The Journal of Spinal Surgery

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2019 | January-March | Volume 6 | Issue 1

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Study of Progression of Spinal Deformity in Dorsolumbar Spinal Injuries Managed by Internal Fixation

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Deformity progression,Denis evaluation score,Dorsolumbar injuries,Short-segment pedicle screw fixation

   DOI: 10.5005/jp-journals-10039-1200  |  Open Access |  How to cite  | 


Introduction: Spinal injuries are frequently seen in India at the thoracolumbar junction. Surgical interventions like pedicle screws are aimed to stabilize the spine preventing long term backache. Studies on the loss of reduction and progression of kyphotic deformity have been reported in the literature but are relatively scarce, and the clinical significance of recurring deformity is uncertain. This study investigated the progression of spinal deformity after management of spinal injuries with short-segment pedicle screw fixation.

Materials and methods: Patients admitted between January 2008 to May 2013 in Dayanand Medical College and Hospital Ludhiana with dorsolumbar injuries and managed surgically with pedicle screw fixation were studied retrospectively and prospectively. At follow up, the patients were examined radiologically on lateral radiographs, neurologically and for pain scales by Denis evaluation score. The correlation between progression of Cobb’s angle with a change in anterior wedge compression angle and intervertebral disc heights was analyzed by regression analysis.

Results: The loss of correction of Cobb’s angle and the decrease in the upper intervertebral disc heights at follow up was found to be statistically significant only anteriorly (r = 0.545, p = 0.013) but not significant at the middle and posteriorly. The back pain was well tolerated at the follow up with 50% patients having no pain and 40% mild pain.

Conclusion: Even as the deformity progresses, the pain is well tolerated by the patients. Significant pain was present in patients who had inadequate postoperative alignment or reduction.



Knee Spine Syndrome: Common Clinical Correlation and Its Management Algorithm

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:5] [Pages No:6 - 10]

Keywords: Degenerative spine disease,Knee spine syndrome,Lumbar lordosis,Total knee replacement

   DOI: 10.5005/jp-journals-10039-1201  |  Open Access |  How to cite  | 


Introduction: Various studies have been carried out proposing the concept of knee spine syndrome measuring simultaneous changes in knee flexion and sacral inclination, but none regarding its management. Here in this study, we put forward the management and diagnostic algorithm for the knee and spine disease operated by the same surgeon.

Materials and methods: This is a prospective study of 10 patients having knee spine syndrome operated by the same surgeon from January 2016 to January 2018. They were selected and treated as per the treatment protocol put forward and clino-radiological outcomes were evaluated with visual analog scale (VAS), oswestry disability index (ODI) scoring, and radiographs.

Results: Age of the patients included in this study ranged from 55–80 years. In 6 patients, the spine was operated first and in others, knee replacement was done as an index procedure. Average pre-operative ODI score was 28.9 which decreased to 7.5 postoperatively at 2-year follow-up. VAS score decreased from 7.4 preoperatively to 1.5.

Conclusion: Knee spine syndrome is one of those entities which need to be identified and treated as a whole and not as two different symptomatic diseases. According to our proposed algorithm, radicular symptoms (spinal pathology) should be treated first. In cases of predominant back pain which could be either due to loss of lumbar lordosis or precipitated by deformity caused by malalignment in osteoarthritis knee, knee replacement was considered first. Despite the proposed algorithm, the clinical acumen of the surgeon in determining the leading cause of morbidity may help prevent unnecessary further staged surgeries.



Study on Single Leg Stance Test as an Outpatient Assessment Tool in Spine Examination

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:5] [Pages No:11 - 15]

   DOI: 10.5005/jp-journals-10039-1202  |  Open Access |  How to cite  | 


Objective: Sciatica is one of the most prevalent clinical conditions seen in spine outpatient clinics. The levels commonly involved are L4-L5 and L5-S1 levels. Examination of L5 nerve root involves motor power of extensor Hallucis Longus (EHL), extensor digitorum, hip abductors and sensation over dorsal aspect of foot. When it comes to the routine out patient clinical examination, the usage of Hip abductor examination is not generally practiced. There is a need to assess the usage of Hip abductor examination as single leg stance test (SLST) in patients presenting with Sciatica in spine outpatient clinics.

Materials and methods: This study is a prospective study involving a total of fifty four patients. Patients presenting with sciatica are made to stand on one leg without support in a firm surface with the other knee flexed to 90° and eyes opened. Interpretations are made. We analyzed our results with motor EHL power and sensory findings.

Results: In our study involving 54 patients, 37% of cases with EHL power 5 had difficulty in performing single leg stance. 100% of cases with EHL power 4 had difficulty. 100% cases with EHL power 3 or less than 3 had difficulty in performing, with 35% among those even not possible to perform SLST.

Conclusion: This study shows Single Leg Stance Test (SLST) as an excellent clinical assessment tool for L5 nerve root examination in patients presenting with sciatica. It is easily reproducible, less inter/intra observer bias, more accurate in predicting deficit, useful in acute painful cases and in people with hallux valgus deformities. Single Leg Stance Test (SLST) may be considered as an assessment tool for patients in spine examination in outpatient clinics.

Keywords: L5 nerve root examination, Single leg stance test, Spine outpatient assessment.

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. No financial aid or funding received.



Cervicodorsal Intramedullary Ependymoma Presenting with Spontaneous Intratumoral Bleed and Acute Quadriparesis

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:3] [Pages No:16 - 18]

Keywords: Acute quadriparesis,Ependymoma,Hemorrhage

   DOI: 10.5005/jp-journals-10039-1203  |  Open Access |  How to cite  | 


Ependymomas are the most common intramedullary spinal cord tumors in adults and account for 1–5% of spinal tumors. The presence of hemorrhage within the spinal ependymoma is not uncommon on imaging studies, however an ependymoma of the cervicodorsal region presenting as sudden acute onset quadriparesis following intratumoral bleed has never been reported in world literature. This rare case of spontaneous hemorrhage into a cervicodorsal intramedullary ependymoma in a 40-year-old lady was immediately operated and showed excellent recovery.



