Result of Study Of Transforaminal Lumbar Interbody Fusion Surgery

Volume 4 | Issue 2 | July – Dec 2019 | Bhavesh R. Namsha, Udaygiri H. Meghnathi, Bhavik K. Ahir


Authors : Bhavesh R. Namsha, Udaygiri H. Meghnathi, Bhavik K. Ahir [1]

[1] Department of Orthopaedics, SSG Hospital & Medical college Baroda, Gujarat, India

Address of Correspondence
Dr. Udaygiri H. Meghnathi,
Department of Orthopaedics, SSG Hospital & Medical college Baroda, Gujarat, India
Email: udaymeghnathi@gmail.com


Abstract

Background: Low back pain is one of the most common reported problem affecting spine. The most common causes of Low back pain are herniated discs, lumbar canal stenosis, degenerative disc disease, spondylolisthesis. Over the past few decades, new treatments and technologies are being implemented to treat spinal disorders to improve patient outcome. The Main objective of study is to access clinical and Radiological result that is obtained with Transforaminal lumbar interbody fusion as a treatment of severe back pain and degenerative disc diseases & to describe outcomes following Transforaminal lumbar interbody fusion (TLIF) surgery.
Methods: A Total of 15 patients who had back pain with degenerative disc disease were operated by TLIF through period from July 2017 to July 2018. Results were measured using the Visual Analogue Scale(VAS) and Oswestry Disability Index (ODI).
Results: Marked improvement in back pain according to VAS. Pre operative Average VAS Score was 7 and post operative average VAS score at 6 month follow up was 1.73. According to ODI score pre operative average ODI score was 66.53 and post operative 6 month ODI score was 18.53
Conclusion: From this study we have concluded that Transforaminal lumbar interbody fusion (TLIF) is a safe and effective method of achieving spinal fusion in patients with degenerative disc disease & low grade spondylolisthesis and thereby reduces back pain and improves patient’s disability score
Keywords: transforaminal lumbar interbody fusion- TLIF, Visual Analogue Scale- VAS, Oswestry Disability Index- ODI, PEEK


How to Cite this ArticleNamsha B R, Meghnathi U H, Ahir B K. Result of Study Of Transforaminal Lumbar Interbody Fusion (TLIF) Surgery. International Journal of Spine July-Dec 2019; 4(2): .


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Management of thoracolumbar fractures in adults: Current algorithm

Volume 4 | Issue 2 | July – Dec 2019  | Vibhu Krishnan Viswanathan, Rishi Mugesh Kanna


Authors : Vibhu Krishnan Viswanathan [1], Rishi Mugesh Kanna [1]

[1] Department of Orthopaedics, Ganga Hospital, Sai Baba Colony, Coimbatore, India.

Address of Correspondence
Dr. Rishi Mugesh Kanna,
Spine Surgeon, Ganga Hospital, Sai Baba Colony, Coimbatore, India.
E-mail: rishiortho@gmail.com


Abstract

Thoraco-lumbar (TL) fractures are the most common sites for spinal injuries. The severity of these injuries can range from minor, un-displaced fractures amenable to conservative management to highly complex, unstable fractures requiring surgical interventions. There is still considerable ambiguity on various issues related to the management of these vertebral injuries. The current article addresses several crucial questions related to the management of TL spinal fractures. An elaborate search was performed on standard medical search engines including pubmed, google and medline databases using keywords “adult TL fractures”, adult thoracolumbar fractures”, “adult thoracolumbar injuries”, “adult thoracolumbar spinal injuries”, “spinal injuries” and “spinal fractures”. Based on this comprehensive narrative review, we have discussed the key consensus of the existing literature on various aspects of management of these fractures. Currently the most useful system for defining TL fractures is the AO classification system. The best initial imaging modality is computerize tomography (CT) scan, with magnetic resonance imaging (MRI) being the most useful modality in AO type B2 injuries. All patients with AO types B and C injuries require surgical intervention. The current literature is shifting in favor of posterior approach, in view of less complications and morbidity associated with these surgeries. The role of decompression in enhancing neurological recovery and the need for surgical fusion in addition to instrumentation in TL fractures are still controversial. The current literature is strongly against the use of high dose steroids in acute TL fractures with SCI.
Key words: Thoraco-lumbar fractures, AO Spine classification, Imaging modalities, Fracture fixation


How to Cite this Article: Viswanathan V K, Kanna R M | Management of thoracolumbar fractures in
adults: Current algorithm | International Journal of Spine | July-Dec 2019; 4(2): .



