The Journal of Spinal Surgery

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2016 | October-December | Volume 3 | Issue 4

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EDITORIAL

Editorial

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/joss-3-4-iv  |  Open Access |  How to cite  | 

613

RESEARCH ARTICLE

Murtuza Sikander, Sean Martin, Bassam Dabbous, Stewart Griffiths, Sumit Karia, Erlick Pereira, Thomas Cadoux-Hudson

Combined C1-C2 Transarticular with C1 Lateral Mass Screw Fixation for the Treatment of Atlantoaxial Instability: A Single Center Experience

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:7] [Pages No:133 - 139]

   DOI: 10.5005/jp-journals-10039-1105  |  Open Access |  How to cite  | 

Abstract

Aim

To study the outcome of a cohort of patients with atlantoaxial instability (AAI) treated with a combination of C1-C2 transarticular screws and C1 lateral mass fixation.

Background

Several surgical techniques have been described for stabilization of the atlantoaxial complex. Each technique differs in its biomechanical properties, advantages, and disadvantages. In this series, we describe our experience with a combined four-point fixation technique that combines C1-C2 transarticular screws with C1 lateral mass fixation for AAI.

Materials and methods

We present a single-center retrospective case series of 30 patients who were surgically treated for AAI over one decade. All patients presented with symptoms and signs of AAI and consequently underwent extensive clinical and radiological evaluation prior to surgery.

The median follow-up of our cohort was 8.3 months (3–143) with three patients lost to follow-up. Pre and postoperative symptoms were compared, including the visual analog scale (VAS) scores for neck and C2 radicular pain. All patients' preand postoperative lateral dynamic cervical radiographs were evaluated and the posterior atlantodental interval (PADI) was measured. Ranawat functional disability score was used for pre and postoperative evaluation.

Results

Of the 30 patients, 8 were male and 22 female. The mean age was 60.4 years (18-78 years). The median hospital stay following surgery was 5 days (2.25 days). The mean preoperative VAS score for neck pain was 6.3 vs 4.3 at the first postoperative review (p≤0.001) on paired comparison. Ranawat scores were available for 26 out of 30 patients. The scores improved following surgery in 8/26 (30.7%) patients, did not change in 17 (65.4%) patients, and deteriorated in only one patient (3.8%). Like the VAS score, improvement in Ranawat score following surgery was significant (p = 0.02).

Complications in this series included two unilateral intraoperative vertebral artery injuries associated with placement of C1-C2 transarticular screws, another patient had worsening C2 pain following surgery, and three patients had numbness in the C2 distribution following the procedure. Radiologically, two patients had suboptimal unilateral C2 screw placement despite satisfactory intraoperative fluoroscopic imaging. There were no infections and no implant failure.

Conclusion

The addition of C1 lateral mass screws to C1-C2 transarticular screw fixation for the treatment of AAI is an effective and safe procedure worthy of note. Our results and experience prove that this method is extremely beneficial where decompression of the posterior elements of C1 is required and may obviate the need of additional posterior wiring traditionally described. Further studies are necessary to look at the longterm fusion rates and compare them with other procedures.

How to cite this article

Sikander M, Martin S, Dabbous B, Griffiths S, Karia S, Pereira E, Cadoux-Hudson T. Combined C1-C2 Transarticular with C1 Lateral Mass Screw Fixation for the Treatment of Atlantoaxial Instability: A Single Center Experience. J Spinal Surg 2016;3(4):133-139.

4,051

RESEARCH ARTICLE

Zulfikar Patel, Shardul V Soman

Spinal Decompression using Ultrasonic Bone Scalpel: A Novel Ultrasonic Surgical Device

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:4] [Pages No:140 - 143]

   DOI: 10.5005/jp-journals-10039-1106  |  Open Access |  How to cite  | 

Abstract

Introduction

The ultrasonic bone scalpel (UBS) is an ultrasonic device that cuts the bone, but does not harm the surrounding soft tissue and duramater. Such a type of selectivity of bone scalpel, particularly for bone destruction, makes the bone scalpel ideal for spine surgeries where there is the need to remove only bone adjacent to the duramater and neural structures, with the sparing of the duramater. Moreover, dural tear is the most common unintended complication of spinal surgeries nowadays.

Materials and methods

This is a retrospective study of 35 patients operated for spinal decompression – cervical, thoracic, or lumbar – between January 2015 and June 2016 at BJ Medical College, Ahmedabad.

Aim

To analyze the result of the use of UBS in spinal decompression over the conventional method of decompression, such as using the Kerrison Rongeur, high-speed burr drills, and conventional osteotome.

Observation and results

Out of the 35 patients in our study, 21 patients (60%) had cervical, 3 patients (8.6%) had thoracic, and 11 patients (31.4%) had lumbar pathologies. There is significant reduction in duration of surgery and need for blood transfusion. We considered the neck disability index (NDI) and oswestry disability index (ODI) scores to measure the clinical outcomes of using bone scalpel at the end of 1 year. Both the scores were significantly improved. We had one case of dural tear (2.9%) in a patient with lumbar canal stenosis. No neurological worsening in any patients was present.

Conclusion

The UBS is a unique surgical device that reduces heat production and decreases the chances of dural tear, which makes it a suitable instrument for different spinal surgeries in recent days.

How to cite this article

Modi JV, Patel KR, Patel Z, Soman SV, Tankshali KV. Spinal Decompression using Ultrasonic Bone Scalpel: A Novel Ultrasonic Surgical Device. J Spinal Surg 2016;3(4):140-143.

