Surgical Management of Tuberculous Vertebra Plana of the Third Cervical vertebra: A Case report.

Volume 4 | Issue 1 | Jan – June 2019 | Page 31-34 | Dhiraj V Sonawane, Bipul Kumar Garg, Harshit Dave, Shrikant Savant


Authors : Dhiraj V Sonawane [1], Bipul Kumar Garg [1], Harshit Dave [1], Shrikant Savant [1]

[1] Sir J.J. Group of Hospitals, Byculla Mumbai(400001).

Address of Correspondence
Dr. Bipul Kumar Garg,
Assistant Professor, Dept of Orthopaedics, J.J. Group of Hospitals Mumbai.
Email id: garg.bipul@gmail.com


Abstract

Tuberculosis disease is commonly caused by Mycobacterium tuberculosis. The higher incidence and prevalence of tuberculosis is a common health problem particularly in developing countries. Spinal tuberculosis usually represents at advanced levels and diagnosis of this disease is not easy. Patients with spinal tuberculosis usually present with gibbus formation, back ache, low grade fever, neurological symptoms and deficits. Although, commonly seen in dorsal spine lesions, cervical and cervico-thoracic lesions with spine tuberculosis rarely seen in literature. Isolated tuberculosis of cervical spine is a rare entity and accounts for incidence of 3 to 5 percent. Early clinical diagnosis and management is great challenge in toddler group. Herein, we would like to present a 12 year old patient of C3 vertebral body tuberculosis with 90 percent collapse with neurological deficits and its management.
Keywords: vertebrae plana, tuberculosis, cervical spine


References

1. Di Lorenzo N, Fortuna A, Guidetti B : Craniovertebral junction malformations. Clinicoradiological findings, long-term results, and surgical indications in 63 cases. J Neurosurg 57 : 603-608, 1982
2. Seung Won Choi, Han Yu Seong,, Sung Woo Roh. Case report – Spinal Extradural Arachnoid Cyst, J Korean Neurosurg Soc 54: 355-358, 2013
3. Netra R, Min L, Shao Hui M, Wang JC, Bin Y, Ming Z : Spinal extradural meningeal cysts : an MRI evaluation of a case series and literature review. J Spinal Disord Tech 24 : 132-136, 2011
4. Elsberg CA, Dyke CG, Brewer ED: The symptoms and diagnosis of extradural cysts. Bull Neurol Inst NY 3:395–417,1934
5. Bergland RM: Congenital intraspinal extradural cyst. Report of three cases in one family. J Neurosurg 28:495–499, 1968
6. Yabuki S, Kikuchi S: Multiple extradural arachnoid cysts: report of two operated cousin cases. Spine (Phila Pa 1976) 32:E585–E588, 2007
7. Lee CH, Hyun SJ, Kim KJ, Jahng TA, Kim HJ : What is a reasonable surgical procedure for spinal extradural arachnoid cysts : is cyst removal mandatory? Eight consecutive cases and a review of the literature. Acta Neurochir (Wien) 154 : 1219-1227, 2012
8. Oh JK, Lee DY, Kim TY, Yi S, Ha Y, Kim KN, et al. : Thoracolumbar extradural arachnoid cysts : a study of 14 consecutive cases. Acta Neurochir (Wien) 154 : 341-348; discussion 348, 2012
9. Hyndman OR, Gerber WF: Spinal extradural cysts, congenital and acquired; report of cases. J Neurosurg 3:474–486, 1946
10. Aaron E. Bond, Gab riel Zada, Ira Bowen, J. Gordon McComb, and Mark D. Krieger,:Spinal arachnoid cysts in the pediatric population: report of31 cases and a review of the literature, J Neurosurg Pediatrics 9:000–000, 2012
11. McCrum C, Williams B: Spinal extradural arachnoid pouches. Report of two cases. J Neurosurg 57:849–852, 1982
12. Sandberg DI, McComb JG, Krieger MD: Chemical analysis of fluid obtained from intracranial arachnoid cysts in pediatric patients. J Neurosurg 103 (5 Suppl):427–432, 2005
13. Nabors MW, Pait TG, Byrd EB, Karim NO, Davis DO, Kobrine AI, et al. : Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68 : 366-377, 1988
14. Perret G, Green D, Keller J: Diagnosis and treatment of intradural arachnoid cysts of the thoracic spine. Radiology 79: 425–429, 1962
15. Rabb CH, McComb JG, Raffel C, Kennedy JG: Spinal arachnoid cysts in the pediatric age group: an association with neural tube defects. J Neurosurg 77:369–372, 1992
16. Cloward RB: Congenital spinal extradural cysts: case report with review of literature. Ann Surg 168:851–864, 1968
17. Kriss TC, Kriss VM: Symptomatic spinal intradural arachnoid cyst development after lumbar myelography. Case report and review of the literature. Spine (Phila Pa 1976) 22:568– 572, 1997
18. De Oliveira RS, Amato MC, Santos MV, Simão GN, Machado HR.: Extradural arachnoid cysts in children.Childs Nerv Syst. 2007 Nov;23(11):1233-8.
19. Ertan Ergun, Alp OzgunBorcek, BerkerCemil, FikretDogulu, M. KemaliBaykaner: Should We Operate all Extradural Spinal Arachnoid Cysts? Report of a Case, Turkish Neurosurgery 2008, Vol: 18, No: 1, 52-55
20. Lee SH, Shim HK, Eun SS.: Twist technique for removal of spinal extradural arachnoid cyst: technical note.Eur Spine J. 2014 Aug;23(8):1755-60
21. Chang IC, Chou MC, Bell WR, Lin ZI: Spinal cord compressioncaused by extradural arachnoid cysts. PediatrNeurosurg 40:70–74, 2004
22. Neo M, Koyama T, Sakamoto T, Fujibayashi S, Nakamura T: Detection of a dural defect by cinematic magnetic resonance imaging and its selective closure as a treatment for a spinal extradural arachnoid cyst. Spine 29: 426–430, 2004
23. Novak L, Dobai J, Nemeth T, Fekete M, Prinzinger A, Csecsei GI: Spinal extradural arachnoid cyst causing cord compression in a 15-year-old girl: a case report. ZentralblNeurochir 66: 43–46, 2005
24. Novak L, Dobai J, Nemeth T, Fekete M, Prinzinger A, Csecsei GI: Spinal extradural arachnoid cyst causing cord compression in a 15-year-old girl: a case report. ZentralblNeurochir 66: 43–46, 2005


