Titles, Money Or Academics: What Drives the Orthopaedic Surgeon in India- Tracing the Happiness and Productivity of Indian Orthopaedic Surgeons

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Volume 7 | Issue 2 | July-December 2022 | Page: 07-13 | Saijyot Raut, Tushar Agrawal, Rajendra Sakhrekar

DOI: https://doi.org/10.13107/ijs.2022.v07i02.38

Authors: Saijyot Raut [1, 2], Tushar Agrawal [3, 4], Rajendra Sakhrekar [5, 6]

[1] One Spine Clinic, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, SL Raheja Hospital, Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Aastha Hospital, Mumbai, Maharashtra, India.
[4] Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India.
[5] Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
[6] Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada.

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

Abstract

Background- Happiness and productivity are two interlinked parameters. Orthopaedic surgery is physically demanding, and often Orthopaedic surgeons need to work for long unpredictable hours. In this study, the factor impacting the happiness and success of Orthopaedic surgeons will be delineated. Moreover, we will try to address different characteristic features of Orthopaedic practice at different geographical locations of the country.
Material and methods- This is a randomized cross-sectional survey that was conducted among practicing Orthopaedic surgeons from Tier 1, Tier 2, and Tier 3 cities of India. We hypothesized that an annual income of Indian Rupees Four Lakhs would be likely to contribute positively to an Orthopaedic surgeon’s productivity. Additionally, we hypothesized that surgeons involved in research, teaching, and conferences would be more likely to be satisfied with their personal and professional life. Participants were selected through random sampling and a questionnaire was sent to them that explored the personal and professional happiness of the participants. This questionnaire was made by four surgeons from differing backgrounds with respect to age, training, city of practice and area of interest and was subsequently reviewed by four peers. The questionnaire contains a total of 18 questions that covered a wide range of characteristics including age, marital status, practice characteristics, quality of life, calorie intake, exercise frequency, burnout, career satisfaction, and monetary satisfaction.
Result- A total of 298 participants were responded in the survey. Among these participants 135 (45.3%) were from Mumbai, 86 (28.86%) were from Bangalore and 77 (25.84%) were from UP. The happiness quotient of Orthopaedic surgeons was shown to be significantly associated with the city where they practiced (p-value= 0.004), age of the surgeons (p-value=0.001), the setup of postgraduate training (P-value=0.004), and the frequency of physical exercise (P-value=0.019). Among the respondents 71.81% were found to have completed their training from a government hospital and 79.05% were found to be happy in their present life. However no statistically significant difference in happiness was observed between surgeons who had undergone training abroad and those that hadn’t among the respondents. It was also reported that surgeons associated with teaching institutions expected a lower salary and this association was also found to be statistically significant (P Value=0.038).
Conclusion- This study reported that practice in a Tier 1 city, age greater than 60 years, post-graduate training in a government institute, higher frequency of physical exercise (thrice a week to daily), the consciousness of daily caloric intake, and an involvement in the organization and management of major conferences and other academic and research activities were some of the factors that contributed to the happiness of Orthopaedic surgeons in India.
Keywords: Happiness, Orthopaedic surgeon, Age, Productivity, Exercise

References

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How to Cite this Article: Raut S, Agrawal T, Sakhrekar R | Titles, Money or Academics: What Drives the Orthopaedic Surgeon in India- Tracing the Happiness and Productivity of Indian Orthopaedic Surgeons | International Journal of Spine| July-December 2022; 7(2): 07-13| https://doi.org/10.13107/ijs.2022.v07i02.38

