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Gorham Stout Disease- A Rare Disorder with Ambiguous Recommendations: A Systematic Review of literature.

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Volume 3 | Issue 2 | October 2022-March 2023 | page: 65-77 | Ajay Krishnan, Preethesh Agrawal, Vatsal Parmar, Vikrant Chauhan, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan, Shiv Kumar Bali, Prartham C Amin, Pranav R Charde, Preety A Krishnan, Mirant R Dave, Bharat R Dave

DOI: https://doi.org/10.13107/bbj.2022.v03i02.043

Authors: Ajay Krishnan [1], Preethesh Agrawal [1], Vatsal Parmar [1], Vikrant Chauhan [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan [1], Shiv Kumar Bali [1], Prartham C Amin [1], Pranav R Charde [1], Preety A Krishnan [2], Mirant R Dave [1], Bharat R Dave [1]

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

Address of Correspondence

Dr. Ajay Krishnan,
Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
E-mail: drajaykrishnan@gmail.com

Abstract

Background: Vanishing bone disease / Gorham-Stout disease (GSD) is a condition that produces deformity and instability of bone. The fibro lympho-vascular tissue replaces the bone leading to massive osteolysis and its sequelae, but the exact cause is yet unknown. The disease involves the spine infrequently, but due to the proximity of the spinal cord it can seriously affect the patient. The aim of this study is to report as a review to contribute to the diagnosis, and treatment modalities in GSD affection of spine with the reported literature available from 1983 till March 2022.
Materials & Method: This metanalysis study is focused on GSD involving the spine. The search was done in two databases PubMed and Google scholar from 1983 up to March 2022. The Study selection was done to study the demographic pattern of GSD in spine and its outcome with conservative and surgical treatment and to determine the best suitable medical treatment for stopping disease progression and achieving remission.
Results: We retrieved 72 articles from Google scholar and PubMed out of which 5 articles were excluded (90 reported cases). Heffez criteria was followed for diagnosis in all these cases (n=86, 95.5%). 57 patients (64%) were operated and 33 patients (36%) were managed conservatively. Per-operative failure to achieve a fixation/reconstruction were reported in 2 (2.53%) cases. Number of surgeries till follow-up were average 1.70+ 1.23 (1-5) surgeries. The average follow-up of cases reported was 47.1+ 48.9 (3-240 months). Union was documented in 10 cases (3.4%). 9 of these cases needed additional bone graft/substitute. Bisphosphonates(n=40), sirolimus (n=5), interferon (n=17), radiotherapy (n= 31) and beta-blockers (n=4) were given in medications. 23 patients had remission. Death occurred in 17 patients (18.88%).
Conclusion: Surgery is needed frequently. Failure of fixations, achieving union and remission are daunting and ’off  label” therapies are the dictum. Radiotherapy has been used more frequently with or without bisphosphonates. Though promising medical treatment are evolving and focus of treatment is directed towards anti-angiogenic, anti-osteolytic and anabolic therapy, but no standard treatment recommendations can be made out from existing literature.
Keywords: Vanishing bone disease, Gorham stout, Osteolysis, Spine, Deformity, Sirolimus, TNF

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How to Cite this Article: Krishnan A, Agrawal P, Parmar V, Chauhan V, Degulmadi D, Mayi S, Ranjan R, Bali SK, Amin PC, Charde PR, Krishnan PA, Dave MR, Dave BR | Gorham Stout Disease- A Rare Disorder with Ambiguous Recommendations: A Systematic Review of literature | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 65-77.  https://doi.org/10.13107/bbj.2022.v03i02.043

