A Prospective Study to Find Out the Association between Supine Lying Low Back Pain and Retrolisthesis

/in /by

Volume 3 | Issue 1 | April-September 2022 | page: 42-46 | Bharat R. Dave, Shivanand C. Mayi, Ajay Krishnan, Ramneesh Kohli, Devanand Degulmadi, Ravi Ranjan Rai, Mirant B. Dave

DOI: https://doi.org/10.13107/bbj.2022.v03i01.039

Authors: Bharat R. Dave [1], Shivanand C. Mayi [1], Ajay Krishnan [1], Ramneesh Kohli [1], Devanand Degulmadi [1], Ravi Ranjan Rai [1], Mirant B. Dave [1]

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

Address of Correspondence

Dr. Shivanand C. Mayi,
Consultant Spine Surgeon, Stavya Spine Hospital & Research Institute, Mithakali, Ahmedabad, Gujarat, India.
E-mail: drshivanandmayi@gmail.com

Abstract

Objectives: The objectives of this study was to test the primary hypothesis that “retrolisthesis causes supine lying low back pain (LBP).”
Methods: Patients with history of chronic back pain (>12 weeks) who presented to the hospital outpatient department were evaluated. Patients with history of supine lying exaggeration of symptoms were specifically asked for duration, for which they can comfortably lie in supine position. Retrolisthesis in this study was measured on MRI mid sagittal image by measuring the slip percent. Slip percent of more than 8% was labeled as retrolisthesis. Statistical analysis was done using SPSS software.
Results: Average age of the study population was 41.46 ± 10.82 years. All the study participants had the history of supine lying LBP for 50 ± 54.51 weeks. About 94.78% (n = 115) of the study subjects had retrolisthesis on MRI. About 46.08% (n = 115) were house wives. L5-S1 was the most commonly involved level, three patients had no instability, and three patients had anterolisthesis. Duration of time up to which the patients can lie down in supine position was not statistically significant when analyzed with the VAS values for supine lying LBP and the slip percent.
Conclusion: The presence of supine lying LBP in an individual should be strongly considered for the underlying subtle instability at the lumbar intervertebral segments and diagnostic evaluation should be performed to rule out retrolisthesis.
Keywords: Retrolisthesis, Low back pain, supine lying, Lumbar instability, Vertebral slippage, Lateral stenosis, Dynamic radiograph.

References

1. Rothman SLG, Glenn WV Jr., Kerber CW. Multiplanar CT in the evaluation of degenerative spondylolisthesis. A review of 150 cases. Comput Radiol 1985;9:223-32.
2. Lee C, Woodring JH, Rogers LF, Kim KS. The radiographic distinction of degenerative slippage (spondylolisthesis and retrolisthesis) from traumatic slippage of the cervical spine. Skeletal Radiol 1986;15:439-43.
3. Ahmed A, Mahesh BH, Shamshery PK, Jayaswal A. Traumatic retrolisthesis of the L4 vertebra. J Trauma 2005;58:393-4.
4. Barrey C, Roussouly P, Le Huec JC, D’Acunzi G, Perrin G. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 2013;22 Suppl 6:S834-41.
5. Berlemann U, Jeszenszky DJ, Bühler DW, Harms J. Mechanisms of retrolisthesis in the lower lumbar spine. A radiographic study. Acta Orthop Belg 1999;65:472-7.
6. Shen M, Razi A, Lurie JD, Hanscom B, Weinstein J. Retrolisthesis and lumbar disc herniation: A pre operative assessment of patient function. Spine J 2007;7:406 13.
7. Iguchi T, Wakami T, Kurihara A, Kasahara K, Yoshiya S, Nishida K. Lumbar multilevel degenerative spondylolisthesis: Radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech 2002;15:93-9.
8. Barrey C, Roussouly P, Perrin G, Le Huec JC. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 2011;20 Suppl 5:626-33.
9. Barrey C, Jund J, Perrin G, Roussouly P. Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery 2007;61:981-6.
10. Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine 1989;14:501-6.
11. Videman T, Battie M. A critical review of the epidemiology of idiopathic low back pain. In: Weinstein JN, Gordon S, editors. Low Back Pain: A Scientific and Clinical Overview. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1996. p. 637-41.
12. Vogt MT, Rubin D, Valentin RS, Palermo L, Donaldson WF 3rd, Nevitt M, et al. Lumbar olisthesis and lower back symptoms in elderly white women. The study of osteoporotic fractures. Spine 1998;23:2640-7.
13. Vogt MT, Rubin DA, Palermo L, Christianson L, Kang JD, Nevitt MC, et al. Lumbar spine listhesis in older African American women. Spine J 2003;3:255-61.
14. Sihvonen T, Lindgren KA, Airaksinen O, Manninen H. Movement disturbances of the lumbar spine and abnormal back muscle. Electromyographic findings in recurrent low back pain. Spine 1997;22:289-95.
15. Kang KK, Shen MS, Zhao W, Lurie JD, Razi AE. Retrolisthesis and lumbar disc herniation: A postoperative assessment of patient function. Spine J 2013;13:367-72.
16. Kim HS, Ju CI, Kim SW, Kang JH. Lying down instability undetected on standing dynamic radiographs. J Korean Neurosurg Soc 2015;58:560-2.
17. Capasso G, Maffulli N, Testa V. Inter and intratester reliability of radiographic measurement of spondlylolisthesis. Act Orthop Belg 1992;58:188-92.
18. White AA 3rd, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia, PA: Lippincot Williams and Wilkins; 1990
19. Friberg O. Lumbar instability: A dynamic approach by traction-compression radiography. Spine 1987;12:119-29.
20. Hayes MA, Howard TC, Gruel CR, Kopta JA. Roentgenographic evaluation of lumbar spine flexion–extension in asymptomatic individuals. Spine 1989;14:327-31.
21. Dvorak J, Panjabi MM, Novotny JE, Chang DG, Grob D. Clinical validation of functional flexion-extension roentgenograms of the lumbar spine. Spine 1991;16:943-50.
22. Stokes IA, Frymoyer JW. Segmental motion and instability. Spine 1987;12:688-91.
23. Shaffer WO, Spratt KF, Weinstein J, Lehmann TR, Goel V. 1990 Volvo Award in clinical sciences. The consistency and accuracy of roentgenograms for measuring sagittal translation in the lumbar vertebral motion segment. An experimental model. Spine 1990;15:741-50.

