Kusaka G, Kanda M, Shoda M, Ikota M, Soma N, Tsuji T, Nagai M, Tanaka Y. A Case of Atlantoaxial Dislocation surgically Fixated with Laminar Craw Hooks, Spinous Plates, and Occipital Plate System. J Spinal Surg 2017;4(2):47-49.

Reyes-Sánchez AA, García-Ramos CL, Kalfopulos BZ, Alpizar-Aguirre A, Olivares LMR. Idiopathic Scoliosis: Anterior Approach and Fixation from the Concavity. J Spinal Surg 2017;4(2):50-54.

Anterior cervical discectomy with fusion (ACDF) and cervical corpectomies are commonly performed procedures in the neurosurgery and orthopedic units across the world. The size of the graft or prosthesis used is variable on individual basis. Also, geographical variations seem to play one of the vital roles in determining the size of the cervical vertebral body and intervertebral disk dimensions.

To study dimension of C3 to C7 vertebral body and C2/3 to C7/T1 intervertebral disk.

Nepalese nationality aged between 18 to 60 year old and those with normal cervical spine Magnetic resonance imaging.

Traumatic cervical spine and any pathological lesion, such as infection/tumor, destructing the normal morphology of cervical vertebra.

Cross-sectional study.

Fifty-two cases.

Nonprobability consecutive sampling.

Retrospective 1 year.

There were a total of 52 patients, 33 female and 19 male. With increasing age of C5 to C7, anterior-posterior (AP) diameter increases significantly. No significant association in different gender was noted. However, vertical height was smaller and AP diameter was in-between the study done at Israel and the US. Thus, there seems to exist geographical variation in the dimension of the cervical spine and may possess a greater clinical impact. The dimensions of the cervical spine may need to be considered while designing the prosthesis used in ACDF for Nepalese population.

Nepal PR, Rijal S, Shrestha J, Devkota UP. Anthropometric Study of Cervical Spine in Adult Nepalese. J Spinal Surg 2017;4(2):55-59.

Percutaneous posterior fixation is a novel and unique modality to fix traumatic spine injury. Conventionally, traumatic spine injury severe enough to consider for fixation is approached by open method. However, this method is disadvantageous as there occurs further trauma to the surrounding soft tissue while approaching spine for fixation. Percutaneous technique, on the contrary, offers stable fixation as conventional method and also offers added advantage of minimal soft tissue damage.

This is an original prospective cohort study of 35 patients having traumatic spine injury operated by percutaneous posterior fixation.

To compare the midterm results of percutaneous posterior fixation vs conventional (open) posterior fixation and to evaluate the role of percutaneous posterior fixation as damage control surgery (DCS).

This is a prospective cohort study of 35 patients operated at a single center from January 2012 to January 2014 with 2 years of follow-up.

As observed in our study, traumatic spine injury is more common in middle-aged male patients. Percutaneous fixation provides definitive advantage over conventional method of posterior fixation in terms of decreased intraoperative blood loss, decreased postoperative pain, earlier mobilization of the patients, reduced duration of hospital stay, less complications, and better functional outcome as measured by visual analog scale (VAS) score, Oswestry disability index (ODI) score, and SF-36 score, modified MacNab's criteria.

Postoperatively, all the patients had either excellent or good outcome as measured by MacNab's criteria.

Midterm results of percutaneous fixation are equivalent to conventional method with added advantage of reduced risk of infection as observed in our study. Percutaneous fixation has more to it rather than only DCS, however, its role in replacing conventional method requires proper surgeon training, steep learning curve, long-term studies and critical evaluation.

Patel KR, Modi JV, Tankshali KV. Percutaneous Posterior Fixation: A Unique Entity to minimize Further Damage to Patient with Traumatic Spine. J Spinal Surg 2017;4(2):60-64.

Kalyanaraman S. Surgical Technique of Excision of Lumbar Intervertebral Disk Protrusion. J Spinal Surg 2017;4(2):65-71.

All patients with thoracolumbar junction fractures included in our study were evaluated between 2014 and 2016 with biomechanical criteria and clinical outcome. The immediate postoperative radiographs were compared with radiographs of each follow-up, evaluating any loss of correction by measuring kyphotic angle using Cobb's method, also at each follow-up, clinical outcome was measured using Oswestry disability index. The intraobserver and interobserver reliability were analyzed.

