted towards right side and with subluxation of C1-C2 articular process on left side.
Clinically patient improved in 24 hours in form of 4/5 power grade in all limbs except left upper limb. Left upper limb shoulder and elbow muscle power was grade 2/5 and o/5 in hand. Bladder/bowel was improved. Even though there was a weakness of left upper limb, but reflexes were preserved remarkably (Cruciate paralysis as a false localizing sign).
Considering atypical unstable fracture, open indirect reduction of C-1-2 done from posteriorly and stabilization done with apofix clamps after fusion between C1-C2 posterior arches.
Result: Patient had Frankel grade-A on admission. At three months follow up patient had almost full neurological recovery except finger grip power grade was 4/5. On final follow up at 12 months, neurology improved to Frankel grade-E. He had no neck pain with mild restriction of rotation. X-ray of cervical spine in flexion-extension shows stability and fusion of C1-C2 posterior elements.
Conclusion: Atypical clinical presentation like cruciate paralysis as a false localizing sign should be kept in mind while dealing with fracture of upper cervical spine. As this fracture has good prognosis, proper treatment is needed. If close reduction is not achieved then open reduction and stabilization with fusion will provide early mobilization and faster neurological recovery.
Keywords: Fracture; Axis; Cruciate; Paralysis.

 

References

1. Hahnle UR, Wisniewski TF, Craig JB. Shear fracture through the body of the axis vertebra. Spine. 1999 Nov 1; 24(21): 2278-81
2. Levi AD, Tator CH, Bunge RP. Clinical syndromes associated with disproportionate weakness of the upper versus the lower extremities after cervical spinal cord injury. Neurosurgery. 1996 Jan; 38(1): 179-83; discussion 183-5.
3. Georgiadis D, Schulte-Mattler WJ. Cruciate paralysis or man-in-the-barrel syndrome? Report of a case of brachial diplegia. Acta Neurol Scand. 2002 Apr; 105(4): 337-40.
4. Hatzakis MJ Jr, Bryce N, Marino R. Cruciate paralysis, hypothesis for injury and recovery. Spinal Cord 2000 Feb; 38(2): 120-5.
5. Coleman, W. P., Benzel, E., Cahill, D. W., Ducker, T., Geisler, F., Green, B., Gropper, M. R., Goffin, J., Madsen, P. W., Maiman, D. J., Ondra, S. L., Rosner, M., Sasso, R. C., Trost, G. R., & Zeidman, S. (2000). A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. Journal of spinal disorders, 13(3), 185-199. https://doi.org/10.1097/00002517-200006000-00001
6. Cruciate paralysis and hemiplegia cruciata: report of three cases. T Yayama, K Uchida, S Kobayashi, H Nakajima,C Kubota, R Sato & H Baba ,Spinal Cord volume 44, pages393–398(2006
7. Revisiting cruciate paralysis: A case report and systematic review. Benjamin Hopkins, Ryan Khanna, and Nader S Dahdaleh. J Craniovertebr Junction Spine. 2016 Oct-Dec; 7(4): 265–272. doi: 10.4103/0974-8237.193262
8. False Localizing Signs in Upper Cervical Spinal Cord Compression.William J. Sonstein, M.D., Patrick A. LaSala, M.D., W. Jost Michelsen, M.D., Stephen T. Onesti, M.D. Neurosurgery, Volume 38, Issue 3, March 1996, Pages 445–449, https://doi.org/10.1097/00006123-199603000-00004
9. J Neurosurg 73:850-858, 1990. Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction CURTIS A. DICKMAN, M.D., MARK N. HADLEY, M.D., CONRAD T. E. PAPPAS, M.D., PH.D., VOLKER K. H. SONNTA6, M.D., AND FRED H. GEISLER, M.D., PH.D.
10. Recovery from Cruciate Paralysis Due to Axial Subluxation from Metastatic Breast Carcinoma: A Case Report. Walter J. Faillace 1, Troy Guthrie. Breast J. 2000 Mar;6(2):139-142. doi: 10.1046/j.1524-4741.2000.98118.x

 

How to Cite this Article: Tharadara GD | Atypical Fracture of Axis With False Localising Sign | Back Bone: The Spine Journal | April-September 2021; 2(1): 48-51.