How to Cite this Article: Dave BR, Mayi SC, Krishnan A, Kohli R, Degulmadi D, Rai RR, Dave MB | A Prospective Study to Find Out the Association Between Supine Lying Low Back Pain and Retrolisthesis | Back Bone: The Spine Journal | April-September 2022; 3(1): 42-46. https://doi.org/10.13107/bbj.2022.v03i01.039

(Abstract Text HTML)      (Download PDF)

.

Spontaneous Spinal Epidural Hematoma Causing Paraparesis in a Patient of Mitral Valve Replacement with Anticoagulant Treatment – A Decision Dilemma

/in /by

Volume 3 | Issue 1 | April-September 2022 | page: 36-41 | Hitesh N. Modi, Udit D. Patel

DOI: https://doi.org/10.13107/bbj.2022.v03i01.038

Authors: Hitesh N. Modi [1], Udit D. Patel [1]

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

Address of Correspondence

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

Abstract

Summary and Background: Spontaneous spinal epidural hematoma (SSEH) is a known occurrence in patients on anticoagulant therapy. There is an increased risk of developing hematoma after the spine surgery if anticoagulation therapy is reinstated.
Purpose of Study: The purpose of the study was to find out solution related with perioperative anticoagulant therapy in high-risk cases if patient redevelops hematoma and paraplegia due to continuation of anticoagulant therapy.
Case Report: A 30-year-old male presented to us with history of progressive paraparesis. He had history of mitral valve replacement twice followed by cerebrovascular stroke and on regular oral anticoagulant therapy. Magnetic resonance imaging revealed SSEH from C6-T1 level with cord compression. Initial decision was taken to conservatively treat as his coagulation parameters were altered and he was on high-risk for developing thromboembolism related complications if anticoagulant medicines were stopped. However, urgent laminectomy and evacuation of SSEH had to be performed due to rapid worsening of neurology. Postoperatively, patient had significant neurological recovery and anticoagulant therapy reinstated after 12 h of surgery. Patient developed acute paraplegia within 2 hours of anticoagulant therapy due to post-operative hematoma, which was drained out by opening the wound bedside. He regained neurological recovery within 5 min. Anticoagulation therapy was withheld for next 36 hours and reinstated with low-dose intravenous heparin followed by low-molecular weight heparin without any complications. His coagulation parameters and 2-D echo were followed up daily to check cardiac conditions. Patient improved clinically and became self-ambulatory.
Conclusion: Post-operative hematoma after spine surgery should be kept in mind in patients who are on anticoagulant treatment. Reinstating anticoagulation treatment in such high-risk patients should be done with lot of caution and initially with low-dose heparin followed by regular anticoagulation therapy. Close observation on neurological status is must to avoid permanent neurological injury.
Keywords: Spontaneous spinal epidural hematoma, Anticoagulat treatment, Decision dilemma

References

1. Jackson R. Case of spinal apoplexy. Lancet 1869;94:2392.
2. Groen RJ, Groenewegen HJ, van Alphen HA, Hoogland PV. Morphology of the human internal vertebral venous plexus: A cadaver study after intravenous Araldite CY 221 injection. Anat Rec 1997;249:285-94.
3. Riaz S, Fox R, Lavoie M, Broad R, Mahood JK. Is preemptive decompression of an asymptomatic spinal epidural hematoma justified? Can J Surg 2008;51:E25-7.
4. Ross JS, et al. Lumbar spine: Postoperative assessment with surface-coil MR imaging. Radiology 1987;164:851-60.
5. Sagar A, Hassan K. Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy. J Neurosci Rural Pract 2010;1:39-42.
6. Oh JY, Lingaraj K, Rahmat R. Spontaneous spinal epidural haematoma associated with aspirin intake. Singapore Med J 2008;49:e353-5.
7. Zuo B, Zhang Y, Zhang J, Song J,·Jiang S, Zhang X. Spontaneous spinal epidural hematoma: A case report. Case Rep Orthop Res 2018;1:27-34.
8. Epstein NE. When to stop anticoagulation, anti-platelet aggregates, and non-steroidal anti-inflammatories (NSAIDs) prior to spine surgery. Surg Neurol Int 2019;10:45.
9. Louie P, Harada G, Harrop J, Mroz T, Al-Saleh K, Brodano GB, et al. Perioperative anticoagulation management in spine surgery: Initial findings from the AO spine anticoagulation global survey. Glob Spine J 2020;10:512-27.
10. Porto GB, Wessell DO, Alvarado A, Arnold PM, Buchholz AL. Anticoagulation and spine surgery. Glob Spine J 2020;10 Suppl 1:53S-64.
11. Bakker NA, Veeger NJ, Vergeer RA, Groen RJ. Prognosis after spinal cord and cauda compression in spontaneous spinal epidural hematomas. Neurology 2015;84:1894-903.
12. Karlekar A, Dutta D, Arora KD, Mishra YK. Spinal-epidural hematoma presenting as paraplegia following mitral valve surgery: A case report. J Cardiothorac Vasc Anesth 2013;29:139-41.
13. Hayashi I, Shimamura Y, Maehara M. Paraplegia due to spinal epidural hematoma after mitral valve surgery: Report of a case. Surg Today 2011;41:704.
14. Kim JK, Kim TH, Park SK, Hwang YS, Shin HS, Shin JJ. Acute spontaneous cervical epidural hematoma mimicking cerebral stroke: A case report and literature review. Korean J Spine 2013;10:170-3.
15. Bono CM, Watters WC 3rd, Heggeness MH, Resnick DK, Shaffer WO, Baisden J, et al. An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery. Spine J 2009;9:1046-51.
16. De la Garza Ramos R, Longo M, Gelfand Y, Echt M, Kinon MD, Yassari R. Timing of prophylactic anticoagulation and its effect on thromboembolic events after surgery for metastatic tumors of the spine. Spine (Phila Pa 1976) 2018;44:E650-5.
17. Goyal G, Singh R, Raj K. Anticoagulant induced spontaneous spinal epidural hematoma, conservative management or surgical interventional A dilemma? J Acute Med 2016;6:38-42.
18. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 1984;61:143-8.
19. Cai HX, Liu C, Zhang JF, Wan SL, Uchida K, Fan SW. Spontaneous epidural hematoma of thoracic spine presenting as Brown-Sequard syndrome: Report of a case with review of the literature. J Spinal Cord Med 2011;34:432-6.
20. Groen R. Non-operative treatment of spontaneous spinal epidural hematomas: A review of the literature and a comparison with operative cases. Acta Neurochirurg 2004;146:103-10.
21. Kim T, Lee CH, Hyun SJ, Yoon SH, Kim KJ, Kim HJ. Clinical outcomes of spontaneous spinal epidural hematoma: A comparative study between conservative and surgical treatment. J Korean Neurosurg Soc 2012;52:523.
22. Matsumura A, Namikawa T, Hashimoto R, Okamoto T, Yanagida I, Hoshi M, et al. Clinical management for spontaneous spinal epidural hematoma: Diagnosis and treatment. Spine J 2008;8:534-7.
23. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: A literature survey with meta-analysis of 613 patients. Neurosurg Rev 2003;26:1-49.
24. Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: A 5-year experience. J Neurosurg Spine 2009;11:480-6.
25. Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg Spine 2004;100:38-45.
26. Groen RJ, Ponssen H. The spontaneous spinal epidural hematoma: A study of the etiology. J Neurol Sci 1990;98:121-38.
27. Connolly ES Jr., Winfree CJ, McCormick PC. Management of spinal epidural hematoma after tissue plasminogen activator: A case report. Spine 1996;21:1694-8.
28. Duffill J, Sparrow O, Millar J, Barker C. Can spontaneous spinal epidural haematoma be managed safely without operation? A report of four cases. J Neurol Neurosurg Psychiatry 2000;69:816-9.
29. Noth I, Hutter JJ, Meltzer PS, Damiano ML, Carter LP. Spinal epidural hematoma in a hemophilic infant. Am J Pediatr Hematol Oncol 1993;15:131-4.
30. Liu Z, Jiao Q, Xu J, Wang X, Li S, You C. Spontaneous spinal epidural hematoma: Analysis of 23 cases. Surg Neurol 2008;69:253-60.
31. Cheng JS, Arnold PM, Anderson PA, Fischer D, Dettori JR. Anticoagulation risk in spine surgery. Spine (Phila Pa 1976) 2010;35 Suppl 9:S117-24.
32. Gandhi SD, Khanna K, Harada G, Louie P, Harrop J, Mroz T, Al-Saleh K, et al. Factors affecting the decision to initiate anticoagulation after spine surgery: Findings from the AOSpine anticoagulation global initiative. Glob Spine J 2020;???:2192568220948027.

