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 – December 2019  | Kanniah Thuraikumar, Kwong-Lee Wan, Sze Wei Lim | Page 7-9

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


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-December 2019; 4(2): 7-9.


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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.


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 .


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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


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


1. Hillibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodeisis. JBJS Am 1999; 81: 519 – 528
2. Wigfield CC, Skrypiec D, Jackowski A, Adams MA. Internal stress distribution in cervical intervertebral discs: the influence of an artificial cervical joint and simulated anterior interbody fusion. J Spianl Disord Tech 2003; 16: 44 – 49
3. Puttlitz CM, Rousseau MA, Xu Z, Hu S, Tay BK, Lotz JC. Intervertebral disc replacement maintains cervical spine kinetics. Spine 2004; 29: 2809 – 2814
4. Powell JW, Sasso RC, Metcalf NH, Anderson PA, Hipp JA. Quality of spinal motion with disc arthoplasty: computer-aided radiographic analysis. J Spinal Disord Tech 2010; 23: 89-95
5. Sekhon LH, Ball JR. Artificial cervical disc replacement: principles, type and techniques. Neurol India 2005; 53: 445 – 450
6. Scoville WB. Recent developments in the diagnosis and treatment of cervical ruptured intervertebral discs. Proc Am Fed Clin Res. 1945; 2:23.
7. Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 2015;28: E251–E259.
8. Church EW, Halpern CH, Faught RW, et al. Cervical laminoforaminotomy for radiculopathy: symptomatic and functional out- comes in a large cohort with long-term follow-up. Surg Neurol Int. 2014;5(suppl 15):S536–S543.
9. Albert TJ, Murrell SE. Surgical management of cervical radiculopathy. J Am Acad Orthop Surg. 1999;7:368–376.
10. Skovrlj B, Gologorsky Y, Haque R, et al. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J. 2014;14:2405–2411
11. Bevevino AJ, Lehman RA Jr, Kang DG, et al. The effect of cervical posterior foraminotomy on segmental range of motion in the setting of total disc arthroplasty. Spine. 2014;39:1572–1577.
12. Zdeblick TA, Abitbol JJ, Kunz DN, et al. Cervical stability after sequential capsule resection. Spine. 1993;18:2005–2008.
13. Lubelski D, Healy AT, Silverstein MP, et al. Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy: a propensity-matched analysis. Spine J. 2015;15: 1277–1283.
14. Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7:265–272.
15. Papavero L, Kothe R. Minimally invasive posterior cervical foraminotomy for treatment of radiculopathy : An effective, time-tested, and cost-efficient motion-preservation technique. Oper Orthop Traumatol. 2018 Feb;30(1):36-45. doi: 10.1007/s00064-017-0516-6.
16. Luo W, Li Y, Zhao J, Zou Y, Gu R, Li H. Skip Laminectomy Compared with Laminoplasty for Cervical Compressive Myelopathy: A Systematic Review and Meta-Analysis. World Neurosurg. 2018 Sep 8. pii: S1878-8750(18)32040-0. doi: 10.1016/j.wneu.2018.08.231.
17. Hidai Y, Ebara S, Kamimura M, et al. Treatment of cervical myelopathy with a new dorsolateral decompressive procedure. J Neurosurg 1999;90:178–85.
18. Ishihara A. Roentgenological investigation on the cervical lordosis of normal subjects. J Jpn Orthop Assoc 1968;42:1033–44.
19. Itoh T, Tsuji H. Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine. Spine 1985;10:729–46.
20. O’Brien MF, Peterson D, Casey AT. A novel technique for lamino- plasty augmentation of spinal canal area using titanium miniplate sta- bilization: a computerized morphometric analysis. Spine 1996;21: 474–84.
21. Yoshida M, Otani K, Shibasaki K, Ueda S. Expansive laminoplasty with reattachment of spinous process and extensor musculature for cervical myelopathy. Spine 1992;17:491–7.
22. Shiraishi T. Skip laminectomy—a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous pro- cesses: a preliminary report. Spine J. 2002;2:108 –115.
23. Shiraishi T, Fukuda K, Yato Y, Nakamura M, Ikegami T. Results of skip laminectomy- minimum 2-year follow-up study compared with open-door laminoplasty. Spine (Phila Pa 1976). 2003;28:2667-2672.
24. Shiraishi T. A new technique for exposure of the cervical spine laminae: technical note. J Neurosurg. 2002;96(Spine 1):122–126.
25. Pickett GE, Mtsis DK, Sekhon LH, Sears WR, Duggal N. Effects of cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 2004; 17: 30 – 35