 

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Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult Male Football Player: Case Report

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Volume 2 | Issue 1 | April-September 2021 | page: 43-47 | Umesh Srikantha, Yadhu K Lokanath, Akshay Hari, Ravi Gopal Varma

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

[1] Department of Neurosurgery, Centre of Excellence: Brain & Spine Aster CMI, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. Yadhu K Lokanath,
Consultant Neurosurgeon, Department of Neurosurgery, Centre of Excellence: Brain & Spine Aster CMI, Bengaluru, Karnataka, India.
E-mail: dryadhu2498@gamil.com

Abstract

Interbody fusion is preferred surgical treatment for various symptomatic pathologies of lumbar spine and spondylolisthesis is one of the commonest indication. Goal is to achieve adequate bony and neural decompression, disc height restoration, deformity correction and good interbody fusion. Numerous techniques and approaches have been designed, minimal invasive tubular transforminal interbody fusion is widely accepted among them. In any case pre-operative planning and identifying any anatomical variation is prerequisite before surgery. In this article, we report, 22-year male football player, presenting with worsening low back pain, left radicular pain with neurogenic claudication. Radiographs revealed a L5-S1 Meyerding grade I isthmic spondylolisthesis with L5-S1 left sub articular disc protrusion with narrowing of lateral recess on left side and no evidence of lumbosacral nerve root anomalies on magnetic resonance imaging. Patient was planned for minimal invasive L5-S1 transforaminal interbody fusion, intraoperatively, Type 3 Neidre and Macnab root anomaly was identified, patient successful underwent interbody fusion with no acute intraoperative or postoperative complications. In follow up period, patient had no radicular pain. In our article, we summarize the incidence, classification of nerve root anomaly along with intra operative strategy for interbody fusion in presence of root anomaly and report this rare twin anomaly.
Keywords: Isthmic spondylolisthesis, nerve root anomaly, MIS TLIF, young football player.

References

1. Trimba R, Spivak JM, Bendo JA. Conjoined nerve roots of the lumbar spine. Spine J 2012;12:515-24.
2. Postacchini F, Urso S, Ferro L. Lumbosacral nerve-root anomalies. J Bone Joint Surg Am 1982;64(5):721-9.
3. Babayeva N, Torgutalp SS, Dönmez G Et al. Spondylolysis in an Adolescent Soccer Player. Austin Sports Med. 2017; 2(1): 1013.
4. Scuderi GJ, Vaccaro AR, Brusovanik GV et al. Conjoined lumbar nerve roots: a frequently underappreciated congenital abnormality. J Spinal Disord Tech 2004; 17:86-93.
5. Kadish LJ, Simmons EH. Anomalies of the lumbosacral nerve roots. An anatomical investigation and myelographic study. J Bone Joint Surg Br 1984; 66:11–16.
6. Song SJ, Lee JW, Choi JY et al. Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skeletal Radiol 2008;37:133-8.
7. Kang CH, Shin MJ, Kim SM et al. Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis. Skeletal Radiol 2008;37:225-31.
8. Davidson D,Rowan R , Reilly C : Lumbosacral Nerve Root Anomaly Associated With Spondylolisthesis in an Adolescent: A Case Report and Review of the Literature : SPINE Volume 31, Number 19,2006 ; pp E718 –E721
9. Hutton WC, Cyron BM, Spondylolysis. The role of the posterior elements in resisting the intervertebral compressive force. Acta Orthop Scand 1978; 49:604–609
10. Ganju A: Isthmic spondylolisthesis: Neurosurg Focus 2002 Jul 15;13(1):E1.
11. Moskowitz A: Transforaminal lumbar interbody fusion. Orthop Clin North Am 2002; 33:359–366
12. Shane MB, Mina GS , Kryzanski J et al : Nerve root anomalies: implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system : Neurosurg 2013 ; Focus 35 (2):E9

How to Cite this Article: Srikantha S, Lokanath YK, Hari A, Varma RG | Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult
Male Football Player: Case Report | Back Bone: The Spine Journal | April-September 2021;
2(1): 43-47.