How to Cite this Article: Modi HN, Patel UD | Spontaneous Spinal Epidural Hematoma Causing Paraparesis in a Patient of Mitral Valve Replacement with Anticoagulant Treatment – A Decision Dilemma | Back Bone: The Spine Journal | April-September 2022; 3(1): 36-41. https://doi.org/10.13107/bbj.2022.v03i01.038

(Abstract Text HTML)      (Download PDF)

.

Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife!

/in /by

Volume 3 | Issue 1 | April-September 2022 | page: 32-35 | Himanshu G. Kulkarni, Gurunath S. Kulkarni, Sidheshwar S. Thosar

DOI: https://doi.org/10.13107/bbj.2022.v03i01.037

Authors: Himanshu G. Kulkarni [1], Gurunath S. Kulkarni [1], Sidheshwar S. Thosar [1]

[1] Department of Orthopaedics, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra, India.

Address of Correspondence

Dr. Sidheshwar S. Thosar,
Department of Orthopaedics, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra, India.
E-mail: dr.sidheshwarthosar@gmail.com

Abstract

Ossification of ligamentum flavum (OLF) is well known but rare entity causing slow progressive thoracic myelopathy. It affects especially lower thoracic spine and is relatively common in the East Asian population particularly in Japan. Posterior decompression in the form of extensive laminectomy with or without instrumented fusion is the treatment of choice. Decompression itself can be very challenging since the flavum is fused with the laminae above and below and it becomes very difficult for the surgeon to insert Kerrison roungers in inter-laminar space. Seven cases of recurrence of OLF at same intervertebral level reported till now but no case of adjacent level OLF in thoracic spine reported yet. We report the case of a 37-year-old male with D6-7-8 ossified ligamentum flavum with coexisting asymptomatic L1-2 disc prolapse and previously operated for D8-9 OLF. Pre-operative counseling of patients should be done regarding possibility of reoperation due to new adjacent segment or same level OLF.
Keywords: Ossified ligamentum flavum, Thoracic myelopathy, Posterior decompression.

References

1. Yamada T, Shindo S, Yoshii T, Ushio S, Kusano K, Miyake N, et al. Surgical outcomes of the thoracic ossification of ligamentum flavum: A retrospective analysis of 61 cases. BMC Musculoskelet Disord 2021;22:7.
2. Ahn DK, Lee S, Moon SH, Boo KH, Chang BK, Lee JI. Ossification of the ligamentum flavum. Asian Spine J 2014;8:89-96.
3. Wang H, Wei F, Long H, Han G, Sribastav SS, Li Z, et al. Surgical outcome of thoracic myelopathy caused by ossification of ligamentum flavum. J Clin Neurosci 2017;45:83-8.
4. Barath AS, Wu OC, Patel M, Kasliwal MK. Repeated recurrence of thoracic spine stenosis following decompression alone for ossification of the ligamentum flavum: Case report. J Neurosurg Spine 2018;30:332-6.
5. Kanno H, Takahashi T, Aizawa T, Hashimoto K, Itoi E, Ozawa H. Recurrence of ossification of ligamentum flavum at the same intervertebral level in the thoracic spine: A report of two cases and review of the literature. Eur Spine J 2018;27:359-67.
6. Okada K, Oka S, Tohge K, Ono K, Yonenobu K, Hosoya T. Thoracic myelopathy caused by ossification of the ligamentum flavum. Clinicopathologic study and surgical treatment. Spine (Phila Pa 1976) 1991;16:280-7.
7. Geber J, Hammer N. Ossification of the ligamentum f lavum in a nineteenth-century skeletal population sample from Ireland: Using bioarchaeology to reveal a neglected spine pathology. Sci Rep 2018;8:9313.
8. Li B, Qiu G, Guo S, Li W, Li Y, Peng H, et al. Dural ossification associated with ossification of ligamentum flavum in the thoracic spine: A retrospective analysis. BMJ Open 2016;6:e013887.
9. Osman NS, Cheung ZB, Hussain AK, Phan K, Arvind V, Vig KS, et al. Outcomes and complications following laminectomy alone for thoracic myelopathy due to ossified ligamentum flavum: A systematic review and meta-analysis. Spine 2018;43:E842-8.

How to Cite this Article: Kulkarni HG, Kulkarni GS, Thosar SS | Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife! | Back Bone: The Spine Journal | April-September 2022; 3(1): 32-35.  https://doi.org/10.13107/bbj.2022.v03i01.037

(Abstract Text HTML)      (Download PDF)

.

