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ORIGINAL ARTICLES
Accuracy and safety of free-hand pedicle screw placement in cervical injury patients
Sanjeeb Rijal, Sarvdeep Singh Dhatt, Vishal Kumar, Deepak Neradi, Mahesh Prakash
0, 0(0):0-0
DOI:10.4103/joss.joss_4_20  
Objectives: The purpose of this study was to describe the free hand method of pedicle screw placement without intraoperative imaging monitors and to evaluate the accuracy of the screw placement in quadriplegics patients. Methods: A free hand screw was inserted in the eleven cervical injury patients with quadriplegia. We studied the preoperative pedicle dimension in all the patients and assessed the clinical and radiological outcome and accuracy of the screw placement. Results: A total of 44 screws were inserted in the cervical pedicles of eleven patients. The postoperative images showed that 28 of the 44 screws had perforated the pedicles but none of them had breached the spinal canal. Among them 16 screws were grade 2 and 12 screws were grade 3. All the screws had penetrated the lateral wall. There were no neurovascular complications related to any malpositioned screw and there was no screw loosening or instrumentation failure in the patients. Conclusion: The free hand screw placement without intraoperative image guidance seems to be safe and effective method of fixation. But this technique requires sound knowledge of the cervical anatomy and experience and is useful in the places where navigation system are not available.
  224 7 -
Combined C1-C2 transarticular with C1 lateral mass screw fixation for the treatment of atlantoaxial instability: A single center experience
Murtuza Sikander, Sean Martin, Bassam Dabbous, Stewart Griffiths, Sumit Karia, Erlick Pereira, Thomas Cadoux-Hudson
October-December 2016, 3(4):133-139
DOI:10.5005/jp-journals-10039-1105  
Aim: To study the outcome of a cohort of patients with atlantoaxial instability (AAI) treated with a combination of C1-C2 transarticular screws and C1 lateral mass fixation. Background: Several surgical techniques have been described for stabilization of the atlantoaxial complex. Each technique differs in its biomechanical properties, advantages, and disadvantages. In this series, we describe our experience with a combined four-point fixation technique that combines C1-C2 transarticular screws with C1 lateral mass fixation for AAI. Materials and methods: We present a single-center retrospective case series of 30 patients who were surgically treated for AAI over one decade. All patients presented with symptoms and signs of AAI and consequently underwent extensive clinical and radiological evaluation prior to surgery. The median follow-up of our cohort was 8.3 months (3–143) with three patients lost to follow-up. Pre and postoperative symptoms were compared, including the visual analog scale (VAS) scores for neck and C2 radicular pain. All patients' preand postoperative lateral dynamic cervical radiographs were evaluated and the posterior atlantodental interval (PADI) was measured. Ranawat functional disability score was used for pre and postoperative evaluation. Results: Of the 30 patients, 8 were male and 22 female. The mean age was 60.4 years (18-78 years). The median hospital stay following surgery was 5 days (2–25 days). The mean preoperative VAS score for neck pain was 6.3 vs 4.3 at the first postoperative review (p = 0.001) on paired comparison. Ranawat scores were available for 26 out of 30 patients. The scores improved following surgery in 8/26 (30.7%) patients, did not change in 17 (65.4%) patients, and deteriorated in only one patient (3.8%). Like the VAS score, improvement in Ranawat score following surgery was significant (p = 0.02). Complications in this series included two unilateral intraoperative vertebral artery injuries associated with placement of C1-C2 transarticular screws, another patient had worsening C2 pain following surgery, and three patients had numbness in the C2 distribution following the procedure. Radiologically, two patients had suboptimal unilateral C2 screw placement despite satisfactory intraoperative fluoroscopic imaging. There were no infections and no implant failure. Conclusion: The addition of C1 lateral mass screws to C1-C2 transarticular screw fixation for the treatment of AAI is an effective and safe procedure worthy of note. Our results and experience prove that this method is extremely beneficial where decompression of the posterior elements of C1 is required and may obviate the need of additional posterior wiring traditionally described. Further studies are necessary to look at the longterm fusion rates and compare them with other procedures.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  66 7 1
CASE REPORTS
Small-cell lung carcinoma diagnosed only after cervical intradural metastasis caused hemiparesis
Yoshitaka Hirano, Daichi Fujimori, Fumito Omi, Meitetsu Masawa, Hideo Sakuma, Kazuo Watanabe
0, 0(0):0-0
DOI:10.4103/joss.joss_5_20  
We present a rare case of intradural extramedullary metastasis of small-cell lung carcinoma in the cervical spine. Optimal treatment strategies, including the indication for decompressive surgery, are discussed. A 70-year-old male who first presented with nuchal region pain suddenly developed right hemiparesis and was referred to our emergency service. Magnetic resonance imaging of his brain was unremarkable, but additional scanning of the cervical spine revealed an intradural tumor at the right C1–C3 levels. Urgent decompressive surgery was carried out, and gross total removal of the tumor was achieved. The histopathological diagnosis was metastasis of small-cell lung carcinoma. Computed tomography of the lung and abdomen revealed a primary tumor in his left lung, with multiple metastases to the mediastinal lymph nodes, liver, and adrenal gland. The patient was being considered for chemotherapy after some improvement of his hemiparesis and pain, but died on the 13th day due to sudden aggravation of the general condition. There was probably no surgical indication for the present case. Careful assessment and management of the primary disease should be considered the top priority even in patients with emergent neuronal insult.
