Spinal tuberculosis (TB) is a common problem in developing countries. Among the bone tuberculosis spine is the most common site. If there are atypical spinal lesions associated with a primary lesion elsewhere in the body, this can mislead the diagnosis and management of disease. We report a case of 63-year-male patient presented with sudden onset of weakness in both lower limbs associated with back pain. Magnetic resonance imaging (MRI) of thoracic spine showed multiple noncontiguous lesions involving thoracic vertebral bodies. The patient had a rapidly growing blackish lesion over the left submandibular region. So clinicoradiological diagnosis considered as melanoma with metastasis. The patient underwent emergency laminectomy with gross total resection of epidural lesion. Histopathology confirmed it as tuberculous lesion. Excisional biopsy of submandibular lesion suggestive of basal cell carcinoma. Multiple vertebral lesions can sometimes be misleading if these are associated with primary lesion. In developing countries like India, where TB is prevalent, TB of the spine should be considered as differential diagnosis even if it is associated with a primary lesion as subsequent treatment protocol has significant impact on the outcome.

[ABSTRACT]   Full text not available  [PDF]

Osteoid osteoma is a rare bone tumor initially described by Jaffe in 1935. It is a bone-producing tumor that is most frequently observed in the lower extremities of children or young adults (11–22 years). Osteoid osteoma is differentiated from osteoblastoma according to size. Osteoid osteoma is smaller than 1.5 cm in diameter. Ten percent of cases involve the spine. Lumbar spine is the commonest site (59%) with the neural arch being the usual location (75%). The tumor is observed in the vertebral column with a predilection for posterior elements of the vertebrae. The atypical MR imaging features and the importance of CT scan in the diagnosis are highlighted.

[ABSTRACT]   Full text not available  [PDF]

From 1970s, endoscopic lumbar nerve root decompression progressed from indirect central nucleotomy to direct excision of non-contained extruded disk fragments. Fifty-nine years old man presented with low back pain and severe left-side sciatica. He had suffered myocardial infarction and underwent coronary angioplasty with stents 2 weeks before. Magnetic resonance (MR) images shows paramedian disk prolapse in L4 to L5 level compressing the left-side nerve root. Patient was assessed by anesthesiologist and cardiologist and reported as very high risk to undergo general anesthesia due to recent myocardial infarction and angioplasty. He underwent percutaneous endoscopic lumbar discectomy (PELD) under local anesthesia with conscious sedation. Patient was able to tell the pain relief on the table after removing the prolapsed fragment. At the end of the procedure freely mobile nerve root was seen. Patient was completely relieved of his symptoms and mobilized on same day. To our knowledge PELD in high risk cardiac patient have not been reported in literature before.

[ABSTRACT]   Full text not available  [PDF]

Objectives: Cauda equina syndrome (CES) is a complex of clinical symptoms/signs secondary to prolapsed intervertebral disk. The clinical presentation depends on varying combinations of lower extremity weakness, sensory loss in the lower extremities and/or saddle area, pain in the low back and/or lower extremities, and visceral impairment of bladder, rectal and/or sexual function. Although CES is sometimes used to describe a syndrome without impairment of bladder and bowel function, generally in the literature the term ‘cauda equina syndrome’ means a syndrome that includes impairment of urinary function and saddle sensory deficits. Materials and Methods: We have taken all the discogenic CES cases that presented to the Department of Neurosurgery at Gauhati Medical College and Hospital for a period of 2 years. All the patients were subjected to thorough clinical evaluation and requisite investigations specifically magnetic resonance imaging (MRI). All underwent surgery followed by analysis of the surgical outcome. Results: Out of the total of 30 patients, male outnumber female, maximum incidence being 4th decade, age incidence ranging from 17 to 70 years. Clinically, patients presented with history of recent onset and an earlier less well-defined history of pre-existing symptoms. Low backache being the most common symptoms followed by radiculopathy, saddle anesthesia. Urinary straining/retention was the most common autonomic disturbance followed by incontinence urinary function outcome was poor in two patients, fair 10 patients, normal 18 patients. Time interval to surgery after autonomic involvement range from 5 to 200 days, mainly due to delayed referral. The most common level was L4-L5 followed by L5-S1, laminectomy single level done in 17 cases, fenestration one cases followed by discectomy. Conclusion: Surgical intervention should be done in CES irrespective of the duration and severity of clinical symptom and autonomic symptoms. Timing of surgical intervention from autonomic involvement does not affect outcome. It is the severity of deficit which is the major determinant of outcome.

[ABSTRACT]   Full text not available  [PDF]

Minimally invasive spine surgery is becoming more prevalent as surgeons seek to provide definitive treatment without the morbidity and dysfunction associated with traditional, open surgical procedures. Minimally invasive surgery has been applied with success to the treatment of degenerative disease and traumatic injuries of the spine. Approaches to metastatic and primary spinal column tumors have also evolved rapidly as clinicians seek to minimize tissue disruption, postoperative pain and blood loss in these susceptible patient populations who may also require adjuvant therapies. The various noninvasive and minimally invasive techniques available for the treatment of these primary spinal tumors are reviewed, and their indications, benefits, and limitations discussed.

