Ramani PS, Pawar S, Babhulkar S. Dilemma in the Surgical Management of Lumbar Canal Stenosis. J Spinal Surg 2014;1(1):1-11.

Spondyloarthropathy as a cause of inflammatory lower back ache often goes undiagnosed for long. Though various clinical criteria have been developed, evidence of sacroiliitis is considered the basis for diagnosis. As sacroiliitis may become apparent on plain radiographs after a long duration, it is important to evaluate the efficacy of other imaging techniques to make an early diagnosis. Magnetic resonance imaging (MRI) and development of various specific sequences have helped in picking up structural changes as well as inflammation in sacroiliitis. The present study is to assess the role of MRI and radionuclide bone scan in patients with early SpA of less than 3 years.

Patients with inflammatory LBA, defined according to the Calin criteria and satisfying the European Spondyloarthropathy Study Group (ESSG) criteria for SpA of less than 3 years duration, were included. Controls had mechanical LBA. A detailed clinical assessment and assessment of disease activity and functional impairment was done with validated measures. Radiological assessment included conventional radiograph of the pelvis, radionuclide scan and MRI of sacroiliac joints (SI joints). The sensitivity, specificity and predictive value of each modality in contributing to the diagnosis of SpA were assessed.

Assessment of 136 SI joints in 42 patients [(Age 29 (± 5.6) and 26 controls (Age 32.1 (± 8.91)] was done. The mean disease duration of cases was 12.5 (± 10.2) months. Conventional radiograph failed to pick up sacroiliitis in any of the cases. Positive bone scan was present in 34 cases (28 bilateral sacroiliitis, 6 unilateral sacroiliitis). Bone scan had a sensitivity of 81.8% and a specificity of 87%. Magnetic resonance imaging abnormality was present in 37/42 (88%) (bilateral in 27 and unilateral in 10) and in none of the controls. This accounted for a sensitivity of 87% and a specificity of 100%. The MRI changes included bone marrow edema (82%), synovial enhancement (60%), subchondral edema (42%), erosions (46%) and sclerosis (38%).

In patients with early Spa of less than 3 years duration, conventional radiographs did not pick up sacroiliitis; however, both the radionuclide scan and MRI were useful.

Shinto AS, Kamaleshwaran KK, Anjali M, Rajamani V, Thirumalaisamy SG, Sreedharan N. Utility of 99mTc-MDP Bone Scan in Comparison to Mri and Plain Radiographs for the Diagnosis of Early Spondyloarthropathy. J Spinal Surg 2014;1(1):12-15.

Dedeepiya VD, William JB, Parthiban JKBC, Yoshioka H, Mori Y, Kuroda S, Iwasaki M, Preethy S, Abraham SJK. Scaffolds for cell Transplantation in Neurology– The Suitability of a Thermoreversible Gelation Polymer: Our Perspectives. J Spinal Surg 2014;1(1):16-24.

In this study, we try to correlate the column theory of the spine with the preoperative and postoperative clinical and radiological findings.

One hundred and twenty-two patients with unstable thoracolumbar or lumbar spine treated surgically were studied. The patients were classified according to their pathogenesis into three groups (trauma, 75 patients, tumor, 30 patients and infection, 17 patients, groups). All patients were also classified according to the three column theory. Detailed radiographic analysis of the vertebra (e) involved was done at admission, at mobilization, and at follow-up. Neurologic assessment was performed using modified Frankel grading scale.

The results of this study did not support the column theory for evaluation of spinal instability. Comparing each group separately does not reveal any significant relationship between the number of the columns involved and radiographic or neurologic findings either before or after surgery.

Spine instability concept is still dilemma and evolving matter. More research is required for better understanding of the nature of the spine and its loading characters.

Aly T, Sayed E. Reliability of the Column Theory to evaluate Thoracolumbar Spinal Instability. J Spinal Surg 2014;1(1):25-27.

Hemangioendotheliomas are vascular neoplasms that rarely involve the neuraxis.

A 50-year-old male patient complaining of severe pain and weakness on both his legs. Patient had history of spinal tumor operation 13 years ago. On examination, patient showed tenderness on his back and no localizing signs.

X-ray and 3D reconstructive CT scan of the dorsal spine showed involvement of D11 and L1 with collapsed D12. MRI showed kyphosis deformity and significant cord compression.