 

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Common Lumbar and Sacral Interventional Pain Procedures

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Volume 2 | Issue 1 | April-September 2021 | page: 33-42 | Milan Mehta, Bharat J Shah, Palak Chudasama

Authors: Milan Mehta [1], Bharat J Shah [1], Palak Chudasama [1]

[1] Department of Pain Management, Zydus Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Milan Mehta,
Interventional Pain Specialist, Zydus Hospital, Ahmedabad, Gujarat, India.
E-mail: milan.aaryen@gmail.com

Abstract

Interventional pain specialists perform all pain procedures under live fluoroscopic guidance and with use of a contrast agent to deliver cortisone as close to the disc herniation or nerve root impingement, as determined by MRI or at the pain generators. Image-guided technique reduces morbidity. Dye spread in AP, lateral and oblique view is to be documented in real-time to reduce catastrophic complications. It outlines the area surrounding exiting and traversing nerve roots along with epidural space and also delineates the perimeter of the joint.
All these procedures help in identifying pain generators by means of diagnostic techniques which helps in conservative management as well as it’s very useful before radio-frequency ablative procedures and before surgery.
Keywords: Lumbar and sacral pain; Non operative treatment; Intervention pain speciality.

References

1. Bartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions. NeurolClinPract. 2014 Aug; 4(4): 347–352.
2. Buy X, Gangi A. Percutaneous Treatment of Intervertebral Disc Herniation. SeminInterventRadiol. 2010 Jun; 27(2): 148–159.
3. Diwan S, Sayed D, Deer T, Salomons A, Liang K. An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach. Pain Med. 2019 Dec; 20(Suppl 2): S23–S31.
4. Schoenfeld AJ, Swiner BK. Treatment of lumbar disc herniation: Evidence-based practice. Int J Gen Med. 2010; 3: 209–214.
5. Parikh KS, Seetharamaiah S. Approach to failed spinal anaesthesia for caesarean section. Indian J Anaesth. 2018 Sep; 62(9): 691–697.
6. NikolalBogduk. ISIS Practice Guidelines for Spinal Diagnostic and Treatment Procedures: 2nd Edition, International Spine Intervention Society, 2014.
7. Kim DH, Kim KH, Kim YC. Minimally Invasive Percutaneous Spinal Techniques: 1st edition, Elsevier B.V publication 2011.

How to Cite this Article:  Mehta M, Shah BJ, Chudasama P | Common Lumbar and Sacral Interventional Pain Procedures | Back Bone: The Spine Journal | April-September 2021; 2(1): 33-42.

 

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Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up

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Volume 2 | Issue 1 | April-September 2021 | page: 27-32 | Hitesh N. Modi, Shakti A. Goel, Utsab Shrestha

Authors: Hitesh N. Modi [1], Shakti A. Goel [1] , Utsab Shrestha [1]

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

Address of Correspondence
Dr. Hitesh N. Modi,
Senior Consultant, Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., SG Highway, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: drmodihitesh@gmail.com

