Sacral Fracture with Neurodeficit – Is Laid-Back Approach a Passe?

Volume 7 | Issue 1 | January-June 2022 | Page: 24-28 | Shreevijay A Phadke, Himanshu G Kulkarni, Sidheshwar S Thosar, Rajendra Sakhrekar

DOI: 10.13107/ijs.2020.v07i01.035


Authors: Shreevijay A Phadke [1], Himanshu G Kulkarni [2], Sidheshwar S Thosar [2], Rajendra Sakhrekar [3]

[1] Department of Spine Surgery, Chirayu Hospital, Ratnagiri, Maharashtra, India.
[2] Department of Spine Surgery, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra, India.
[3] Department of Spine Surgery, Schoen Klinik Neustadt Holestine, Germany.

Address of Correspondence
Dr.Sidheshwar S Thosar,
Fellow Spine Surgery, Shraddha Surgical and accident Hospital, Sangli, Maharashtra, India.
E-mail: dr.sidheshwarthosar@gmail.com


Abstract

Management of sacral fractures with neurological deficits has been a topic of debate. Literature is divided between conservative and operative management. We report a case of a 32-year-old male with post-traumatic unstable complex transverse sacrum fracture and associated stable pelvic ring fractures with loss of bowel and bladder control. He had a fall from the second floor over the buttocks. Plain lateral radiography showed a transverse sacral fracture located between S2 and S3 with kyphosis at the fracture site. MRI showed a compromised canal due to a large retro pulsed fragment pressing over the anterior aspect of sacral roots. Thorough decompression of cauda equina and sacral roots was performed, and sacral ala fracture was fixed with two percutaneous 6.5 mm cannulated cancellous Ilio-sacral screws and two 3.5 mm recon locking plates were applied for the sacrum. The patient regained his bladder control 3 months after the surgery and bowel control 4 months after the surgery. At the end of 1 year, the patient has persistent saddle anaesthesia but good bowel and bladder control. Early decompression and stabilization of unstable complex sacrum fractures with neurological compromise can facilitate optimum neurological improvement and favourable clinical outcomes in terms of early mobilization and pain relief.

Keywords: Fracture, Sacrum, Decompression surgery


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How to Cite this Article: Phadke SA, Kulkarni HG, Thosar SS, Sakhrekar R | Sacral Fracture with Neurodeficit – Is Laid-Back Approach a Passe? | International Journal of Spine | January-June 2020; 7(1): 24-28.


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Langerhans Cell Histiocytosis of Dorsal Spine in a Child Presenting with Deformity of the Back: A Rare Case Report and Review of Literature

Volume 7 | Issue 1 | January-June 2022 | Page: 19-23 | Bharath HD, Krishnakumar R, Jeffy John

DOI: 10.13107/ijs.2020.v07i01.034


Authors: Bharath HD [1], Krishnakumar R [1], Jeffy John [2]

[1] Department of Spine Surgery, Medical Trust Hospital, Cochin, Kerala, India.
[2] Department of Pathology, Medical Trust Hospital, Cochin, Kerala, India.

Address of Correspondence
Dr. Krishnakumar R,
Department of Spine Surgery, Medical Trust Hospital, Cochin, Kerala, India.
E-mail: krishnakumar.ram@gmaiall.com


Abstract

Background: Back pain in the pediatric population is a common complaint with wide differentials including mechanical cause, musculoskeletal involvement, infectious or inflammatory pathologies, and tumors. Transient back pain is common among children, and in majority of cases resolves without any treatment or with rest and mere hot/cold fomentations. However, pain disproportionate to physical findings and not reduced by pain medications, strongly suggest the presence of a serious underlying pathology. Case presentation: A 13 year old boy presented with a history of mild mid back pain lasting for a week associated with gradually developing deformity of the back, noticed by his parents. There is no history of any injury or fall prior to presentation. He had no history of any other constitutional symptoms. Upon radiological investigations he was found to have an isolated lytic lesion in D9 vertebra with differentials of tubercular/neoplastic/metastatic etiologies. Histopathological examination after biopsy was suggestive of Langerhans cell histiocytosis and was proven by immunohistochemistry. He was managed with conservative line of treatment with analgesics and other supportive care. Discussion: LCH is considered a pediatric disease, and involvement of the pediatric spine in not uncommon. A child presenting with persistent and progressive back pain should be evaluated in detail even if the child is not presenting with any other constitutional symptoms to rule out rare causes of vertebral lytic lesions. There are no cases reported in the literature suggesting LCH of the spine in pediatric population presenting as the deformity of the back. Conservative treatment is a good choice for a patient with LCH without neurological deficits or spinal instability.
Keywords: Spine deformity, Children, LCH, Back pain