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

/in /by

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

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

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

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

Address of Correspondence

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

Abstract

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

References

1. Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR. Postoperative posterior spinal wound infections. Clin OrthopRelat Res 1992;284:99-108.
2. Sasso RC, Garrido BJ. Postoperative spinal wound infections. J Am Acad Orthop Surg 2008;16:330-7.
3. Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: A review of 2,391 consecutive index procedures. J Spinal Disord 2000;13:422-6.
4. Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, et al. Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: Incidence and management. J Spinal Disord 2000;13:42-5.
5. Ido K, Shimizu K, Nakayama Y, Shikata J, Matsushita M, Nakamura T. Suction/irritation for deep wound infection after spinal instrumentation: A case study. Eur Spine J 1996;5:345-9.
6. Viola RW, King HA, Adler SM, Wilson CB. Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine 1997;22:2444-51.
7. Gristina AG, Costerton JW. Bacterial adherence to biomaterials and tissue. The significance of its role in clinical sepsis. J Bone Joint Surg Am 1985;67:264-73.
8. Richards B. Delayed infections following posterior spinal instrumentation for the treatment of isopathic scoliosis. J Bone Joint Surg Am 1995;77:524-9.
9. Dietz FR, Koontz FP, Round EM, Marsh JL. Thee importance of positive bacterial cultures of specimens obtained during clean orthopaedic operations. J Bone Joint Surg Am 1991;73:1200-7.
10. Heggeness MH, Esses SI, Errico T, Yuan HA. Late infection of spinal instrumentation by hematogenous seeding. Spine 1993;18:492-6.
11. Dubousset J, Shufflebarger H, Wenger D. Late “infection” with CD instrumentation. Orthop Trans 1994;18:121.
12. Robertson PA, Taylor TK. Late presentation of infection as a complication of Dwyer anterior spinal instrumentation. J Spinal Disord 1993;6:256-9.
13. Clark CE, Shufflebarger HL. Late-developing infection in instrumented idiopathic scoliosis. Spine 1999;24:1909-12.
14. Richards BS, Emara KM. Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis. Spine 2001;18:1990-6.
15. Hatch RS, Sturm PF, Wellborn CC. Late complication after single rod instrumentation. Spine 1998;13:1503-5.
16. Wimmer C, Gluch H. Aseptic loosening after CD instrumentation in the treatment of scoliosis: A report about eight cases. J Spinal Disord 1998;11:440-3.
17. Rigamonti D, Liem L, Sampath P, Knoller N, Namaguchi Y, Schreibman DL, et al. Spinal epidural abscess: Contemporary trends in etiology, evaluation, and management. Surg Neurol 1999;52:189-97.
18. Post MJ, Sze G, Quencer RM, Eismont FJ, Green BA, Gahbauer H. Gadolinium-enhanced MR in spinal infection. J Comput Assist Tomogr1990;14:721-9.
19. Smith AS, Blaser SI. Infectious and inflammatory processes of the spine. Radiol Clin North Am 1991;29:809-27.
20. Thalgott JS, Cotler HB, Sasso RC, LaRocca H, Gardner V. Postoperative infections in spinal implants. Classification and analysis: A multicenter study. Spine (Phila Pa 1976) 1991;16:981-4.
21. Mehbod AA, Ogilvie JW, Pinto MR, Schwender JD, Transfeldt EE, Wood KB, et al. Postoperative deep wound infections in adults after spinal fusion: Management with vacuum-assisted wound closure. J Spinal Disord Tech 2005;18:14-7.
22. Dumanian GA, Ondra SL, Liu J, Schafer MF, Chao JD. Muscle flap salvage of spine wounds with soft tissue defects or infection. Spine 2003;28:1203-11.
23. Mitra A, Mitra A, Harlin S. Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery. Plast Reconstr Surg 2004;113:206-13.
24. Yuan-Innes MJ, Temple CL, Lacey MS. Vacuum-assisted wound closure: A new approach to spinal wounds with exposed hardware. Spine 2001;26:E30-3.

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

(Abstract Text HTML)      (Download PDF)

.

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

/in /by

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

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

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

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

Address of Correspondence

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

Abstract

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

References

1. Khadilkar AV, Mandlik RM. Epidemiology and treatment of osteoporosis in women: An Indian perspective. Int J Womens Health 2015;7:841-50.
2. Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 1998;8:261-7.
3. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990;141:68-71.
4. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: A prospective study. Arch Intern Med 1999;159:1215-20.
5. Girardo M, Cinnella P, Gargiulo G, Viglierchio P, Rava A, Aleotti S, et al. Treatment of osteoporotic vertebral compression fractures: Applicability of appropriateness criteria in clinical practice. Pain Physician 2018;19:546-51
6. Schupfner R, Stoevelaar HJ, Blattert TR, Fagan D, Fransen P, Marcia S, et al. Treatment of osteoporotic vertebral compression fractures: Applicability of appropriateness criteria in clinical practice. Pain Physician 2016;19:E113-20.
7. Alpantaki K, Dohm M, Korovessis P, Hadjipavlou A. Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit. Injury 2017;49:261-71.
8. Girardo M, Cinnella P, Gargiulo G, Viglierchio P, Rava A, Aleotti S. Surgical treatment of osteoporotic thoraco-lumbar compressive fractures: The use of pedicle screw with augmentation PMMA. Eur Spine J 2017;26:546-51.
9. Tan JS, Bailey CS, Dvorak MF, Fisher CG, Cripton PA, Oxland TR. Cement augmentation of vertebral screws enhances the interface strength between interbody device and vertebral body. Spine (Phila Pa 1976) 2007;32:334-41.
10. Schultheiss M, Hartwig E, Claes L, Kinzl L, Wilke HJ. Influence of screw-cement enhancement on the stability of anterior thoracolumbar fracture stabilization with circumferential instability. Eur Spine J 2004;13:598-604.
11. Bai B, Kummer FJ, Spivak J. Augmentation of anterior vertebral body screw fixation by an injectable, biodegradable calcium phosphate bone substitute. Spine (Phila Pa 1976) 2001;26:2679-83.
12. Bong JM, Bo YC, Eun YC, Ho YZ. Polymethylmethacrylate-augmented screw fixation for stabilization of the osteoporotic spine: A three-year follow-up of 37 patients. J Korean Neurosurg Soc 2009;46:305-11.
13. Pingel A, Kandziora F, Hoffmann CH. Osteoporotic L1 burst fracture treated by short-segment percutaneous stabilization with cement-augmented screws and kyphoplasty (hybrid technique). Eur Spine J 2014;23:2022-3.
14. Afathi M, Mansouri N, Farah K, Benichoux V, Blondel B, Fuentes S. Use of cement-augmented percutaneous pedicular screws in the management of multifocal tumoral spinal fractures. Asian Spine J 2019;13:305-12.
15. Jung HJ, Kim SW, Ju CI, Kim SH, Kim HS. Bone cement-augmented short segment fixation with percutaneous screws for thoracolumbar burst fractures accompanied by severe osteoporosis. J Korean Neurosurg Soc 2012;52:353-8.
16. Pesenti S, Blondel B, Peltier E, Adetchessi T, Dufour H, Fuentes S. Percutaneous cement-augmented screws fixation in the fractures of the aging spine: Is it the solution? Biomed Res Int 2014;2014:610675.
17. Choma TJ, Pfeiffer FM, Swope RW, Hirner JP. Pedicle screw design and cement augmentation in osteoporotic vertebrae: Effects of fenestrations and cement viscosity on fixation and extraction. Spine (Phila Pa 1976) 2012;37:1628-32.
18. Yuan Q, Zhang G, Wu J, Xing Y, Sun Y, Tian W. Clinical evaluation of the polymethylmethacrylate-augmented thoracic and lumbar pedicle screw fixation guided by the three-dimensional navigation for the osteoporosis patients. Eur Spine J 2015;24:1043-50.
19. Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine 2007;7:47-53.
20. Access O. Clinical therapeutic effects of anterior decompression on spinal osteoporotic fracture and inflammatory cytokines. Pak J Med Sci 2014;30:931-5.