Abstract

Objective: There is controversy in surgical management of cervical spondylotic myelopathy (CSM); a few group encourage only laminectomy or laminoplasty while the others emphasize on lateral mass fixation along with laminectomy. Cervical lordosis is an important factor for maintaining posture neck and preventing postoperative axial neck pain. Literature has reported that cervical lordosis less than -20 degrees is often responsible for neck pain. The purpose of this study was to evaluate clinical outcome and radiological parameters after posterior cervical laminectomy and fixation in CSM.
Material and Methods: This retrospective study included 37 patients operated with posterior cervical decompression and lateral mass screw fixation with minimum two-year follow-up. All patients were operated for CSM. All were operated by a single surgeon and followed up at six weeks, twelve weeks, six months, one year and yearly afterwards. Clinical outcome and radiological parameters were analyzed for clinical improvement [European Myelopathy Score (EMS)] and cervical lordotic angle.
Results: Average age 68±8.3 years. The cervical lordotic angle of -23.02±4.19 degrees was maintained in patients operated with lateral mass screw fixations along with laminectomy at final follow-up. The EMS and VAS score showed significant improvement postoperatively from 15.7 to 13.6 (p<0.05) and 8.1 to 1.5 (p<0.05), respectively. Three patients had postoperative C5 palsy that recovered completely within three months. Two patients expired within a few months after surgery due to acute myocardial infarction and respiratory arrest, respectively. There were three patients who had postoperative C5 palsy, which recovered completely within three months postoperatively. There was no permanent postoperative neurological deficit noticed in the series.
Conclusion: Posterior cervical lateral mass screw fixation for CSM gives satisfactory clinical outcome and maintains cervical lordosis. Lateral mass fixation with decompression helps preventing postoperative progressive kyphotic deformity of cervical spine after multilevel cervical laminectomy.
Keywords: Cervical Spondylotic Myelopathy, Lateral Mass Screws, Cervical Lordosis, European Myelopathy Score.