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How to Cite this Article: HD Bharath, R Krishnakumar, John J Langerhans | Cell Histiocytosis of
Dorsal Spine in a Child Presenting with Deformity of the Back: A Rare Case Report and Review of Literature| International Journal of Spine | January-June 2020; 7(1): 19-23.



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Fat is Bad? Lumbar Discectomy in Patients with High Body Mass Index

Volume 7 | Issue 1 | January-June 2022 | Page: 12-18 | Akshay B Phuse, Sumit Sinha, Nishant Yagnik, Ankush Gupta

DOI: 10.13107/ijs.2020.v07i01.033


Authors: Akshay B Phuse [1], Sumit Sinha [2], Nishant Yagnik [2], Ankush Gupta [2]

[1] Department of Spine Surgery, Atlas Spine and Orthopaedic Hospital, Nagpur, Maharashtra, India.
[2] Department of Spine Surgery, Paras Hospitals, Gurgaon, Haryana, India.

Address of Correspondence
Dr. Akshay B Phuse,
Spine Surgeon, Department of Spine Surgery, Atlas Spine and Orthopaedic
Hospital, Nagpur, Maharashtra, India.
E-mail: phuse.akshay@gmail.com


Abstract

Objective: Spine surgeons are experiencing increased morbidly obese patients with lumbar spine pathology in regular practice. There is a close association between back pain and morbid obesity, particularly due to chronic stresses on the spine. Our objective of this review of literature is to identify the difficulties encountered by the spine surgeons in lumbar spine microdiscectomy and to provide possible solutions for the same. All pre-operative, intra-operative including surgical techniques and post-operative complications with clinical outcomes are taken into consideration.

Methods: obesity was defined as body mass index (BMI) more than 30kg/m2 whereas  Morbidly obese are the people who have BMI more than 40kg/m2 or BMI 35kg/m2 associated with at least 2 co morbid conditions. Keywords were taken as Micro discectomy, lumbar spine disease, morbidly obese, obese, obesity related spine pathology, spinal surgery in obese, Body mass index. This review article examined articles published concerning “lumbar microdiscectomy in obese patients” on Pub Med and Google scholar. We also included some articles related to lumbar fusion surgery in obese patient. Articles in which lumbar spine surgeries operated on non-obese patients and surgeries performed at cervical and dorsal level were excluded. We included 71 articles published on the related topic

Results:  Review illustrated that obese patients were at higher risk of complications at all stages of management. Pre-operatively obese patients showed inferior outcome to conservative management. Health care professionals  are challenged in transportation, imaging, and resuscitation procedures of obese patients  because of large body fat. Intra operatively obese patients have showed increased blood loss, operative time and infection rates. Even surgeries in obese patients were technically demanding. Obese patients demonstrated inferior clinical outcomes, increased complications rates compared to non-obese patients. Minimally invasive spine surgery has shown better and promising results in lumbar discectomy.

Conclusion: lumbar surgeries on obese patients is fraught with multiple challenges starting from preoperative period might through the surgical procedure and rehabilitation With the increasing availability of technology and surgical expertise, MIS has proven to be equally effective, if not better, than traditional lumbar surgeries in this group of patients. Smaller surgical incisions, early mobilization and shorter duration of hospital stay are some of the advantages of this technique

Keywords: Micro discectomy, Lumbar spine disease, Morbidly obese, Obese, Obesity related spine pathology, Spinal surgery in obese, Body mass index.


