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Ewing’s Sarcoma of Spine-Current Concepts and Review of literature

Volume 7 | Issue 2 | July-December 2022 | Page: 14-18 | Rajendra Sakhrekar, Samuel Yoon, Carlo Iorio, Saijyot Raut

DOI: https://doi.org/10.13107/ijs.2022.v07i02.39


Authors: Rajendra Sakhrekar [1, 2], Samuel Yoon [1. 2], Carlo Iorio [1, 2, 3], Saijyot Raut [4, 5], Aditya Raj [6]

[1] Division of Orthopaedic Surgery, The Hospital for Sick Children, 555 University Avenue Toronto, Canada M5G1X8.
[2] Division of Orthopaedic Surgery, University of Toronto, Canada.
[3] Spine Surgery Unit, Department of Surgery, Bambino Gesù Children’s Hospital, Rome, Italy.
[4] One Spine Clinic, Mumbai, Maharashtra, India.
[5] Department of Spine Surgery, SL Raheja Hospital, Mumbai, Maharashtra, India.
[6] Division of Orthopaedic Surgery, Toronto Western Hospital, Canada.

Address of Correspondence
Dr. Rajendra Sakhrekar
Division of Orthopaedic Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8 & Division of Orthopaedic Surgery, University of Toronto, Canada.
E-mail: raj.sakhrekar@gmail.com


Abstract

Introduction- Ewing sarcoma (ES) is a malignant and aggressive bony tumor affecting the most common age group of 5-20 years. It constitutes 10%-15% of all bone sarcomas and is the second most common primary malignant bone tumor after osteosarcoma.
Methods- We undertook a review of the literature on Ewing’s Sarcoma of the spine to evaluate its etiology, clinical presentations, differential diagnosis, imaging modalities, and management with chemotherapy, radiotherapy, and surgical management. PubMed, EMBASE, Google Scholar, and Cochrane key articles were searched. Keywords like ‘Ewing’s Sarcoma’, ‘Spine’, ‘etiology’, ‘treatment’, ‘surgical management’, and ‘en bloc resection’ were used
Discussion- The current management of Ewing’s sarcoma of the spine usually involves three main modalities: combination chemotherapy, surgery, and/or radiotherapy. Recent improvements in combination chemotherapy (vincristine, doxorubicin, cyclophosphamide +/- Ifosfamide, and etoposide) are one of the most significant factors for improving survival. Also, recent advancements in radiotherapy and instrumentation, and fusion techniques in surgical management have also been demonstrated to improve local disease control and overall survival.
Conclusion- Primary Ewing sarcoma of the spine is a rare condition affecting the most common age group of 5-20 years and accounting for 1-3 cases/million/year. About 5 % of cases have spine involvement. Recent improvements in combination chemotherapy have improved the overall survival rates. En block resection and/or radiotherapy have improved local control of the disease.
Keywords: Ewing’s Sarcoma, Spine, etiology, Treatment, Surgical management, En-bloc resection


References

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How to Cite this Article: Sakhrekar R, Yoon S, Iorio C, Raut S, Raj A |  Ewing’s Sarcoma of Spine-Current Concepts and Review of literature | International Journal of Spine | July- December 2022; 7(2): 14-18 | https://doi.org/10.13107/ijs.2022.v07i02.39


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Recent Review Article on Os Odontoideum

Volume 7 | Issue 1 | January-June 2022 | Page: 07-11 | Rajendra Sakhrekar, Mohan Gavande, Sriram Srinivasan

DOI: 10.13107/ijs.2020.v07i01.032


Authors: Rajendra Sakhrekar [1], Mohan Gawande [2], Sriram Srinivasan [3], Himanshu G Kulkarni [4]

[1]  Department of Spine Surgery, Hospital for Sick Children, Toronto, Canada.
[2]  Department of Spine Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
[3] Department of Spine Surgery, Royal Stoke University Hospital, UK.
[4] Department of Spine Surgery, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra, India.