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

 

(Abstract Text HTML)      (Download PDF)

.

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

/in /by

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

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

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

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

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

Abstract

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

References

1. Liu V, Weill D, Bhattacharya J. Racial disparities in survival after lung transplantation. Arch Surg 2011;146:286-93.
2. McClelland S 3rd, Guo H, Okuyemi KS. Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era. Neuro Oncol 2011;13:1252-9.
3. Drazin D, Shweikeh F, Lagman C, Ugiliweneza B, Boakye M. Racial disparities in elderly patients receiving lumbar spinal stenosis surgery. Global Spine J 2017;7:162-9.
4. Cahill KS, Chi JH, Day A, Claus EB. Prevalence, complications, and hospital charges associated with use of bone-morphogenetic proteins in spinal fusion procedures. JAMA 2009;302:58-66.
5. Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses: Dorsal traction-reposition and anterior fusion (author’s transl). Z Orthop Ihre Grenzgeb 1982;120:343-7.
6. Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976) 2003;28 Suppl 15:S26-35.
7. Styf JR, Willén 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. Arima H, Dimar JR 2nd, Glassman SD, Yamato Y, Matsuyama Y, Mac-Thiong JM, et al. Differences in lumbar and pelvic parameters among African American, Caucasian and Asian populations. Eur Spine J 2018;27:2990-8.
14. Jain A, Menga E, Mesfin A. Outcomes following surgical management of Cauda Equina syndrome: Does race matter? J Racial Ethn Health Disparities 2018;5:287-92.
15. Seicean A, Seicean S, Neuhauser D, Benzel EC, Weil RJ. The influence of race on short-term outcomes after laminectomy and/or fusion spine surgery. Spine (Phila Pa 1976) 2017;42:34-41.
16. Rantanen J, Hurme M, Falck B, Alaranta H, Nykvist F, Lehto M, et al. The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 1993;18:568-74.
17. Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976) 1993;18:575-81.
18. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976) 1996;21:941-4.
19. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine (Phila Pa 1976) 1994;19:2598-602.
20. Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, et al. Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine (Phila Pa 1976) 1989;14:33-6.
21. 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 Tech 2005;18:40-7.
22. Zhao J, Zhang S, Li X, He B, Ou Y, Jiang D. Comparison of minimally invasive and open transforaminal lumbar interbody fusion for lumbar disc herniation: A retrospective cohort study. Med Sci Monit 2018;24:8693-8.
23. 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.
24. Suk KS, Kim KT, Lee SH, Kim JM. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976) 2003;28:2001-5.
25. Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: A fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998;7:99-103.
26. Burkus M, Schlégl AT, O’Sullivan I, Márkus I, Vermes C, Tunyogi-Csapó M. Sagittal plane assessment of spino-pelvic complex in a Central European population with adolescent idiopathic scoliosis: A case control study. Scoliosis Spinal Disord 2018;13:10.
27. Sullivan TB, Marino N, Reighard FG, Newton PO. Relationship between lumbar lordosis and pelvic incidence in the adolescent patient: Normal cohort analysis and literature comparison. Spine Deform 2018;6:529-36.
28. Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 2007;16:227-34.
29. Ould-Slimane M, Lenoir T, Dauzac C, Rillardon L, Hoffmann E, Guigui P, et al. Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance. Eur Spine J 2012;21:1200-6.
30. Recnik G, Košak R, Vengust R. Influencing segmental balance in isthmic spondylolisthesis using transforaminal lumbar interbody fusion. J Spinal Disord Tech 2013;26:246-51.
31. Massie LW, Zakaria HM, Schultz LR, Basheer A, Buraimoh MA, Chang V. Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis. Neurosurg Focus 2018;44:E8.
32. Barbagallo GM, Piccini M, Alobaid A, Al-Mutair A, Albanese V, Certo F. Bilateral tubular minimally invasive surgery for low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS): analysis of a series focusing on postoperative sagittal balance and review of the literature. Eur Spine J 2014;23 Suppl 6:705-13.
33. Rajakumar DV, Hari A, Krishna M, Sharma A, Reddy M. Complete anatomic reduction and monosegmental fusion for lumbar spondylolisthesis of Grade II and higher: Use of the minimally invasive “rocking” technique. Neurosurg Focus 2017;43:E12.
34. Hsieh PC, Koski TR, O’Shaughnessy BA, Sugrue P, Salehi S, Ondra S, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 2007;7:379-86.
35. Champagne PO, Walsh C, Diabira J, Plante ME, Wang Z, Boubez G, et al. Sagittal balance correction following lumbar interbody fusion: A comparison of the three approaches. Asian Spine J 2019;13:450-8.
36. Marty C, Boisaubert B, Descamps H, Montigny JP, 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.

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

 

(Abstract Text HTML)      (Download PDF)

.