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How to Cite this Article: Phuse AB, Sinha S, Yagnik N, Gupta A | Fat is Bad? Lumbar Discectomy in
Patients with High Body Mass Index | International Journal of Spine | January-June 2020; 7(1): 12-18.



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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’


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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.

24) Goel A, Laheri V. Plate and screw fixation for atlantoaxial subluxation. Acta Neurochir. 1994; 129(1-2): 47-53. doi:10.1007/BF01400872

25) Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine. 2001; 26(22): 2467-2471.


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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Detection of Spinal TB Infection: A Retrospective Study Evaluating Comparative Diagnostic Efficacy of AFB Smear, Gene Expert, Histopathology, Culture Sensitivity and LPA Tests From a Biopsy Sample

Volume 7 | Issue 1 | January-June 2022 | Page: 01-06 | Abhijith Shetty, Saijyot Raut, Manikant Anand, Vishal Kundnani, Praveen Goparaju, Mukul Jain

DOI: 10.13107/ijs.2020.v07i01.031


Authors: Abhijith Shetty [1], Saijyot Raut [1], Manikant Anand [1], Vishal Kundnani [1], Praveen Goparaju [1], Mukul Jain [1]

[1] Department of Orthopaedics, Bombay Hospital and Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhijith Shetty,
Spine Surgeon, Department of Orthopaedics, Bombay Hospital and Research
Centre, Mumbai, Maharashtra, India.
E-mail: abhijithshettyabhi03@gmail.com


Abstract

Background: Spinal Tuberculosis (TB) is one of the significant health dangers that affect the general wellbeing of an individual. It is one of the most common form of extra pulmonary tuberculosis that affects the general population. Diagnosis of tuberculosis is done using an array of techniques. The present study has compared the efficacy of these tests used for detecting the spinal TB in biopsy samples.
Material and Methods: The study was conducted on patients who suffered from spondylodiscitis and with biopsy proven spinal TB by one of the following tests and were treated in the study center. The study included a total of 150 patients with spinal TB who visited the department for further treatment. The biopsy samples of these patients were then processed for Line probe assay (LPA), Gene Xpert, liquid culture (bactec MGIT) followed by gram staining and fungal staining, and histopathological examination.
Result: In this study total of 150 patients were included who had ages ranging from 16-77 years with 93male and 57 female patients. When the study results were compared Gene Experts showed a 100% sensitivity and 80% of specificity. When we compared the histopathology results with gene expert, we get a sensitivity of 16.7% and specificity of 50%.
Gram stain with the sensitive gene expert, the sensitivity is 45.5% and specificity is 25%. Similar analysis was done with sensitive gene and now with the resistant gene to identify their sensitivity was 0% and the specificity was at 42.9%. Gram stain when correlated with gene, the sensitivity came out to be 9.1% and specificity at 25%. Fungal stain with resistant gene, when correlated, sensitivity comes to 9.1% and specificity is at 0%.
Conclusion: This study showed that for detection of tuberculosis rather than relying on only single technique it should be done with a combination of techniques.
Keywords: Gene Xpert, LPA, Histopathological examination, Tuberculosis, Gram staining


References

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  9. Patel J, Upadhyay M, Kundnani V, Merchant Z, Jain S, Kire N. Diagnostic Efficacy, Sensitivity, and Specificity of Xpert MTB/RIF Assay for Spinal Tuberculosis and Rifampicin Resistance. Spine. 2020 Feb 1;45(3):163–9.
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  14. Crudu V, Stratan E, Romancenco E, Allerheiligen V, Hillemann A, Moraru N. First evaluation of an improved assay for molecular genetic detection of tuberculosis as well as rifampin and isoniazid resistances.J ClinMicrobiol. 2012 Apr;50(4):1264–9.
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  16. Rufai SB, Kumar P, Singh A, Prajapati S, Balooni V, Singh S. Comparison of Xpert MTB/RIF with line probe assay for detection of rifampin-monoresistant Mycobacterium tuberculosis. J ClinMicrobiol. 2014 Jun;52(6):1846–52.
  17. Hillemann D, Rusch-Gerdes S, Boehme C, Richter E. Rapid Molecular Detection of Extrapulmonary Tuberculosis by the Automated GeneXpert MTB/RIF System. J ClinMicrobiol. 2011 Apr 1;49(4):1202–5.