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

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

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

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

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

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

Abstract

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

References

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12. Chan P, Boriani S, Fourney DR, Biagini R, Dekutoski MB, Fehlings MG, Ryken TC, Gokaslan ZL, Vrionis FD, Harrop JS, Schmidt MH, Vialle LR, Gerszten PC, Rhines LD, Ondra SL, Pratt SR, Fisher CG (2009) An Assessment of the Reliability of the Enneking and Weinstein-Boriani-Biagini Classifications for Staging of Primary Spinal Tumors by the Spine Oncology Study Group. Spine (Phila Pa 1976) 34:384–391.
13. Kandel R, Coakley N, Werier J, Engel J, Ghert M, Verma S (2013) Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline. Current Oncology 20:247–254.
14. Durer S SH (2023) Ewing Sarcoma. StatPearls Publishing.
15. Paulussen M, Craft AW, Lewis I, Hackshaw A, Douglas C, Dunst J, Schuck A, Winkelmann W, Köhler G, Poremba C, Zoubek A, Ladenstein R, van den Berg H, Hunold A, Cassoni A, Spooner D, Grimer R, Whelan J, McTiernan A, Jürgens H (2008) Results of the EICESS-92 Study: Two Randomized Trials of Ewing’s Sarcoma Treatment—Cyclophosphamide Compared With Ifosfamide in Standard-Risk Patients and Assessment of Benefit of Etoposide Added to Standard Treatment in High-Risk Patients. Journal of Clinical Oncology 26:4385–4393.
16. Schuck A, Ahrens S, Paulussen M, Kuhlen M, Könemann S, Rübe C, Winkelmann W, Kotz R, Dunst J, Willich N, Jürgens H (2003) Local therapy in localized Ewing tumors: results of 1058 patients treated in the CESS 81, CESS 86, and EICESS 92 trials. International Journal of Radiation Oncology*Biology*Physics 55:168–177.
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27. Boriani S ALCACMBSFS (2011) Ewing’s sarcoma of the mobile spine. Eur Rev Med Pharmacol Sci 15:831–839.
28. Hesla AC, Bruland ØS, Jebsen N, Styring E, Eriksson S, Tsagozis P (2019) Ewing sarcoma of the mobile spine; predictive factors for survival, neurological function and local control. A Scandinavian sarcoma group study with a mean follow-up of 12 years. J Bone Oncol 14:100216.

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

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Adult Eosinophilic Granuloma of Thoracic Spine

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Volume 7 | Issue 2 | July-December 2022 | Page: 27-29 | Vijaya Anand , Krishnakumar R , Ranjima Abraham

DOI: https://doi.org/10.13107/ijs.2022.v07i02.42

Authors: Vijaya Anand [1], Krishnakumar R [1], Ranjima Abraham [2]

[1] Department of Spine Surgery, Medical Trust Hospital, Kochi, India.
[2] Department of Pathology, Medical Trust Hospital, Kochi, India.
Dr. Vijaya Anand
Department of Spine Surgery, Medical Trust Hospital, Kochi, India.
E-mail: drvijayanand24@gmail.com

Abstract

A rare case report of Adult Eosinophilic Granuloma of the upper thoracic spine involving the vertebral body. A 48-year-old male with chronic pain over the lower neck without neurological involvement. MR imaging shows a lytic lesion over D2 vertebral body. Open biopsy is done; it is consistent with EG. Immunohistochemistry markers are positive for CD1a, S100. Adult Eosinophilic Granuloma is a self-limiting and spontaneous resolution condition in adults. It should be in the list of differential diagnoses for a solitary lytic lesion of the spine in adults.

Keywords: Adult eosinophilic granuloma, Solitary lytic lesion, Langerhans cell histiocytosis

References

1. Lichtenstein L, Jaffe HL. Histiocytosis X eosinophilic granuloma, Litterer- Siwe-Disease and Schuller-Christian Disease. J Bone Joint Surg 1964;46A: 76–90.
2. Otani S, Ehrlich JC. Solitary granuloma of bone simulating primary neoplasm. Am J Pathol 1940;16:479–90.
3. Zheng W, Wu J, Wu Z, Xiao J. Atlantoaxial instability secondary to eosinophilic granuloma of the axis in adults: Long-term follow-up in six cases. Spine J. 2014;14:2701-2709.
4 Reddy PK, Vannemreddy PS, Nanda A. Eosinophilic granuloma of spine in adults: A case report and review of literature. Spinal Cord. 2000;38: 766-768.
5.Floman Y et al. Eosinophilic granuloma of the spine. J Paed Orthop 1997; 6-B: 260 ± 265.
6. Huang W, Yang X, Cao D, et al. Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome. Acta Neurochir (Wien). 2010; 152(7):1129-1137.
7. Lau€enburger MD, Dull ST, Toselli R. Eosinophilic granuloma of the adult spine: A case report and review of the literature. J Spinal Disord 1995; 8: 243 ± 245.
8.Villas C, Martinez-Perric R, Barrios RH, Beguiristain JL. Eosinophilic granuloma of the spine with and without vertebra plana: Long term follow-up of six cases. J Spinal Disord 1993; 6: 260 ± 268.

