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

1. Kilian H. Mannheim: Verlag Von Bosserman; 1854 (2016) Schilderungenneuerbecken formen und ihresverhaltens in lebened Randall RM, Silverstein M, Goodwin R. Review of Pediatric Spondylolysis and Spondylolisthesis. Sports Med Arthrosc Rev 24(4):184-187.
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7. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine 32:120–125.

 

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

References

1. Gasbarrini A, Cappuccio M, Bandiera S, Amendola L, van Urk P, Boriani S. Osteoid osteoma of the mobile spine: Surgical outcomes in 81 patients. Spine (Phila Pa 1976) 2011;36:2089-93.
2. Jackson RP, Reckling FW, Mants FA. Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories. Clin Orthop Relat Res 1977;128:303-13.
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7. Kadhim M, Binitie O, O’Toole P, Grigoriou E, De Mattos CB, Dormans JP. Surgical resection of osteoid osteoma and osteoblastoma of the spine. J Pediatr Orthop B 2017;26:362-9.
8. Albisinni U, Facchini G, Spinnato P, Gasbarrini A, Bazzocchi A. Spinal osteoid osteoma: Efficacy and safety of radiofrequency ablation. Skeletal Radiol 2017;46:1087-94.
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10. Etemadifar MR, Hadi A. Clinical findings and results of surgical resection in 19 cases of spinal osteoid osteoma. Asian Spine J 2015;9:386-93.
11. Pourfeizi HH, Tabrizi A, Bazavar M, Sales JG. Clinical findings and results of surgical resection of thoracolumbar osteoid osteoma. Asian Spine J 2014;8:150-5.
12. Tsoumakidou G, Thenint MA, Garnon J, Buy X, Steib JP, Gangi A. Percutaneous image-guided laser photocoagulation of spinal osteoid osteoma: A single-institution series. Radiology 2016;278:936-43.
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14. Nzokou A, Weil AG, Shedid D. Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor. J Neurosurg Spine 2013;19:708-15.
15. Nakamura Y, Yabuki S, Kikuchi S, Konno S. Minimally invasive surgery for osteoid osteoma of the cervical spine using microendoscopic discectomy system. Asian Spine J 2013;7:143-7.
16. Xie T, Xiu P, Song Y, Zeng J, Huang S. Percutaneous endoscopic excision and ablation of osteoid osteoma of the lumbar spine and sacrum: A technical note and outcomes. World Neurosurg 2020;133:121-6.
17. Kim CW, Siemionow K, Anderson DG, Phillips FM. The current state of minimally invasive spine surgery. Instr Course Lect 2011;60:353-70.
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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

1. Boriani S, De Iure F, Campanacci L, Gasbarrini A, Bandiera S, Biagini R, et al. Aneurysmal bone cyst of the mobile spine: Report on 41 cases. Spine 2001;26:27-35
2. Ruiter DJ, Van Rijssel TG, Van Der Velde EA. Aneurysmal bone cysts: A clinicopathological study of 105 cases. Cancer 1977;39:2231-9.
3. Pennekamp W, Peters S, Schinkel C, Kuhnen C, Nicolas V, Muhr G, et al. Aneurysmal bone cyst of the cervical spine. Eur Radiol 2008;18:2356-60.
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5. Di Caprio MR, Murphy MJ, Camp RL. Aneurysmal bone cyst of the spine with familial incidence. Spine 2000;25:1589-92.
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10. Caro PA, Mandell GA, Stanton RP. Aneurysmal bone cyst of the spine in children. Mri imaging at 0.5 Tesla. Pediatr Radiol 1991;21:114-6.
11. Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ. From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: Radiologic-pathologic correlation. Radiographics 2001;21:1283-309.
12. Suzuki M, Satoh T, Nishida J, Kato S, Toba T, Honda T, et al. Solid variant of aneurysmal bone cyst of the cervical spine. Spine 2004;29:E376-81.
13. Sanerkin NG, Mott MG, Roylance J. An unusual intraosseous lesion with fibroblastic, osteoclastic, osteoblastic, aneurysmal and fibromyxoid elements: “Solid” variant of aneurysmal bone cyst. Cancer 1983;51:227.
14. Cottalorda J, Bourelle S. Current treatments of primary aneurysmal bone cysts. J Pediatr Orthop B 2006;15:155-67.
15. Gladden ML Jr., Gillingham BL, Hennrikus W, Vaughan LM. Aneurysmal bone cyst of the first cervical vertebrae in a child treated with percutaneous intralesional injection of calcitonin and methylprednisolone. A case report. Spine 2000;25:527-30.
16. Cybulski GR, Anson J, Gleason T, Homsi MF, Reyes MG. Aneurysmal bone cyst of the thoracic spine: Treatment by excision and segmental stabilization with Luque rods. Neurosurgery 1989;24: 273-6.
17. Garneti N, Dunn D, El Gamal E, Williams DA, Nelson IW, Sandemon DR. Cervical spondyloptosis caused by an aneurysmal bone cyst. Spine 2003;28:E68-70.

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

References

1. Standring S, editor. Gray’s Anatomy E-Book: The Anatomical Basis of Clinical Practice. Amsterdam, Netherlands: Elsevier Health Sciences; 2020.
2. Bogduk N. Cervical causes of headache and dizziness. In Grieve GP, editor. Modern Manual Therapy of the Vertebral Column. London: Churchill Livingston; 1987. p. 289-302.
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9. Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia 2002;22:15-22.
10. Elliott RE, Tanweer O, Smith ML, Frempong-Boadu A. Outcomes of fusion for lateral atlantoaxial osteoarthritis: Meta-analysis and review of literature. World Neurosurg 2013;80:e337-46.
11. Falco FJ, Erhart S, Wargo BW, Bryce DA, Atluri S, Datta S, et al. Systematic review of diagnostic utility and therapeutic effectiveness of cervical facet joint interventions. Pain Physician 2009;12:323-44.
12. Manchikanti L, Singh V, Falco FJ, Cash KM, Fellows B. Cervical medial branch blocks for chronic cervical facet joint pain: A randomized, double-blind, controlled trial with one-year follow-up. Spine 2008;33:1813-20.
13. Narouze SN, Casanova J, Mekhail N. The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache. Pain Med 2007;8:184-8.
14. Glémarec J, Guillot P, Laborie Y, Berthelot JM, Prost A, Maugars Y. Intraarticular glucocorticosteroid injection into the lateral atlantoaxial joint under fluoroscopic control. A retrospective comparative study in patients with mechanical and inflammatory disorders. Joint Bone Spine 2000;67:54-61.
15. Dach F, Éckeli ÁL, Ferreira KD, Speciali JG. Nerve block for the treatment of headaches and cranial neuralgias a practical approach. Headache 2015;55:59-71.

 

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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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.
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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.
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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

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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

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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

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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.

 

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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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