How to Cite this Article: Shetty A, Raut S, Anand M, Kundnani V, Goparaju P, Jain M | Detection of Spinal
TB Infection: A Retrospective Study Evaluating Comparative Diagnostic Efficacy of AFB Smear, Gene Expert, Histopathology, Culture Sensitivity and LPA Tests From a Biopsy Sample | International Journal of Spine | January-June 2020; 7(1): 01-06.



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Unusual Association of KBG Syndrome with Scheuermann’s Disease

Volume 7 | Issue 1 | January-June 2022 | Page: 01-06 | Sanjay N. Murthy, Jaganaathan Srinivasan, Cheryl Honeyman, Rajendra Sakhrekar, Amit Bishnoi, Sriram H. Srinivasan

DOI: 10.13107/ijs.2020.v07i01.036


Authors: Sanjay N. Murthy [1], Jaganaathan Srinivasan [2], Cheryl Honeyman [3], Rajendra Sakhrekar [4], Amit Bishnoi [5], Sriram H. Srinivasan [6]

[1] Department of Orthopaedics, Royal Stoke University Hospital, UK.
[2] Department of Orthopaedics, James Cook University Hospital, Middlesbrough, BW.
[3] Department of Orthopaedic Nursing, James Cook University Hospital, Middlesbrough, BW.
[4] Department of Spinal Surgery, Schoen klinik Neustadt Holestine, Germany.
[5] Department of Spinal Surgery, Leicester University Hospital, UK.
[6] Department of Spinal Surgery, Ipswich University Hospital NHS Trust, UK.

Address of Correspondence
Dr. Sanjay N. Murthy,
Core Trainee, Department of Orthopaedics, Royal Stoke University Hospital, UK.
E-mail: sanjayn293@gmail.com


Abstract

In this paper we discuss a novel case in which a patient had a comorbid diagnosis of KBG syndrome and Scheuermann’s disease. The patient was a 14-year-old boy, referred to orthopaedics for assessment of his spinal deformity. Initial assessment revealed that he had a rib prominence on his right side, which was corrected upon bending forward. SLR examination indicated significantly tight hamstrings. Plantars were upturning, but other reflexes were normal. He had kyphosis measuring up to 59.4 degrees. MRI of the spine depicted features of classic Scheuermann’s disease, from D6-D10. The patient was given conservative treatment consisting of physical therapy and postural training. He remained asymptomatic during the course of a 5-year follow-up period. This case is unique due to the comorbidity of Scheuermann’s disease and KBG syndrome, which has never been reported in the literature. This case report suggests that routine spinal screening in cases of KBG syndrome would contribute to a better understanding of treatment and diagnosis.

Keywords: KBG syndrome, Scheuermann’s disease


References

1.Herrmann J, Pallister PD, Tiddy W, Opitz JM. The KBG syndrome-a syndrome of short stature, characteristic facies, mental retardation, macrodontia and skeletal anomalies. Birth Defects Orig Artic Ser.1975;11:7–18.

2. Li QY, Yang L, Wu J, Lu W, Zhang MY, Luo FH. A case of KBG syndrome caused by mutation of ANKRD11 gene and literature review Clin J Evid Based Pediatr. 2018;13:452–458.