How to Cite this Article: Anand V, R Krishnakumar, Abraham R | Adult Eosinophilic Granuloma of Thoracic Spine | International Journal of Spine | July-December 2022; 7(2): 27-29 | https://doi.org/10.13107/ijs.2022.v07i02.42

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Spontaneous Cervical Epidural Hematoma Following Anti-Coagulant Medications with Quadriparesis: A Case Report and Narrative Review

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Volume 7 | Issue 2 | July-December 2022 | Page: 23-27 | Vijay Kumar Loya, Charanjit Singh Dhillon, T.V. Krishna Narayana, Chetan S. Pophale, Sameen V.K.

DOI: https://doi.org/10.13107/ijs.2022.v07i02.41

Authors: Vijay Kumar Loya [1], Charanjit Singh Dhillon [2], T.V. Krishna Narayana [3], Chetan S. Pophale [2], Sameen V.K [4]

[1] Department of Spine Surgery, Germanten Hospital, Hyderabad, Telangana, India.
[2] Department of Spine Surgery, M.I.O.T International, Chennai, Tamil Nadu, India.
[3] Department of Spine Surgery, Udai Omni Hospital, Hyderabad, Telangana, India.
[4] Department of Spine Surgery, Government Medical College, Kottayam, Kerala, India.

Address of Correspondence
Dr. Vijay Kumar Loya,
Consultant Spine Surgeon, Germanten Hospital, Hyderabad, Telangana, India.
E-mail: dr.vijaykumarloya@gmail.com.

Abstract

Spontaneous spinal epidural hematoma is an uncommon entity. We present a 42-year gentleman who was a known case of chronic deep vein thrombosis of leg on Tab. Acitrom (6 mg OD) for one & half year presented with sudden-onset weakness of bilateral upper & lower limbs with bowel & bladder involvement. MRI showed ventral epidural haematoma extending from the lower margin of C2 to C6 with severe canal compromise. Patient underwent emergency decompression with hematoma evacuation on the same day within 06 hours of presentation to our centre. At a 2-year follow-up, the patient has recovered good bowel and bladder control and has a residual left leg foot drop. Spontaneous spinal epidural hematoma is a rare condition where early management is the key. If associated with neuro deficits, early decompression (<48 hours) is indicated for a better prognosis. This case report highlights the fact, if dealt proactively patient can have a good neurologic recovery.
Keywords: Epidural hematoma, Quadriparesis, Cervical spine, Anti-coagulants

References

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3. MR imaging of spinal haematoma: a pictorial review – PMC [Internet]. [cited 2023 Mar 7]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541191/
4. Hadley MN, Walters BC. Introduction to the Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Neurosurgery. 2013 Mar;72 Suppl 2:5–16.
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8. Lee HH, Park SC, Kim Y, Ha YS. Spontaneous Spinal Epidural Hematoma on the Ventral Portion of Whole Spinal Canal: A Case Report. Korean J Spine. 2015 Sep;12(3):173–6.
9. Raasck K, Khoury J, Aoude A, Abduljabbar F, Jarzem P. Nonsurgical management of an extensive spontaneous spinal epidural hematoma causing quadriplegia and respiratory distress in a choledocholithiasis patient. Medicine (Baltimore). 2017 Dec 22;96(51):e9368.
10. Zhong W, Chen H, You C, Li J, Liu Y, Huang S. Spontaneous spinal epidural hematoma. J Clin Neurosci. 2011 Nov;18(11):1490–4.
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13. Vierunen RM, Koivikko MP, Siironen JO, Kerttula LI, Bensch FV. Post-traumatic spinal hematoma in ankylosing spondylitis. Emerg Radiol. 2021 Jun;28(3):601–11.
14. Hanna G, Uddin SA, Trontis A, Ross L, Drazin D, Kim TT, et al. Epidural hematoma in patients with ankylosing spondylitis requiring surgical stabilization: a single-institution retrospective review with literature analysis. Neurosurg Focus. 2021 Oct;51(4):E5.
15. Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg. 2004 Jan;100(1 Suppl Spine):38–45.

