Current Issue Volume 5, Number 3 , July-September 2018

Sarvdeep S Dhatt, Vishal Kumar, Sanjeeb Rijal, Mahesh Prakash

Morphometric Analysis of Cervical Spine Pedicles in an Indian Population

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:103-106]

Introduction: The quantitative understanding of cervical pedicle morphology minimizes the injury to the neurovascular structure and improves the surgical outcome. This study aimed to investigate the morphometry of the cervical pedicle using Computerized CT scans.

Methods: The CT scan was performed in eleven cervical spine injury patients and the axial and sagittal images were used to calculate the four linear parameters-Outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle axis length (PAL) and the pedicle transverse angle (PTA).

Results: A total of 110 pedicles were measured and studied. The mean outer pedicle width, inner pedicle width, and pedicle height showed a gradual increase of the value from C3 to C7. The pedicle transverse angle showed maximum value at C4 vertebra and the minimum value at C7 vertebrae.

Conclusion: The study demonstrated that pedicle dimensions were small in comparison to the European and other Asian populations. To enhance the safety of cervical pedicle screw insertion, the pedicle dimensions and trajectories should be determined individually.The screw diameter should also be optimal to avoid pedicle violations because of narrow outer pedicle widths in our study population.

Keywords: Cervical pedicle, Cervical pedicle screw, Pedicle morphometry

How to cite this article: Dhatt SS, Kumar V, Rijal S, Prakash M. Morphometric Analysis of Cervical Spine Pedicles in an Indian Population. J Spinal Surg 2018;5(3):103-106.

Source of support: Nil

Conflict of interest: None

Ankush Gupta, Bijesh Ravindran Nair, Vivek Joseph

Odontoid Fractures: 7-Year Experience from a Tertiary Care Referral Center in South India

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:107-114]

Introduction: Odontoid fractures form about 10% of all cervical spine injuries. We looked at our 7-year experience with odontoid fractures.

Material and methods: A retrospective analysis of all patients admitted with a diagnosis of odontoid fracture, in a neurosurgical unit of Christian Medical College, Vellore, India, during the period from April 2008 to January 2015 was done. Their preand postoperative clinical status, radiology, treatment given, outcomes and complications were assessed.

Results: Twenty-three patients with odontoid fractures were treated during this period, predominantly males (n = 21) and with a mean age of 37 years. There were 17 Type II fractures and 6 Type III fractures. Eight patients were managed with anterior odontoid screw fixation, eight with posterior instrumented fusion and four underwent a transoral odontoidectomy followed by posterior fusion. Three patients were conservatively managed (two with halo fixation and one with cervical collar). Two patients developed cut out of the anterior odontoid screw through the C2 body, thereby requiring posterior fusion. There was no mortality in our series. At a mean follow-up duration of 24.6 months (n = 17), there was no worsening of American Spinal Injury Association (ASIA) grade clinically, with evidence of radiological fusion in all cases except the one case managed with a cervical collar.

Conclusion: Odontoid fractures can be managed in a variety of ways. Choosing the appropriate treatment for each patient is important. Bony fusion in a reduced position is the goal of the treatment.

Keywords: Cervical, Fracture, Fusion, Odontoid, Spine, Trauma

How to cite this article: Gupta A, Nair BR, Joseph V. Odontoid Fractures-7-Year Experience from a Tertiary Care Referral Center in South India. J Spinal Surg 2018;5(3):107-114.

Source of support: Nil

Conflict of interest: None

Pankaj R Nepal, Suman Rijal

Prevalence and Factors Associated with Modic Changes of Lumbosacral Spine in Nepalese Patients with Chronic Low Back Pain

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:115-119]

Aim: To determine prevalence and factors affecting modic changes (MC) of vertebral endplate in patients with chronic low back pain Nepalese patients coming to a neurosurgical.tertiary care center in Nepal.

Materials and methods

Study design: Prospective analytical study

Sample size: 194 cases

Sampling technique: Nonprobability consecutive sampling

Data collection and analysis: Patients clinical data like age, gender, occupation, body mass index, smoking habit, and history of diabetes mellitus (DM) were noted and status of Modic changes were noted from the MRI. The analysis was done using SPSS-20. Mean and standard deviation (SD) were calculated for quantitative variables. Frequency and percentage were calculated for qualitative variables. Effect modifier has been controlled through stratification and post-stratification Chi-square test was applied with P.0.05 was taken significantly.

Results: Overall prevalence of the Modic changes was 50.5% where MC II was the commonest of all the types. Prevalence of MC was significantly higher in patients who are elderly, obese, had severe pain on presentation, and had a habit of smoking.

Conclusion: Modic change occurring at the vertebral endplate is a common phenomenon with significant association with the age, severity of pain, smoking, and Body Mass Index (BMI).