References

1. Roy-Camille, R., G. Saillant, and C. Mazel, Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws. The Cervical Spine, 2nd ed. Philadelphia: JB Lippincott, 1989: p. 390–403.
2. Mohamed, E., et al., Lateral mass fixation in subaxial cervical spine: anatomic review. Global Spine J, 2012. 2(1): p. 39-46.
3. An, H.S. and M.A. Coppes, Posterior cervical fixation for fracture and degenerative disc disease. Clin Orthop Relat Res, 1997(335): p. 101-11.
4. Crockard, A., Evaluation of spinal laminar fixation by a new, flexible stainless steel cable (Sof’wire): early results. Neurosurgery, 1994. 35(5): p. 892-8; discussion 898.
5. Geisler, F.H., et al., Titanium wire internal fixation for stabilization of injury of the cervical spine: clinical results and postoperative magnetic resonance imaging of the spinal cord. Neurosurgery, 1989. 25(3): p. 356-62.
6. Deen, H.G., et al., Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up. Spine J, 2003. 3(6): p. 489-95.
7. Horgan, M.A., J.X. Kellogg, and R.M. Chesnut, Posterior cervical arthrodesis and stabilization: an early report using a novel lateral mass screw and rod technique. Neurosurgery, 1999. 44(6): p. 1267-71; discussion 1271-2.
8. Muffoletto, A.J., et al., Techniques and pitfalls of cervical lateral mass plate fixation. Am J Orthop (Belle Mead NJ), 2000. 29(11): p. 897-903.
9. Anderson, P.A., et al., Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine (Phila Pa 1976), 1991. 16(3 Suppl): p. S72-9.
10. Shapiro, S., et al., Outcome of 51 cases of unilateral locked cervical facets: interspinous braided cable for lateral mass plate fusion compared with interspinous wire and facet wiring with iliac crest. J Neurosurg, 1999. 91(1 Suppl): p. 19-24.
11. Ulrich, C., M. Arand, and J. Nothwang, Internal fixation on the lower cervical spine–biomechanics and clinical practice of procedures and implants. Eur Spine J, 2001. 10(2): p. 88-100.
12. Hamdan, A.R.K., et al., Effect of Sub-axial Cervical Lateral Mass Screw Fixation on Functional Outcome in Patients with Cervical Spondylotic Myelopathy. Asian J Neurosurg, 2019. 14(1): p. 140-147.
13. Ishida, Y., et al., Critical analysis of extensive cervical laminectomy. Neurosurgery, 1989. 24(2): p. 215-22.
14. Kaminsky, S.B., C.R. Clark, and V.C. Traynelis, Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. Iowa Orthop J, 2004. 24: p. 95-105.
15. Kaptain, G.J., et al., Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg, 2000. 93(2 Suppl): p. 199-204.
16. Kato, Y., et al., Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament. J Neurosurg, 1998. 89(2): p. 217-23.
17. Matsunaga, S., T. Sakou, and K. Nakanisi, Analysis of the cervical spine alignment following laminoplasty and laminectomy. Spinal Cord, 1999. 37(1): p. 20-4.
18. Mikawa, Y., J. Shikata, and T. Yamamuro, Spinal deformity and instability after multilevel cervical laminectomy. Spine (Phila Pa 1976), 1987. 12(1): p. 6-11.
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20. McAviney, J., et al., Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther, 2005. 28(3): p. 187-93.
21. Herdmann, J., et al. The European Myelopathy Score. 1994. Berlin, Heidelberg: Springer Berlin Heidelberg.
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23. Eldin, M. and A. Hassan, Free hand technique of cervical lateral mass screw fixation. Journal of Craniovertebral Junction and Spine, 2017. 8(2): p. 113-118.
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25. Houten, J.K. and P.R. Cooper, Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery, 2003. 52(5): p. 1081-7; discussion 1087-8.
26. Uchida, K., et al., Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine, 2009. 11(5): p. 521-8.
27. Epstein, J.A., et al., A comparative study of the treatment of cervical spondylotic myeloradiculopathy. Experience with 50 cases treated by means of extensive laminectomy, foraminotomy, and excision of osteophytes during the past 10 years. Acta Neurochir (Wien), 1982. 61(1-3): p. 89-104.
28. Graham, A.W., et al., Posterior cervical arthrodesis and stabilization with a lateral mass plate. Clinical and computed tomographic evaluation of lateral mass screw placement and associated complications. Spine (Phila Pa 1976), 1996. 21(3): p. 323-8; discussion 329.
29. Du, W., et al., Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J, 2014. 14(1): p. 57-64.
30. McAllister, B.D., B.J. Rebholz, and J.C. Wang, Is posterior fusion necessary with laminectomy in the cervical spine? Surg Neurol Int, 2012. 3(Suppl 3): p. S225-31.
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32. Anderson, P.A., et al., Laminectomy and fusion for the treatment of cervical degenerative myelopathy. J Neurosurg Spine, 2009. 11(2): p. 150-6.
33. Sakaura, H., et al., Incidence and Risk Factors for Late Neurologic Deterioration after C3-C6 Laminoplasty for Cervical Spondylotic Myelopathy. Global Spine J, 2016. 6(1): p. 53-9.
34. Al Barbarawi, M.M., et al., Decompressive cervical laminectomy and lateral mass screw-rod arthrodesis. Surgical analysis and outcome. Scoliosis, 2011. 6: p. 10.
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How to Cite this Article:  Modi HN, Goel SA, Shrestha U | Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up | Back Bone: The Spine Journal | April-September 2021; 2(1): 27-32.

 

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SARS-CoV-2 (COVID-19) and Spine Surgeries in Tertiary-care Hospital of India

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Volume 2 | Issue 1 | April-September 2021 | page: 23-26 | Bharat R. Dave, Ajay Krishnan, Ravi Ranjan Rai, Devanand Degulmadi, Shivanand Mayi, Kirit Jadhav

Authors: Ghanshyam Kakadiya [1], Kalpesh Saindane [1], Prashant Gedam [1], Nitin Pothare [1]

[1] Department of Orthopedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Ghanshyam Kakadiya,
Department of Orthopedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
E-mail: drghanshyam89@gmail.com

Abstract

The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on spine surgery worldwide. India, with its large population and limited health resources, will be overwrought due to the number of cases of critically ill patients with COVID-19. It is important to understand the challenges for spine surgeons in India when dealing with patients during the COVID-19 pandemic. In India, elective spine surgeries stand cancelled whilst trauma and emergency surgeries have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines.
This article highlights the challenges in the triaging of patients, care in dealing with a patient with COVID-19 in spine surgery, and the effects on academics and research activities; it also suggests immediate measures and recommendations that also apply to other specialties.
Keywords: COVID-19, coronavirus disease, Spine surgery, India.