Preoperative embolization was performed followed by transthoracic removal of the tumor and D12 vertebral body which was followed interbody vertebral cage. A second surgery was undertaken to further excise the tumor and stabilize the spine.

Patient was relieved of his symptoms and neurological deficit postoperatively.

A rare case of spinal hemangioendothelioma was treated with embolization and two step surgery requiring stabilization.

Gill AS, Cahyadi A, Babhulkar S, Pawar S, Ramani PS. Recurrent Hemangioendothelioma of the Spine. J Spinal Surg 2014;1(1):28-31.

Miller fisher syndrome (MFS) could be found in coincidence with ossification of posterior longitudinal ligament. High index of suspicion is required that lead to further investigation.

A 56-year-old male presented with four days history of loss of sensation on both lower and upper extremity. The complaint was felt more on the lower than upper extremity. The patient felt imbalance during walking. Muscle strengh of all extremity was normal, but sensory lost was found in all extremity. Deep tendon reflexes were absent in all extremity.

Computed tomography (CT) scan and MRI showed canal stenosis due to of the posterior longitudinal ligament. Nerve conduction velocity suggested peripheral neuropathy on both upper and lower extremity. Antibody anti GQ1b was positive. Cerebrospinal fluid examination showed cytoalbuminemic dissociation.

Patient was treated conservatively.

Improvement was achieved in 5 days, and progressively return to normal condition.

Peripheral polineuropathy could be found in coincident with of the posterior longitudinal ligament and required specific management.

Cahyadi A, Singh A, Ramani PS, Babhulkar S, Pawar S, Shenoy A. Concurrent Miller Fisher Syndrome Variant in Ossification of Posterior Longitudinal Ligament. J Spinal Surg 2014;1(1):32-34.

Chowdhury FH, Haque MR, Kawsar KA, Haque AFMM. J Spinal Surg 2014;1(1):35-38.

Natesan S, Raghavendran R, Narasimman V, Kunjithapatham D. Spinal Intramedullary Tubercular Abscess. J Spinal Surg 2014;1(1):39-40.

Alveolar soft-part sarcoma (ASPS) is a rare soft tissue sarcoma often affecting adolescents and young adults. Though the tumor has as indolent clinical course, the ultimate prognosis is poor characterized by late metastasis. Histopathological evaluation is the crucial to a correct diagnosis.

A 30-year-old Indian woman presented with paraplegia and a persistent mass over the back. A thorough histological examination alongside imaging techniques shaped a reliable diagnosis.

Alveolar soft tissue sarcoma of the spine is a rare tumor and a very high index of suspicion is required to make an early diagnosis and achievement of complete microscopic resection is critical for successful outcome.

Gupta R, Kayal A. Alveolar Soft Part Sarcoma presenting as Cauda Equina Syndrome. J Spinal Surg 2014;1(1):41-45.

A 54-year-old female presented with complaints of backache since 6 to 8 months, weakness in both lower limbs and difficulty in walking. She had past history of cervical and lumbar decompression surgery.

On MRI, a focal kink was seen in the dorsal spinal cord at T8-T9 level. Anterior displacement of the spinal cord was also seen at this level with prominent posterior subarachnoid spaces. Along with other findings described, it was suggestive of idiopathic spinal cord herniation.

Management strategy along with the etiopathogenesis and differential diagnosis is described in the text.

Despite the fact that MR imaging appearances of this entity are pathognomonic, missed diagnosis and misdiagnosis are common. Careful imaging study would avoid this.

Kotecha J, Kulkarni M. Idiopathic Spinal Cord Herniation. J Spinal Surg 2014;1(1):46-48.

Hepatic myelopathy is characterized by spastic paraparesis and minimal sensory abnormalities in patients with cirrhosis, particularly those with portosystemic shunts that have been created surgically or have occurred spontaneously.

We described a patient who presented with spastic paraparesis and diagnosed as hepatic myelopathy when all the other possible diagnoses were ruled out with a review of literature in the goal of promoting prompt recognition and enhancing understanding of HM.

We reported a patient aged 51 years who presented with spastic paraparesis with insidious onset and progressive course and diagnosed as hepatic myelopathy.

Unlike hepatic encephalopathy, hepatic myelopathy is usually considered irreversible.

Bouali S, Boubaker A, Bouhoula A, Kallel J, Lassaad A, Jemel H. A Rare Complication of Cirrhosis: Hepatic Myelopathy. J Spinal Surg 2014;1(1):49-51.