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

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

DOI: 10.13107/bbj.2022.v02i02.024

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

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

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

Abstract

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

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6. Deschamps A, Carvalho G. Lumbo-sacral spine surgery and severe bradycardia (Letter). Can J Anesth 2004;51:277.
7. Mandal N. More on lumbo-sacral spine surgery and bradycardia (Letter). Can J Anaesth 2004;51:942.
8. Dooney N. Prone CPR for transient asystole during lumbosacral spinal surgery. Anaesth Intensive Care 2010;38:212-3.
9. Chowdhury T, Sapra H, Dubey S. Severe hypotension in transforaminal lumbar interbody fusion surgery: Is it vasovagal or? Asian J Neurosurg 2017;12:149-50.
10. Chowdhury T, Narayanasamy S, Dube SK, Rath GP. Acute hemodynamic disturbances during lumbar spine surgery. J Neurosurg Anesthesiol 2012;24:80-1.
11. Nash CL Jr., Lorig RA, Schatzinger LA, Brown RH. Spinal cord monitoring during operative treatment of the spine. Clin Orthop Relat Res 1977;126:100-5.
12. Devlin VJ, Schwartz DM. Intraoperative neurophysiologic monitoring during spinal surgery. J Am Acad Orthop Surg 2007;15:549-60.
13. Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU classification for herniated lumbar discs on MRI: Toward developing objective criteria for surgical selection. Eur Spine J 2010;19:1087-93.
14. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 2010;35:1919-24.
15. UK National Institute for Health and Care Excellence. Low Back Pain and Sciatica in Over 16s: Assessment and Management; 2016. Available from: https://www.nice.org.uk/guidance/ng59. [Last accessed on 2017 Nov 07].
16. Swift A. Understanding pain and the human body’s response to it. Nurs Times 2018;114:22-6.
17. Ditunno JF, Little JW, Tessler A, Burns AS. Spinal shock revisited: A four-phase model. Spinal Cord 2004;42:383-95.
18. Krassioukov A. Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol 2009;169:157-64.
19. Wallin BG, Stjernberg L. Sympathetic activity in man after spinal cord injury. Brain 1984;107:183-98.
20. Krassioukov A, Warburton DE, Teasell R, Eng JJ. Spinal cord injury rehabilitation evidence research team. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil 2009;90:682-95.
21. Karlsson AK Autonomic dysreflexia. Spinal Cord 1999;37:383-91.
22. Groen GJ, Baljet B, Drukker J. The innervation of the spinal dura mater: Anatomy and clinical implications. Acta Neurochirur 1988;92:39-46.
23. Bogduk N. The innervation of the lumbar spine. Spine 1983;8:286-93.
24. Bridge CJ. Innervation of spinal meninges and epidural structures. Anat Gec 1959;133:553-61.
25. Pedersen HE, Blunck CF, Gardner E. The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerves (sinu-vertebral nerves). J Bone Joint Surg 1956;38:377-91.
26. Stilwell DL. The nerve supply of the vertebral column and its associated structures in the monkey. Anat Rec 1956;125:139-169.
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28. Musizza B, Ribaric S. Monitoring the depth of anaesthesia. Sensors 2010;10:10896-935.
29. Kaul H, Bharti N. Monitoring the depth of anaesthesia. Indian J Anaesth 2002;46:323-32.
30. Wiedemayer H, Sandalcioglu IE, Armbruster W, Regel J, Schaefer H, Stolke D. False negative findings in intraoperative SEP monitoring: Analysis of 658 consecutive neurosurgical cases and review of published reports. J Neurol Neurosurg Psychiatry 2004;75:280-6.
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37. Jang KM, Park SW, Kim YB, Park YS, Nam TK, Lee YS. Acute contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion. J Korean Neurosurg Soc 2015;58:350-6.
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39. Choi JW, Lee JK, Moon KS, Hur H, Kim YS, Kim SH. Transdural approach for calcified central disc herniations of the upper lumbar spine. J Neurosurg Spine 2007;7:370-4.
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46. Marie JR, Jennifer S, Alexander PH, Andrew AS, Ronald GE, Carrie G, et al. Hemodynamically significant cardiac arrhythmias during general anesthesia for spine surgery: A case series and literature review. N Am Spine Soc J 2020;2:100010.
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How to Cite this Article: Krishnan A, Degulmadi D, Ranjan R, Mayi S, Nitherwal N, Reddy L, Patel A, Singh I, Dave M, Shah KR, Mehta PA, Dudhia S, Dave BR Hemodynamic | Neuromonitoring, a Proposed Spino- Cardiac Protective Reflex: Prospective Study in 200 Patients of Lumbar Surgery | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 71-78.