There were 35 patients with unstable thoracolumbar fractures in our study who were operated using posterior spinal fixation system during 2014 to 2016 with pedicle screw insertion at the level of the fractured vertebrae. The average follow-up was 18 months. The average preoperative kyphotic angle as measured by Cobb's method in all the cases was 17.2°, which improved to 5.9°, achieving a mean of 65% correction immediately postoperatively. At final follow-up, average postoperative Cobb's angle was 7.7°, maintaining 55% correction at final follow-up. Disability improved from 78% mean preoperatively to 47.27% mean postoperatively at final follow-up.

Short same-segment posterior fixation decreases implantation failure rate and has better biomechanical stability compared with traditional SSPF; however, long-term kyphosis correction to a greater extent was not maintained, which was also statistically insignificant. Despite this loss of kyphosis correction, clinical pain and disability improved at long-term follow-up.

Jain S, Mittal P, Kumar A. Outcome of Short Same-segment Fixation in Thoracolumbar Junction Fractures. J Spinal Surg 2017;4(2):72-75.

Vishwanath S, Pavan S, Jayanth H. A Walk to Remember. J Spinal Surg 2017;4(2):76-78.

Shrivastav A, Mediratta S. Artificial Cervical Disk Replacement at Three Levels Following Multilevel Cervical Diskectomy. J Spinal Surg 2017;4(2):79-82.

A case report and literature review.

Hemangiomas are frequently considered as hamartomatous congenital vascular malformations. Hemangiomas of the spine are usually lesions of the vertebral bodies, but they can occur at other locations, such as the intramedullary or epidural space. Purely epidural hemangiomas are rare and most of them are of cavernous type.

This is a case report of a 70-year-old male with a D6, D7 dumbbell-shaped capillary hemangioma with extraforaminal extension on the left side. Patient underwent D6-8 laminectomy and en bloc resection of the lesion.

Microscopic evaluation showed a fibrofatty tissue with a proliferation of small-sized vascular structures with areas of myxoid appearance. To date, there have been nine epidural capillary hemangiomas of the thoracic and lumbar spine reported in the literature.

It is important to consider hemangiomas in the differential diagnosis of epidural lesions with dumbbell-shaped appearance in the magnetic resonance imaging study, especially at the thoracic level. These benign lesions usually present as a progressive myelopathy, so early treatment may prevent permanent neurological deficits and result in complete cure.

Sankar MM, Kumar RSS, Rajkumar S. A Rare Case of Dumbbell-shaped Spinal Epidural Capillary Hemangioma. J Spinal Surg 2017;4(2):83-86.

Modi MN. Lumbar Intramedullary Abscess and Thoracic Syrinx Secondary to Congenital Dermal Sinus: A Rare Case of Paraplegia. J Spinal Surg 2017;4(2):87-88.

To discuss a rare entity that was encountered along with its findings and outcome.

Malignant peripheral nerve sheath tumors (MPNSTs) are sarcomas which originate from peripheral nerves or from cells associated with the nerve sheath, such as Schwann cells, perineural cells, or fibroblasts. These are rare but aggressive neoplasms. The MPNST are frequently seen in the head, neck, and upper extremities. Retroperitoneal cases are fairly rare and clinically difficult to be detected. These tumors have a very aggressive clinical course. The MPNSTs can arise de novo or from malignant transformation of benign nerve sheath tumors. The clinical course is usually short. In most cases, the diagnosis depends on the pathologic and immunohistochemical studies.

Here we report the case of a 42-year-old male patient who presented with swelling over lower back region and paresthesia over anterior aspect of left thigh since last 2 years, which aggravated over last 1 month. It was of pins-and-needle sensation type. Radiologically, the tumor was found extended from retroperitoneum into the spinal canal through the intervertebral foramina of D12–L1 and L1–L2 and compressing dura and its contents. Patient was treated surgically and histopathological examination confirmed MPNSTs.

The MPNSTs can arise de novo or from malignant transformation of benign nerve sheath tumors. The clinical course is usually short. In most cases, the diagnosis depends on the pathologic and immunohistochemical studies.

Jain SK, Lamba A, Peethambaran A, Kutty RK, Kumar S, Nagar M. Malignant Nerve Sheath Tumor with Retroperitoneal Extension. J Spinal Surg 2017;4(2):89-92.