How to Cite this Article: Loya VK, Dhillon CS, Narayana TVK, Pophale CS, Sameen VK | Spontaneous Cervical Epidural Hematoma Following Anti-Coagulant Medications with Quadriparesis: A Case Report and Narrative Review | International Journal of Spine | July-December 2022; 7(2): 23-27 | https://doi.org/10.13107/ijs.2022.v07i02.41

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Efficiency of Spinal Anaesthesia Versus General Anaesthesia for Single Level Lumbar Micro-Discectomy Prospective Analysis of 50 Patients: An Observational Study

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Volume 7 | Issue 2 | July-December 2022 | Page: 19-22 | Ashutosh.C. Tripathi, Chaitanya Chikhale, Ganesh N. Pundkar, Rajendra.W. Baitule, Yogesh Rathod, Sanjeev Jaiswal

DOI: https://doi.org/10.13107/ijs.2022.v07i02.40

Authors: Ashutosh.C. Tripathi [1], Chaitanya Chikhale [1], Ganesh N. Pundkar [1], Rajendra.W. Baitule [1], Yogesh Rathod [1], Sanjeev Jaiswal [1]

[1] Department of Orthopaedics, PDMMC, Amravati, Maharashtra, India.

Address of Correspondence
Dr. Ashutosh C. Tripathi,
Department of Orthopaedics, PDMMC, Amravati, Maharashtra, India.
E-mail: ashutoshckv.95@gmail.com

Abstract

Background: In most of the institutes Lumbar Microdiscectomy surgery is done under General Anaesthesia. However, it is not uncommon to do these surgeries under Spinal Anaesthesia
Aims and objectives: To compare the analgesic effectiveness in postoperative pain, cost-effectiveness and complications of spinal anaesthesia and general anaesthesia who underwent single Level Lumbar Microdiscectomy under General Anaesthesia vs who were administered Spinal anaesthesia for the same
Materials and methods: A prospective observational study was conducted on patients undergoing lumbar micro-discectomy in the department of orthopaedics of a tertiary care hospital in Maharashtra, India. The study duration was two years [January 2020 to December 2020]. The patients older than 18 years who were not responding to 6 weeks of conservative therapy, epidural steroid injection, physiotherapy, and having low back pain with radiculopathy with claudication with or without neurological deficit were included in the study. We included 25 cases each in the spinal anaesthesia (SA) and general anaesthesia (GA) group. Outcome variables like peri-operative complications (blood loss, urinary retention, PONV), surgery length, length of stay (LOS), time from entering OT to incision, time from bandaging to exit time, and time of stay in the recovery room were studied among both the groups. Chi-square or fishers exact test to test the difference between proportions and student t-test to test between the means were statistical tests used.
Results: The VAS score reduction immediately post-operative among GA group was 79% and SA group was 75% and this difference was not significant. (p>0.05)The time from post anaesthesia care unit from operation theatre [GA Vs. SA; 60.44 minutes Vs. 20.45 minutes] , time of surgery (time to enter in OT to incision) [GA Vs. SA; 30.22 minutes Vs. 15.55 minutes], time from bandaging to exit from OT[GA Vs. SA; 16.34 minutes Vs. 6.12 minutes] and average hospital stay[GA Vs. SA; 3.05 days Vs. 1.61 days] were significantly higher among GA group when compared to SA group. (p<0.05) The average cost of procedure among GA group was 26500 INR and among SA group was 18500 INR. (p<0.05)
Conclusions: In terms of VAS pain score reduction, SA was comparable with GA. Our study showed that SA was superior to GA in terms of time consumption, cost, and hospital stay while maintaining better perioperative hemodynamic stability without increasing adverse side effects.
Keywords: Lumbar micro-discectomy, Spinal Anaesthesia, General Anaesthesia, Cost-effectiveness