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Strategies of Avoiding Medicolegal Problems

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Volume 1 | Issue 1 | October 2020-March 2021 | page: 5-7  | Pankaj R. Patel

Authors: Pankaj R. Patel [1]

[1] NHL Municipal Medical College, Ahmedabad, Gujarat, India.
[2] Department of Orthopaedics, Vadilal Sarabhai General Hospital,
Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Pankaj R. Patel,
Dean NHL Municipal Medical College and Department of Orthopaedics,
Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
E-mail: pankajpateldr@gmail.com

“Medicine is of all the arts the most noble, but owing to ignorance of those who practice it, and those who, inconsiderately form a judgment of them, it is at present far behind all other arts.” Hippocrates
The provision of unnecessary health care is a serious problem and involves two key legal issues. First, doctors’ fear of litigation drives defensive practices – ordering tests and procedures, making referrals, and prescribing drugs to reduce perceived legal risks, rather than to advance patient care. Second, suboptimal communication and decision-making processes undermine a patient’s right to make informed health-care choices [1]. Information is available to judge and evaluate with limited knowledge in the field. Do we feel the same thing nowadays? Probably yes; and before consulting a patient, medicolegal implications are the first fear in our mind due to some of the facts such as decline in self-regulatory standards, rise in medical malpractices and commercialization, imbalance between service and business, and lack of an effective internal or external regulation. We must not forget the truth that there is a public outcry against medical profession due to some incidences, which is generally being applied to all healthcare professional community by media because of negative coverage. We should also remember that this is not the commonest issue in each doctor’s career; and media are not always negative, however, only a few incidences will imprint a general impression on the mindset of public and end up in to medicolegal consequences. We must come out of this fear and phobia and succeed in career if we maintain an acceptable standard of care and communication.
If we discuss about the difference of medicolegal problems between physicians and surgeons, it is found that surgeons receive complaints twice as much as received by physicians [2]. This increased risk of litigation arises partly from involvement in surgical procedures and treatments but also reflects wider concerns about interpersonal skills, professional ethics, and substance use. Improved understanding of these patterns may assist efforts to reduce harm and support safe practice. Medical negligence is a very commonly heard when a patient or their relative files a litigation case against any doctor or hospital since the medical profession is considered as service, not a profession and patient is considered as a customer. In 1995, the Supreme Court’s decision in Indian Medical Association versus V P Shantha brought the medical profession within the ambit of a “service” as defined in the Consumer Protection Act, 1986. This defined the relationship between patients and medical professionals as contractual [3]. In simple words, medical negligence is doing a thing that other doctor would not do (i.e., commission, etc.) or not doing something that the other doctor would do (i.e., omission, etc.). It can be applied if practices acceptable to medical profession of the newer methods or more skilled doctors are available. Therefore, it is imperative for all of us to maintain evidence-based ethical practice, and thereby, remaining away from medical negligence. We should remember that the h
Honorable court would consider those issues in case such as, Res Ipsa Loquiter means thing that speaks itself, the expert evidence if present, medical records of the hospital, available medical literature, and postmortem in case of mortality.
“Man may tell lie but documents would not.” This would definitely apply when we treat a patient, and therefore, maintenance of medical record is must to avoid any kind of medicolegal consequences. Remember it is the doctor’s or hospital’s responsibility to maintain and preserve records, not patient’s. The medical record and other documentation from the treating doctor or hospital generally speak truth. It is generally prepared at the time of presentation in outpatient, emergency, or wards. It is considered as unbiased, objective, and independent evidence in case of any dispute. It also reflects the real condition of patient at different times of management. It exhibits the overall gravity of the condition and outcome. Therefore, it is mandatory to document complete diagnosis, ways of management, and possible complications in the record. There should not be correction afterward that becomes obvious. Inpatient records considered are daily visit notes, surgical notes, anesthetist notes, other references notes, prescriptions with details of medicines with their proper dose and schedule, daily clinical parameter charts, laboratory and radiological investigations reports, daily progress or deterioration reports, etc. It is also advisable to have computerized reports in electronic medical record, which can be reproducible. The treating doctor must sign all documents, certificates, and daily notes including discharge papers.
The former President of United States Mr. Abraham Lincon said, “No man is good enough to govern another man without the other’s consent.” Informed and signed consent is mandatory document in case of interventional procedure or surgery. “Informed consent” is defined as consent that is given by a person after receipt of following information: The nature and purpose of the proposed procedure or treatment; the expected outcome and likelihood of success and risks; the alternative to the procedure and supporting information regarding those alternatives; and the effect of no treatment or procedure including its effect on prognosis and instructions concerning what should be done if the procedure turns out to be harmful or unsuccessful. It is mandatory to inform and take separate consent if procedure is two or more stages or two or even more surgical approaches. Consent should also be repeated if any additional procedure is to be done. In medical law, consent taken for diagnostic procedure cannot be considered as authorization or permission to perform therapeutic procedure such as angiography and angioplasty. Sometimes, it is also practiced taking an audiovisual consent in case of vulnerable or emergency patients and specially in research subjects in clinical trials. However, it is neither the routine practice nor it is mandatory at present. Another possible explanation for a higher risk of medicolegal problems in a surgical case is that surgeons administer the riskiest treatments to the sickest patients; and therefore, easily observable poor outcomes go with the territory [4]. Therefore, it up to the surgeon to decide or involve further opinion before implementing risky surgeries in a high-risk patient.