Clinical significance: Modic changes (MC) are the pathological changes of the vertebral body and endplate of the vertebra. Its prevalence in the general population is about 6% and presented in about 35% of patients with low back pain. Various researches have been conducted to see its association with back pain; however, controversies still persist. So this research further highlights the factors that could be associated with its prevalence.

Keywords: Low backache, Lower back pain, Modic changes, Herniated lumbar disc

How to cite this article: Nepal PR, Rijal S. Prevalence and Factors Associated withModic Changes of Lumbosacral Spine in Nepalese Patients with Chronic Low Back Pain. J Spinal Surg 2018;5(3):115-119.

Source of support: Nil

Conflict of interest: None

Abhidha Shah, Abhinandan Patil, Shashi Ranjan, Atul Goel

Concepts in the Management of Syringomyelia

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:120-127]

Objective: The authors analyze their experience with syringomyelia. The treatment was focused on identification of the primary etiological factor and its treatment.

Methods: Depending on the etiological factors and treatment considerations the series was classified into three groups. Group 1 had cases where there was no definite demonstrable etiological factor. Group 2 cases had basilar invagination and/or Chiari malformation, and Group 3 consisted of cases where the syrinx was secondary to an obvious aetiology, such as a mass lesion either in the posterior cranial fossa or in the spine or a severe kyphotic spinal deformity. Post-traumatic syringomyelia and syrinx in association with spina bifida were not studied. There is a significant subgroup where no cause is identified when evaluated by conventional radiological parameters. However, atlantoaxial dislocation was identified when assessed by Goel classification of facetal alignment.

Results: In general, in Group 1 (or in idiopathic group), atlantoaxial instability was identified and was accordingly treated. In Group II, atlantoaxial instability was considered to be defining phenomenon. Accordingly atlantoaxial fixation was the treatment. In Group III the treatment was focused on the etiological factor. It was identified that direct syrinx drainage was not only not useful, but was harmful. It was observed that clinical outcome rather than radiological improvement is the reliable indicator of the surgical result.

Conclusion: Syringomyelia is ’never’ a primary pathological event but is secondary to a known or unknown (or unidentified) pathology. Treatment of the primary etiology is the goal in management of this condition

Keywords: Atlantoaxial instability, Basilar invagination, Chiari formation, Syringomyelia.

How to cite this article: Shah A, Patil A, Ranjan S, Goel A. Concepts in the Management of Syringomyelia. J Spinal Surg 2018;5(3):120-127.

Source of support: Nil

Conflict of interest: None

Jitendra M Tadghare, Shrikant Rege

Lumbar Intervertebral Discal Cyst: A very Rare Cause of Low Back Pain and Radiculopathy in Adults

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:128-131]

The lumbar intervertebral discal cyst is a very rare benign spinal lesion. Only a few cases are reported in the literature. It may cause spinal nerve root compression and subsequent neurological deficits like low back pain and radiculopathy. MRI is the investigation of choice. Surgical excision of the cyst and the decompression of the nerve root and the thecal sac is the definitive treatment. Here, we are presenting a similar case in 26-year male, its diagnosis, surgical management, and outcome.

Keywords: Discal cyst, Lumbar spine, Intervertebral.

How to cite this article: Tadghare JM, Rege S. Lumbar Intervertebral Discal Cyst : A very Rare Cause of Low Back Pain and Radiculopathy in Adults. J Spinal Surg 2018;5(3):128-131.

Source of support: Nil

Conflict of interest: None

Amit Agrawal

Management of a Case of Spinal Cord Injury Sustained During Pregnancy

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:132-134]

Spinal cord injuries during pregnancy are not frequently reported in the literature. In the present article, we report a case of a 20 year pregnant female who sustained a spinal fracture in a road traffic accident. On examination, there were no neurological deficits. Imaging findings were suggestive of an unstable spine fracture which was managed surgically. The patient made a good recovery.

Key words: Pregnancy, Spinal cord injury, Spinal fracture

How to cite this article: Agrawal A. Management of a Case of Spinal Cord Injury Sustained During Pregnancy. J Spinal Surg 2018;5(3):132-134.

Source of support: Nil

Conflict of interest: None

Lokesh S Nehete, Indiradevi Bhagavatula, Subhas Konar, Varun Reddy, Prashant Singh

Uncommon Presentation of Ankylosing Spondylitis–Primary Stenosis at C1 Arch

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:135-137]

Aim: The object of this case report is to report primary C1 arch stenosis as a cause of myelopathy in an ankylosing spondylitis patient.

Background: Myelopathy at the level of the atlas in ankylosing spondylitis is commonly caused by atlantoaxial or occipitocervical subluxation, retro-odontiod pannus formation, cranial settling/ basilar invagination, odontoid fracture. Myelopathic feature are often neglected and are attributed to sacroiliac and lumbar spine involvement initially in these patients.