How to Cite this Article: Sonawane DV, Garg BK, Dave H, Singh V, Chandanwale A. Multiple Spinal Extradural Arachnoid Cyst : A Case Report. International Journal of Spine Jan-June 2019;4(1):31-34.


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Genomics in Spine Health

Volume 4 | Issue 1 | Jan – June 2019 | Page 43-45 | Ketan Khurjekar, Aniket Ausekar, Jyotsna Jotshi


Authors : Ketan Khurjekar [1], Aniket Ausekar [1], Jyotsna Jotshi [1]

[1] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India

Address of Correspondence
Dr. Ketan Khurjekar,
Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India
Email: kkhurjekar@gmail.com


Abstract

Discovery of the structure of DNA monograph and DNA Sequencing brought a paradigm shift and saw the advent of a new era in science and medicine. Neoplastic conditions are a result of aberrant mutations in protooncogenes or tumor suppressor genes, which control cell signalling and act as checkpoints of various cellular and subcellular processes..
Genomics focuses on structure, function, evolution, mapping, and editing of genomes. The study of genomics deals with the sequencing and analysis of an organism’s genome. It attempts to map the entire genome of an organism and tries to distinguish between the genetic markers to see which one deal with what traits. An area which has seen a tremendous advancement as a result of molecular genomics is oncology. Spinal metastasis is one of the leading causes of morbidity in cancer patients. Spine being the third most common site for cancer cells to metastasize and are generally indicative of a late stage malignancy. Application of molecular biology and genetics to better understand and hence treat vertebral neoplastic conditions is shrinking the gap between diagnosis and mortality.
Case Study- A 42 year-old male with Tuberculosis of spine (advance stage IV NSCLC with spinal cord metastasis and  primary lung adenocarcinoma ) This case is a representation of result of targeted therapy regimen for the driver mutation responsible for prolific adenocarcinoma of lung and its metastasis.
Conclusion- Surgery, chemotherapy and Radiotherapy cannot be replaced but can be directed with more efficacy with genomic guidance.

Keywords:
DNA sequencing, genomics, Spinal metastasis.