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

/in /by

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

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

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

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

Abstract

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

References

[1] Kazemi N, Crew LK, Tredway TL. The future of spine surgery: New horizons in the treatment of spinal disorders. Surg Neurol Int 2013;4:15–21. doi:10.4103/2152-7806.109186.
[2] Fehlings MG, Ahuja CS, Mroz T, Hsu W, Harrop J. Future advances in spine surgery: The AOSpine North America perspective. Clin Neurosurg 2017;80:S1–8. doi:10.1093/neuros/nyw112.
[3] Perez-Cruet MJ, Foley KT, Isaacs RE, Rice-Wyllie L, Wellington R, Smith MM, et al. Microendoscopic lumbar discectomy: technical note. Neurosurgery 2002;51:S129-36.
[4] Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine. Spine (Phila Pa 1976) 2002;27:432–8. doi:10.1097/00007632-200202150-00021.
[5] O’Toole JE, Eichholz KM, Fessler RG. Minimally invasive insertion of syringosubarachnoid shunt for posttraumatic syringomyelia: Technical case report. Neurosurgery 2007;61:E331-2; discussion E332. doi:10.1227/01.neu.0000303990.03235.81.
[6] Ogden AT, Fessler RG. Minimally invasive resection of intramedullary ependymoma: Case report. Neurosurgery 2009;65:E1203-4; discussion E1204. doi:10.1227/01.NEU.0000360153.65238.F0.
[7] Tredway TL, Musleh W, Christie SD, Khavkin Y, Fessler RG, Curry DJ. A novel minimally invasive technique for spinal cord untethering. Neurosurgery 2007;60:ONS70-4; discussion ONS74. doi:10.1227/01.NEU.0000249254.63546.D7.
[8] Tredway TL, Santiago P, Hrubes MR, Song JK, Christie SD, Fessler RG. Minimally invasive resection of intradural-extramedullary spinal neoplasms. Neurosurgery 2006;58:ONS52-8; discussion ONS52-8. doi:10.1227/01.neu.0000192661.08192.1c.
[9] Sandhu FA, Santiago P, Fessler RG, Palmer S. Minimally invasive surgical treatment of lumbar synovial cysts. Neurosurgery 2004;54:107–11; discussion 111-2. doi:10.1227/01.neu.0000097269.79994.2f.
[10] Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: A review of techniques and outcomes. Spine (Phila Pa 1976) 2010;35:S294-301. doi:10.1097/BRS.0b013e3182022ddc.
[11] Ozgur BM, Yoo K, Rodriguez G, Taylor WR. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J 2005;14:887–94. doi:10.1007/s00586-005-0941-3.
[12] Kulkarni AG, Kantharajanna SB, Dhruv AN. The use of tubular retractors for translaminar discectomy for cranially and caudally extruded discs. Indian J Orthop 2018;52:328–33. doi:10.4103/ortho.IJOrtho_364_16.
[13] Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 2006;6:435–43. doi:10.1016/j.spinee.2005.08.012.
[14] Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: Perioperative outcomes and complications. Spine (Phila Pa 1976) 2010;35:S322-30. doi:10.1097/BRS.0b013e3182022e04.
[15] Hsieh PC, Koski TR, Sciubba DM, Moller DJ, O’Shaughnessy BA, Li KW, et al. Maximizing the potential of minimally invasive spine surgery in complex spinal disorders. Neurosurg Focus 2008;25:E19. doi:10.3171/FOC/2008/25/8/E19.
[16] Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS. Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 2010;28:1–7. doi:10.3171/2010.1.FOCUS09263.
[17] Pimenta L, Oliveira L, Schaffa T, Coutinho E, Marchi L. Lumbar total disc replacement from an extreme lateral approach: Clinical experience with a minimum of 2 years’ follow-up: Clinical article. J Neurosurg Spine 2011;14:38–45. doi:10.3171/2010.9.SPINE09865.
[18] Jin C, Jaiswal MS, Jeun SS, Ryu KS, Hur JW, Kim JS. Outcomes of oblique lateral interbody fusion for degenerative lumbar disease in patients under or over 65years of age. J Orthop Surg Res 2018;13:1–10. doi:10.1186/s13018-018-0740-2.
[19] Yue JJ, Long W. Full endoscopic spinal surgery techniques: Advancements, indications, and outcomes. Int J Spine Surg 2015;9. doi:10.14444/2017.
[20] Blumenthal S, McAfee PC, Guyer RD, Hochschuler SH, Geisler FH, Holt RT, et al. A prospective, randomized, multicenter Food and Drug Administration Investigational Device Exemptions study of lumbar total disc replacement with the CHARITÉTM artificial disc versus lumbar fusion – Part I: Evaluation of clinical outcomes. Spine (Phila Pa 1976) 2005;30:1565–75. doi:10.1097/01.brs.0000170587.32676.0e.
[21] Guyer RD, McAfee PC, Hochschuler SH, Blumenthal SL, Fedder IL, Ohnmeiss DD, et al. Prospective randomized study of the Charité artificial disc: Data from two investigational centers. Spine J 2004;4:S252–9. doi:10.1016/j.spinee.2004.07.019.
[22] Geisler FH. The CHARITE Artificial Disc: design history, FDA IDE study results, and surgical technique. Clin Neurosurg 2006;53:223–8.
[23] Delamarter RB, Bae HW, Pradhan BB. Clinical results of ProDisc-II lumbar total disc replacement: Report from the United States clinical trial. Orthop Clin North Am 2005;36:301–13. doi:10.1016/j.ocl.2005.03.004.
[24] Sekhon LHS, Duggal N, Lynch JJ, Haid RW, Heller JG, Riew KD, et al. Magnetic resonance imaging clarity of the Bryan®, Prodisc-C®, Prestige LP®, and PCM® cervical arthroplasty devices. Spine (Phila Pa 1976) 2007;32:673–80. doi:10.1097/01.brs.0000257547.17822.14.
[25] Oskouian RJ, Whitehill R, Samii A, Shaffrey ME, Johnson JP, Shaffrey CI. The future of spinal arthroplasty: a biomaterial perspective. Neurosurg Focus 2004;17:E2. doi:10.3171/foc.2004.17.3.2.
