How to cite this article: Parthiban JKBC. Launch Pad—God's Own Country: Special Note on Development of Spinal Surgery. J Spinal Surg 2017;4(4):141-144.

To find out the morphometric factors predicting outcome in Chiari I malformation (CM I) associated with syringomyelia.

In a series of 73 patients with CM I and syrinx who underwent posterior fossa decompression (PFD) between August 2013 and October 2015, a total of 54 subjects with sufficient clinical data and imaging suitable for morphometric measurments were evaluated. The parameters analyzed were posterior fossa volume (PFV), tonsillar descent (TD), foramen magnum (FM) diameter, supra-occiput length, clival length, the syrinx, and cord diameter. Patients were divided into two groups: With or without improvement. Improvement at follow-up was assessed with the Chicago Chiari Outcome Scale (CCOS).

Mean PFV was significantly higher in the improvement group (219.90 ± 30.20 vs 187.95 ± 12.51 cm³, p = 0.047). Syrinx to cord ratio was lower in the improved group (0.54 ± 0.21 vs 0.64 ± 0.27, p = 0.081). The cut-off value of preoperative PFV for prediction of improvement was found to be 198.58 cm³ (sensitivity 77.8%, specificity 100%).

To the best of our knowledge, this is the largest series to evaluate the role of morphometry in prediction of surgical outcome in patients with CM I associated with syringomyelia. The PFV is the only radiological factor that differs significantly in patients with and without improvement.

Kumar A, Pruthi N, Devi BI, Gupta AK. Morphometric Factors affecting Functional Outcome in Symptomatic Chiari I Malformation and Syrinx. J Spinal Surg 2017;4(4):145-149.

Anichini G, Gulsin G, Iqbal M, MacIntosh C, Kamel M, Bhatt P. Cauda Equina Syndrome Assessment, Diagnosis, and Management: Results from a Neurosurgical Unit from 1-year Retrospective Series—Is Our Referral System Effective? J Spinal Surg 2017;4(4):150-157.

To conduct a detailed computed tomography (CT) assessment of dimensions of the subaxial cervical spine pedicle in volunteers without any cervical spine pathology.

Sixty-six asymptomatic subjects were analyzed in a single center using cervical spine CT, with imaging reconstruction of each vertebra in axial plane with 1 mm, and in sagittal plane reconstruction with 2 mm slice thickness. Height and weight of each volunteer were measured and body mass index (BMI) was calculated. Parameters, such as pedicle width (PW), pedicle axis length (PAL), pedicle transverse angle (PTA) in axial plane, and pedicle height (PH) in sagittal plane were measured and analyzed. Height and weight of each subject were measured and BMI was calculated as per the formula.

The analysis of CT scan images of the cervical spine of 66 asymptomatic subjects with mean age of 45 years with equal distribution of males and females gave mean BMI values as males: 24.58 ± 2.6 and females: 24.03 ± 2.07. Mean values of PAL were smaller in females compared with males, PAL progressively increased from C3 to C6 vertebrae level for both males and females, while C6 and C7 were similar. The PTA showed no gender variation. However, PTA among C3 to C7 demonstrated the same pattern among the left and right pedicles as they had wide angle in the upper subaxial cervical spine, C3 to C6, and became slightly narrow in the lower cervical region at C7. The PH was found to be smaller in females in comparison with males. The PH difference was observed between left and right-side values for men and women, men's right-side values were higher, whereas higher left-side values were observed in females. The PW was found to be smaller in females in comparison with males, PW increased from C3 to C7 vertebrae level, but we found little difference between left side and right side for both men and women.

Our results are in correlation with previous studies, but our study showed strong correlation between BMI and PW, and the frequency of subjects with PW < 3.5 mm in our population especially in females is higher, suggesting an increased risk to the neurovascular structures while attempting transpedicular screw technique, especially in females.

Murahari P, Bhargav H, Kumar ALMV, Santosh KV, Reddy LJ, Banala RR, Subbaiah GPV. Subaxial Cervical Pedicle Morphometric Assessment in Normal South Indian Subjects using Computed Tomography Scan Images. J Spinal Surg 2017;4(4):158-163.

Respiratory dysfunction in craniovertebral junction (CVJ) pathology can be due to (1) direct compression of neural tissue, or (2) weakness of muscles of respiration. Majority of the times, this impairment is clinically occult. The outcome of a patient with CVJ anomaly is also dependent upon his/her respiratory function.

To assess the respiratory function following relief of compression in the early postoperative (within first week of surgery) and late postoperative period (3 months or more after surgery) and to compare with preoperative status using pulmonary function tests (PFTs).

Twenty-five patients with CVJ pathology underwent bedside evaluation with single breath count (SBC) and respiratory system examination. Spirometry was performed in the preoperative phase and immediate postoperative phase and on follow-up (3 months), and the results were compared and analyzed between the preoperative and postoperative phases and also were compared with healthy, age- and sex-matched controls. Descriptive statistical analysis was carried out using Student's t-test. Wilcoxon signed rank test was used to find the significance of study parameters between pre- and postintervention in each group. Statistical software Statistical Package for the Social Sciences (SPSS) version 15.0, Stata 8.0, MedCalc 9.0.1, and Systat 11.0 were used for the analysis of the data.