References

1. Jain AK. Current state of Orthopaedic education in India. Indian J Ortho,2016 C50: p.341–344.
2. https://www.boa.ac.uk/resources/covid-19-boasts-combined.html
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6. Sandaradura, I, Goeman, E, Pontivivo, G (2020) A close shave? Performance of P2/N95 respirators in healthcare workers with facial hair: results of the BEARDS (BEnchmarking Adequate Respiratory DefenceS) study. J Hosp Infection (104) 4 : p.529-533
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How to Cite this Article:  Kakadiya G, Saindane K, Gedam P, Pothare N | SARS- CoV-2 (COVID-19) and Spine Surgeries in Tertiary-care Hospital of India | Back Bone: The Spine Journal | April-September 2021; 2(1):
23-26.

 

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Drain Tip Culture: Would It Help Us Predict and Prevent Surgical Site Infection After Spinal Surgery?

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Volume 2 | Issue 1 | April-September 2021 | page: 19-22 | Bharat R. Dave, Ajay Krishnan, Ravi Ranjan Rai, Devanand Degulmadi, Shivanand Mayi, Kirit Jadhav

Authors: Bharat R. Dave [1], Ajay Krishnan [1], Ravi Ranjan Rai [1],
Devanand Degulmadi [1], Shivanand Mayi [1], Kirit Jadhav [1]

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

Address of Correspondence
Dr. Ravi Ranjan Rai,
Consultant Spine Surgeon, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
E-mail: drravirai84@gmail.com

Abstract

Background: Systematic cultures of drain tips or drainage fluids are commonly used by surgical teams for the early detection of Surgical Site Infection (SSI), even in the absence of clinical suspicion of infection. However, their prognostic values are controversial.
Method: This was a prospective study of patients undergoing spine surgery at our institute during the study period. Patients already diagnosed with spine infection were excluded from the study. At the time of drain removal, the drain tip was cut and sent to microbiology laboratory for bacterial culture. All patients were treated with antimicrobial prophylaxis based on evidence-based guidelines and were monitored for at least 6 months after surgery for the development of Surgical Site Infection (SSI). SSI was defined according to Centers for Disease Control and Prevention criteria.
Results: The study comprised of 183 patients including 85 males and 98 females. The rate of Surgical Site Infection in our study was 2.73 % (5 patients). Drain Tip Culture (DTC) was positive in 4 patients (2.18 %). Association of DTC with SSI was found to have high Specificity (98.31 %) and Negative Predictive Value (97.76 %) but low Sensitivity (20 %) and Positive Predictive Value (25 %).
Conclusion: Culture of drain tip after spine surgery does not conclusively predict the presence or absence of surgical site infection. However, statistical significance was observed between drain tip culture and surgical site infection with high specificity, high negative predictive value, low sensitivity and low positive predictive value.
Keywords: Drain tip culture; Spinal Surgery; Surgical site infection.

References

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[16]. Overgaard S, Thomsen NO, Kulinski B, et al. Closed suction drainage after hip arthroplasty. Prospective study of bacterial contamination in 81 cases. Acta Orthop Scand. 1993; 64:417–420.

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[22] Humphreys H. Staphylococcus aureus: the enduring pathogen in surgery. Surgeon. 2012; 10:357–360.

[23] Li Zhang, Siyu Cao, Nicole Marsh, Gillian Ray-Barruel, Julie Flynn, Emily Larsen, and Claire M Rickard. Infection risks associated with peripheral vascular catheters. J Infect Prev. 2016 Sep; 17(5): 207–213. doi: 10.1177/1757177416655472
[24] Lindsay E Nicolle. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014; 3: 23. Published online 2014 Jul 25. doi: 10.1186/2047-2994-3-23

How to Cite this Article:  Dave BR, Krishnan A, Rai RR, Degulmadi D, Mayi S, Jadhav K | Drain Tip Culture: Would It Help Us Predict and Prevent Surgical Site Infection After Spinal Surgery? | Back Bone: The Spine
Journal | April-September 2021; 2(1): 19-22.