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Headless fully threaded screw (headless screw) versus headed partially threaded screw (headed screw) fixation techniques for odontoid fracture type II- A Case Series

Volume 4 | Issue 2 | July – Dec 2019  | Kanniah Thuraikumar, Kwong-Lee Wan, Sze Wei Lim


Authors : Kanniah Thuraikumar [1], Kwong-Lee Wan [1], Sze Wei Lim [1]

[1] Department of Orthopaedics surgeon, Sungai Buloh Hospital, Jalan
Hospital, 47000 Sungai Buloh, Selangor, Malaysia.

Address of Correspondence
Dr. Kwong-Lee Wan,
Department of Orthopaedics surgeon, Sungai Buloh Hospital, Jalan
Hospital, 47000 Sungai Buloh, Selangor, Malaysia
Email: wankwonglee@yahoo.com


Abstract

Odontoid type II fracture is managed with various methods from non-operative such as Halo-vest to operative such as via anterior or posterior approaches and fixation. Posterior fixation of C1-C2 reduces the rotational range of motion significantly. Anterior odontoid fixation is typically done with screws. We present a case series of anterior odontoid screw fixation comparing three cases of headed partially threaded screw (headed screw) to two cases of headless fully threaded screw (headless screw). The headless screw had the advantages of able to be embedded which reduced the risk of prominent hardware and allowed further advancement for more compression effect. The headless screw has better biomechanical strength compared to a headed screw.
Keywords: Anterior odontoid fixation, Odontoid screw, Headless screw


How to Cite this Article:  Thuraikumar K, Wan K-L, Lim S W. | Headless fully threaded screw (headless screw) versus headed partially threaded screw (headed screw) fixation techniques for odontoid fracture type II- A Case Series | . International Journal of Spin | July-Dec 2019; 4(2):


 


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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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Safety Scores in Spine Surgery – Technique or Technology ?

Volume 4 | Issue 1 | Jan – June 2019 | Page 1-2 | Shailesh Hadgaonkar [1], Ketan Khurjekar [1], Ashok Shyam[1],[2]


Authors : Shailesh Hadgaonkar [1], Ketan Khurjekar [1], Ashok Shyam[1],[2]

[1] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India
[2] Indian Orthopaedic Research Group, Thane, India

Address of Correspondence
IJS Editorial Officie
A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane [W]
Maharashtra, India.
Email: editor.ijspine@gmail.com


The last 2 decades have seen a sea of change in the realm of spine surgery, in India, Asia and the world over. Ever improving implants, surgical techniques and diagnostic modalities have improved our results and reduced the risks involved in spine surgery. However, even today, explaining the risks and complications of spine surgery to a patient sitting in your consultation room is a daunting task- be it regarding a routine Microdiscectomy or a complex spinal reconstruction.

We often see and read of devastating complications and adverse events in spine surgery. And this is extremely disheartening because as surgeons, we attempt to deliver nothing but the best to our patients. What further complicates this intricate formula is the fact that similar surgery for a particular clinical prototype often has widely varied outcomes.

Where Do We Stand Today?
Diagnostic imaging too has come a long way from when Dr. Jules Guerin first attempted to surgically correct scoliosis. In fact, recent literature tells us that even our “State-of-the-art” PET scans and high-resolution Tesla MRI machines are soon to be supplemented by hybrid technologies such as the Fusion PET-MRI which combine the superior soft tissue contrast afforded by MRI scanners with PET-provided real time physiologic and metabolic data. Our understanding of conditions, especially spinal tumors stands to exponentially improve owing to such advancements in imaging.