[26] Robbins MM, Vaccaro AR, Madigan L. The use of bioabsorbable implants in spine surgery. Neurosurg Focus 2004;16:E1. doi:10.3171/foc.2004.16.3.2.
[27] Tafazal SI, Sell PJ. Incidental durotomy in lumbar spine surgery: Incidence and management. Eur Spine J 2005;14:287–90. doi:10.1007/s00586-004-0821-2.
[28] D’Andrea K, Dreyer J, Fahim DK. Utility of preoperative magnetic resonance imaging coregistered with intraoperative computed tomographic scan for the resection of complex tumors of the spine. World Neurosurg 2015;84:1804–15. doi:10.1016/j.wneu.2015.07.072.
[29] Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, et al. Accuracy of pedicle screw placement: A systematic review of prospective in vivo studies comparing free hand,fluoroscopy guidance and navigation techniques. Eur Spine J 2012;21:247–55. doi:10.1007/s00586-011-2011-3.
[30] Rampersaud YR, Lee KS. Fluoroscopic computer-assisted pedicle screw placement through a mature fusion mass: An assessment of 24 consecutive cases with independent analysis of computed tomography and clinical data. Spine (Phila Pa 1976) 2007;32:217–22. doi:10.1097/01.brs.0000251751.51936.3f.
[31] Roser F, Tatagiba M, Maier G. Spinal robotics: Current applications and future perspectives. Neurosurgery 2013;72:12–8. doi:10.1227/NEU.0b013e318270d02c.
[32] Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and Robotics in Spinal Surgery: Where Are We Now? Neurosurgery 2017;80:S86–99. doi:10.1093/neuros/nyw077.
[33] Lee JYK, Lega B, Bhowmick D, Newman JG, O’Malley BW, Weinstein GS, et al. Da vinci robot-assisted transoral odontoidectomy for basilar invagination. ORL 2010;72:91–5. doi:10.1159/000278256.
[34] Yang MS, Yoon DH, Kim KN, Kim H, Yang JW, Yi S, et al. Robot-assisted anterior lumbar interbody fusion in a swine model in vivo test of the da vinci surgical-assisted spinal surgery system. Spine (Phila Pa 1976) 2011;36:E139-43. doi:10.1097/BRS.0b013e3181d40ba3.
[35] Kim MJ, Ha Y, Yang MS, Yoon DH, Kim KN, Kim H, et al. Robot-assisted anterior lumbar interbody fusion (ALIF) using retroperitoneal approach. Acta Neurochir (Wien) 2010;152:675–9. doi:10.1007/s00701-009-0568-y.
[36] Ponnusamy K, Chewning S, Mohr C. Robotic approaches to the posterior spine. Spine (Phila Pa 1976) 2009;34:2104–9. doi:10.1097/BRS.0b013e3181b20212.
[37] Artibani W, Fracalanza S, Cavalleri S, Iafrate M, Aragona M, Novara G, et al. Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int 2008;80:237–44. doi:10.1159/000127333.
[38] Holly LT, Foley KT. Intraoperative spinal navigation. Spine (Phila Pa 1976) 2003;28:S54-61. doi:10.1097/01.BRS.0000076899.78522.D9.
[39] Ughwanogho E, Patel NM, Baldwin KD, Sampson NR, Flynn JM. Computed tomography-guided navigation of thoracic pedicle screws for adolescent idiopathic scoliosis results in more accurate placement and less screw removal. Spine (Phila Pa 1976) 2012;37:E473-8. doi:10.1097/BRS.0b013e318238bbd9.
[40] Lee JH, Jang HL, Lee KM, Baek HR, Jin K, Hong KS, et al. In vitro and in vivo evaluation of the bioactivity of hydroxyapatite-coated polyetheretherketone biocomposites created by cold spray technology. Acta Biomater 2013;9:6177–87. doi:10.1016/j.actbio.2012.11.030.
[41] Schroeder GD, Hsu WK, Kepler CK, Kurd MF, Vaccaro AR, Patel AA, et al. Use of recombinant human bone morphogenetic protein-2 in the treatment of degenerative spondylolisthesis. Spine (Phila Pa 1976) 2016;41:445–9. doi:10.1097/BRS.0000000000001228.
[42] Zweckberger K, Ahuja CS, Liu Y, Wang J, Fehlings MG. Self-assembling peptides optimize the post-traumatic milieu and synergistically enhance the effects of neural stem cell therapy after cervical spinal cord injury. Acta Biomater 2016;42:77–89. doi:10.1016/j.actbio.2016.06.016.
[43] Leckie AE, Akens MK, Woodhouse KA, Yee AJM, Whyne CM. Evaluation of thiol-modified hyaluronan and elastin-like polypeptide composite augmentation in early-stage disc degeneration: Comparing 2 minimally invasive techniques. Spine (Phila Pa 1976) 2012;37:E1296-303. doi:10.1097/BRS.0b013e318266ecea.
[44] Leung VYL, Tam V, Chan D, Chan BP, Cheung KMC. Tissue Engineering for Intervertebral Disk Degeneration. Orthop Clin North Am 2011;42:575–83. doi:10.1016/j.ocl.2011.07.003.
[45] He Z, Zhai Q, Hu M, Cao C, Wang J, Yang H, et al. Bone cements for percutaneous vertebroplasty and balloon kyphoplasty: Current status and future developments. J Orthop Transl 2015;3:1–11. doi:10.1016/j.jot.2014.11.002.
[46] Girolami M, Boriani S, Bandiera S, Barbanti-Bródano G, Ghermandi R, Terzi S, et al. Biomimetic 3D-printed custom-made prosthesis for anterior column reconstruction in the thoracolumbar spine: a tailored option following en bloc resection for spinal tumors: Preliminary results on a case-series of 13 patients. Eur Spine J 2018;27:3073–83. doi:10.1007/s00586-018-5708-8.
[47] Smith JS, Shaffrey CI, Bess S, Shamji MF, Brodke D, Lenke LG, et al. Recent and Emerging Advances in Spinal Deformity. Neurosurgery 2017;80:S70–85. doi:10.1093/neuros/nyw048.
[48] Saindane AM. Recent Advances in Brain and Spine Imaging. Radiol Clin North Am 2015;53:477–96. doi:10.1016/j.rcl.2014.12.004.
[49] Mahboub-Ahari A, Hajebrahimi S, Yusefi M, Velayati A. EOS imaging versus current radiography: A health technology assessment study. Med J Islam Repub Iran 2016;30.

