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   Table of Contents - Current issue
April-June 2022
Volume 9 | Issue 2
Page Nos. 69-135

Online since Tuesday, May 31, 2022

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From the desk of editor in chief Highly accessed article p. 69
J K B C Parthiban
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Does cervical laminoplasty cause postoperative kyphosis? Highly accessed article p. 70
Sachin Anil Borkar
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Minimally invasive spinal surgery and disc space infection p. 73
PS Ramani
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Sub-axial cervical dislocation: Challenges and recommendations p. 75
Amit Shukla, Suyash Singh
A cervical dislocation injury is unstable and defined by the ligamentous complex disruption with separation of the adjacent spine vertebrae. Dislocation is used when the articular facets of the apophyseal joints are no longer in contact with each other and both inferior articular facets of the upper vertebra are locked in front of the superior articular facets of the lower vertebra. Hence, dislocation can be unilateral or bilateral accordingly. It is usually the result of combined flexion and distraction moments most commonly caused by a road traffic accident. In this review article, we have made an attempt to simplify and brief the topic and collectively presented all available recommendations for practical usage.
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Utility of the annular closure device in the treatment of degenerative disc disease: A Meta-Analysis with trial sequential analysis p. 82
Akshay Ganeshkumar, Priya Narwal, Manoj Phalak, Varidh Katiyar, Ravi Sharma, Sachin Anil Borkar, Shashank Sharad Kale
Lumbar degenerative disc disease is a common etiology of lower backache and resulting morbidity, severe disease can even result in neurological deficits. Recurrence occurs even after surgical treatment and results in poor prognosis, loss of productivity, and increased healthcare costs. Novel methods to tackle this based on countering plausible biomechanical reasons for recurrence have emerged including the recently investigated Annular Closure Device (ACD). Few RCTs and numerous comparative studies and post-hoc analyses have evaluated its safety, efficacy, and health economics; this review aims to provide an objective overview of the ACD. It was observed that ACD use was associated with significantly lower reoperations and re-herniations while having comparable or slightly higher complication rates and significantly saving direct and indirect costs. Leg pain and Back pain at follow-up were comparable between ACD and control groups. TSA objectively reveals the need for more data to ascertain ACD safety and efficacy. ACD usage has been shown to reduce re-herniations, reoperations while having comparable back pain and complication rates; thus having a positive health economics benefit. This should encourage more widespread adoption of ACD which would function to reduce the data gap.
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Does harvesting cancellous bone destabilize cervical spine in cervical interbody fusion? A prospective clinicoradiological analysis p. 94
J K B C Parthiban, Sheena Ali
Background: To analyse the effect of graft harvesting from adjacent vertebral bodies in Anterior Cervical Discectomy and Fusion. Objective: The objective of this study is to analyze the effect of harvesting bone graft from adjacent vertebral bodies on cervical spine stability, vertebral segment height, and cervical lordosis in single-level anterior cervical discectomy and fusion (ACDF). Material and Methods: Thirty patients suffering from cervical radiculopathy and myelopathy were operated on using adjacent corticocancellous bone graft (ACBG) technique. In this technique, autologous cancellous bone is harvested from adjacent vertebral bodies and packed in the intervertebral body cage and the cavities in vertebral bodies are filled with tricalcium phosphate granules. Radiological studies with X-rays of the cervical spine were taken in lateral views preoperatively, immediate postoperatively, and during follow-up periods at intervals of 3-month duration, namely 3, 6, 9, 12 months, and at the end of 2 years postoperatively. Studies undertaken were – degree of fusion using modified Bridewell's formula, disc space settlement using Indigenous method, and vertebral segment height and lordotic angle using Cobb's angle. Results: Satisfactory bony fusion was seen achieved in all patients at the end of 1 year. Although the settlement of disc space was appreciated, vertebral segment height remained increased at the end of 1 year. Cervical lordosis increased over a period of time during fusion process. The average preoperative Cobb's angle of 15.61° ± 1.81° improved to 20° ± 1.37°degrees at the end of 2 years postoperatively. Conclusion: Harvesting bone from adjacent cervical vertebrae does not weaken spinal segment and the fear and skepticism that prevailed over the years are false. ACBG technique is a potential alternative to other existing techniques in ACDF.
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Diaphragm sparing mini open thoracotomy with standalone expandable cage: Observational study of a safe novel approach for stabilising thoracolumbar fractures p. 101
Narayan Swamy, Neeraj Basantani
Objective: An ideal surgical procedure to any vertebral fracture with cord compression produces maximum decompression, without producing additional deficits, achieve fixation by fusion of minimum number of motion segments and maintain the corrected kyphosis without any long-term deterioration. Although conventional posterior approach provides three column fixation, it invariably devitalizes the strong paraspinal muscles and posterior ligamentous complex of the involved vertebra and the adjacent segments necessary for maintaining erect posture. The lateral approach too, damages the strongest portion of the vertebra, the pedicle and sometimes the diaphragm has to be cut open and re-sutured. Conventional anterior approaches are mainly used either as a part of combined approach where in, there is extensive destruction of anterior longitudinal ligament and crus of the diaphragm and have the limitation that they cannot address the T11 and T12 fractures without cutting open the diaphragm. The anterior approach is not usually attempted as it is not a familiar approach to the neurosurgeon and literature reports increased morbidity. The main aim of this study is to encourage the reader to employ a new anterior approach toward thoracolumbar fracture management. Materials and Methods: The chief author has devised a novel, safe, mini open, diaphragm sparing approach to address all these issues, exploring a corridor between medial margin of psoas and left crus of the diaphragm which is sufficient enough for good decompression of the cord and that even a standalone broad foot plated expandable cage for stabilization is effective in correction of kyphosis without posterior supplementation or potential respiratory complications. Results: All 37 operated patients recovered well and their kyphotic angles were maintained on follow up. All patients improved neurologically without any respiratory complications potentially associated with thoracotomy. Conclusion: This prospective study proved that kyphotic corrections were better, no subsidence rates observed, and were maintained at 1 year follow-up with this novel approach.