Address of Correspondence
Dr Rajendra Sakhrekar,
Paediatric Spine Fellow, Department of Spine Surgery, Hospital for Sick Children,
Toronto, Canada.
E-mail: raj.sakhrekar1@gmail.com


Abstract

Introduction

Os-odontoideum is a rare condition, described radiographically and clinically as a congenital anomaly of the second cervical vertebra (axis), it a smooth, independent ossicle of variable size and shape separated from the base of a shortened odontoid process by an obvious gap, with no osseous connection to the body of C2.

Material and methods

This study reviewed the literature on OO to evaluate its etiology, the clinical presentations, differential diagnosis, imaging modalities and outcomes in the management of asymptomatic and symptomatic cases of os odontoideum. PubMed, EMBASE, Google Scholar and Cochrane key articles were searched.

Discussion

Considering etiology traumatic hypothesis is favoured over congenital hypothesis as per recent literature on OO. Clinical presentation varies from asymptomatic to mild neck pain to severe myelopathy and neurodeficit. Various C1-C2 instrumentation and fusion techniques like wiring, trans articular screw and laminar screws have been described with good success rates.

Conclusion

Os odontoideum is a rare condition with limited existing literature. Considering significant risks involved if conservative management is opted like severe neurodeficit to sudden death on trivial trauma and the recent improvement of imaging tools helping to understand the pathology of the disease, surgery can be indicated even in an incidentally detected os odontoideum. Although for asymptomatic stable patients’ individual case-by-case approach can be considered depending on factors such as age, activity level, comorbidities, syndromic association and radiographic findings.

Keywords: ‘Os-odontoideum’, ‘surgical management’, ‘etiology’, ‘Atlanto-axial instability’ ‘complications’


References

1) Giacomini C. Sull’esistenza dell’ “os odontoideum” nell’uomo. Gior Accad Med Torino. 1886; 49: 24-28.

2) Bevan WL, Shepherd SW. A Dictionary of the Bible: Comprising its Antiquities, Biography, Geography, and Natural History. Boston, MA, USA: Houghton Mifflin and Company; 1863:1268-1270.

3) Fielding JW, Griffin PP: Os odontoideum: an acquired lesion. J Bone Joint Surg. 1974, 56:187–190

4) Fielding JW, Hensinger R, Hawkins R. Os odontoideum. J Bone Joint Surg Am. 1980; 62(3): 376-383.

5) Ricciardi JE, Kaufer H, Louis DS: Acquired os odontoideum following acute ligament injury. Report of a case. J Bone Joint Surg. 1976, 58:410–412.

6) Dai L, Yuan W, Ni B, Jia L. Os odontoideum: Etiology, diagnosis, and management. Surg Neurol. 2000; 53(2): 106-109. doi:10.1016/S0090-3019(99)00184-6

7) Jumah F, Alkhdour S, Mansour S, He P, Hroub A, Adeeb N, Hanif R, Mortazavi MM, Tubbs RS, Nanda A. Os Odontoideum: A Comprehensive Clinical and Surgical Review. Cureus. 2017 Aug 8;9(8):e1551. doi: 10.7759/cureus.1551. PMID: 29018648; PMCID: PMC5630463.

8) Klimo Jr P, Kan P, Rao G, Apfelbaum R, Brockmeyer D. Os odontoideum: Presentation, diagnosis, and treatment in a series of 78 patients. J Neurosurg Spine. 2008; 9(4): 332342.Website.http://thejns.org/doi/abs/10.3171/SPI.2008.9.10.332.

9) Klimo P, Jr., Coon V, Brockmeyer D: Incidental os odontoideum: current management strategies. Neurosurg Focus. 2011, 31:10. 10.3171/2011.9.focus11227

10) Goel A, Patil A, Shah A, Dandpat S, Rai S, Ranjan S. Os Odontoideum: Analysis of 190 Surgically Treated Cases. World Neurosurg. 2020 Feb;134:e512-e523. doi: 10.1016/j.wneu.2019.10.107. Epub 2019 Oct 26. PMID: 31669688.

11) Hughes TB Jr, Richman JD, Rothfus WE: Diagnosis of Os odontoideum using kinematic magnetic resonance imaging. A case report. Spine. 1999, 24:715–718.

12) Goel A. Indicators of atlantoaxial instability. J Craniovertebr Junction Spine. 2021 Apr-Jun;12(2):103-106.