 

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Conservative Management of Thoracolumbar Spinal Tuberculosis in The Tertiary Care Hospital of India

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Volume 2 | Issue 1 | April-September 2021 | page: 12-18 | Ghanshyam Kakadiya, Yogesh Soni, Kalpesh Saindane, Kushal Gohil, Kshitij Chaudhary, Akash Shakya

Authors: Ghanshyam Kakadiya [1], Yogesh Soni [1], Kalpesh Saindane [1], Kushal Gohil [1], Kshitij Chaudhary [1, 3], Akash Shakya [1]

[1] Department of Orthopaedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, SSIMS, Bhilai, Chhattisgarh, India.
[3] PD Hinduja Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Ghanshyam Kakadiya,
Department of Orthopaedics, TNMC & BYL Nair Hospital, Mumbai-400008
E-mail: drghanshyam89@gmail.com

Abstract

Introduction: Spinal tuberculosis is a leading cause of non-traumatic paraplegia in a developing country like India. There is an emerging trend to operate on patients early with spinal TB. A study aim was to reiterate the importance of conservative management in Spinal Tuberculosis. The study aim was to assess the clinical and radiological outcomes of the conservative management of thoracolumbar spine tuberculosis and reiterate the importance of conservative management.
Methods: A prospective study with 188 thoracolumbar tuberculosis patients included from May 2016 to April 2019. All the patients were subjected to computed tomography-guided biopsy followed by anti-tuberculous therapy (ATT) for 12-months. Indications for surgery included patients in which biopsy either failed and persistent/worsening of neurology. Preoperative and postoperative clinical and functional outcomes Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and ASIA scale were measured.
Results: 160 patients had a neurological deficit of ASIA-C and ASIA-D in 28. A failed performed biopsy was in 18 patients. Out of 170 successful biopsies,18 patients had persistent/worsening of neurology, these 18 (10.58%) patients required surgery. VAS was significantly improved from mean value preoperative 7.90±0.60 to 4.0±0.54 postoperative 1 month and 2.90±0.54 at the final follow‐up. ODI was improved from mean value preoperative 77.10±6.90 to 30.50±6.50 postoperative 1 month and 21.30±6.70 at final follow‐up. Pre-treatment mean kyphosis was 5.68±3.84 that improved to 6.51±3.88 post-treatment.
Conclusions: The results of conservative treatment consisting of biopsy and ATT for at least 12 months in compliant patients are excellent. A combined approach using clinical staging, biopsy, and ATT can minimize surgical intervention in most patients. Early diagnosis and early treatment lead to a good prognosis. Periodic evaluation is a must to look for evidence of improvement and the adverse effect of ATT.
Keywords: Spinal tuberculosis; biopsy; Conservative Management; ATT.

 

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How to Cite this Article:  Kakadiya G, Soni Y, Saindane K, Gohil K, Chaudhary K, Shakya A | Conservative Management of Thoracolumbar Spinal Tuberculosis in The Tertiary Care Hospital of India | Back Bone: The
Spine Journal | April-September 2021; 2(1): 12-18.