References

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How to Cite this Article: Tripathi Ac, Chikhale C, Pundkar GN, Baitule RW, Rathod Y, Jaiswal S | Efficiency of Spinal Anaesthesiaversus General Anaesthesia for Single level Lumbar Micro-discectomy Prospective Analysis of 50 Patients: An Observational Study | International Journal of Spine | July-December 2022; 7(2): 19-22 | https://doi.org/10.13107/ijs.2022.v07i02.40

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Awake Microtubular Spinal Decompression: A Step Towards Better Peri-Operative Patient Safety, and Satisfaction

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Volume 7 | Issue 2 | July-December 2022 | Page: 01-06 | Goparaju VNR Praveen, Amit Chugh, Ameya Rangnekar, Vishal Kundnani, Mani Kant Anand, Abhijith Shetty, Sunil Chodavadiya, Saijyot Raut

DOI: https://doi.org/10.13107/ijs.2022.v07i02.37

Authors: Goparaju VNR Praveen [1], Amit Chugh [1], Ameya Rangnekar [1], Vishal Kundnani [1], Mani Kant Anand [1], Abhijith Shetty [1],  Sunil Chodavadiya [1], Saijyot Raut [2]

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

[2] Department of Orthopaedics, Lilavati Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Goparaju VNR Praveen,
Fellow, Association of Spine Surgeons in India, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
E-mail: praveen.gvnr@gmail.com

Abstract

Introduction: Microtubular decompression (MTD) being a short-duration surgery, with many advantages, has gained popularity and can be done either in general anaesthesia (GA) or awake techniques like spinal anaesthesia (SA). The authors ventured to assess perioperative parameters, quantify peri-operative complications as the primary aim and determine patient satisfaction as the secondary aim of the study.
Materials and Methods: It was a retrospective study performed over a period of ten years (2009–2019) and included 625 patients. The patients included were aged greater than 18 years, American Society of Anaesthesiologists (ASA) score 1, 2, or 3. Patients with ASA 4 or 5, spinal instability, infection, or revision surgeries were excluded.
Results: There is no significant difference in the complication rates. The clinical outcome in the form of VAS and ODI scores showed significant differences both in SA and GA groups at the final follow-up. The total anaesthetic, surgical times, mean arterial pressure (MAP), and heart rate (HR) perioperatively were longer in the GA group (P < 0.05). The perioperative blood pressures are lower in the SA group. The dissatisfaction rate is about 3.5%, of which the patients and a total of 88.5% of patients would like to opt for SA for future surgeries.
Conclusion: This study represents the ten-year experience with MTD operated either with SA or GA. Awake spinal surgery is promising and has the glaring benefits of better peri-operative hemodynamic stability, and faster recovery with reduced surgical and anaesthetic duration. Dissatisfaction rates can be decreased by better explanation and the patient’s decision.
Keywords: Awake spine surgery, Microtubular decompression, Hemodynamic parameters, Complications, Patient satisfaction.

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How to Cite this Article: Praveen GVNR, Chugh A, Rangnekar A, Kundnani V, Anand MK, Shetty A, Chodavadiya S, Raut S | Awake microtubular spinal decompression: A step towards better peri-operative patient safety and satisfaction | International Journal of Spine | July-December 2022; 7(2): 01-06 |  https://doi.org/10.13107/ijs.2022.v07i02.37

(Abstract Text HTML)         (Download PDF)