Tibble et al. found systematic differences in complaints about other issues, including communication and interpersonal behavior in cases of surgeons who were challenged mediolegally [2]. Recent research into discrimination and bullying in the surgical profession found that these behaviors are “pervasive and serious problems in the practice of surgery” [5]. Therefore, it is understood that poor communication between doctor and patient is a prime factor behind majority of the medicolegal cases, which results into unfolding of various documentation errors. It is commonly observed that a surgeon with an excellent communication skill with an average clinical skill excels in his/her career; and on the other hand, a surgeon with poor communication skill with an extraordinary clinical skill often has a turbulent career path. We have also seen that a patient with multiple complications during the treatment often turns out to be your best and loyal customer who also refers more patients to you. While, on the other hand, the patient who has an excellent outcome and better than expected results may not recommend your name in a similar case. The only reason is communication. Therefore, importance of communication ideally should come before documentation. Communication should be frequent and interactive between doctor and patient with the relatives as well. Communication should always be two-sided rather than one-sided especially doctor giving information without giving patient an opportunity to ask. Explanation of all events must be discussed on regular basis and during visits as well. Practitioner should himself face the patient and the family in case of any event, complication, or poor prognosis rather than sending the information through a junior colleague or staff that create a fear and anger component in the patient’s mind. The duty of a clinician is to provide confidence and trust with actual facts in a patient and family while treating. In addition, document your communication for future purpose as well with dually signed by the doctor and patient. I would like to say there are four things to avoid medicolegal problems in a surgeon’s life by enlarge: Communication, Documentation, Communication of documentation, and Documentation of communication. I think we must follow this principle into our own practice whether it is done at a government or private place, other colleague’s referral place, our own clinic, or even on teleconsultation.
The remainder of the difference arose from surgeons’ higher risk of complaints across a range of issues: Surgeons have complaint rates that are more than 1.5 times as high as physicians in relation to monitoring and follow-up, fees and fraud, reports and certificates, substance use, communication, and interpersonal behavior. Surgeons were at a lower risk in relation to prescribing [2, 4]. Among surgeons, male sex, older age, and practice in regional or remote areas are also risk factors for complaints, as were practice in orthopedics, neurosurgery, and plastic surgery. The previous studies have shown worrying levels of alcohol misuse and burnout among surgeons [6, 7]. These should be better explained by following the ethical code of conduct in case of medical profession. When a patient decides for filing a case against the doctor, his surrounding environment thinks that the first is “High fees and poor care” including the media conversation. Therefore, in recent times, the suggestion is to have a lenient view of finances in a really needy patient, however, it should not be a waiver which gives in fact a negative message regarding doctor’s mistake resulted in to fees waiver. In addition, there should not be too much downgrading of the treatment cost which indirectly indicates the initial quotation as inflated or wrong. In addition, we should not hesitate handing over the hospital records or documents including other colleague’s opinion, especially in case of a complication, technically challenging case or a high-risk case. Such behavior in fact infuses confidence in the mind of patient and proves transparency from clinician’s end. It also infuses the trust when we keep back up literature support with an effective communication with explanation of standard care of treatment while discussing treatment options. We must not forget mentioning that we need to treat patient not the radiology reports or laboratory reports, which indirectly attract patient toward the clinician. In addition, doctor must be a good listener to his/her patient. If you listen to your patient carefully with proper attention, you will better understand the actual problem and requirement, which indirectly help in prescribing the correct treatment.
Finally, we must remember the words by the greatest scientist Mr. Albert Einstein, “Any man who reads too much and uses his own brain too little, falls into lazy habits of thinking.” Therefore to avoid medicolegal problems in a medical profession is to use our common senses (brain) and implementing techniques of communication with patience while listening to patient’s (customer’s) problem, documenting all his/her problems with both way agreement, maintain and handling all records up to date, remaining in current world with recent literature, facing any complication and showing responsibility on your end for further plans yourself and being lenient regarding financial aspects especially self-paying patients.
I acknowledge the kind help from Dr. Hitesh Modi and Dr. Bharat Dave for preparing this article for the publication in the journal.