References

1. Shendure J, Balasubramanian S, Church GM, Gilbert W, Rogers J, Schloss JA and Waterston RH. DNA sequencing at 40: past, present and future. Nature 2017; 550(7676): 345–353.
2. Jerjes W, Upile T, Petrie A, Riskalla A, Hamdoon Z, Vourvachis M, Karavidas K, Jay A, Sandison A, Thomas GJ, Kalavrezos N and Hopper C. Clinicopathological parameters, recurrence, locoregional and distant metastasis in 115 T1-T2 oral squamous cell carcinoma patients. Head Neck Oncol 2010;2:9
3. Byers P. The role of genomics in medicine―past, present and future. J Zhejiang Univ Sci B. 2006; 7(2): 159–160.
4. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D and Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-86
5. Shah LS and Salzman KL. Imaging of Spinal Metastatic Disease. Int J Surg Oncol 2011;769753.
6. Ebert C, von Haken M, Meyer-Puttlitz B, Wiestler OD, Reifenberger G, Pietsch T, von Deimling A. Molecular genetic analysis of ependymal tumors. NF2 mutations and chromosome 22q loss occur preferentially in intramedullary spinal ependymomas. Am J Pathol 1999;155(2):627-32
7. Zarghooni M, Bartels U, Lee E, Buczkowicz P, Morrison A, Huang A, Bouffet E, and Hawkins C. Whole-Genome profiling of pediatric diffuse intrinsic pontine gliomas highlights platelet-derived growth factor receptor α and poly (ADP-ribose) polymerase as potential therapeutic targets. J Clin Oncol 2010;28:8, 1337-1344
8. Hawkins C, Walker C, Mohamed N, Zhang C, Jacob K, Shirinian M, Alon N, Kahn D, Fried I, Scheinemann K, Tsangaris E, Dirks P, Tressler R, Bouffet E, Jabado N and U Tabori. BRAF-KIAA1549 Fusion Predicts Better Clinical Outcome in Pediatric Low-Grade Astrocytoma. Clin Cancer Res 2011;17 (14): 4790-8
9. Liang X, Wang D, Wang Y, Zhou Z, Zhang J and Li J. Expression of Aurora Kinase A and B in chondrosarcoma and its relationship with the prognosis. Diagn Pathol 2012;7:84
10. Dea N, Gokaslan Z, Choi D, Fisher C. Spine Oncology – Primary Spine Tumors. Neurosurgery 2017;80(3S): S124–S130.
11. Massacesi C, Di Tomaso E, Urban P, Germa C, Quadt C, Trandafir L, Aimone P, Fretault N, Dharan B, Tavorath R and Hirawat S. PI3K inhibitors as new cancer therapeutics: implications for clinical trial design Onco Targets Ther2016; 9:203-10.
12. Lu C, Wu J, Wang H, Wang S, Diao N, Wang F, Gao Y, Chen J, Shao L, Weng X, Zhang Y, Zhang W. Novel biomarkers distinguishing active tuberculosis from latent infection identified by gene expression profile of peripheral blood mononuclear cells. PLoS One 2011;6(8)
13. Niu N, Wang Q, Shi J, Zhang X, Geng G, Zhou S, Thach C, Cheng F and Wang Z. Clinical and genomic responses to ultra-short course chemotherapy in spinal tuberculosis. Exp Ther Med 2017;13(5): 1681–1688.
14. Witney AA, Gould KA, Arnold A, Coleman D, Delgado R, Dhillon J, Pond MJ, Pope CF, Planche TD, Stoker NG, Cosgrove CA, Butcher PD, Harrison TS and Hinds J. Clinical application of whole-genome sequencing to inform treatment for multidrug-resistant tuberculosis cases. J Clin Microbiol 2015;53:1473–1483.


How to Cite this Article: Khurjekar K, Ausekar A, Jotshi J. Confluence of mainstream clinical practices and advanced genomic technologies: Advent of Genomic Medicine. International Journal of Spine Jan-June 2019;4(1):43-45.


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Robotics in Spine Surgery – Is it going to be the Future ?