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Commentary on “Does harvesting cancellous bone destabilise cervical spine in cervical inter body fusion? A prospective clinico radiological analysis” p. 110
Atul Goel
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Professor Ravi Bhatia: An Epitome of Excellence p. 111
Sudheer Kumar Tyagi
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Degenerative occipitocervical dislocation – Uncommon entity at extreme of Life: A case report and review of literature p. 115
Batuk D Diyora, Gagan Dhall, Mehool Patel, Rahul Chhajed, Kavin Devani, Anup Purandare
Traumatic occipitocervical dislocation (OCD) has been reported numerous times both in children and adults. Nontraumatic OCD is rare. An 85-year-male referred with 2 months history of motor and sensory complaints in all four limbs. There was no history of trauma. Neck movements were restricted. A lateral radiograph of the cervical spine was suggestive of extensive degenerative changes in the cervical spine. Computed tomography scan of the cervical spine revealed posterior OCD with degenerative changes. Magnetic resonance imaging revealed compressive myelopathy at the cervico-medullary junction. Posterior occipitocervical fixation was performed. His neurological symptoms significantly improved. The procedure resulted in an excellent immediate and long-term clinical outcome.
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Dumbbell chondrosarcoma of lumbar spine with intradural extension: A unique case p. 120
Biren Khimji Patel, Ganesh Divakar, Tobin George, Krishnakumar Kesavapisharady, Sreenath Prabha Rajeev, HV Easwer, Rajalakshmi Poyuran
Chondrosarcomas are very rare tumors of the spine constituting for only 10% of all bony tumors and 12% of primary malignant tumors of the spine. It is the third most common primary malignant bone tumor after osteosarcoma and Ewing's sarcoma, and the third most common primary malignant tumor of the spine after chordoma and osteosarcoma. The thoracic vertebrae are the most commonly affected, followed by the cervical and lumbar. These are slow-growing tumors and are usually asymptomatic until late in their course when they cause neurological deficits by compression on the thecal sac, spinal cord, or nerve roots. As is the case for all malignant spinal tumors, en bloc resection without contamination or violation of the reactive zone (pseudocapsule) is the most appropriate surgical strategy, but in some cases, this is impossible due to unacceptable morbidity because of close proximity to critical neurovascular structures or multicompartmental location of the tumor. Here, we describe a case of L5 chondrosarcoma arising from the left pedicle with significant intradural and extraspinal components. Intradural extension of chondrosarcomas, or for that matter any malignant spinal tumor, has never been reported in literature.
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A case report of a rare entity: Double dermal sinus with double intradural dermoid p. 125
Shanmugam Muthiah, Vijay Kumar Sivaramamoorthy, Muthukumar Natrajan
Congenital spinal dermal sinus tract is a rare entity and is usually solitary. Multiple dermal sinus tracts in a child are extremely rare; so far, only five cases have been published in the English literature to our knowledge. We report a case of double dermal sinus tracts with double intradural dermoid, and such a combination has not been reported. Meticulous excision of both dermal sinus tracts and intradural dermoid resulted in complete recovery. We present this rare entity and review the literature.
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Delayed C5 palsy following anterior cervical discectomy and arthroplasty – Rare presentation of two cases by an unusual phenomenon of “flosealoma” p. 128
Umesh Srikantha, Akshay Hari, Yadhu K Lokanath, Deepak Somasundar, Shilpa Rao
Hemostatic agents are commonly used in neurosurgical procedures with often exceptionally low complication rates. Rarely, they may cause neurological deficits secondary to pressure effect on neurologic structures, especially when applied within narrow bony cavities. We would like to report two cases of delayed unilateral C5 palsy following anterior cervical discectomy and arthroplasty for a C5–C6 cervical disc herniation. Clinical presentation was identical in both cases, with left deltoid and bicep weakness and left-arm pain without myelopathy symptoms, although with the unusual imaging findings of a new left C4–C5 foraminal lesion. An additional emergency posterior minimally invasive cervical laminoforaminotomy was carried out to decompress the nerve. The weakness improved fully within 2 months after the second surgery. This case report highlights the importance of strong clinical suspicion for a possible lesion as a cause of postoperative C5 palsy. In this case, it was due to an unusual phenomenon where flowable hemostatic agent used in the first surgery had migrated superiorly leading to nerve compression away from the primary level.
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Cervical Intramedullary Cysticercosis p. 134
Ashutosh Kumar, Kamlesh Singh Bhaisora, Sudhir Sasapardhi, Arun Kumar Srivastava
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