  60 9 -
REVIEW ARTICLES
Concepts in the Management of Syringomyelia
Abhidha Shah, Abhinandan Patil, Shashi Ranjan, Atul Goel
July-September 2018, 5(3):120-127
DOI:10.5005/jp-journals-10039-1184  
Objective: The authors analyze their experience with syringomyelia. The treatment was focused on identification of the primary etiological factor and its treatment. Methods: Depending on the etiological factors and treatment considerations the series was classified into three groups. Group 1 had cases where there was no definite demonstrable etiological factor. Group 2 cases had basilar invagination and/or Chiari malformation, and Group 3 consisted of cases where the syrinx was secondary to an obvious aetiology, such as a mass lesion either in the posterior cranial fossa or in the spine or a severe kyphotic spinal deformity. Post-traumatic syringomyelia and syrinx in association with spina bifida were not studied. There is a significant subgroup where no cause is identified when evaluated by conventional radiological parameters. However, atlantoaxial dislocation was identified when assessed by Goel classification of facetal alignment. Results: In general, in Group 1 (or in idiopathic group), atlantoaxial instability was identified and was accordingly treated. In Group II, atlantoaxial instability was considered to be defining phenomenon. Accordingly atlantoaxial fixation was the treatment. In Group III the treatment was focused on the etiological factor. It was identified that direct syrinx drainage was not only not useful, but was harmful. It was observed that clinical outcome rather than radiological improvement is the reliable indicator of the surgical result. Conclusion: Syringomyelia is ‘never’ a primary pathological event but is secondary to a known or unknown (or unidentified) pathology. Treatment of the primary etiology is the goal in management of this condition
[ABSTRACT]   Full text not available  [PDF]
  54 6 -
RESEARCH ARTICLE
Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in a South Indian population for guiding pedicular mass fixation
Nithin Asadhi, Narayan Gudi, Anil K Sakalecha, Arun Shanthappa, Hariprasad Seenappa
July-September 2016, 3(3):96-102
DOI:10.5005/jp-journals-10039-1099  
Introduction: Our hospital Sri RL Jalappa Hospital is located on the national highway in South India. We receive many patients with history of trauma following road traffic accidents and fall from height. Most of the patients have sustained injuries to head and spine including cervical spine. The general population also presents with neck pain of various etiologies (e.g., cervical myelopathy). Aim: To assess the morphometry of the subaxial cervical spine pedicles through computerized tomography and to determine the frequency of neurovascular injuries in patients who undergo pedicular mass fixation in cervical spine. Materials and methods: This study was a hospital-based prospective intervention study centered at RL Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar, from November 2013 to July 2015 in which data of 200 patients who underwent computerized tomographic scans of the cervical spine and neck for various pathologies were collected and assessed. Results: The mean values of pedicle lengths and widths were found to be progressively increasing for both males and females from C3 to C6 vertebrae level and then slightly decreasing at C7 level. Also, it can be seen that the mean values for females are smaller than those for males, for both left and right side. We found that transverse and sagittal plane angulations were significantly dependent on spinal level. Transverse angulation was approximately 45° at C3 through C5 and decreased caudally to approximately 33°at C7 for both sexes. Conclusion: Through this study we found that there is less significance in the demographic profile. There was a progressive increase in the lengths, widths, and height of the pedicles from C3 to C7 vertebra pedicle transverse angle. Though the literature describes the use of 3.5 mm cervical pedicular screws, Indian population will require a smaller size.
[ABSTRACT]   Full text not available  [PDF]
  48 11 -
EDITORIAL
Adjacent corticocancellous bone graft in anterior cervical interbody fusion: A technical note
J K B C Parthiban
July-September 2016, 3(3):75-78
DOI:10.5005/jp-journals-10039-1095  
Autologous bone graft is the gold standard in cervical fusion. Obtaining autologous cancellous bone from adjacent vertebral body is unique and beneficial in anterior cervical interbody fusion. Sufficient amount of cancellous bone graft is curetted from adjacent cervical vertebral bodies and packed in the titanium cages placed in the intervertebral space. Cortical bone obtained from corticectomy and anterior osteophytes add to the volume along with cancellous bone. Fusion achieved is satisfactory and the technique obviates harvesting corticocancellous graft from iliac crest.
