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

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


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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

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

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


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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

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Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife!

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.
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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

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

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

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


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

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

Address of Correspondence

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


Abstract


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


References


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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

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

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

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


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

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

Address of Correspondence

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


Abstract


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


References


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

 


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

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


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

 


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

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


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

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

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


Abstract


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


References


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

 


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Paradigm Shift of Interspinous Device Surgery for Degenerative Lumbar Diseases

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


Authors: Jong-Beom Park [1]

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

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


Guest Editorial


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


References


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


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

 


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Lemon Principle and Signaling Quality in Context with Spine Surgery

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

 


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