Arjun Dhar

Internal decompression for spinal stenosis (IDSS) for decompression and use of interlaminar dynamic device (CoflexTM) for stabilization in the surgical management of degenerative lumbar canal stenosis with or without mild segmental instability: our initial results

Abstract Introduction: Internal decompression of spinal stenosis (IDSS) and Posterior dynamic stabilization (PDS) form a bridge between decompression laminectomy alone and rigid fusion, by attempting to sustain beneficial effects of decompression and stabilization in an attempt to prevent bad effects of relentless degeneration. Objective: To evaluate the clinical outcome in operated patient of posterior dynamic stabilization. Design: Data were collected over 1 year in prospective, nonrandomized follow-up study using outcome scales. Setting: Single surgeon, tertiary care centre in Mumbai, India. Described here is the operative technique of posterior dynamic stabilization using CoFlexTM and clinical outcome of 67 consecutive patients using Visual Analogue Scale and Oswestry Disability Score.

Software version of Roland Morris Disability questionnaire for outcome assessment in low back pain

Abstract Background: Developing and using the software version of existing validated paper version of patient-related outcome can go a long way in saving cost, time and effort. However, the equivalence of paper version and software versions cannot be assumed. The aim of the study is to test the equivalence between paper version and software version of Roland Morris Disability Questionnaire and its acceptability among patients. Methods: This is a within-subject cross over equivalence study. Fifty-five patients with back pain were asked to complete the paper and software version of RMDQ in random order. Patients were included from the Neuro Spinal surgery outpatient department of Lilavati Hospital and Research Center. Results: Statistical analysis of 52 patients who completed the study showed high agreement between the paper and software version of the questionnaire (intraclass correlation coefficient 0.994, 95% confidence interval (0.989–0.996)). High sensitivity and specificity of 84 and 88% of the software version was noted. About 69.2% patients preferred software version over paper version. Conclusion: Our study shows that software version is comparable to the paper version. It may prove to be a useful tool for epidemiological studies and patient follow-up over longer period.

Central or axial atlantoaxial dislocation as a cause of cervical myelopathy: a report of outcome of 5 cases treated by atlantoaxial stabilization

OBJECTIVE The implications of diagnosis and treatment of central or axial atlantoaxial dislocation (CAAD) as a cause of symptoms of cervical myelopathy are evaluated. METHODS This is a report of a series of 5 patients who presented with the primary symptoms of spasticity and motor weakness and paresthesias in all the limbs. There was no evidence of any significant compression of the dural tube or neural structures at the craniovertebral junction. There was no craniovertebral junction instability when assessed by classically described radiologic parameters. CAAD was diagnosed based on our recently discussed parameter of facetal alignment, corroborative clinical and radiologic evidence, and direct observation of atlantoaxial instability by manual manipulation of the bones of the region. All patients underwent atlantoaxial fixation. RESULTS There was remarkable improvement in the clinical symptoms in the immediate postoperative period and during the follow-up period of 12-24 months (average, 16 months). All patients have continued to have progressive clinical recovery. Clinical assessments were done using Goel clinical evaluation scale, Japanese Orthopedic Association score, and visual analog scale. CONCLUSIONS Identification and treatment of CAAD can have a significant management impact on patients where the cause of spastic quadriparesis is otherwise undiagnosed.

Multilevel Spinal Segmental Fixation for Kyphotic Cervical Spinal Deformity in Pediatric Age Group—Report of Management in 2 Cases

OBJECTIVE We discuss the role of instability of multiple spinal segments including the atlantoaxial joint in the pathogenesis of cervical kyphotic deformity. MATERIAL AND METHODS Two male patients (5 and 17 years old) had severe cervical kyphosis and presented with symptoms related to myelopathy. The patients underwent multisegmental spinal distraction and fixation that included atlantoaxial joint. No bone decompression was done. RESULTS At a follow-up of >30 months, both patients had significant neurologic recovery. Investigations at follow-up showed successful arthrodesis of treated spinal segments. Although incomplete, there was recovery in kyphosis. CONCLUSIONS Multisegmental spinal distraction and fixation can lead to reduction in kyphosis and relief from symptoms related to myelopathy. Role of spinal instability in general and atlantoaxial joint instability in particular in pathogenesis of cervical kyphosis need to be assessed on the basis of studies with a larger number of patients.

Silent Spinal Cord Tumor

Introduction: Intramedullary spinal cord tumors are rare, representing 4 to 10% of all central nervous system tumors. They account for 20% of all intraspinal tumors in adults and 35% of all intraspinal tumors in children. Study design: Observational study. Purpose: Understanding the natural progression of an intramedullary spinal cord tumor. Materials and methods: To report a case of silent intradural intramedullary spinal cord tumor in a 38-year-old patient, on regular follow-up in the outpatient department since 6 years. Investigations: Magnetic resonance imaging thoracic spine revealing intramedullary tumor which is localized, central, uniformly enhancing on contrast and is associated with syrinx formation from D1 to D7. Management: Conservative. Conclusion: The rare incidence of intradural tumors commonly results in misdiagnosis and improper diagnostic workup, resulting in delayed diagnosis and treatment. Dilemma exists in the management of clinically silent intramedullary tumors as no specific guidelines have been formulated.

Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre

Abstract Objective: Analysis of three case reports of nerve root anomalies detected intra-operatively and its implications. Design: Data collected during one year prospective non-randomised study using hospital records. Setting: Single tertiary care centre. Subjects: 3 patients in one year period.

Approaches to paraspinal tumours – a technical note

Abstract Neurogenic tumours of the paraspinal space can occur in all age groups. It is common in adult population and relatively rare in elderly group. Usually they are benign, but in children, arising from the autonomic system, tends to be malignant in nature. Usually in adults, they arise from peripheral nerve sheath and are labelled as schwannomas. For a given tumour, determination of a correct surgical approach is mandatory to achieve a successful surgical outcome. Several factors like tumour size, histology, involvement of the bony spinal canal, etc. are some of the deciding factors for a correct surgical approach. Since many such tumours are benign, total excision is possible with a correct surgical approach. If the tumour involves the integrity of the spine then additionally a stabilization procedure may have to be carried out. Unfortunately, there are still no guidelines regarding the choice of surgical approach for the excision of such tumors. Presented here is a series of five patients managed by us over a period of 10 years. Four patients were adults and one female child was three years old. Four patients were operated upon successfully and the fifth one is waiting for surgery.

Chiari malformation: Has the dilemma ended?

Chiari malformation as a clinical entity has been described more than hundred years ago. The concepts regarding pathogenesis, clinical features and management options have not yet conclusively evolved. Considering that a variety of treatment methods are being adopted to treat Chiari malformation is suggestive of the fact that confusion still reigns supreme in the minds of treating clinicians. Over the years, the understanding of Chiari malformation has changed from a disease process to a natural protective phenomenon and the treatment from decompression to fixation.