 

References

1. Ries NM. Choosing wisely: Law’s contribution as a cause of and a cure for unwise health care choices. J Law Med 2017;25:210-28.
2. Tibble HM, Broughton NS, Studdert DM, Spittal MJ, Hill N, Morris JM, et al. Why do surgeons receive more complaints than their physician peers? ANZ J Surg 2018;88:269-73.
3. Supreme Court of India. Indian medical association vs V.P. Shentha. Judgem Inform Syst 1995;6:651.
4. McNamara S. Surgeons top Multiple Complaints List. United States: MJA InSight; 2011. p. 24.
5. Knowles R, et al. Expert advisory group on discrimination, bullying and sexual harassment: Report to RACS; 2015. Available from: https://www.data.gwa.gov.au/datasets.html-part-1.
6. Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J, et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg 2012;147:168-74.
7. Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: Understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg 2009;144:371-6.

How to Cite this Article: Patel PR| Strategies of Avoiding Medicolegal Problems| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 5-7.

 

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Dedicating “BackBone- The Spine Journal” to the Spine Research

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Volume 1 | Issue 1 | October 2020-March 2021 | page: 3-4  | Katikeya P. Pathak

Authors: Katikeya P. Pathak [1]

[1] Department of Orthopaedics, Jivraj Mehta Memorial hospital,
Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Katikeya P. Pathak,
Consultant Orthopaedic Surgeon, Jivraj Mehta Memorial hospital,
Ahmedabad, Gujarat, India.
E-mail: kartikppathak@yahoo.co.in

