Premanand S Ramani

Anterior instrumentation for cervical spine tuberculosis: An analysis of surgical experience with 61 cases

OBJECTIVE To evaluate the efficacy of anterior instrumentation in patients with subaxial and cervicodorsal spinal tuberculosis in reconstruction of the spine, providing pain relief, neurological recovery and prevention of deformity. MATERIALS AND METHODS The records of 61 consecutive patients, of surgically treated spinal tuberculosis affecting C3 to D2 region, in our neuro and spinal surgery unit over a five-year period were retrospectively reviewed. Patients with involvement of the C3-C6 vertebrae underwent excision of the involved vertebrae and intervertebral discs followed by reconstruction with titanium implants by anterior approach. A transclavicular approach was used for patients with involvement of the C7-D2 vertebrae. A five-drug antituberculous regimen was administered for a period of one year. The follow-up ranged from 24 to 84 months (mean 38 months). Clinical and radiological assessment using flexion and extension radiographs was performed at 24 months for all cases. RESULTS The neck pain score based on a visual analog scale (1-10) changed from a pre-operative average of 7 to 2 at follow-up after 4 months. Fifty-two patients (85%) had complete relief of pain while 16 patients who had Grade III to IV muscle strength regained complete power. The asymmetric wasting in patients with involvement of the cervicodorsal region did not recover completely. Flexion-extension radiographs at 24 months did not show any evidence of instability or nonunion. CONCLUSIONS Anterior reconstruction using titanium plates and locking screws for stabilization of the subaxial and cervicodorsal region tuberculosis is a useful adjunct in preventing kyphotic deformity. A satisfactory segmental stability and fusion is achieved by this technique.

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.

Predictive Factors of Cervical Traction based on Cervical Spine Realignment shown by Series Lateral Cervical X-ray in Subaxial Cervical Spine Injury Patients

Introduction: Cervical spine injury is the most feared spinal injury for physicians, patients, and their families. All patients with unstable subaxial cervical spine injury must be managed by cervical traction and stabilization. Lateral cervical X-ray remains standard diagnostic tools to evaluate the stability of cervical spine structure and has a high diagnosis value in evaluating the success of the cervical traction. The success of the cervical traction could be predicted by observing the alignment of the cervical based on series lateral cervical spine X-ray. Materials and methods: This retrospective study involves 30 patients with subaxial cervical spine injury admitted to the Emergency Unit of Dr. Hasan Sadikin Hospital, Bandung, Indonesia, from 2012 to 2016. This study uses the logistic regression analysis with p < 0.05 considered to be significant and the confidence interval (CI) of 95%. Results: The results of this study showed that the failure of cervical traction (closed reduction) was mainly determined by interval admission time and facet lock (FL). The interval admission time (p = 0.015; two-sided tail, Pearson’s chi-square) and distribution of FL showed significant results (p = 0.001; two-sided tail Fisher’s exact test). Odds ratio (OR) whether FL is present or absent is 3.8; 95% CI 0.5 to 27.1, with p = 0.001. Conclusion: It is concluded that informed consent regarding cervical traction failure is needed in subaxial cervical injury >24 hours, where in patients with FL cervical traction trail is not needed, instead immediate definitive management (opened reduction) with stabilization is recommended.

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.

Current Concepts in the Management of Type II Odontoid Fractures

Introduction: Fracture of the odontoid and particularly type II, is the commonest injury in the upper cervical spine. In the past, it was presumed to cause by high velocity road traffic accidents. But now, with the increase in the number of two-wheeler vehicles and sub-standard conditions of indian roads, this type of injury is common. It is usually caused by hyper-extension of the neck but, can be caused by hyper-flexion. The surgical management has remained controversial. Material and methods: Data was collected from four centres in MaharashtraIndia. In one centre, the treatment was posterior C1-C2 stabilization with screws and plate. In centre two, odontoid fracture line was fixed by anterior screws. In the third centre, Magerel technique was used. The fourth centre believed in direct anterior screw and plate fixation of the fracture line. Analysis: The number of patients operated upon, were too less in each centre to analyse and compare with each other. As a result, use of software analysis was not felt necessary which is in fact the need to assess the best technique which can be used to treat this fracture. Results: No definite conclusion could be arrived at by studying the pattern of treatment in these four centres. Conclusion: Way back in 2009, an attempt was made to do a multi-centre retrospective analysis. There was no definite conclusion and even in the present study, no definite conclusion is derived. keywords: Better bony fusion with screw and plate, Fracture odontoid, Surgical management, Varied approaches. How to cite this article: Ramani PS. Current Concepts in the Management of Type II Odontoid Fractures. J Spinal Surg 2017;4(3):104-112. Source of support: Nil Conflict of interest: None

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.