3,885

RESEARCH ARTICLE

Vishwanath Sidram, PC Chandrakumar, Raghavendra Bellara

A Prospective Study of Spectrum of Lumbar Disk Herniation and Its Surgical Outcome

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:7] [Pages No:144 - 150]

   DOI: 10.5005/jp-journals-10039-1107  |  Open Access |  How to cite  | 

Abstract

Objectives

To study the surgical outcome of lumber disk herniation and factors influencing the surgical outcome.

Materials and methods

A case series study of 200 patients with herniated lumbar disk were studied in setting of tertiary hospital in the Department of Neurosurgery at Vijayanagara Institute of Medical Sciences, Bellary, Karnataka during the period of June 2013 to January 2015. Among the selected patients, the sociodemographic profile, clinical profile, radiological profile, and the surgical interventions were undertaken and the outcome was noted. The MacNab scale was used to determine the clinical outcome after surgery. All patients were followed for a period 6 months postoperatively for the presence of complications.

Results

Mean age of the patients was 45.63 ± 18.54 years with 61% of males and 39% of them were females. L4-L5 interspace was involved in 138 cases (68.0%), disk was protruded in 54% of the cases, and extruded in 28% of the cases. According to MacNab's criteria, in this study “Excellent” outcome was seen in 146 patients (73%), outcome was “Good” in 45 (22.5%) patients, “Fair” in 7 (3.5%) patients, and “Poor” in 2 cases (1%). Better surgical outcomes were associated with younger patients (p = 0.002), disk prolapse at the level of L4-L5 (p < 0.001), extruded and protruded type of disk prolapse (p = 0.034), and disk prolapse precipitated by lifting inappropriate weight (p = 0.002).

Conclusion

The outcome of lumbar discectomy depends more on patient's age, level and type of disk prolapse, factors precipitating disk prolapse, and patient selection than on surgical technique.

How to cite this article

Sidram V, Chandrakumar PC, Bellara R. A Prospective Study of Spectrum of Lumbar Disk Herniation and Its Surgical Outcome. J Spinal Surg 2016;3(4):144-150.

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CASE REPORT

Suresh Nair, Krishnakumar Kesavapisharady

Ellis-van Creveld Syndrome associated with Atlantoaxial Dislocation

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:3] [Pages No:151 - 153]

   DOI: 10.5005/jp-journals-10039-1108  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Kesavapisharady K, Nair S. Ellis-van Creveld Syndrome associated with Atlantoaxial Dislocation. J Spinal Surg 2016;3(4):151-153.

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CASE REPORT

Harshad Patil, Shrikant Rege

Spontaneous Cervical Epidural Hematoma during Pregnancy

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:3] [Pages No:154 - 156]

   DOI: 10.5005/jp-journals-10039-1109  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Rege S, Gupta R, Patil H, Narayan S, Tadghare J. Spontaneous Cervical Epidural Hematoma during Pregnancy. J Spinal Surg 2016;3(4):154-156.

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CASE REPORT

Sourabh Chachan, Niraj S Kasat, Paul KL Thng

Cervical Myelopathy Secondary to Combined Ossification of Ligamentum Flavum and Posterior Longitudinal Ligament

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:3] [Pages No:157 - 159]

   DOI: 10.5005/jp-journals-10039-1110  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Chachan S, Kasat NS, Thng PKL. Cervical Myelopathy Secondary to Combined Ossification of Ligamentum Flavum and Posterior Longitudinal Ligament. J Spinal Surg 2016;3(4):157-159.

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CASE REPORT

Shanthanam S Mahalingam, N Vaibhav

Hemorrhage within the Schwannoma of Thoracic Spinal Cord presenting as Acute rapidly Progressive Paraplegia: A Rare Case

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:3] [Pages No:160 - 162]

   DOI: 10.5005/jp-journals-10039-1111  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Vaibhav N, Mahalingam SS, Parthiban JKBC. Hemorrhage within the Schwannoma of Thoracic Spinal Cord presenting as Acute rapidly Progressive Paraplegia: A Rare Case. J Spinal Surg 2016;3(4):160-162.

3,280

CASE REPORT

Shanthanam S Mahalingam, ST Prahlad

Esophageal Perforation due to Anterior Cervical Osteophyte: A Rare Case

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:3] [Pages No:163 - 165]

   DOI: 10.5005/jp-journals-10039-1112  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Prahlad ST, Mahalingam SS, Parthiban JKBC. Esophageal Perforation due to Anterior Cervical Osteophyte: A Rare Case. J Spinal Surg 2016;3(4):163-165.

5,551

CASE REPORT

Varun Gupta, Shraddha K Singhania, Shirish Vaidya, Bhushan Patil

Spinal Meningiomas: A Diagnostic Challenge

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:3] [Pages No:166 - 168]

   DOI: 10.5005/jp-journals-10039-1113  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Singhania SK, Khan SM, Vaidya S, Patil B, Gupta V, Singh PK. Spinal Meningiomas: A Diagnostic Challenge. J Spinal Surg 2016;3(4):166-168.

4,792

RESEARCH ARTICLE

Gopalakrishnan Madhavan Sasidharan

The Great Neurosurgeon and Spinal Surgery

[Year:2016] [Month:October-December] [Volume:3] [Number:4] [Pages:4] [Pages No:169 - 172]

   DOI: 10.5005/jp-journals-10039-1114  |  Open Access |  How to cite  | 

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