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

 

(Abstract Text HTML)      (Download PDF)

.

Paradigm Shift of Interspinous Device Surgery for Degenerative Lumbar Diseases

/in /by

Volume 3 | Issue 1 | April-September 2022 | page: 04-06 | Jong-Beom Park
DOI: https://doi.org/10.13107/bbj.2022.v03i01.032

Authors: Jong-Beom Park [1]

[1] Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address of Correspondence
Dr. Jong-Beom Park,
Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Korea.
E-mail: spinepjb@catholic.ac.kr

Guest Editorial

Instrumented fusion surgery is an effective surgery for severe degenerative lumbar diseases and can achieve satisfactory clinical outcomes with a high fusion rate. However, due to extensive nature and loss of segmental motion, instrumented fusion can cause complications and adjacent segment disease, and some patients require second surgery. On the contrary, decompression alone is an effective surgery for moderate degenerative lumbar diseases and can achieve satisfactory clinical outcomes. However, failed back surgery syndrome, such as recurrent lumbar disc herniation or spinal stenosis, can occur at the segment of prior surgery, and some patients also require second surgery. In clinical practice, there are indications for instrumented fusion surgery or decompression alone. However, for some cases, it is difficult to decide which surgery is appropriate for the patients; such a situation is called a grey zone (Fig. 1). Instrumented fusion surgery can be excessive, while decompression alone can involve segmental imbalance or problems postoperatively. Interspinous device surgery (ISD) can be considered for grey zone of degenerative lumbar diseases as new solution.
According to the traditional concepts, diseased lumbar segment with instability is a cause of low back pain and can require fusion. However, in clinical situations, fusion does not always correlate with successful outcomes. While about 10–20% of solid fusion patients complain of persistent low back pain, some non-union patients do not complain of low back pain. These results lead to questions and uncertainty regarding fusion surgery. First, it is unclear if lumbar instability is a cause of low back pain. Second, it must be determined if fusion surgery is necessary for lumbar instability. Recently, the biomechanical concept of the cause of low back pain has changed. Increased load transmission to facet joints and increased intradiscal pressure to the posterior part of a disc are considered important causes of low back pain. Therefore, spine surgeons view degenerative lumbar diseases differently, resulting in a paradigm shift in surgery of degenerative lumbar diseases.
ISD surgery is a dynamic stabilization surgery with an action mechanism of distraction of narrow interspinous space: ISD can widen the spinal canal and neural foramen to achieve indirect decompression of neural structures. In addition, ISD can restore normal lordosis and offset abnormal load shift of facet joints and increased intradiscal pressure to the posterior part of the disc to relieve low back pain. Based on the concept and action mechanism, good indications of ISD surgery are moderate lumbar spinal stenosis (Fig. 2), lumbar disc herniation (Fig. 3), and internal disc derangement (Fig. 4) associated with flexible extension instability or segmental imbalance, such as retrolisthesis or hyperlordosis, which can be reduced in flexion. In contrast, contraindications of ISD surgery are severe lumbar spinal stenosis, flexion instability, degenerative or isthmic spondylolisthesis, rigid extension instability of segmental imbalance that cannot be reduced in flexion, and multilevel degenerative lumbar scoliosis.
In our experiences of about 20 years with primary ISD surgery and revision surgery for failures of ISD surgery, the most common cause of failure of ISD surgery is inappropriate indication or patient selection. Another important cause of failure is incorrect surgical technique such as stand-alone use of ISD without decompression, excessive over-distraction (by over-sized ISD), and supraspinous ligament injury or spinous process fracture. These incorrect surgical techniques cause poor surgical outcomes and might require revision surgery. Based on these outcomes, the following advice is offered for successful ISD surgery for degenerative lumbar diseases. First, ISD surgery should be performed for patients with good indications. Second, ISD implantation should be performed after limited decompression including removal of a hypertrophied ligamentum flavum to preserve segmental stability (Fig. 5).
In our BMC Musculoskeletal Disorders Publication (Cho et al.) [1], we performed 15-year survivorship analysis of 94 patients with single-level lumbar disc herniation who underwent discectomy and DIAM implantation. We aimed to provide the longest follow-up evidence on the efficacy of DIAM implantation for single-level lumbar disc herniation. The results showed that 8.5% of the patients underwent reoperation at the DIAM implantation level during the 15-year follow-up. The mean time to reoperation was 6.5 years. Kaplan–Meier analysis showed a cumulative survival rate of the DIAM implant of 99% at 1 year, 97% at 5 years, 93% at 10 years, and 92% at 15 years after surgery. Our results showed that DIAM implantation significantly decreased reoperation rate for single-level lumbar disc herniation in 15-year survivorship analysis. This study provides the strongest evidence for the efficacy of DIAM implantation for the treatment of single-level lumbar disc herniation. In our view, this paper, coupled with our previous paper (Sur et al.) [2], settles the debate on the efficacy of DIAM implantation for the treatment of moderate lumbar spinal stenosis or lumbar herniation associated flexible extension instability or segmental imbalance.

References

1. Cho YJ, Park JB, Chang DG, Kim HJ. 15-year survivorship analysis of an interspinous device in surgery for single-level lumbar disc herniation. BMC Musculoskelet Disord 2021;22:1030.
2. Sur YJ, Kong JG, Park JB. Survivorship analysis of 150 consecutive patients with DIAM implantation for surgery of lumbar spinal stenosis and disc herniation. Eur Spine J 2011;20:280-8.

How to Cite this Article: Park JB Paradigm Shift of Interspinous Device Surgery | for Degenerative Lumbar Diseases | Back Bone: The Spine Journal | April-September 2022; 3(1): 04-06. https://doi.org/10.13107/bbj.2022.v03i01.032

 

(Abstract Text HTML)      (Download PDF)

.

Lemon Principle and Signaling Quality in Context with Spine Surgery

/in /by

Volume 3 | Issue 1 | April-September 2022 | page: 01-03 | Hitesh N. Modi
DOI: https://doi.org/10.13107/bbj.2022.v03i01.031

Authors: Hitesh N. Modi [1]

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

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

Abstract

Medical specialty has been considered as a noble profession related with the service to mankind. However, consumer protection act considers it as a service industry with all its norms and rules applicable. If we consider spine surgery, the majority of patients as well as society advocating non-surgical treatment due to associated misbelieves and complexity of surgeries despite of its obvious benefits. The question arises how can we apply business principles to alleviate the hurdles in the spine surgeries and elevate the perception of the surgical treatment in the minds of the patients. Two famous noble prize-winning principles of business “Lemon principle” and “Signaling” would probably answer these. In this article, I have attempted to touch on these two principles in relation with spine surgeries and I am sure that such principles would help us in improving the health-care quality across all specialties.
Keywords: Medical service, consumer act, lemon principle, signaling, business.

References

1. Varian HR. Microeconomic Analysis. Vol. 3. New York: Norton; 1992.
2. Akerlof GA. Quality uncertainty and the market mechanism. Q J Econ 1970;84:488-500.
3. Spence M. Job market signaling. Q J Econ 1973;87:355-74.
4. Connelly BL, Hoskisson RE, Tihanyi L, Certo ST. Signaling theory: A review and assessment. J Manag 2010;37:39-67.

How to Cite this Article: Modi HN | Lemon Principle and Signalling Quality in Context with Spine Surgery | Back Bone: The Spine Journal | April-September 2022; 3(1): 01-03.  https://doi.org/10.13107/bbj.2022.v03i01.031

 

(Abstract Text HTML)      (Download PDF)

.