3. Sirmaci A, Spiliopoulos M, Brancati F, Powell E, Duman D, Abrams A, Bademci G, Agolini E, Guo S, Konuk B, Kavaz A, Blanton S, Digilio MC, Dallapiccola B, Young J, Zuchner S, Tekin M. Mutations in ANKRD11 cause KBG syndrome, characterized by intellectual disability, skeletal malformations, and macrodontia

4. Goldenberg, A., Riccardi, F., Tessier, A., Pfundt, R., Busa, T., Cacciagli, P., … Philip, N. (2016). Clinical and molecular findings in 39 patients with KBG syndrome caused by deletion or mutation of ANKRD11. American Journal of Medical Genetics Part A, 170(11), 2847–2859. https://doi. org/10.1002/ajmg.a.37878

5. Damborg F, Engell V, Andersen M, et al. Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. J Bone Joint Surg Am 2006;88:2133–6.

6. Makurthou AA, Oei L, El Saddy S, et al. Scheuermann disease: Evaluation of radiological criteria and population prevalence. Spine (Phila Pa 1976) 2013;38:1690–4

7. McKenzie L, Sillence D. Familial Scheuermann disease: a genetic and linkage study. J Med Genet 1992;29:41–5.

8. Brancati, F., Sarkozy, A. & Dallapiccola, B. KBG syndrome. Orphanet J Rare Dis 1, 50 (2006). https://doi.org/10.1186/1750-1172-1-50

9. Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akri- topoulos P, Akritopoulou K. Scheuermann’s disease: Focus on weight and height role. Eur Spine J. 2008; 17: 673-678.

10. Lowe TG. Scheuermann’s disease. Orthop Clin North Am 618 1999; 30: 475-487, ix

11. Lowe TG. Scheuermann’s disease. In: Textbook of Spine 655 Surgery, Bridwell KH, DeWald RL Eds. Philadelphia: 656 Lippincott-Raven 1997:1173-1198

12. Horn, Samantha R.; Poorman, Gregory W.; Tishelman, Jared C.; Bortz, Cole A.; Segreto, Frank A.; Moon, John Y.; Zhou, Peter L.; Vaynrub, Max; Vasquez-Montes, Dennis; Beaubrun, Bryan M.; Diebo, Bassel G. (2019-01-01). “Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012”. Spine Deformity 7 (1): 100–106. doi:10.1016/j.jspd.2018.06.004. ISSN 2212-134X. PMC 7102192. PMID 30587300

13. Huq, Sakibul; Ehresman, Jeffrey; Cottrill, Ethan; Ahmed, A. Karim; Pennington, Zach; Westbroek, Erick M.; Sciubba, Daniel M. (2019-11-01). “Treatment approaches for Scheuermann kyphosis: a systematic review of historic and current management”. Journal of Neurosurgery: Spine. -1 (aop): 235–247. doi:10.3171/2019.8.SPINE19500. PMID 31675699.

14. Riouallon, Guillaume; Morin, Christian; Charles, Yann-Philippe; Roussouly, Pierre; Kreichati, Gaby; Obeid, Ibrahim; Wolff, Stéphane; French Scoliosis Study Group (2018-09-01). “Posterior-only versus combined anterior/posterior fusion in Scheuermann disease: a large retrospective study”. European Spine Journal. 27 (9): 2322–2330. doi:10.1007/s00586-018-5633-x. ISSN 1432-0932. PMID 29779056. S2CID 29169417

15. Hawes, Martha (2006). “Impact of spine surgery on signs and symptoms of spinal deformity”. Developmental Neurorehabilitation. 9 (4): 318–39. doi:10.1080/13638490500402264. PMID 17111548. S2CID 20680230

16. Hawes, Martha C.; O’Brien, Joseph P. (2008). “A century of spine surgery: What can patients expect?”. Disability & Rehabilitation. 30 (10): 808–17. doi:10.1080/09638280801889972. PMID 18432439. S2CID 19443315.

17. Mansfield JT, Bennett M. Scheuermann Disease. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499966/


How to Cite this Article: Murthy SN, Srinivasan J, Honeyman C, Sakhrekar R, Swamy G, Srinivasan SH Unusual Association of | KBG Syndrome with Scheuermann’s Disease | International Journal of Spine | January-June 2020; 7(1): 29-32.