[ABSTRACT]   Full text not available  [PDF]
  48 10 -
CASE REPORTS
Aneurysmal bone cyst of C2, C3 cervical spine: A rare case report and review of literature
MA Naveen, Vikas Naik, GC Keshav, SA Santhosh Kumar, Sanjeev Balaji Pai
April-June 2015, 2(2):52-54
DOI:10.5005/jp-journals-10039-1056  
Aneurysmal bone cysts (ABCs) are benign lesions occurring predominantly in metaphysis of long bones. Lesions involving the cervical spine comprise 1% of all spinal ABCs. We report a rare case of C2, C3 ABC in a 39-year-old male patient, who presented with progressive weakness of all four limbs since 8 months. Magnetic resonance imaging (MRI) of spine showed an expansile osteolytic mixed intensity lesion with fluid level involving the body of axis and left pedicle causing significant compression on thecal sac posteriorly suggestive of ABC. Decompression of the cyst along with occipitocervical stabilization with iliac crest bone grafting by combined anterior and posterior approach was done. Histopathological examination revealed trabeculated, dilated vascular beds consistent with the diagnosis of ABC. The patient's neurological status improved immediately after surgery and he continues to do well 6 months postoperatively. Conclusion: Aneurysmal bone cyst of the cervical spine is very rare. It requires thorough neural decompression and 360° fusion for better stability and outcome.
[ABSTRACT]   Full text not available  [PDF]
  46 11 -
Split cord malformation type 2 complicated by presence of tuberculous arachnoiditis
Tarang Kamalkishore Vora, RR Ravi
April-June 2015, 2(2):55-57
DOI:10.5005/jp-journals-10039-1057  
We present a rare case of split cord malformation (SCM) type II complicated by presence of tuberculous arachnoiditis without any history of systemic tuberculosis or vertebral body lesions. Diagnosis was made based on intraoperative findings and was confirmed by histopathology. Surgical decompression along with a combination of steroid and antitubercular therapy resulted in a good outcome. Clinical features, magnetic resonance imaging (MRI), intraoperative findings, pathology and the relevant literature are herein discussed.
[ABSTRACT]   Full text not available  [PDF]
  48 9 -
Old and neglected odontoid fracture with C1-C2 dislocation: An approach
Ankit Arunbhai Desai, Adarsh Trivedi, BL Chandrakar, Ritesh Soni
January-March 2015, 2(1):27-29
DOI:10.5005/jp-journals-10039-1051  
In Indian health setup with short of précised expertize, the nonunion with C1-C2 instability of odontoid fractures usually results from delayed diagnosis and its inappropriate treatment. Our patient had kyphotic deformities at the C1-C2 joint complex secondary to neglected odontoid fractures. Patient was asymptomatic for a long period of time before appearance of symptoms, neck pain and instability, despite being obvious subluxation and kyphotic deformities at C1-C2 joint complex. The reactive new bone formation around the odontoid fracture plays a chief role in preventing further movement and development of myelopathy or instability. However, the treatment options available for neglected odontoid fractures remain controversial. Patient was operated by us without posterior C1 decompression, occipital-to-C2 fusion and spinal instrumentation with two lateral mass screws.
[ABSTRACT]   Full text not available  [PDF]
  45 10 -
Concurrent miller fisher syndrome variant in ossification of posterior longitudinal ligament
Alexander Cahyadi, Arwinder Singh, PS Ramani, Sudhendoo Babhulkar, Sumeet Pawar, Amrita Shenoy
January-March 2014, 1(1):32-34
DOI:10.5005/jp-journals-10039-1006  
Introduction: Miller fisher syndrome (MFS) could be found in coincidence with ossification of posterior longitudinal ligament. High index of suspicion is required that lead to further investigation. Case report: A 56-year-old male presented with four days history of loss of sensation on both lower and upper extremity. The complaint was felt more on the lower than upper extremity. The patient felt imbalance during walking. Muscle strengh of all extremity was normal, but sensory lost was found in all extremity. Deep tendon reflexes were absent in all extremity. Investigations: Computed tomography (CT) scan and MRI showed canal stenosis due to of the posterior longitudinal ligament. Nerve conduction velocity suggested peripheral neuropathy on both upper and lower extremity. Antibody anti GQ1b was positive. Cerebrospinal fluid examination showed cytoalbuminemic dissociation. Treatment: Patient was treated conservatively. Results: Improvement was achieved in 5 days, and progressively return to normal condition. Conclusion: Peripheral polineuropathy could be found in coincident with of the posterior longitudinal ligament and required specific management.