Volume 4 | Issue 1 | Jan – June 2019 | Page 35-41 | Ketan Shripad Khurjekar, Pradhyumn Rathi


Authors : Ketan Shripad Khurjekar [1], Pradhyumn Rathi [1]

[1] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India

Address of Correspondence
Dr. Ketan Khurjekar,
Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India
Email: kkhurjekar@gmail.com


Abstract

Spine surgery requires fine motor skills to manipulate neural elements and a steady hand to work in challenging corridors utilising exposures that reduce collateral damage. Long and arduous procedures may predispose a spine surgeon to mental and physical fatigue. Hence, there was a need to integrate robotic assistance in spine surgery. Robotics was commonly used in other arenas, but remained in its infancy in spine surgery, until recently, there has been growing evidence to suggest that robotics may be a part of our everyday spine surgery practice. Screw placement remains a critical step in spine surgery, Spine- Assist/Renaissance robot helps to ease the process. This robots works on MIS, robotic software, Degree of freedom, Number of assistive arms and its functioning accuracy. Robots function on various techniques- Spine Assist robot, fluoroscopy guided, navigation techniques. Article include comparative studies evaluating robots, Operating time analysis, Radiation exposure and robotics in surgery, Complications, Robotic Failure, Appropriate instrumentation, cost-benefit analyses, nascent stage of surgical robots. Future approach.
Conclusion:  Robotics in spine surgery has some limitations, advantages and promising future.
Keywords: Spine assist robot, MIS, Cost benefit analysis.



How to Cite this Article: Khurjekar KS, Rathi P. Robotics in Spine Surgery – Is it going to be the Future ? International Journal of Spine Jan-June 2019;4(1):35-41.


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Multiple Spinal Extradural Arachnoid Cyst : A Case Report

Volume 4 | Issue 1 | Jan – June 2019 | Page 27-30 | Dhiraj V Sonawane, Bipul Kumar Garg, Harshit Dave, Vikramsinh Nangare, Ajay Chandanwale


Authors : Dhiraj V Sonawane [1], Bipul Kumar Garg [1], Harshit Dave [1], Vikramsinh Nangare [1], Ajay Chandanwale [1]

[1] Sir J.J. Group of Hospitals, Byculla Mumbai(400001).

Address of Correspondence
Dr. Bipul Kumar Garg,
Assistant Professor, Dept of Orthopaedics, J.J. Group of Hospitals Mumbai.
Email id: garg.bipul@gmail.com


Abstract

Introduction: Spinal extradural arachnoid cysts(SEAC) are a rare cause of spinal cord compression, nerve root compression, or both, accounting for approximately 1-3% of all primary spinal space-occupying lesions. Multiple SEACs are rarely reported in the literature. Aim of this article is to illustrate our experience of surgical treatment of this rare but curable disease.
Case Report: We present a case report of 15-year-old boy who presented with progressive lower extremity weakness, pain and dysaesthesia. Magnetic resonance (MR) of the spine revealed two extradural arachnoid cysts. The patient underwent a thoracic laminoplasty for en bloc resection of the spinal extradural arachnoid cyst. Postoperatively, the patient’s motor strength and ambulation improved immediately.
Conclusion: We have described a rare case of back pain and leg weakness in patient with multiple thoracolumbar spinal extradural cysts. Clinical outcome after Laminoplasty and surgical excision of cyst was excellent and there has not been any evidence of cyst recurrence and symptomatic worsening till now(three years post surgical enbloc excision).
Keywords: spinal extradural arachnoid cyst, laminoplasty, excision