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Horner’s Syndrome After Anterior Decompression And Fusion For Cervical Spine Pathologies: Report Of Two Cases

Volume 5 | Issue 1 | January-June 2020 | Page: 6-8 | Tomotaka Umimura, Satoshi Maki, Masao Koda, Seiji Ohtori


Authors : Tomotaka Umimura [1], Satoshi Maki [1], Masao Koda [2], Seiji Ohtori [1]

[1] Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan.
[2] Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaragi, 305-8575 Japan.

Address of Correspondence
Dr. Tomotaka Umimura,
Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan.
Email : adna4547@gmail.com


Abstract

Introduction: Horner’s syndrome is caused by impairment of the sympathetic trunk, resulting in associated ptosis, miosis, and anhidrosis. The cervical sympathetic trunk is sometimes damaged during an anterior approach to the lower cervical spine. We report two cases of Horner’s syndrome after anterior decompression and fusion for lower cervical spine pathologies.
Case Presentation: Case 1 was in a 58-year-old Japanese woman with a herniated C5-6 intervertebral disc presenting myelopathy who underwent anterior cervical discectomy and fusion of C5–C6. After the operation, miosis, and anhidrosis of the right face occurred and the symptoms continued for more than 15 years. Case 2 was in a 40-year-old Japanese woman whose diagnosis was flexion myelopathy with kyphosis at C5–C6 and canal stenosis, so she underwent anterior cervical C5-6 discectomy and fusion of C5–C6. Immediately after surgery, ptosis and miosis occurred, which lasted for 4 months.
Conclusion: Horner’s syndrome tends to occur during anterior cervical spine procedures, especially at the lower level, and the syndrome may be transient or irreversible. During an anterior approach to the lower cervical spine, taking care not to damage the sympathetic trunk is important to avoid this complication.
Keywords: Horner’s syndrome, Anterior cervical spine surgery, Complication.


References

1. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007 Oct 1;32(21):2310-7.
2. Tew JM Jr, Mayfield FH. Complications of surgery of the anterior cervical spine. Clin Neurosurg 1976;23:424-34.
3. Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 1989;99(1-2):41-50.
4. Giombini S, Solero CL. Considerations on 100 Anterior Cervical Discectomies Without Fusion. Surgery of Cervical Myelopathy 1980;302-7.
5. George B, Lot G. Oblique. Transcorporeal Drilling to Treat Anterior Compression of the Spinal Cord at the Cervical Level. Minim Invasive Neurosurg 1994;37(2):48-52.
6. Saylam CY, Ozgiray E, Orhan M, Cagli S, Zileli M. Neuroanatomy of cervical sympathetic trunk: a cadaveric study. Clin Anat 2009 Apr;22(3):324-30.
7. Ebraheim NA, Lu J, Yang H, Heck BE, Yeasting RA. Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine. Spine (Phila Pa 1976). 2000 Jul 1;25(13):1603-6.
8. Civelek E, Karasu A, Cansever T, Hepgul K, Kiris T, Sabanci A, Canbolat A. Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine. Eur Spine J 2008 Aug;17(8):991-5.

How to Cite this Article: Umimura T, Maki S, Koda M, Ohtori S | Horner’s Syndrome After Anterior Decompression And Fusion For Cervical Spine Pathologies: Report Of Two Cases | International Journal of Spine| January-June 2020; 5(1): 6-8 .


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Wide Open Laminectomy, Posterior Decompression and Discectomy in Lumbar Spine with Preservation of Posterior Ligamentous Complex in Cauda Equina Syndrome – Case Series, Early Outcome and Literature Review

Volume 5 | Issue 1 | January-June 2020 | Page: 9-11 | Ong Kean Loong, Ng Bing Wui, Thuraikumar Kanniah, Wang Chee Seiang, Lim Sze Wei, Nor Azlin Zainal Abidin


Authors : Ong Kean Loong [1], Ng Bing Wui [2], Thuraikumar Kanniah [1], Wang Chee Seiang [1], Lim Sze Wei [1], Nor Azlin Zainal Abidin [1]

[1] Spine unit, Department of Orthopaedic, Hospital Sungai Buloh, Malaysia.
[2] Department of Orthopaedic, Hospital Segamat, Malaysia.