Twenty-five patients underwent preoperative and early postoperative and late postoperative evaluation. Majority were in their second and third decades of life. Males were predominant (76%). Atlantoaxial dislocation (AAD) was the most common pathology. All parameters, viz., forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), ratio between FEV1 and FVC (FEV1:FVC), forced expiratory flow, maximal voluntary ventilation (MVV), and peak expiratory flow rate (PEFR) showed significant compromise in the preoperative period compared with normative data, and improvement in all these values occurred in late postoperative period only.

Significant yet occult respiratory dysfunction exists in patients with CVJ anomalies. An objective evaluation of this occult respiratory dysfunction is essential to prevent respiratory complications and improve postoperative respiratory rehabilitation.

Uppar AM, Vilanilam GC, Devi BI, Bhat DI, Shukla DP, Siroya H, Sathyaprabha TN. Respiratory Dysfunction in Craniovertebral Junction Pathology: A Pulmonary Function Test Correlation. J Spinal Surg 2017;4(4):164-170.

6,000 patients were operated for cervical disk herniation and the results of operating anteriorly (anterior diskectomy with/without fusion) were compared to the results of operating posteriorly (laminoforamenotomy/“keyhole” facetectomy). The anterior group (mean follow-up: 5.9 years) had 80% good/excellent results, while the posterior group (mean follow-up: 8.5 years) had 94% good/excellent results (p < 0.05). Perhaps the more complete decompression of the nerve root over time is the reason for the superior long-term outcome.

39,048 patients were operated on for lumbar disk herniation. They were divided into three groups: microdiskectomy, endoscopic microdiskectomy and the classical operation (laminectomy/laminotomy with diskectomy). Mean follow-ups were 4.1 years, 2.9 years, and 6.3 years. Good/excellent results were approximately 80% in all three groups. The same results in each group raises questions about the complete origins of the symptoms in 20% of patients.

Dohrmann GJ, Hsieh JC, Mansour N. Operations for Symptomatic Herniated Intervertebral Disk: A Study of 45,048 Patients. J Spinal Surg 2017;4(4):171-172.

To find the incidence of cervical injury in patients dying due to polytrauma observed during autopsy.

A total of 282 autopsies were studied. The cases included were those of polytrauma. The postmortem examination was done in these cases. Examination of Cervical Column was done from C1 to C7 and evidence of injury was noted and its incidence was found.

Spinal injuries were often secondary to head impacts, or to primary accelerations of the torso without head impact. At postmortem, cervical spine injuries were noted mostly at C5 to C6 level. The most common age group was 21 to 30 years and road traffic accident (RTA) was the most common mode of injury.

We examined the cervical spine at autopsy and found significant results. Cervical spine injuries should always be suspected in polytrauma patients and cervical supportive care should be given right from the initial handling from site of injury till their transportation to emergency centers.

Tadghare J, Rege SV, Nigam M. Incidence of Cervical Spine Injury observed in Polytrauma Patients at Autopsy. J Spinal Surg 2017;4(4):173-177.

To describe a single reference entry point technique for lumbar pedicle screw fixation in degenerative spine and to assess its accuracy in a retrospective case series.

We describe a simple technique for lumbar pedicle screw insertion which is based only on a single reference point, the superior half of transverse process. We retrospectively evaluated the computed tomography (CT) images for any pedicle wall violation with screw of all the patients who were treated by this technique who also had undergone a postoperative CT scan during the study period. A team of three evaluators of different experience and training, including one spine consultant, one spine fellow, and a musculoskeletal radiologist independently studied the CT pictures and pedicle wall violations graded using a previously described grading system, and the data were analyzed by simple percentages.

A total of 240 patients had undergone lumbar pedicle screw fixation with this new technique during the study period, of which 36 had underwent a CT scan. A total of 164 lumbar pedicle screws were assessed. Pedicle wall violations were recorded in 9.7, 8.5, and 12.2% of the screws respectively, by consultant spine surgeon, radiologist, and spine fellow. Most of the breaches were of grade I severity as per all the three observers. There were no grade IV breaches.

The single reference point entry for pedicle screws in the lumbar spine described was as accurate as other well-established techniques with comparable pedicle malposition rates.

Namboothiri SPE, Rangasamy K, Kasi V. Single Reference Point for Lumbar Pedicle Screw Insertion in Degenerative Spine: A Technique and Case Series Analysis. J Spinal Surg 2017;4(4):178-182.

Pathrose E, Sharma M, Kutty S, Saseedharan S, Gadgil Y. Acute Spontaneous Spinal Epidural Hematoma Secondary to Aspirin. J Spinal Surg 2017; 4(4):183-186.

Pawar SG, Prasad A, Ramani PS. Use of Posterior Dynamic Stabilization in Multilevel Degeneration of Lumbar Spine. J Spinal Surg 2017;4(4):187-190.

Rege SV, Jatav G. Multilevel Intramedullary Spinal Epidermoid Cyst. J Spinal Surg 2017;4(4):191-194.

Gotecha S, Chugh A, Amle G, Punia P, Ashok A, Kotecha M. Multifocal Skeletal Tuberculosis involving the Calvarium and Posterior Spinal Elements in an Immunocompetent Patient. J Spinal Surg 2017;4(4):195-199.