Orthopedic and neurosurgery community in Gujarat and across the country has been seeded with an increasing number of spine surgeons, since the past few decades. The volume of work done in the specialty has been increasing steadily, as is the confidence of the surgeons. The trend of medical specialties has been toward increased fellowship training and subspecialization. There are numerous reasons for pursuing fellowship training, including personal and financial [1]. Spine surgery is an emerging career option in the field of orthopedic surgery and neurosurgery, which is due to the increasing awareness and requirement of technical superiority of recent years, thanks to the hard work of our mentors and patrons.
In the initial days, most spine surgeries were performed at small nursing homes by enthusiasts who had sown the seeds of interest in the field of spine surgery. They helped to change the various disbeliefs among the patients regarding spine surgeries outcomes such as paralysis, bedridden status, tremendous blood loss, and exorbitant expense. Spine surgery has also been supported by the increasing number of corporate hospitals, which are well provided with the backup for the safe performance of surgery. This is not to devalue the huge volume of work being done in smaller private hospitals, which are also equipped with modern anesthetic and intensive postoperative care backup. Modern technologies of minimally invasive and endoscopic techniques, navigation system, BoneScalpel, robotic surgeries, and motion-preserving technologies have increased the utility as well as safety during spine surgeries in various setups. This is one of the possible factors behind the increasing popularity of this subspecialty [2,3]. The comfortable feeling, with which the spine surgeons are working, is reflected in their generally good health and fitness status; their demeanor is not haunted and worried.
In India, the number of doctors is still low, compared to the averages of the world [4], which indirectly indicates that the work is increasing tremendously. It is not important only to perform as many surgeries as possible, but it is equally imperative to spread the knowledge and information across the country and the world. The biggest orthopedic names in the country have passed away without publishing a single paper. Why did that happen? Was it merely due to the lack of journals or due to their ignorance of research and academics? Certainly not. They were as keen on teaching and passing on their skills to their juniors. They ruled our hearts but failed to make an impact in the academic world that would benefit their colleagues in the field. Therefore, it is emphasized that academic research and publishing are of lasting benefit to the subsequent generations of the state, country, and the world. Clinical work flows steadily like a perennial river, taking it to an ultimate sea of oblivion, from which it cannot be recovered for any benefit. The benefit of work and research should last long. It is, therefore, a laudable idea for the members of Spine Association of Gujarat to start a journal of their academic activities and to share their knowledge. It is indeed a “Great Leap” for the evolving spine community that will create and increase awareness in developing the field to a better level. A word of caution about the Great leap is, “Look before you leap.” Any leap should always be in a concerned forward manner, not like the “Jumping frog of Calaveras County” by Mark Twain. In this, frogs sponsored for the annual race were lined up at a starting line to end up at the finish. The frogs were not tame or the trainable, and some would refuse to jump at all, and others might turn around and jump sideways or backwards. Owners were not allowed to touch or guide in any way except by hollering from the finish line. The Great Leap should not jump over priorities of work discipline such as effective communication between members, common pattern of data storage and interpolation, and accessibility. One recent study states that medical students, who conducted research leading to a publication before graduation, were more likely to be scientifically active after graduation [5]. Furthermore, the health-care professionals who conduct the research are likely to be more active in accepting newly developing technologies and in upgrading their work. There is an old saying about the people of Gujarat, “Gujaratio Arambhe Shoora!” meaning, Gujaratis are brave at the start, but falter to sustain or finish what they have started. I feel that this picture has changed and a match finishing spirit seems to prevail in the spine surgery community. The new journal should ignite the desire to publish research work and thereby develop interest for accepting upgradation in the field. An exponential growth in members of the Spine Association of Gujarat has occurred, indicating eagerness to learn. This journal should inculcate a system in the learning.
Electronic revolution helped the contributors to gather knowledge and in giving the best possible shape to the matter for submission. As Jacobs told that “electronic media takes on paper publishing,” increasing use of various platforms such as PUBMED, MEDLINE, Scopus, and Cochrane reviews is handy on our mobile phones or computers that will enhance our speed of spreading and sharing knowledge across the world by publishing a paper in minimal time [6]. The formation of an editorial board, unbiased and experienced reviewers, well-informed guideline for authors, convenient submission methods, faster peer-review process and publication time, and minimum publication fees would further add to the value of the journal that makes it widely acceptable. The idea is to work in a sustained organized manner, to produce a useful publication that will survive and grow better every year, serving as a genuine material to seekers. Problems need solutions, not negative criticism, which is the motto of our endeavor. A journal is very different from reading a paper, however grand the conference may be. It is a welcome step to start Spine Journal with different sections such as editorials, guest articles, current concept and other review articles, technical tips, novel case reports, innovations, complications, letter to the editor, conference proceedings, residents, and fellows research forum. I would like to urge the community to take the benefits of our initiatives with blessings from our teachers and mentors to publish our valuable contribution to the journal.
English is a gratefully borrowed language but one must not accept bad grammar, insisting that since it is not our language, we are free to twist and anyhow torture it. Editing the paper once accepted would make our research widely readable worldwide. Publication documents and records are the base for developing spine registries that form a useful base for preparation of future research work and white papers. A registry to start with may not be all encompassing but may be subject wise. This will create a cohesive feeling among the members by participation without any criticism. Evolving humbly together is the way, not to bring personal quirks or aggrandizement. Even if each worker has own records, the format and application of skills must make a paper universally acceptable. Potential authors must be painstakingly and politely approached repeatedly and convinced to apply their minds to the preparation of a presentable paper. The status of a contributor should not influence an acceptance of ineligible material. Instead, help may be given to improve it. The addition of contributors as coauthors who had worked for making it more presentable is a generous and honest measure.
Please do not hang on to some good material that you have, in the hope that you may publish it in some foreign prestigious famous journal. Publishing our work in our own journal and elevating the quality of research, automatically becomes a highly valued journal across the world. Respect our journal and our country and make others refer. In the words of The Honorable Prime Minister of India, Shri Narendra Modi, “Vocal for Local” which means, “lend your voice for what is generated in your own nation.” This journal and research published should make a long-lasting effect in the minds of readers of this journal and we dedicate it to our mentors, teachers, patrons, and patients.
Be happy working together and my encouragement may always be with you.