13) Jordan Lacy, Jitin Bajaj, Atlantoaxial Instability. StatPearls publishing,NCBI bookshelf Jan2021

14) The Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons Os Odontoideum SpineUniverse Web site. 2001 http://www.spineuniverse.com/pdf/traumaguide/19.pdf

15) Wilson JR, Dettori JR, Vanalstyne EM, Fehlings MG. Addressing the challenges and controversies of managing os odontoideum: results of a systematic review. Evid Based Spine Care J. 2010 May;1(1):67-74. doi: 10.1055/s-0028-1100896. PMID: 23544027; PMCID: PMC3608999.

16) Spierings E, Braakman R. The management of os odontoideum: Analysis of 37 cases. Bone Joint J. 1982; 64(4): 422-428. Website.http://www.bjj.boneandjoint.org.uk/content/64-B/4/422.

17) McGoldrick JM, Marx JA. Traumatic central cord syndrome in a patient with os odontoideum. Ann Emerg Med. 1989; 18(12):1358-1361. doi: 10.1016/S0196-0644(89)80276-892.

18) Dempster AG, Heap SW. Fatal high cervical spinal cord injury in an automobile accident complicating os odontoideum.Am J Foren Med Pathol. 1990; 11(3): 252-256.

19) Zhang Z, Zhou Y, Wang J, et al. Acute traumatic cervical cord injury in patients with os odontoideum. J Clin Neurosci. 2010; 17(10): 1289-1293. doi: 10.1016/j.jocn.2010.01.051

20) Rahimizadeh A, Rahimizadeh A. Os Odontoideum: Review article. Orthop Res Traumatol Open J. 2016; 1(2): 33-55. doi: 10.17140/ORTOJ-1-107

21) Goyal N, Bali S, Ahuja K, Chaudhary S, Barik S, Kandwal P. Posterior Arthrodesis of Atlantoaxial Joint in Congenital Atlantoaxial Instability Under 5 Years of Age: A Systematic Review. J Pediatr Neurosci. 2021 Apr-Jun;16(2):97-105. [PMC free article] [PubMed]

22) Magerl F, Seemann P-S. Stable posterior fusion of the atlas and axis by transarticular screw fixation. Cervical Spine I. 1987: 322-327. doi: 10.1007/978-3-7091-8882-8_59

23) Gluf W M, Brockmeyer D L. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients. J Neurosurg Spine. 2005;2:164–169.

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How to Cite this Article:  Sakhrekar R, Gawande M, Srinivasan S | Recent Review Article on Os Odontoideum | International Journal of Spine | January-June 2020; 7(1): 07-11.

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Management of Cervical Myelopathy

Volume 4 | Issue 1 | Jan – June 2019 | Page 16-21 | Naresh Babu J


Authors : Naresh Babu J [1]

[1] Dept of Spine Surgery, Mallika Spine Centre, Hyderabad, India

Address of Correspondence
Dr. Naresh Babu
Department of Spine Surgery, Mallika Spine Centre, 12-12-30 Old Club Road, Kothapet, Guntur & B-58, Journalist Colony, Jubilee Hills, Hyderabad 500033, India.


Abstract

Conservative management has limited role in established cases of cervical myelopathy. However intervention during early stages of the disease when there are minimal symptoms is still controversial. Conservative management in CSM has poor prognostic factors such as presence of myelopathy for more than 6 months, compression ratio of more than 0.4 (dividing sagittal diameter by transverse diameter) indicating severe compression of spinal cord and transverse area of cord less than 40mm2. Conservative treatment is aimed to prevent further neurological deterioration. As observed in the natural history studies, regression of myelopathy is highly unlikely. Surgical intervention is often pursued during the course of CSM depending on the progression of the condition. The degree of neurological recovery depends on pre-operative duration of symptoms. This review provides an overview of cervical myelopathy and focusses on the management and decision making aspect.
Keywords: cervical myelopathy, surgical management, natural history


How to Cite this Article: Babu N. Management of Cervical Myelopathy. International Journal of Spine Jan-June 2019;4(1):19-21 .


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