References

1. Di Lorenzo N, Fortuna A, Guidetti B : Craniovertebral junction malformations. Clinicoradiological findings, long-term results, and surgical indications in 63 cases. J Neurosurg 57 : 603-608, 1982
2. Seung Won Choi, Han Yu Seong,, Sung Woo Roh. Case report – Spinal Extradural Arachnoid Cyst, J Korean Neurosurg Soc 54: 355-358, 2013
3. Netra R, Min L, Shao Hui M, Wang JC, Bin Y, Ming Z : Spinal extradural meningeal cysts : an MRI evaluation of a case series and literature review. J Spinal Disord Tech 24 : 132-136, 2011
4. Elsberg CA, Dyke CG, Brewer ED: The symptoms and diagnosis of extradural cysts. Bull Neurol Inst NY 3:395–417,1934
5. Bergland RM: Congenital intraspinal extradural cyst. Report of three cases in one family. J Neurosurg 28:495–499, 1968
6. Yabuki S, Kikuchi S: Multiple extradural arachnoid cysts: report of two operated cousin cases. Spine (Phila Pa 1976) 32:E585–E588, 2007
7. Lee CH, Hyun SJ, Kim KJ, Jahng TA, Kim HJ : What is a reasonable surgical procedure for spinal extradural arachnoid cysts : is cyst removal mandatory? Eight consecutive cases and a review of the literature. Acta Neurochir (Wien) 154 : 1219-1227, 2012
8. Oh JK, Lee DY, Kim TY, Yi S, Ha Y, Kim KN, et al. : Thoracolumbar extradural arachnoid cysts : a study of 14 consecutive cases. Acta Neurochir (Wien) 154 : 341-348; discussion 348, 2012
9. Hyndman OR, Gerber WF: Spinal extradural cysts, congenital and acquired; report of cases. J Neurosurg 3:474–486, 1946
10. Aaron E. Bond, Gab riel Zada, Ira Bowen, J. Gordon McComb, and Mark D. Krieger,:Spinal arachnoid cysts in the pediatric population: report of31 cases and a review of the literature, J Neurosurg Pediatrics 9:000–000, 2012
11. McCrum C, Williams B: Spinal extradural arachnoid pouches. Report of two cases. J Neurosurg 57:849–852, 1982
12. Sandberg DI, McComb JG, Krieger MD: Chemical analysis of fluid obtained from intracranial arachnoid cysts in pediatric patients. J Neurosurg 103 (5 Suppl):427–432, 2005
13. Nabors MW, Pait TG, Byrd EB, Karim NO, Davis DO, Kobrine AI, et al. : Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68 : 366-377, 1988
14. Perret G, Green D, Keller J: Diagnosis and treatment of intradural arachnoid cysts of the thoracic spine. Radiology 79: 425–429, 1962
15. Rabb CH, McComb JG, Raffel C, Kennedy JG: Spinal arachnoid cysts in the pediatric age group: an association with neural tube defects. J Neurosurg 77:369–372, 1992
16. Cloward RB: Congenital spinal extradural cysts: case report with review of literature. Ann Surg 168:851–864, 1968
17. Kriss TC, Kriss VM: Symptomatic spinal intradural arachnoid cyst development after lumbar myelography. Case report and review of the literature. Spine (Phila Pa 1976) 22:568– 572, 1997
18. De Oliveira RS, Amato MC, Santos MV, Simão GN, Machado HR.: Extradural arachnoid cysts in children.Childs Nerv Syst. 2007 Nov;23(11):1233-8.
19. Ertan Ergun, Alp OzgunBorcek, BerkerCemil, FikretDogulu, M. KemaliBaykaner: Should We Operate all Extradural Spinal Arachnoid Cysts? Report of a Case, Turkish Neurosurgery 2008, Vol: 18, No: 1, 52-55
20. Lee SH, Shim HK, Eun SS.: Twist technique for removal of spinal extradural arachnoid cyst: technical note.Eur Spine J. 2014 Aug;23(8):1755-60
21. Chang IC, Chou MC, Bell WR, Lin ZI: Spinal cord compressioncaused by extradural arachnoid cysts. PediatrNeurosurg 40:70–74, 2004
22. Neo M, Koyama T, Sakamoto T, Fujibayashi S, Nakamura T: Detection of a dural defect by cinematic magnetic resonance imaging and its selective closure as a treatment for a spinal extradural arachnoid cyst. Spine 29: 426–430, 2004
23. Novak L, Dobai J, Nemeth T, Fekete M, Prinzinger A, Csecsei GI: Spinal extradural arachnoid cyst causing cord compression in a 15-year-old girl: a case report. ZentralblNeurochir 66: 43–46, 2005
24. Novak L, Dobai J, Nemeth T, Fekete M, Prinzinger A, Csecsei GI: Spinal extradural arachnoid cyst causing cord compression in a 15-year-old girl: a case report. ZentralblNeurochir 66: 43–46, 2005


How to Cite this Article: Sonawane DV, Garg BK, Dave H, Nangare V, Chandanwale A. Multiple Spinal Extradural Arachnoid Cyst : A Case Report. International Journal of Spine Jan-June 2019;4(1):27-30.


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A Prospective Study of Functional and Clinical Recovery Following Conventional Microlumbar Discectomy

Volume 4 | Issue 1 | Jan – June 2019 | Page 22-26 | M B Lingayat, Ghaniuzzoha Asadi


Authors : M B Lingayat [1], Ghaniuzzoha Asadi [2]

[1] Department of Orthopaedics, GMC, Aurangabad, Maharashtra, India, GMC, Aurangabad, Maharashtra, India.