Case report: A 54 years old patient with long-standing ankylosing spondylitis presented with history neck pain with restriction of neck movements, gradually progressive weakness and stiffening of all four limbs. On examination, the patient had myelopathic features. Computed tomography (CT) of cervical spine showed straightening of cervical spine with severe stenosis at the C1 and bamboo stick appearance of a spine. The Magnetic resonance imaging (MRI) showed cord compression and T2 cord signal changes at the C1 level. The patient underwent C2 laminectomy and C1 posterior arch excision in neutral prone position. Postoperatively, the patient demonstrated improved limbs activity with a reduction in the flexor spasm.

Conclusion: Primary C1 arch stenosis may be one of the causes of myelopathy in ankylosing spondylitis patients and timely diagnosis and intervention benefits the patient and reduces morbidity.

Keywords: Ankylosing spondylitis, C1 arch stenosis, Enthesopathy.

How to cite this article: Nehete LS, Bhagavatula I, Konar S, Reddy V, Singh P. Uncommon Presentation of Ankylosing Spondylitis - Primary Stenosis at C1 Arch. J Spinal Surg 2018;5(3):135-137.

Source of support: Nil

Conflict of interest: None

Bipin Chaurasia, Dhiman Chowdhury, Ayub Ansari, Robert A Khan, Raushan Chaurasia, Akhlaque H Khan, Ranjit K Chaurasiya, Kanak K Barua, Ramesh Chaurasia, Nazmin A Lopa, Sweta K Chaurasia, Pulak Biswas, Md. Mainul Islam

Bilateral Symmetric Dumbbell C1-C2 Ganglioneuroma in Neurofibromatosis Type 1 Patient Causing Spastic Quadriparesis

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:138-143]

Introduction: Ganglioneuroma is a very rare tumor and rarely found bilaterally in association with neurofibromatosis patient. Very few cases of dumbbell ganglioneuroma in the cervical region have been reported in the literature.

Materials and methods: A 36-year young male presented to us with a complaint of progressive spastic quadriparesis for 4 years. We did MRI of the cervical spine with contrast and found bilateral symmetrical dumbbell mass at the C1-C2 level severely compressing the spinal cord. Rest of the spine and brain imaging showed normal findings.

Result: We operated the patient. Bilateral decompression of the cervical spine at the corresponding level was achieved by complete removal of tumor. Patient’s motor power of all limbs gradually improved. Histopathology was done which revealed ganglioneuroma of both the resected tumors.

Conclusion: Bilateral symmetric dumbbell ganglioneuroma is extremely rare in C1-C2 region and can be associated with neurofibromatosis Type 1.

Keywords: Dumbbell, Ganglioneuroma, Neurofibromatosis Type 1, Spastic quadriparesis

How to cite this article: Chaurasia B, Chowdhury D, Ansari A, Khan RA, Chaurasia R, Khan AH, Chaurasiya RK, Barua KK, Chaurasia R, Lopa NA, Chaurasia SK, Biswas P, Islam MM. Bilateral Symmetric Dumbbell C1-C2 Ganglioneuroma in Neurofibromatosis Type 1 Patient Causing Spastic Quadriparesis J Spinal Surg 2018;5(3):138-143.

Source of support: Nil

Conflict of interest: None

Satyashiva Munjal

Conus Hemangioblastoma with Holocord Syrinx not Associated with von-Hippel Lindau (vHL) Syndrome: A Case Report

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:144-146]

We present a case of 40-year-old male who presented with backache, numbness and gradually progressive weakness of lower limbs of 6 months duration. Magnetic resonance imaging (MRI) revealed a homogeneously enhancing tumor in the conus with holocord syrinx suggestive of a hemangioblastoma. Hemangioblastoma of the conus medullaris is a rare pathology especially when it is not associated with vHL syndrome. Here we discuss surgical nuances of operating upon such a rare pathology and briefly review the literature.

Keywords: Conus medullaris tumor, Holocord syrinx, Spinal hemangioblastoma.

How to cite this article: Munjal S. Conus Hemangioblastoma with Holocord Syrinx not Associated with vHL Syndrome: A Case Report. J Spinal Surg 2018;5(3):144-146.

Source of support: Nil

Conflict of interest: None

Abhidha Shah

The Great Neurosurgeon and Spinal Surgery Atul Goel—A Neurosurgical Genius

[Year:2018] [Month:July-September] [Volumn:5 ] [Number:3] [Pages:50] [Pages No:147-153]

“Throughout the centuries some men took first steps down new roads with nothing but their own vision.” This quote by Ayn Rand very aptly suits the persona of Dr. Atul Goel. I would like to call him the John Galt of neurosurgery. His “out of the box” concepts and ideas have revolutionized many a neurosurgical practice. A neurosurgeon par excellence, Dr. Goel is a unique combination of science and philosophy rolled in one