26. Wigfield C, Gill S, Nelson R, et al. Influence of an artificial cervical joint compared with fusion on adjacent level motion in the treatment of degenerative cervical disc disease. J Neurosurg Spine 2002; 96: 17 – 21.
27. Eck JC, Humphreys SC, Lim TH, et al. Biomecahnical study on the effect of cervical spine fusion on adjacent-level intra-discal pressure and segmental motion. Spine 2002; 27 : 2431 – 4.
28. Matsunaga S, Kabayama S, Yamamoto T, et al. Strain on inter-vertebral discs after anterior cervical decompression and fusion. Spine 1999; 24: 670 – 5
29. Kotani Y, Cunningham BW, Abumi K, et al. Multidirectional flexibility analysis of cervical artificial disc reconstruction: in vitro human cadaveric spine model. J Neurosurg Spine 2005; 2: 188 – 194.
30. Phillips FM, Garfin SR. Cervical disc replacement. Spine 2005; 30: 527 – 533.
31. McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacement porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 2003; 28: S176 – S185
32. Dooris AP, Goel VK, Grosland NM, et al. Load sharing between anterior and posterior elements in a lumbar motion segment implanted with an artificial disc. Spine 2001: 26: E122 – E129
33. Anderson PA, Sasso RC, Hipp J, Norvell DC, Raich A, Hashimoto R. Kinematics of the cervical adjacent segments after disc arthoplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis. Spine 2012; 37 (22 Suppl): S85 – S95
34. Takasali S, Graeur JN, Vaccaro A. Material considertaions for intervertebral disc replacement implants. The Spine Journal 4 (2004); 231S – 238S
35. Anderson PA, Rouleau JP, Bryan VE, Carlson CS. Wear analysis of the Bryan Cervical Disc Prospthesis. Spine 28 (20S); 2003: S186 – S194
36. Mummaneni PV, Burkus JK, Haid RW, Traynelis VC, Zdeblick TA. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 2007; 6: 198 – 209
37. McAfee PC, Reah C, Gilder K, Eisermann L, Cunningham B. A meta-analysis of comparative outcomes following cervical arthroplasty or anterior cervical fusion. Spine 37 (11); 2012: 943 – 952
38. Ryu WH, Kowalczyk I, Duggal N. Long term kinematic analysis of cerbical spine after single level implantation of Bryan cervical disc prosthesis. The Spine Journal 13 (2103): 628 – 634
39. Hisey MS, Bae HW, Davis R, et al. Multi-centre, prospective, randomized, controlled investiogational device exemption clinical trail comparing Mobi-C cervical artificial disc to anterior discectomy and fusion in the treatment of symptomatic degenerative disc disease in the cervical spine. Int J Spine Surgery 2014, 8
40. Harrod CC, Hillibrand AS, Fischer DJ, Skelly AC. Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: a systematic review. Spine 2012; 37 (22 Suppl): S96 – S112
41. Goel VK, Faizan A, Palepu V, Bhattacharya S. Parameters that effect spine biomechanics following cervical disc replacement. Eur Spine J 2012; 21 (5): S688 – 699
42. Zhao Y, Du C, at al. Does rotation centre in artificial disc affect cervical biomechanics? Spine 40 (8); 2015: E469 – E475
43. Goffin J, Geusens E, Vantomme N, et al. Long term follow-up after interbody fusion of the cervical spien. J Spinal Disord Tech 2004; 17: 79 – 85
44. Bovouratwet P, Fu, Ondeck NT, et al. Safety of artificial single level cervical total disc replacement: A propensity matched multi-institution study. Spine 2018, sept 21
45. Segal DN, Wilson JM, Staley C, Yoon TS. Outpatient and Inpatient single level cervical total disc replacement: A comparison of 30 day outcomes. Spine June 11, 2018
46. Li Y, Shen H, Khan KZ, et al. Comparison of multi-level cervical disc replacement and multi-level anterior discectomy and fusion: A systematic review of biomechanical and clinical evidence. World Neurosurgery Aug 2018; 116: 94 – 104
47. Wu TK, Meng Y, Wang BY, et al. Is the behaviour of disc replacement adjacent to fusion affected by the location of the fused level in hybrid surgery? Spine J 2018, Aug 27.
48. Mehren C, Heider F, Sauer D, et al. Clinical and radiological outcome of a new total cervical dsic replacement design. Spine July 2018
49. Sasso RC, Anderson PA, Riew KD, Heller JG. Results of cervical arthoplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am 2011; 93: 1684 – 1692

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


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


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


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.

DNA sequencing, genomics, Spinal metastasis.


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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