[ABSTRACT]   Full text not available  [PDF]
  45 10 -
ORIGINAL ARTICLES
Spinal decompression using ultrasonic bone scalpel: A novel ultrasonic surgical device
Jayprakash V Modi, Kaushal R Patel, Zulfikar Patel, Shardul V Soman, Kirtan V Tankshali
October-December 2016, 3(4):140-143
DOI:10.5005/jp-journals-10039-1106  
Introduction: The ultrasonic bone scalpel (UBS) is an ultrasonic device that cuts the bone, but does not harm the surrounding soft tissue and duramater. Such a type of selectivity of bone scalpel, particularly for bone destruction, makes the bone scalpel ideal for spine surgeries where there is the need to remove only bone adjacent to the duramater and neural structures, with the sparing of the duramater. Moreover, dural tear is the most common unintended complication of spinal surgeries nowadays. Materials and methods: This is a retrospective study of 35 patients operated for spinal decompression – cervical, thoracic, or lumbar – between January 2015 and June 2016 at BJ Medical College, Ahmedabad. Aim: To analyze the result of the use of UBS in spinal decompression over the conventional method of decompression, such as using the Kerrison Rongeur, high-speed burr drills, and conventional osteotome. Observation and results: Out of the 35 patients in our study, 21 patients (60%) had cervical, 3 patients (8.6%) had thoracic, and 11 patients (31.4%) had lumbar pathologies. There is significant reduction in duration of surgery and need for blood transfusion. We considered the neck disability index (NDI) and oswestry disability index (ODI) scores to measure the clinical outcomes of using bone scalpel at the end of 1 year. Both the scores were significantly improved. We had one case of dural tear (2.9%) in a patient with lumbar canal stenosis. No neurological worsening in any patients was present. Conclusion: The UBS is a unique surgical device that reduces heat production and decreases the chances of dural tear, which makes it a suitable instrument for different spinal surgeries in recent days.
[ABSTRACT]   Full text not available  [PDF]
  47 7 -
Role of plastic surgeon in the management of pressure ulcers during rehabilitation of patients with traumatic spinal cord injury: A tertiary hospital experience
Lekshmi S Bhooshan, P Binod, M Lekshmi
October-December 2018, 5(4):162-169
DOI:10.5005/jp-journals-10039-1192  
Background: Pressure ulcers and their management represent one of the most challenging situations following traumatic spinal cord injury (SCI). It requires frequent hospitalizations and hence aggravates the physical, psychological and socioeconomic burden of patients and their caregivers. Early surgical intervention will help in reducing the morbidity as well as improve the quality of life of these patients. In this study,we present a retrospective review of reconstructive surgeries for pressure sores highlighting the role of the plastic surgeon in the rehabilitation of traumatic SCI. Methods: A three-year retrospective review (January 2014–December 2017) of 25 traumatic SCI patients who underwent reconstructive surgeries for pressure ulcers in the Department of Plastic Surgery in a Tertiary Care Government Hospital in South India was done.Variables like demographic and clinical details, reconstructive procedures done, postoperative complications, duration of hospital stay and relation of wound complication with serum albumin were statistically analyzed and interpreted using statistical package for social sciences (SPSS) software. Results: Twenty-five male patients with age between 22 and 69 years (mean age = 49.4+/-12.24)were analyzed. 88% of the patients (n = 22) had paraplegia, and 12% had quadriplegia. 12% of patients had a cervical spinal injury, while 88% had a thoracolumbar injury. Mean duration of hospital stay was 36.5 days.Of the 25 patients, 68% (n = 17) had pressure sores at multiple sites while the rest had a single pressure sore. Of the total 49 pressure sores, 30 were ischial, 11 sacral, 7 trochanteric and one perineal pressure sore.Forty-five pressure sores were of grade II/IV and was managed with various flap reconstructions. One sacral pressure sore and one ischial pressure sore (grade II) underwent excision and primary closure. Split skin grafting was done for 2 sacral pressure sores. Postoperative wound complications were analyzed and there was a significant relation between hypoalbuminemia and major wound complications (Fischer exact p = <0.0001) Conclusion: Plastic surgeons have an important role to play in the rehabilitation phase of traumatic spinal cord injury patients with pressure sores. Early reconstructive surgeries for pressure sores will prevent the development of complications and provide better quality of life (QOL) for these patients.