Address of Correspondence
Dr. Ng Bing Wui,
Spine unit, Department of Orthopaedic, Hospital Sungai Buloh, Malaysia.
Email : bingwuing@gmail.com


Abstract

Introduction: Spinous process osteotomy has been described as an alternative approach to allow better visualization during laminectomy and decompression of the spinal cord in cases of lumbar spinal stenosis.1 In this study, the authors describe the experience and early outcome of using this technique in treatment of Cauda Equina Syndrome.
Method: This is a retrospective study conducted between March 2018 until March 2019. Cases of Cauda Equina Syndrome treated with spinous process osteotomy, wide laminectomy, decompression and discectomy without instrumentation will be included in this study. Owestry Disability Index (ODI) and outcome of patients will be studied.
Result: 5 cases were found during the study period. All patients have shown marked improvement in terms of neurology and ODI score.
Conclusion: Spinous process osteotomy, wide laminectomy and discectomy can be used effectively for the treatment of Cauda Equina Syndrome. This study intend to be a pilot study in understanding the effectiveness and early outcome of patients treated with this approach. Larger prospective study is needed to provide meaningful comparison between this technique with the conventional approach used in treatment of Cauda Equina Syndrome.
Keywords: Cauda Equina Syndrome, Spinous process osteotomy, Posterior ligamentous complex.


References

1. Yong-Hing K, Kirkaldy-Willis WH. Osteotomy of lumbar spinous process to increase surgical exposure. Clinical orthopaedics and related research. 1978(134):218-20.
2. Dhatt S, Tahasildar N, Tripathy SK, et al. Outcome of spinal decompression in cauda equina syndrome presenting late in developing countries: case series of 50 cases. Eur Spine J 2011; 20:2235–2239.
3. GitelmanA,Hishmeh S, Morelli BN, Joseph SA Jr, Casden A, et al. (2008) Caudaequina syndrome: a comprehensive review.Am J Orthop (Belle Mead NJ) 37: 556-562
4. Waschke A, Hartmann C, Walter J, Dünisch P, Wahnschaff F, Kalff R, Ewald C. Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients. Acta neurochirurgica. 2014 Feb 1;156(2):235-44.
5. Kim DY, Lee SH, Chung SK, Lee HY. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine. 2005 Jan 1;30(1):123-9.
6. Chen LH, Lai PL, Tai CL, Niu CC, Fu TS, Chen WJ. The effect of interspinous ligament integrity on adjacent segment instability after lumbar instrumentation and laminectomy–an experimental study in porcine model. Bio-medical materials and engineering. 2006 Jan 1;16(4):261-7.
7. Weiner BK, Fraser RD, Peterson M. Spinous process osteotomies to facilitate lumbar decompressive surgery. Spine. 1999 Jan 1;24(1):62-6.
8. Erland Hermansen, Gunnar Moen et al. Spinous Process Osteotomy to Facilitate the access to the spinal canal when decompressing the spinal canal in patients with lumbar spinal stenosis. Asian Spine Journal. 2014 Apr; 8(2): 138-144
9. Gun WL ,Myun WA Comparative study of two spinous process osteotomy techniques for posterior decompression surgery in lumbar spinal stenosis. European spine journal 2018
10. Namboothiri S, Gore S, Raja P (2016) Novel Surgical Technique for Discogenic Cauda Equina Syndrome – Transforaminal Intra Discal Access by Annulotomy outside Central Spinal Canal. J Spine S7:008.doi:10.4172/2165-7939.S7-008.


How to Cite this Article: Loong OK, Wui NB, Kanniah T, Seiang WC, Wei LS, Abidin NAZ | Wide Open Laminectomy, Posterior Decompression and Discectomy in Lumbar Spine with Preservation of Posterior Ligamentous Complex in Cauda Equina Syndrome – Case Series, Early Outcome and Literature Review | International Journal of Spine| January-June 2020; 5(1): 9-11.