Address of Correspondence
Dr. M. B. Lingayat,
Lotus Hospital, Pushpanagiri, Aurangabad. Maharashtra.
Email: shaziezoha@gmail.com


Abstract

Background: Lumbar disc lesion is a common problem encountered in clinical practice. Historically, laminectomy was performed to remove the offending disc material, But it was associated with significant morbidity. Conventional Microlumbar discectomy has resulted in quick recovery and early return to work. Conventional Microlumbar discectomy has become the “Gold Standard” for treating lumbar disc lesion when surgery is indicated. The main objective is to study functional and clinical recovery following conventional microlumbar discectomy.
Methods: A Total of 40 patients who had single level disc herniation with radicular symptoms were operated by conventional microlumbar discectomy through period from September 2013 to August 2015. Results were measured using the Visual Analogue Scale(VAS) for leg pain and PROLO Economic and Functional Outcome Rating Scale. All quantitative data were summarized using mean and standard deviation.
Results: Marked improvement in Leg pain according to VAS (90% having no leg pain at last follow-up). Pre-operative Average VAS Score was 5 and post-operative last follow-up score was 1. According to PROLO Scale mean total score improved from 4.2 pre-operatively to 8.37 post-operatively and recovery rate was excellent in 95% cases. Most of the patients returned to their work of previous occupation with no restriction of any kind.
Conclusions: Conventional Microlumbar Discectomy is a safe, effective, reliable and least traumatic procedure for removal of lumbar disc lesion with very good long-term results. It resulted in early recovery and quick return to work. Good functional and clinical recovery achieved following surgery. It provided excellent pain relief.
Keywords: Lumbar disc lesion, conventional microlumbar discectomy, visual analog scale.


References

1. Richard, A. Dayo. 1983 “Conservative therapy for low back pain”. Journal of American Medical Association, 250(8): 1057–1062.
2. Bo Jonsson. 1996 “Neurologic signs and lumbar disc herniation”. Acta Ortho Scand, 67(5): 466–469.
3. Nagi, O.M. 1985 “Early results of discectomy ”. Indian Journal of Orthopaedics, 19(1): 15-19.
4. Nagi, O.M. 1985 “Early results of discectomy by fenestration technique”. Indian Journal of Orthopaedics, 19(1): 15–19.
5. Pappas, 1992 “Outcome analysis in 654 surgically treated lumbar disc herniation”. Neurosurgery, 30(6): 55–62.
6. Davies, 1994 “Longterm outcome analysis of 984 surgically treated herniated lumbar disc”. Journal of Neurosurgery, 80: 415–421.
7. Yash Gulati, 2004-Lumbar Microdiscectomy;-Apollo Medicine Journal Vol.1 september 2004 :29-32
8. K.V.Manohara Babu,2006-Surgical Management of lumbar disc prolapse,Journal of orthopaedics,2006,3(4)e6.
9. Chin KR 2008;-Success of lumbar microdiscectomy .J.Spinal Disord 2008 Apr;21(2):139-44. doi: 10.1097/BSD.0b013e318093e5dc.
10. R.Pedrosa et.al.2010-Day surgery treatment of lumbar disc herniations,journal of international association of ambulatory surgery,16.3 october 2010;62-65.
11. Lecya Vacilevna Chichanovskaya et.al.(2013)-A comprehensive study of outcome after Lumbar discectomy at 6 months post-operative period. The Open Neurosurgery Journal, 2013, 6, 1-5.


How to Cite this Article: Lingayat MB, Asadi G. A Prospective Study of Functional and Clinical Recovery Following Conventional Microlumbar Discectomy. International Journal of Spine Jan-June 2019;4(1):22-26.