[ABSTRACT]   Full text not available  [PDF]
  45 9 -
Lumbar microendoscopic discectomy: Clinical results of 920 patients
Amitesh Dubey, Nishtha Yadav, Shailendra Ratre, Vijay S Parihar, Yad R Yadav
January-March 2018, 5(1):23-28
DOI:10.5005/jp-journals-10039-1164  
Introduction: Surgery in properly selected lumbar disk prolapse provides better early results than conservative management. Lumbar microendoscopic discectomy (MED) has been found to be associated with good results. We are reporting our experience of 920 consecutive patients using MED technique. Materials and methods: Visual analog scale (VAS) scores for back pain and leg pain were recorded preoperatively and at 3, 6, and 12 months postoperatively. MacNab criteria were used to measure postoperative outcome. Indication for surgery was persistent leg pain despite 12 weeks of conservative management. The progressive neurologic deficit was also an indication for surgery. Disk prolapses associated with spinal instability and infections were excluded. Results: The mean VAS score for leg and back pain before surgery was 7.6 and 2.4 respectively, which improved to 1.5 and 0.6 three months after surgery. There was a significant improvement in VAS scores for backache and radicular pain in 819 patients (89%) compared with preoperative values. About 91% patients had good-to-excellent results according to MacNab criteria. The average operative time and blood loss were 70 minutes and 20 mL respectively. Unilateral or bilateral symptoms were observed in 673 and 247 patients respectively. There were 14 recurrent disk surgeries. Accidental intraoperative single-facet injury, minor dural injuries, postoperative discitis, and root injury occurred in 5, 12, 5, and 2 patients respectively. The mean follow-up was 38 months. Conclusion: Microendoscopic discectomy is an effective and safe alternate technique for lumbar disk disease.
[ABSTRACT]   Full text not available  [PDF]
  44 9 -
Importance of hyaline material in herniated lumbar disk pathology: Predicting the presence of hyaline from preoperative magnetic resonance imaging and its clinical significance
Vinu V Gopal, K Mahadevan
April-June 2015, 2(2):42-47
DOI:10.5005/jp-journals-10039-1054  
Aim: To conduct a prospective study to assess whether we can predict the presence of hyaline material in the extruded disk from preoperative magnetic resonance imaging (MRI) in patients with lumbar disk herniations and its clinical significance. Materials and methods: Hundred patients posted for microlumbar discectomy were included in the study. They were assessed preoperatively for severity of symptoms using visual analog scale (VAS). Detailed radiological assessment was done using MRI. Following surgery, extruded disk specimens were sent for histopathological examination. The presence of hyaline material in biopsy was correlated with specific MRI findings and postoperative outcome assessed based on the VAS score. Results: Out of the 100 patients, there were 58 males and 42 females between the age of 18 and 55 years. Histopathology of herniated disk material showed annulus fibrosis in 15% of patients, nucleus pulposus in 78% and a combination of both in 7%. Hyaline cartilage was found in 24% of patients. Extend of Modic changes more than 50% of vertebral end plate in MRI was indicative of the presence of hyaline in biopsy (p < 0.001). Preoperative MRI finding of vertebral end plate defect (VEPD) was associated with the presence of hyaline in 92.8% of cases. Presence of hyaline was correlated with the improvement in mean VAS score postoperatively. Conclusion: In this study, the importance of hyaline in the extruded disk with its clinical significance is emphasized. We conclude that the presence of hyaline, as predicted from MRI findings like VEPD and extend of Modic changes, is a predictor of good postoperative outcome.
[ABSTRACT]   Full text not available  [PDF]
  46 7 -
SPINE TRAUMA
Predictive factors of cervical traction based on cervical spine realignment shown by series lateral cervical X-ray in subaxial cervical spine injury patients
Rully H Dahlan, Sevline E Ompusunggu, Farid Yudoyono, Premanand S Ramani
January-March 2018, 5(1):48-51
DOI:10.5005/jp-journals-10039-1169  
Introduction: Cervical spine injury is the most feared spinal injury for physicians, patients, and their families. All patients with unstable subaxial cervical spine injury must be managed by cervical traction and stabilization. Lateral cervical X-ray remains standard diagnostic tools to evaluate the stability of cervical spine structure and has a high diagnosis value in evaluating the success of the cervical traction. The success of the cervical traction could be predicted by observing the alignment of the cervical based on series lateral cervical spine X-ray. Materials and methods: This retrospective study involves 30 patients with subaxial cervical spine injury admitted to the Emergency Unit of Dr. Hasan Sadikin Hospital, Bandung, Indonesia, from 2012 to 2016. This study uses the logistic regression analysis with p = 0.05 considered to be significant and the confidence interval (CI) of 95%. Results: The results of this study showed that the failure of cervical traction (closed reduction) was mainly determined by interval admission time and facet lock (FL). The interval admission time (p = 0.015; two-sided tail, Pearson's chi-square) and distribution of FL showed significant results (p = 0.001; two-sided tail Fisher's exact test). Odds ratio (OR) whether FL is present or absent is 3.8; 95% CI 0.5 to 27.1, with p = 0.001. Conclusion: It is concluded that informed consent regarding cervical traction failure is needed in subaxial cervical injury >24 hours, where in patients with FL cervical traction trail is not needed, instead immediate definitive management (opened reduction) with stabilization is recommended.