 

References

1. Mead M, Atkinson T, Srivastava A, Walter N. The return on investment of orthopaedic fellowship training: A ten-year update. J Am Acad Orthop Surg 2020;28:e524-31.
2. Virk S, Qureshi S, Sandhu H. History of spinal fusion: Where we came from and where we are going. HSS J 2020;16:137-42.
3. Momin AA, Steinmetz MP. Evolution of minimally invasive lumbar spine surgery. World Neurosurg 2020;140:622-6.
4. Karan A, Negandhi H, Nair R, Sharma A, Tiwari R, Zodpey S. Size, composition and distribution of human resource for health in India: New estimates using national sample survey and registry data. BMJ Open 2019;9:e025979.
5. Waaijer CJ, Ommering BW, Van Der Wurff LJ, Van Leeuwen TN, Dekker FW, NVMO Special Interest Group on Scientific Education. Scientific activity by medical students: The relationship between academic publishing during medical school and publication careers after graduation. Perspect Med Educ 2019;8:223-9.
6. Jacobs AV. Electronic media takes on paper puablishing. Br Dent J 2000;188:174-5.

How to Cite this Article: Pathak KP| Dedicating “BackBone- The Spine Journal” to the Spine Research| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 3-4.

 

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Road Map for the Journal and Achieving New Horizon in Coming Years

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Volume 1 | Issue 1 | October 2020-March 2021 | page: 1-2  | Hitesh N. Modi

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,
Spine Surgeon, Zydus Hospital and Healthcare Research Pvt.Ltd ,
Ahmedabad, Gujarat, India.
E-mail: modispine@gmail.com; drmodihitesh@gmail.com