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Revision Spine With Hartshill and Sublaminar Wiring in Operated Osteoporotic Fracture- A Case Note

Volume 5 | Issue 1 | January-June 2020 | Page: 2-5 | Shailesh Hadgaonkar, Vivek Vincent, Pradhyumn Rathi, Parag Sancheti, Ashok Shyam


Authors : Shailesh Hadgaonkar [1], Vivek Vincent [1], Pradhyumn Rathi [1], Parag Sancheti [1], Ashok Shyam [1]

[1] Department of Spine, Sancheti Institute of Orthopedics and Rehabilitation

Address of Correspondence
Dr. Pradhyumn Rathi,
Row House No.1, Shamail complex, Balaji nagar, Bhayander west Thane 401101
E-mail: pradhyumnrathi@gmail.com


Abstract

Introduction: Osteoporotic vertebral compression fractures (OVCF) are one of the commonest fractures seen in day to day practise. We present a unique case of failure of pedicle screw instrumentation in OVCF revised by sublaminar wiring (SLW).
Case report: A 70 year old lady with old operated osteorporotic fracture with sagittal imbalance and implant loosening was revised with single spinal rectangular loop and sublaminar wires (SLW).
Conclusion: Pedicle screws constructs for short segment fixation are rigid and biomechanically superior with greatest pull out strength, which mainly depends on bone mineral density. But, sublaminar wires should be considered far more superior in severely osteoporotic bone.
Keywords: Bone density, Bone wires, Compression, Fractures, Osteoporosis, Pedical screws, Spinal fractures.


References

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How to Cite this Article: Hadgaonkar S, Vincent V, Rathi P, Sancheti P, Shyam A | Revision spine with Hartshill and Sublaminar wiring in operated osteoporotic fracture- A case note| International Journal of Spine| January-June 2020; 5(1): 2-5..


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A prospective Study of Dural Tears among 430 cases of Lumber Spine Surgery

Volume 5 | Issue 1 | January-June 2020 | Page: 12-15 | Md. Alauddin, A.H.M Tanvir Hasan Siddiquee, Md. Matiur Rahman, Malay Kumar Roy, Shahidul Islam khan, Md. Abdullah Al Mahmud


Authors : Md. Alauddin [1], A.H.M Tanvir Hasan Siddiquee [1], Md. Matiur Rahman [1], Malay Kumar Roy [1], Shahidul Islam khan [2], Md. Abdullah Al Mahmud [3]

[1] Department of Orthopaedic Surgery, Mymensingh Medical College, Mymensingh, Bangladesh.
[2] Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
[3] Department of Orthopaedic Surgery, Rangpur Medical College, Rangpur, Bangladesh.

Address of Correspondence
Dr. Md. Alauddin,
Department of Orthopaedic Surgery, Mymensingh Medical College, Mymensingh, Bangladesh.
E-mail: alauddin.md.k49@gmail.com


Abstract

Inadvertent Dural tear (DT) is a possible feared complication of spinal surgery. This is a prospective study of 430 consecutive patients with different types of lumber spinal surgery within the period of ‘January 2010 to December 2018′. Aim of the study is to evaluate incidence of dural tear (DT) with risk factors, compare between DT and non DT group with outcome. Incidence of dural tear were more on patients with older age, degenerative spinal stenosis, spondylolisthesis, re-operative surgery, multiple level surgery and with instrumentation. No significance sex difference found. Postoperative complications were more and outcome poor in DT group in comparison to non DT group. Every spine surgeon should be aware of possible dural tear and must know how to deal it.
Keywords: Dural Tear (DT); DT group; Non DT group.


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How to Cite this Article: Alauddin M, Siddiquee AHMTH, Rahman MM, Roy MK, khan SI, Mahmud MAA | A prospective Study of Dural Tears among 430 cases of Lumber Spine Surgery | International Journal of Spine| January-June 2020; 5(1): 12-15.

(Abstract) (Full Text HTML) (Download PDF)