[ABSTRACT]   Full text not available  [PDF]
  47 6 -
CASE REPORTS
Microsurgical management of intraspinal tumors in the lumbar spine: Hemilaminectomy as an alternative to laminectomy
Don Mathew, Tinu Ravi Abraham, Ajith R Nair
April-June 2014, 1(2):84-90
DOI:10.5005/jp-journals-10039-1017  
Introduction: Laminectomy is the classical surgical technique done for exposure of the spinal cord in the removal of intraspinal lesions. Here, we report a case where multilevel hemilaminectomy has been done to remove a long segment intraspinal tumor extending from D11 to L5. Case report: A 47-year-old lady who had backache for 5 years, difficulty in walking for 6 month. She came to us with paraplegia (grade 0 power of both lower limbs), decreased sensation of both lower limbs and bladder incontinence. MRI revealed an intradural mass lesion extending from D11 to L5 level. multilevel hemilaminectomy was performed from D11 to L5 and near total resection of the tumor was done. Postoperatively, patient showed improvement with grade 1-2 power in lower limbs at the end of 3 months. Advantages of hemilaminectomy: The main advantage of hemilaminectomy is the complete preservation of dorsal static structure of the vertebral column; such as the spinous process, the interspinous and supraspinous ligaments, and the unilateral preservation of the intervertebral joints, laminae, ligamentum flavae and the paraspinal muscles. Conclusion: It is without doubt that patient morbidity and spine stability is better when surgery is performed through a narrow corridor. It can be concluded that hemilaminectomy is a safe and better alternative to laminectomy in the removal of long segment intradural tumors.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Morphometric analysis of cervical spine pedicles in an Indian population
Sarvdeep S Dhatt, Vishal Kumar, Sanjeeb Rijal, Mahesh Prakash
July-September 2018, 5(3):103-106
DOI:10.5005/jp-journals-10039-1181  
Introduction: The quantitative understanding of cervical pedicle morphology minimizes the injury to the neurovascular structure and improves the surgical outcome. This study aimed to investigate the morphometry of the cervical pedicle using Computerized CT scans. Methods: The CT scan was performed in eleven cervical spine injury patients and the axial and sagittal images were used to calculate the four linear parameters–Outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle axis length (PAL) and the pedicle transverse angle (PTA). Results: A total of 110 pedicles were measured and studied. The mean outer pedicle width, inner pedicle width, and pedicle height showed a gradual increase of the value from C3 to C7. The pedicle transverse angle showed maximum value at C4 vertebra and the minimum value at C7 vertebrae. Conclusion: The study demonstrated that pedicle dimensions were small in comparison to the European and other Asian populations. To enhance the safety of cervical pedicle screw insertion, the pedicle dimensions and trajectories should be determined individually.The screw diameter should also be optimal to avoid pedicle violations because of narrow outer pedicle widths in our study population.
[ABSTRACT]   Full text not available  [PDF]
  42 10 -
Determinants of neurological outcome in surgically treated patients of pott's spine
Faran Ahmad, Kaif Mohammad, Tarun Pandey
January-March 2018, 5(1):18-22
DOI:10.5005/jp-journals-10039-1163  
Introduction: Surgery for Pott's spine is a controversial issue with respect to the unpredictable outcome. In this, we made an attempt to evaluate the factors that determine a role in determining the neurological results of surgery. Materials and methods: Thirty patients who underwent any surgical procedure for Pott's spine were included in the study. Demographic, clinical, hematological, and radiological profiles were noted. Drainage of abscess/debridement/posterior decompression, and stabilization; radical debridement and bone grafting and radical debridement, bone grafting, and instrumentation were the surgical interventions done. All the patients were followed up for minimum 9 months. The outcome was noted as partial neurological recovery (PNR), near complete neurological recovery (NCNR), and complete neurological recovery (CNR). Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: At the last follow-up, majority had NCNR (53.3%), followed by PNR (33.3%) and CNR (13.3%). Illness duration .3 months, presence of sphincter disturbance, and McCormick grade III/IV were significantly associated with PNR (p < 0.05). Conclusion: The findings of the study indicate that duration of illness and few clinical factors might be associated with poor outcome in patients of Pott's spine who underwent surgery.
