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 .


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


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


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


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


References

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 .


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


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

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


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

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

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


Abstract

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


References

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


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


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


Genomics in Spine Health

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


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

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

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


Abstract

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

Keywords:
DNA sequencing, genomics, Spinal metastasis.


References

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


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


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


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.


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


Multiple Spinal Extradural Arachnoid Cyst : A Case Report

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


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

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

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


Abstract

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


References

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


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


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


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

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


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

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

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


Abstract

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


References

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


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


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


Diagnosing Early Post-operative Spinal Infection – A Systematic Review

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


Authors : Ross B. Ingber [1]

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

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


Abstract

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


References

1. deLissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37(5):387-397.
2. Whitmore RG, Stephen J, Stein SC, Campbell PG, Yadla S, Harrop JS, et al. Patient comorbidities and complications after spinal surgery: A societal-based cost analysis. Spine 2012;37(12):1065-1071.
3. Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: Efficacy, drug levels, and patient outcomes. Spine 2011;36(24):2084-2088.
4. Molinari RW, Khera OA, Molinari WJ 3rd. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J 2012;21 Suppl4:S476-S482.
5. Collins I, Wilson-MacDonald J, Chami G, Burgoyne W, Vineyakam P. The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 2008;17(3):445-450.
6. Hong HS, Chang MC, Liu CL, Chen TH. Is aggressive surgery necessary for acute postoperative deep spinal wound infection? Spine 2008;33(22):2473-2478.
7. Hsieh MK, Chen LH, Niu CC, Fu TS, Lai PL, Chen WJ. Postoperative anterior spondylodiscitis after posterior pedicle screw instrumentation. Spine J 2011;11(1):24-29.
8. Jonsson B, Soderholm R, Stromqvist B. Erythrocyte sedimentation rate after lumbar spine surgery. Spine 1991;16(9):1049-1050.
9. Khan MH, Smith PN, Rao N, Donaldson WF. Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery. Spine J 2006;6(3):311-315.
10. Lee JH, Lee JH, Kim JB, Lee HS, Lee DY, Lee DO. Normal range of the inflammation related laboratory findings and predictors of the postoperative infection in spinal posterior fusion surgery. ClinOrthopSurg 2012;4(4):269-277.
11. Mok JM, Pekmezci M, Piper SL, Boyd E, Berven SH, Burch S, et al. Use of C-reactive protein after spinal surgery: Comparison with erythrocyte sedimentation rate as predictor of early postoperative infectious complications. Spine 2008;33(4):415-421.
12. Nie H, Jiang D, Ou Y, Quan Z, Hao J, Bai C, et al. Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury. Spinal Cord 2011;49(6):715-720.
13. Piper KE, Fernandez-Sampedro M, Steckelberg KE, Huddleston PM, Piper KE, Karua MJ, et al. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PloS One 2010;5(2):e9358.
14. Gunne AF, Mohamed AS, Skolasky RL, van Laarhoven CJ, Cohen DB. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery. Spine 2010;35(13):1323-1328.
15. Sugita S, Hozumi T, Yamakawa K, Goto T, Kondo T. White blood cell count and C-Reactive protein variations following posterior surgery with intraoperative radiotherapy for spinal metastasis. J Spinal Disord Tech 2015;38(1):17-23.
16. Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: A review of 2,391 consecutive index procedures. J Spinal Disord 2000;13(5):422-426.
17. Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: Detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 2010;13(2):158-164.
18. Meyer B, Schaller K, Rohde V, Hassler W. The C-reactive protein for detection of early infections after lumbar microdiscectomy. ActaNeurochir 1995;136(3-4):145-150.
19. Bible JE, Biswas D, Devin CJ. Postoperative infections of the spine. Am J Orthop 2011;40(12):E264-E271.
20. Wimmer C, Gluch H, Franzreb M, Ogon M. Predisposing factors for infection in spine surgery: A survey of 850 spinal procedures. J Spinal Disord 1998;11(2):124-128.
21. Kuhn MG, Lenke LG, Bridwell KH, O’Donnell JC, Luhmann SJ. The utility of erythrocyte sedimentation rate values and white blood cell counts after spinal deformity surgery in the early (</=3 months) post-operative period. J Child Orthop 2012;6(1):61-67.
22. Schinsky MF, Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone JtSurg Am 2008;90(9):1869-1875.
23. Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone JtSurg Am 1999;81(5):672-683.
24. Takahashi J, Ebara S, Kamimura M, Shono Y, Hirabayashi H, Nakagawa H, et al. Early-phase enhanced inflammatory reaction after spinal instrumentation surgery. Spine 2001;26(15):1698-1704.
25. Pepys MB, Hirschfield GM. C-reactive protein: A critical update. J Clin Invest 2003;111(12):1805-1812.
26. Kasliwal MK, Tan LA, Traynelis VC. Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management. SurgNeurolInt 2013;4 Suppl5:S392-S403.
27. Hegde V, Meredith DS, Kepler CK, Huang RC. Management of postoperative spinal infections. World J Orthop 2012;3(11):182-189.
28. Kong CG, Kim YY, Park JB. Postoperative changes of early-phase inflammatory indices after uncomplicated anterior cervical discectomy and fusion using allograft and demineralised bone matrix. IntOrthop 2012;36(11):2293-2297.
29. Shen CJ, Wu MS, Lin KH, Lin WL, Chen HC, Wu JY, et al. The use of procalcitonin in the diagnosis of bone and joint infection: A systemic review and meta-analysis. Eur J ClinMicrobiol Infect Dis 2013;32(6):807-814.


How to Cite this Article: Ingber R B. Diagnosing Early Post-operative Spinal Infection – A Systematic Review. International Journal of Spine Jan-June 2019;4(1):10-15.


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