Mediastinal Hydatid Disease with Spinal Involvement—A Rare Cause of Spinal Cord Compression

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:3] [Pages No:19 - 21]

Keywords: Echinococcus,Hydatid,Mediastinum,Spine

   DOI: 10.5005/jp-journals-10039-1204  |  Open Access |  How to cite  | 


Spinal hydatid disease accounts for less than 1% of human hydatid disease. It can very rarely lead to paraplegia. We report a rare case of spinal hydatid disease and review the pertinent literature. A young man presented with gradually progressive paraparesis and urinary incontinence. Imaging showed with thoracic extension, pathologically confirmed as hydatid cyst following surgical excision. He showed remarkable postoperative improvement and is now able to ambulate without support at 1-year follow-up. This case stands distinct in highlighting two aspects, the rare spinal location of a hydatid cyst and complete recovery of paraplegia following surgical excision.



A Case Report of Spondylodiscitis Masquerading as Malignancy

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: Mesenchymal neoplasm,Role of culture and biopsy

   DOI: 10.5005/jp-journals-10039-1205  |  Open Access |  How to cite  | 


Aim: A case report of spondylodiscitis mimicking as malignancy.

Background: Spinal infections include a broad spectrum of presentations like spondylodiscitis, osteomyelitis and paravertebral abscess formation. Disease presentation is varied and can be back pain, leg pain, fever or neurologic deficit. Diagnosis is often delayed by misinterpretation of spinal infectious diseases with urological or abdominal disorders and malignancies.

Case description: Sixty-year-old male presented with Low Back pain and radiating right leg pain. He underwent computed tomography (CT) guided biopsy from the left paravertebral region at L3 level. Biopsy showed fibromuscular tissue and collagen infiltrated with poorly differentiated spindle cells, suggestive of poorly differentiated low-grade mesenchymal neoplasm. He was started on radiotherapy and chemotherapy. The patient followed the treatment for 4 weeks and his condition continued to worsen since then. The patient was referred to our center. magnetic resonance imaging (MRI) showed L2-L3 level T1 hypointense endplate changes with marrow edema with thick walled soft tissue paravertebral collections on bilateral psoas. Laboratory results showed elevated ESR (65 mm) and Image result for CRP full form in

C-Reactive Protein (CRP) (102) values. Intraoperatively, granulation tissue was seen compressing the cord and frank pus discharge seen after annulotomy of the L2–L3 Disc space. Biopsy obtained, decompression and stabilization done. Histopathology showed tissue infiltrated by neutrophils, no granuloma/ malignant cells, consistent with suppurative inflammation. Escherichia coli heavy growth obtained in tissue culture. The patient was started on culture sensitive antibiotics. He showed signs of clinical improvement and continued on intravenous antibiotics for 3 weeks, followed by oral antibiotics for 3 weeks. At 24 weeks, he is completely relieved of pain, doing his routine activities, walking independently and lab values normal.

Conclusion: Spinal infections should be suspected in patients with back pain, fever, and elevated inflammatory markers. Diagnosis should involve imaging, microbiology, and histopathology.

Clinical significance: Tissue culture and histopathological examination should be indicated for all spinal lesions to avoid mismanagement.



Unilateral Multilevel Interlaminar Fenestration—An Alternative Approach to Multisegment Intraspinal Space Occupying Lesion

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:3] [Pages No:26 - 28]

Keywords: Interlaminar fenestration,Intraspinal,Multilevel,Space occupying lesion

   DOI: 10.5005/jp-journals-10039-1206  |  Open Access |  How to cite  | 


Conventional laminectomy is the most common dorsal approach to intraspinal space-occupying lesions. But this approach may result in instability of the vertebral column leading to progressing spinal deformities. Lesser invasive procedures like hemilaminectomies and osteoplastic laminotomies also interfere with the spinal stability to a certain extent. This technical note is a demonstration of interlaminar fenestration done for removal of multisegmental spinal tumor thereby retaining the functional stability of the spine.



Spinal Cord Rotation by Denticulate Ligamental Stay-sutures for Anteriorly Placed Intradural Lesions—Technical Note

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:3] [Pages No:29 - 31]

Keywords: Dentate ligament,Denticulate ligament,Spinal cord tumor,Spinal cord rotation,Spinal cord retraction

   DOI: 10.5005/jp-journals-10039-1207  |  Open Access |  How to cite  | 


Anteriorly placed intradural lesions pose specific surgical challenges in accomplishing tumor resection without manipulation of the spinal cord. The authors describe a technique of ‘flipping of spinal cord’ by up to 30-degrees using denticulate ligamental rotational stay-sutures. The technique of spinal cord rotation enables the surgeon to obtain corridor amongst dorsal nerve rootlets for tumor exposure through standard posterior or postero-lateral approaches to the spinal column. The authors believe that this technique minimizes handling of the spinal cord and negates the need for spinal cord retraction for tumor access. Relevant anatomy of dentate ligaments, salient steps in the procedure with representative pictures and video are described. Advantages, as well as limitations of this technique, are highlighted.



Ralph Bingham Cloward: A Historical Vignette

[Year:2019] [Month:January-March] [Volume:6] [Number:1] [Pages:2] [Pages No:32 - 33]

   DOI: 10.5005/jp-journals-10039-1208  |  Open Access |  How to cite  | 


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