[ABSTRACT]   Full text not available  [PDF]
  43 9 -
CASE REPORTS
Recurrent hemangioendothelioma of the spine
Singh Arwinder Gill, Alexander Cahyadi, Sudhendoo Babhulkar, Sumeet Pawar, PS Ramani
January-March 2014, 1(1):28-31
DOI:10.5005/jp-journals-10039-1005  
Introduction: Hemangioendotheliomas are vascular neoplasms that rarely involve the neuraxis. Case report: A 50-year-old male patient complaining of severe pain and weakness on both his legs. Patient had history of spinal tumor operation 13 years ago. On examination, patient showed tenderness on his back and no localizing signs. Investigations: X-ray and 3D reconstructive CT scan of the dorsal spine showed involvement of D11 and L1 with collapsed D12. MRI showed kyphosis deformity and significant cord compression. Treatment: Preoperative embolization was performed followed by transthoracic removal of the tumor and D12 vertebral body which was followed interbody vertebral cage. A second surgery was undertaken to further excise the tumor and stabilize the spine. Results: Patient was relieved of his symptoms and neurological deficit postoperatively. Conclusion: A rare case of spinal hemangioendothelioma was treated with embolization and two step surgery requiring stabilization.
[ABSTRACT]   Full text not available  [PDF]
  39 12 -
Isolated giant cell tumor of the lumbar spine
Ankit Arunbhai Desai, Adarsh Trivedi, BL Chandrakar, Rakesh Thakkar
April-June 2015, 2(2):58-60
DOI:10.5005/jp-journals-10039-1058  
Giant cell tumors (GCTs) are benign tumors of the bone that most commonly occur at the ends of the long bones; they are rarely found in the spine above the sacrum. The management of patients with GCTs of the spine represents a challenge, and the clinical approach to this problem continues to evolve with improvements in surgical and adjunctive therapies. Giant cell tumor is a rare bone tumor seen in 3 to 5% of primary bone neoplasm. Approximately, 7% of GCTs are found in the vertebral column. Giant cell tumors of the spine are found in only 5 to 7% of cases and can occur in any region of the spine but are believed to be predominantly in the sacrum. Despite its benign nature, expansion in a confined space makes early detection of spinal GCTs important to prevent occurrence of compressive myelopathy/radiculopathy. Although complete en bloc surgical resection is difficult in the spine, treatment with adjuvant radiotherapy has been considered controversial because of a small risk of malignant transformation. We are reporting a cases of GCTs in the lumbar vertebrae that were treated successfully with surgical excision, decompression and as well as follow-up.
[ABSTRACT]   Full text not available  [PDF]
  42 9 -
REVIEW ARTICLES
Does pelvic incidence vary between different ethnicity? An Indian perspective
Ganesan Ram Ganesan, Rajkumar Jayachandran Sundarapandian, Karthik Kailash Kannan, Faraz Ahmed, Vijayaraghavan Phagal Varthi
October-December 2014, 1(4):151-153
DOI:10.5005/jp-journals-10039-1035  
Background: The importance of sagittal plane alignment in adults involves both spinal and pelvic parameters. Most papers published in this field have studied white people and, to the best of our knowledge, there are only few studies on Asians and none in south Indian population. Materials and methods: Prospective study of 120 healthy individuals done in Sri Ramachandra Medical college, Chennai, India, from August 2012 to June 2014. The study was conducted in the department of spinal surgery at our center with the approval of the ethical committee. Informed consent was obtained from all volunteers. Inclusion criteria were healthy individuals more than 18 years of age both male and female. Exclusion criteria were those who had any kind of spine or hip surgery, carriers of any type of musculoskeletal syndrome, or had a pelvic limb discrepancy (2 cm). The following items like age, sex and lateral radiographs of the lumbosacral region with the individual standing, so as to obtain the pelvic parameters of PT, SS and PI were collected. Results: The mean pelvic parameters in our study were pelvic tilt 14.20 ± 7.32, sacral slope 41.20 ± 11.01 and pelvic incidence 58.64 ± 12.59. Conclusion: The pelvic parameters vary between different ethnicity was evident from our study. However, pelvic parameters of south Indian population have shown some similarity to the Mexican population.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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CASE REPORTS
A case of recurrent cervical spondylolisthesis following cervical laminoplasty
Hiroshi Nomura, Yoshikazu Yanagisawa, Junichi Arima
April-June 2016, 3(2):55-58
DOI:10.5005/jp-journals-10039-1088  
We report a case of recurrent cervical spondylolisthesis following cervical laminoplasty. A 77-year-old woman with progressive quadriplegia due to cervical spondylotic myelopathy (CSM) without spondylolisthesis was treated with C3 to 5 French-door laminoplasty. At 15 months postoperatively, anterior slippage of the C4 vertebral body in flexion was prominent. At 20 months postoperatively, slippage had worsened, and C4 to 5 posterior fixation with a lateral mass screw and rod system was performed. At 8 months after C4 to 5 fixation, anterior slippage of the C3 and C5 vertebral bodies was noted, and occipitocervical–upper thoracic posterior fusion was performed. In this case, after laminoplasty, atrophy of the cervical extensor muscles progressed in a time-dependent manner. Therefore, we suggest that progressive atrophy of the cervical extensor muscles might cause isolated neck extensor myopathy with flexible dropped head syndrome, leading to recurrent cervical spondylolisthesis.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Posterior cervical microdiscectomy