 

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Clinical Evaluation, Functional Outcome and Complications of MicroEndoscopic Discectomy(MED) in Single or Double Level Lumbar Disc Herniation- A Retrospective Review of 156 Patients

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Volume 2 | Issue 1 | April-September 2021 | page: 06-11 | Hitesh N. Modi, Alkesh Rathod, Utsab Shrestha

Authors: Hitesh N. Modi [1], Alkesh Rathod [1], Utsab Shrestha [1]

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

Address of Correspondence
Dr. Hitesh N. Modi,
Senior Consultant, Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., SG Highway, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: drmodihitesh@gmail.com

Abstract

Introduction: Lumbar disc herniation (LDH) is one of the most common causes for low back pain and related disabilities. Surgery is indicated in patients who do not respond to the conservative measures for at least 6 weeks or symptoms are worsened. Microendoscopic discectomy (MED) is a well-accepted minimally invasive surgical technique with similar results compared to open surgery. The purpose of this study was to evaluate the clinical outcome, functional improvement and analyze complications during MED.
Methods: A retrospective analysis was conducted in 156 patients who were operated for single or double level LDH using MED between 2016 and 2018. All patients were evaluated for pain and disability using visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Modified MabNab’s criteria used to evaluate overall outcome of surgery. Operation time, estimated blood loss (EBL), hospital stay and time to return back to previous activities were evaluated. Complications and revisions were noted during follow-up to analyze clinical results. Paired t-test was used to evaluate statistical difference in VAS and ODI score during follow-up.
Results: All patients were followed up at 6 weeks, 3 months, 6 months, 1 year and yearly thereafter postoperatively. Average follow-up was 25.5±9.7 months and average age was 45.0±12.7 years. Average VAS scores improved significantly from preoperative 8.7±0.8 to 2.0±1.1 postoperatively (p<0.0001). Average preoperative ODI improved significantly from 53.8±6.1 to 22.6±5.1 postoperatively (p<0.0001). Both score were maintained at the final follow-up. The average time to return to previous activity level was 35.7±14.3 days. Average operation time, EBL and hospital stay were 57.6±14.6 minutes, 36.7±13.1 mL and 2.4±0.7 days, respectively. There were total 19 (12.2%) complications and 12 (7.7%) revisions in the series. Overall clinical outcome was excellent, good, fair and poor in 73.1%, 20.5%, 5.1% and 1.3% of cases using modified MacNab’s criteria.
Conclusion: Study of 156 patients operated for single or double level LDH using MED has shown encouraging clinical results and functional outcome with similar complications reported in literature. However, less intraoperative blood loss, shorter hospital stay and early return to work are some of the advantages which favours its wide spread acceptability.
Keywords: Lumbar disc herniation; Microendoscopic discectomy; clinical outcome; Complications.

 

References

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How to Cite this Article:  Modi HN, Rathod A, Shrestha U | Clinical Evaluation, Functional Outcome and Complications of MicroEndoscopic Discectomy(MED) in Single or Double Level Lumbar Disc Herniation- A
Retrospective Review of 156 Patients | Back Bone: The Spine Journal | April-September 2021;
2(1): 06-11.

 

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Incorporation of MISS in Routine Spine Practice

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Volume 2 | Issue 1 | April-September 2021 | page: 01-05 | Amit C. Jhala

Authors: Amit C. Jhala [1]

[1] Department of Spine Surgery, Chirayu Hospital, Vishwakunj Cross Roads, Paldi, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Amit C. Jhala,
Consultant Spine Surgeon, Chirayu Hospital, Vishwakunj Cross Roads, Paldi, Ahmedabad, Gujarat, India.
E-mail: acjhala@gmail.com

Abstract

Traditional open spine surgery is the gold standard procedure in spine practice. Minimally invasive spine surgery (MISS) since last two decades have tremendously improved in technique and technology improving the clinical and functional outcomes of the surgery and patients. But still MISS has steep learning curve, many challenges and hurdles to inculcate it in the routine spine practice of the surgeon who may be either a novice or even an established in spine practice. The author has tried to identify the hurdles in incorporating MISS in routine spine practice and suggested methods to overcome these hurdles to incorporate MISS in routine clinical practice.
Keywords: Minimally Invasive Spine Surgery (MISS); Spine practice; Spine Surgeon.

 

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How to Cite this Article:  Jhala AC | Incorporation of MISS in Routine Spine Practice  | Back Bone: The Spine Journal | April-September 2021; 2(1): 01-05.

 

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