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Diagnosing Early Post-operative Spinal Infection – A Systematic Review

Volume 4 | Issue 1 | Jan – June 2019 | Page 10-15 | Ross B. Ingber


Authors : Ross B. Ingber [1]

[1] Northwell Health, Department of Radiology, Manhasset, New York

Address of Correspondence
Dr. Ross B. Ingber,
Northwell Health, 300 Community Drive Manhasset, NY 11030
Email: ross.b.ingber@gmail.com


Abstract

Background: Early post-operative spinal infection (EPSI) is a potentially catastrophic complicationfollowing spinal surgeries.Although critically important, diagnosing spinal infections in the early post-operative period is challenging due to anelevation of serologicmarkers causedby invasive surgery.The purpose of thestudy is to find the indicators in bloodtest results to aid in thedifferentiation of EPSI.
Methods: Studies were systematicallyevaluated thePubMed, Embase, and Ovid peer-reviewed librarydatabases to assess all studiesthrough July 2015. The studies reviewed discussed erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count in both infected and noninfected patients following orthopedic surgery. The literature was heterogeneous; however, areview of the articles illustrated the importance of serologic markers in diagnosing post-operative infection.
Results: There was a marked difference between the type of surgical procedures and timing for diagnosis in the studies evaluating WBC count, ESR, and CRP levels for the diagnosis of spinal infections.Furthermore, the sensitivity and specificity varied in the different procedures, timing for diagnosis, and cutoff value pointswithin each serologicmarker. However,thesecond peakin ESR and CRP levels could be utilized as an indicatorwhen attempting to diagnose an infection.
Conclusions: Based on this systematic review, it is difficult to recommend a specific marker or a specific level to determine EPSI. However, a combination of these markers in adjunction with clinical examination and imaging studies may aid in determiningEPSI.Studies are necessary to investigate the serologicmarkers based on the specific days after surgery and the size of spinal surgery. Finally, blood test results may be just supplemental information for the determination of EPSI.
Keywords: C-reactive protein, erythrocyte sedimentation rate, white blood cell count, post-operative infection, acute spine infection.


References

1. deLissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37(5):387-397.
2. Whitmore RG, Stephen J, Stein SC, Campbell PG, Yadla S, Harrop JS, et al. Patient comorbidities and complications after spinal surgery: A societal-based cost analysis. Spine 2012;37(12):1065-1071.
3. Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: Efficacy, drug levels, and patient outcomes. Spine 2011;36(24):2084-2088.
4. Molinari RW, Khera OA, Molinari WJ 3rd. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J 2012;21 Suppl4:S476-S482.
5. Collins I, Wilson-MacDonald J, Chami G, Burgoyne W, Vineyakam P. The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 2008;17(3):445-450.
6. Hong HS, Chang MC, Liu CL, Chen TH. Is aggressive surgery necessary for acute postoperative deep spinal wound infection? Spine 2008;33(22):2473-2478.
7. Hsieh MK, Chen LH, Niu CC, Fu TS, Lai PL, Chen WJ. Postoperative anterior spondylodiscitis after posterior pedicle screw instrumentation. Spine J 2011;11(1):24-29.
8. Jonsson B, Soderholm R, Stromqvist B. Erythrocyte sedimentation rate after lumbar spine surgery. Spine 1991;16(9):1049-1050.
9. Khan MH, Smith PN, Rao N, Donaldson WF. Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery. Spine J 2006;6(3):311-315.
10. Lee JH, Lee JH, Kim JB, Lee HS, Lee DY, Lee DO. Normal range of the inflammation related laboratory findings and predictors of the postoperative infection in spinal posterior fusion surgery. ClinOrthopSurg 2012;4(4):269-277.
11. Mok JM, Pekmezci M, Piper SL, Boyd E, Berven SH, Burch S, et al. Use of C-reactive protein after spinal surgery: Comparison with erythrocyte sedimentation rate as predictor of early postoperative infectious complications. Spine 2008;33(4):415-421.
12. Nie H, Jiang D, Ou Y, Quan Z, Hao J, Bai C, et al. Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury. Spinal Cord 2011;49(6):715-720.
13. Piper KE, Fernandez-Sampedro M, Steckelberg KE, Huddleston PM, Piper KE, Karua MJ, et al. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PloS One 2010;5(2):e9358.
14. Gunne AF, Mohamed AS, Skolasky RL, van Laarhoven CJ, Cohen DB. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery. Spine 2010;35(13):1323-1328.
15. Sugita S, Hozumi T, Yamakawa K, Goto T, Kondo T. White blood cell count and C-Reactive protein variations following posterior surgery with intraoperative radiotherapy for spinal metastasis. J Spinal Disord Tech 2015;38(1):17-23.
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How to Cite this Article: Ingber R B. Diagnosing Early Post-operative Spinal Infection – A Systematic Review. International Journal of Spine Jan-June 2019;4(1):10-15.


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