S Balaji Pai, G Raghuram, BG Srihari
April-June 2015, 2(2):33-36
DOI:10.5005/jp-journals-10039-1052  
Background: Posterior cervical foraminotomy was first described by Spurling and Scoville. With the incorporation of the operating microscope and microsurgical techniques, there has been renewed interest in this approach for laterally placed cervical disk prolapse. Materials and methods: Twenty-nine patients (20 males and 9 females) with ages varying from 31 to 55 years underwent posterior cervical microdiscectomy for laterally placed cervical disk prolapse at 30 levels. Surgical procedure employed by us for the posterior cervical microdiscectomy is described in the article. Results: All the patients had relief from radiculopathy following the surgery. No major complication was noted in our series. One patient developed transient nerve root deficit which improved, over 6 weeks. No fusion was required in any case. Hence, all the complications of anterior approach and fusion could be avoided. Conclusion: Posterior cervical microdiscectomy is a safe and effective approach for the treatment of laterally placed cervical disk prolapse. In selected cases, this approach provides excellent results with minimal complications.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
A rare case of caudal regression syndrome linked to tethered cord and dermal cysts
Claudia Marcela Restrepo, Erik Muñoz, Juan David Cano, Andres Garay, Andreina Martinez Amado
July-September 2014, 1(3):132-134
DOI:10.5005/jp-journals-10039-1030  
Caudal regression syndrome (CRS) is a rare congenital disorder characterized by agenesis of the vertebral bodies of the lumbosacral spine associated with other malformations of the pelvis and inferiors limbs. We present a case of a 18 months boy referred to Central Military Hospital (Bogotá, Colombia) with sacrococcygeal fistula and a permanent hip abduction brace. On physical examination, there was an abnormal palpation of the sacral hiatus and coccyx. His hips were flexed and abducted, but did not have contractures. Neurological examination and psychomotor development were normal. In lumbar MRI, there were found hypoplasia of the sacrum and agenesis of the coccyx with a large subcutaneous and spinal lipoma, tethered spinal cord, and two dermal tracts at the level of L4 and S3 vertebrae. Somatosensory evoked potentials with latency and amplitude within normal ranges. Because of this, operation was not considered.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLE
Pedicle screw placement in the thoracic and lumbar spine by the C-arm guided navigation and the free hand method: A technical and outcome analysis
Anantha Gabbita, Mohamed M Usman, Anantha Kishan, DN Varadaraju, Shivalinge G Patil, Amrut V Hosmath
July-September 2016, 3(3):90-95
DOI:10.5005/jp-journals-10039-1098  
Introduction: The use of pedicle screws in stabilizing all three columns of the spine is a well-known but technically demanding procedure. Various assisted techniques like intraoperative fluoroscopy and stereotaxy-guided techniques have marginally increased placement accuracy along with increased radiation exposure to the surgeon and the patient, with an increased operative time. Over the last two decades, a detailed understanding of the anatomy of the thoracolumbar pedicles has led to the emergence of the “free-hand” technique. Objectives: To analyze the pedicle screw placement in thoracic, lumbar, and sacral spine over a 3-year period in terms of the intraoperative and immediate postoperative procedural results using navigation-guided and free hand techniques. Materials and methods: A retrospective study was done over a period of 3 years from November 2012 to December 2015 in a tertiary care center by a single surgeon, involving 118 cases that were done using the C-arm navigation and the free hand technique. Results: The study involved a total of 118 patients and 546 screws over a period of 3 years. The indications consisted of degenerative diseases (72%), infection (12.7%), trauma (12.7%), and malignancy (2.54%). The initial 77 cases were done by image guidance under C arm navigation and the later 41 cases with free hand techniques. Among these, there were eight breaches noted (6.72%), five (6.49%) in the image-guided technique vs three (7.3%) in the freehand technique. The direction of breach was lateral in one case (12.5%) and medial in seven cases (87.5%). Three patients (37.5%) with suboptimal screw placement underwent revision surgery. Four patients (3.36%) in the present study had postoperative neurological deficit in the form of foot drop and preoperative durotomies noted in nine patients (7.62%). Postoperative surgical site infections were noted in four cases (3.38%). Conclusion: Free hand pedicle screw placement based on external anatomy alone can be performed with acceptable safety and accuracy in experienced hands and allows avoidance of radiation exposure encountered in fluoroscopic techniques.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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