[ABSTRACT]   Full text not available  [PDF]

Background: To report the surgical outcome of intradural extramedullary (IDEM) tumors in 52 patients. Clinical effect was evaluated based on Frankel grade. Purpose: The results of a single neurosurgery institution are reported to highlight the peculiarities and pitfalls of the management of this disease. Tumors are analyzed from the point of view of their localization, histology, surgical technique and outcome was evaluated in term of Frankle classification. Methods: Fifty-two cases of histopathologically confirmed IDEM were treated laminectomy with complete resection of tumors between January 2011 and February 2014. There were 34 males and 18 females with an average age of 41.53 years. The mean postoperative follow-up period was 22.44 months. The histopathological findings, locations of the tumors, and clinical results were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up was evaluated according to the Frankel grading. Results: The histopathological results are as follows: 14 cases of a meningioma, 30 cases of nerve sheath tumors (28 cases schwannoma and 2 cases neurofibroma), 4 cases of an arachnoid cyst, 3 cases of tarlov cyst, and one case of benign cystic teratoma. The locations of the tumors were as follows: 40 cases in the thoracic region, eight cases in the cervical region, and two cases in the lumbar and two cases of sacral region. The most common diagnosis was nerve sheath tumors (57.69%), followed by meningioma (26.92%). At the final follow-up, a 3-grade, 2-grade and 1-grade improvement was observed in 6, 22 and 24 cases, respectively. There were changes in the Frankel grade in every case. The preoperative neurological deficit improved within 6 postoperative weeks in most cases. Postoperatively, there were one case of cerebrospinal fluid leakage. Conclusion: intradural extramedullary tumors detected by magnetic resonance imaging (MRI) are mostly benign and good clinical results can be obtained when treated surgically. Therefore, more dynamic surgical approaches by neurosurgeons are suggested to decline morbidity.

[ABSTRACT]   Full text not available  [PDF]

Objective: To do a retrospective evaluation of clinical outcome of the patients with spinal metastases treated with minimally invasive posterior spinal stabilization and vertebroplasty. Methods and results: We retrospectively analyzed 22 patients with biopsy proven metastatic thoracolumbar spinal lesion treated with percutaneous posterior stabilization with pedicle screws and vertebroplasty operated in Ramachandra Medical University from June 2006 to May 2012. Neurologically intact patients with Tokuhashi's score of 9 or and Spine instability neoplastic score of more than 6 were included. Average age group was 61.8 years with 14 males and eight females. Clinical outcome was assessed using pre- and postoperative visual analog score (VAS), intraoperative blood loss, duration of surgery, time taken to mobilize the patients after surgery and length of hospital stay. The average VAS decreased from 9.2 preoperatively to 4.1 postoperatively (p < 0.001) and 2.2 (< 0.04) at 3 months postoperative period. The mean Karnofsky's performance index increased from 45% preoperatively to 70% postoperatively. Average blood loss was 80 ml and the average duration of surgery was 85 minutes. Fifteen patients were mobilized on the second postoperative day with most patients discharged on 4th day. No patients had evidence of implant loosening and failure. Three patients had radiological evidence of cement extravasation. No patient had neurological deficit postoperatively and none had radiological evidence of deformity or adjacent level fracture in follow-up X-rays. Conclusion: Percutaneous pedicle screw stabilization with vertebroplasty provided good pain relief and short-term clinical improvement in patients with thoracolumbar spinal metastasis with minimal postoperative morbidity.

[ABSTRACT]   Full text not available  [PDF]

Full text not available  [PDF]

Paragangliomas are neuroendocrine tumors with differentiation of chromaffin cells originated from neural crests. Paragangliomas most commonly occur in the head and neck regions (more than 90% of cases). Spinal paragangliomas are uncommon and difficult to diagnose preoperatively due to the absence of any specific radiological and clinical findings. A 39-year male patient presented with severe back pain with inability to lie down for 2 days. Neurological examination revealed paraparesis with brisk lower limb reflexes. His magnetic resonance imaging (MRI) lumbosacral spine suggestive of homogeneously contrast enhancing intradural mass confined to L1 to L2 level. The patient underwent laminectomy with excision of the highly vascular intradural lesion. Histopathological examination confirmed as paraganglioma. Lumbar spinal paragangliomas are diagnostic dilemma not only due to the rarity of these lesions, but also due to radiological features mimicking other common lesions at this location like ependymoma and schwannomas. Characteristic features on T2-weighted MRI and gradient echo imaging can help in preoperative diagnosis, though these features are not specific of these lesions. Preoperative consideration of these lesions helps in taking precautions during excision as these tumors can be functioning paragangliomas.

[ABSTRACT]   Full text not available  [PDF]

Full text not available  [PDF]

Full text not available  [PDF]

Full text not available  [PDF]