Any published article is the proof of the clinician’s academic growth and success of his career. Academic journal is usually considered the face of any representative body or organization. It also reflects the research activities carried out by its members and indirectly indicates how much its people are inclined to spreading and sharing their knowledge amongst others. Spine Association of Gujarat (SAG) is an esteemed organisation representing all the surgeons from Orthopaedic surgery and Neurosurgical specialty performing and involving in spine related treatment in their day-to-day practise. The purpose of bringing this journal is to make the face of our organisation shining like a star in the academic world. We want other parts of the world should know that our members are doing the best job in spine surgery, which is at par with the all advances in spine treatment. For this to achieve, we must stand and work together.
With the introduction of this scientific peer reviewed journal, we would like to invite articles from any part of the world and from any specialty, which is related to the spine care and related to the spine surgery. It is also a benchmark of SAG to exchange the knowledge in spine and spine related management amongst the members. It also facilitates knowledge and research exchange with the rest of the world. Let us think what SAG has achieved over the past years since its inception. SAG is currently involved in many scientific activities such as, regularly arranging one day conferences (one in three months), monthly medical forum to promote second line specialists, organising national conferences (by so far two ASSICON and one MISSICON) and also teaching newer surgeons (through individual capacity of the member) in form of fellowships. However, we still lack in publication and research activities. Our journal will provide a platform for its members to achieve their name scientifically recognised across the world.
The journal will be initially launched with online version that is readable easily on the internet. There are no processing fees for the article submission, review or publication and eve for the download. This will create a rapid acceptance of the journal in the scientific world. The expenditure is to be borne by the association. However, we also intend to print the journal in hard copy version in limited numbers, which will be distributed amongst our members and certain other organisations. Google scholar will also our primary search engine for the scientific search. The prestige of any journal is considered by how many abstracting and indexing services cover that journal. Citation index (indexing) is an ordered list of cited articles, each accompanied by a list of citing articles [1, 2]. Currently SCI and SCI-expanded[3], which is published by ISI a part of Thomson Reuters, Scopus, which is a bibliographic database containing abstracts and citations for academic journal articles and ICI (Indian Citation Index), which is an online citation data for measuring performance of India research periodically are the major citation indexing services[4]. PubMed central is a free digital repository that archives publically accessible full-text articles. More than 1600 peer reviewed scientific journals automatically deposit their articles in PubMed Central. As per my knowledge, MEDLINE, PubMed Central, ISI and Scopus are four major online bibliographic sites, and searched all over the world. Our primary aim of the journal is to list our article and journal in these online sites as soon as possible to make our research visible publically.
The citing article is identified as source and the cited article as reference. Our aim for the journal is to be an excellent source of research activities and to be known as reference book in the literature. The journal has its own website www.backbonejournal.com and one can electronically submit the manuscript as well as read archives from the site. The submission and decision time is aimed to decrease within period of three months, so that article becomes visible online at a faster pace. Currently we are going with two issues per year, and later we are planning to publish three or four issues per year to produce our academic activities more visible. Looking at the road map and future of the journal, our mission is to work for new opportunities for global exposure and improve the impact factor of the journal once it is achieved. The transparency in the review process will continue from the beginning. We also aim at publishing specific and additional issues related to particular topic, which eventually represent and publish the academic work of a specialised person and provide research material like a book and ultimate for the particular topic. Publishing is teamwork. Therefore, we cordially invite you all to submit your manuscript to Backbone journal, which guarantees the highest level of peer review and quick publication after the acceptance. This is our journal and we must work and contribute together towards its growth.

 

References

1. Garfield, E., Citation indexing for studying science. Nature, 1970. 227(5259): p. 669-71.
2. Garfield, E., “Science Citation Index”–A New Dimension in Indexing. Science, 1964. 144(3619): p. 649-54.
3. Fu, H.Z. and Y.S. Ho, Independent research of China in Science Citation Index Expanded during 1980-2011. J Informetr. 7(1): p. 210-222.
4. Marc, D.T., et al., Indexing Publicly Available Health Data with Medical Subject Headings (MeSH): An Evaluation of Term Coverage. Stud Health Technol Inform. 216: p. 529-33.

How to Cite this Article: Modi HN | Road Map for the Journal and Achieving New Horizon in Coming Years | Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 1-2.

 

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