Neuromonitoring has emerged as a valuable tool in ensuring safety during the intra-operative period. Mainly of use in deformity corrections, Tumor surgeries and other complex spine surgery, it is on its way to becoming a requisite piece of tech in the spine surgeon’s armamentarium.

The arrival of guidance and navigation capabilities in real-time combined with the computing power to reconstruct these into a 3D map has ushered in an era where robots and surgeons today work hand in hand to improve patient outcomes. These technologies have come a long way from merely improving the accuracy of pedicle screw placement. Today, image guided robotics and intra op navigation are being put to use in complex spinal surgeries, spinal revisions, intra-dural tumor resections and even spinal column reconstructions. In addition to improving accuracy, they also aid the surgeon by reducing the physiological element of fatigue from repetitive actions and reducing the exposure to ionising radiation.

Minimally invasive spine surgery techniques are today being used for an ever- expanding list of indications. Despite suffering from a steeper learning curve, reduced intra op and post op morbidity, shorter hospital stay and earlier return to normal life are making MISS a mainstay in the management of many degenerative, traumatic, deformity and neoplastic processes.

It will not be long before molecular engineering ties hands with biomaterial advances and materials such as Bone Morphogenetic Proteins (BMPs) are available on a commercial level for selective cases in spinal fusions. This is likely to eliminate the need for auto and allografts and is expected to even usher in an era of biodegradable spacers. The theoretical possibility of implanting genetically engineered Growth stimulating proteins into degenerated discs to bring about the regeneration of disc material is also being tested in various centres around the globe.

It is truly a great time to be practicing as a spine surgeon these days when the line between science fiction and science are rapidly blurring. The day is not far when the patient and the operating surgeon will no longer even need to be in the same operating room. These new machines and gizmos shall probably end up replacing every aspect of our professional lives.  Save the most quintessential of them all, a thorough understanding of the basic principles and biomechanics of the spinal column. For all said and done, in the words of the Wright brothers, “It is possible to fly without motors, but not without knowledge and skill”.

It’s paramount to understand the principles, concepts and surgical exposure to be an expert who will always have an edge to perform these specialized surgeries safely with the combination of the latest advances and technology.


How to Cite this ArticleKhurjekar K, Hadgaonkar S, Shyam A. Safety Scores in Spine Surgery – Technique or Technology? International Journal of Spine Jan-June 2019;4(1):1-2 .

1


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Non Fusion Options in Cervical Disc Herniations

Volume 4 | Issue 1 | Jan – June 2019 | Page 3-9 | Jwalant S. Mehta, Marcin Czyz


Authors : Jwalant S. Mehta [1], Marcin Czyz [1]

[1] The Royal Orthopaedic Hospital Bristol Road South Birmingham B31 2AP, UK

Address of Correspondence
Dr. Jwalant S. Mehta
1The Royal Orthopaedic Hospital Bristol Road South Birmingham B31 2AP, UK
Email : Jwalant_mehta@hotmail.com


Abstract

Cervical disc herniations are common disease encountered by spine surgeon. dISCESCTOMY and fusion have been long regarded as glod standard but non fusion options are gaining ground for speciifc indications. If the pathology is limited to one or two levels in the absence of instability, a limited posterior cervical foraminotomy (PCF) can be useful in decompressing the nerve roots to achieve clinical improvement in radiculopathy. A multilevel pathology with cord compression in the absence of instability can be treated effectively with a skip cervical laminectomy or a laminoplasty. In the presence of instability in two or single level pathology, where in the past a fusion would have been considered a gold standard, non-fusion options such as cervical disc arthroplasty have evolved (ACDR).
Keywords: Cervical dis herniation, foraminotomy, laminectomy, laminoplasty, cervical disc arthroplasty


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How to Cite this Article: Mehta J S, Czyz M. Non Fusion options in Cervical Disc Herniations. International Journal of Spine Jan-June 2019;4(1):3-9 .


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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


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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

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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


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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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