Pub Date : 2021-10-01DOI: 10.21608/esj.2022.111781.1205
Mohamed K. Elkazaz, A. Abou -Madawi, Hassan A. Alshatoury, Mohamed Alqazaz, Ahmed Abdemoniem, K. Salem
Background Data: Adult degenerative scoliosis has at its starting point the same broader definition of adult scoliosis, which is defined as a Cobb angle of greater than 10 degrees measured in the coronal plane. However, it is exclusive for adults who previously had normal spinal alignment. Such pathology with no specific etiology results from a combination of degenerative lumbar diseases. Oblique lumbar interbody fusion (OLIF) is one of the fusion techniques used. It was introduced to overcome the disadvantages of the commonly used interbody fusions like anterior (ALIF), lateral (LLIF), or posterior (PLIF) interbody fusions. OLIF can achieve spinal stability, correct alignment in coronal and sagittal balance anteriorly, and indirectly decompress neural structures with fewer complications related to traditional transpsoas or retropsoas approaches. Study Design: Prospective clinical case study. Objective: To assess the degree of coronal and sagittal deformity correction in patients suffering from degenerative lumbar spine deformities after stand-alone (SA) OLIF. Patients and Methods: Patients with ADS following specific inclusion criteria underwent SA OLIF. Preand postoperative clinical data (back and leg pain VAS and ODI), radiological data (spinopelvic parameters, segmental Cobb’s angle, and anterior disc height), and intraoperative data (operative time, amount of blood loss, “intraoperative or postoperative” complications, and hospital stay) were all analyzed and compared statistically. Results: A total of 28 patients and 30 levels underwent operation by SA OLIF, with a mean age of 50.54 ± 6.05 years, including 14 males and 14 females. The mean operative time/min, blood loss/ml, and hospital stay/day was 91.29 ± 14.23, 195.54 ± 42.299, and 2.78 ± 0.875, respectively. The mean of back pain VAS, the mean of leg pain VAS, and ODI changed from preoperatively 7.36 ± 0.98, 6.36 ± 0.911, and 68.615 ± 8.72 to 4.07 ± 1.01, 2.07 ± 0.9, and 20.23 ± 4.7 in 1 year, respectively. The average SVA, PT, and Cobb angle decreased from 12.93, 19.21, and 10.39 to 8.93, 18.42, and 7.04 in 1 year, respectively.
{"title":"Correcting Degenerative Lumbar Spine Deformity by Stand-Alone Anterior Oblique Lumbar Interbody Fusion","authors":"Mohamed K. Elkazaz, A. Abou -Madawi, Hassan A. Alshatoury, Mohamed Alqazaz, Ahmed Abdemoniem, K. Salem","doi":"10.21608/esj.2022.111781.1205","DOIUrl":"https://doi.org/10.21608/esj.2022.111781.1205","url":null,"abstract":"Background Data: Adult degenerative scoliosis has at its starting point the same broader definition of adult scoliosis, which is defined as a Cobb angle of greater than 10 degrees measured in the coronal plane. However, it is exclusive for adults who previously had normal spinal alignment. Such pathology with no specific etiology results from a combination of degenerative lumbar diseases. Oblique lumbar interbody fusion (OLIF) is one of the fusion techniques used. It was introduced to overcome the disadvantages of the commonly used interbody fusions like anterior (ALIF), lateral (LLIF), or posterior (PLIF) interbody fusions. OLIF can achieve spinal stability, correct alignment in coronal and sagittal balance anteriorly, and indirectly decompress neural structures with fewer complications related to traditional transpsoas or retropsoas approaches. Study Design: Prospective clinical case study. Objective: To assess the degree of coronal and sagittal deformity correction in patients suffering from degenerative lumbar spine deformities after stand-alone (SA) OLIF. Patients and Methods: Patients with ADS following specific inclusion criteria underwent SA OLIF. Preand postoperative clinical data (back and leg pain VAS and ODI), radiological data (spinopelvic parameters, segmental Cobb’s angle, and anterior disc height), and intraoperative data (operative time, amount of blood loss, “intraoperative or postoperative” complications, and hospital stay) were all analyzed and compared statistically. Results: A total of 28 patients and 30 levels underwent operation by SA OLIF, with a mean age of 50.54 ± 6.05 years, including 14 males and 14 females. The mean operative time/min, blood loss/ml, and hospital stay/day was 91.29 ± 14.23, 195.54 ± 42.299, and 2.78 ± 0.875, respectively. The mean of back pain VAS, the mean of leg pain VAS, and ODI changed from preoperatively 7.36 ± 0.98, 6.36 ± 0.911, and 68.615 ± 8.72 to 4.07 ± 1.01, 2.07 ± 0.9, and 20.23 ± 4.7 in 1 year, respectively. The average SVA, PT, and Cobb angle decreased from 12.93, 19.21, and 10.39 to 8.93, 18.42, and 7.04 in 1 year, respectively.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48916593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.21608/esj.2022.117288.1211
Ghazwan A. Hasan, A. Ali, A. Al-Jasim, Shahbaz Khan
Background Data: Multiple noncontiguous spontaneous pyogenic spondylodiscitis is rare and has only been explained in the literature by case reports and case series. Purpose : We present a case report of multiple noncontiguous spontaneous spondylodiscitis caused by E. coli involving the cervical and lumbar spine following a mastectomy for breast cancer. We will explain the difficulties in diagnosis, treatment, and follow-up with the concomitant. Study Design: A case report and literature review. Case Report: A middle-aged patient with a history of breast carcinoma underwent surgery. Two weeks after mastectomy, the patient developed severe cervical and lumbar spine pain and a low-grade fever (37.5– 38.3 °C). Moreover, neurological examination revealed a right-sided antalgic gait, right-sided weakness, and a positive straight leg raising test. Upon presentation, elevated C-reactive protein (CRP) and white blood cells (WBC) were noted. Magnetic resonance imaging (MRI) showed consistent spondylodiscitis at C5-C6 and L3-L4 levels with stenotic features at L4-L5 levels. Surgical treatment of the lumbar region via posterior spinal instrumentation from L3 to L5 levels and decompression was done with a biopsy. Erythrocyte sedimentation rate (ESR) CRP titers were also performed for the follow-up plan, which showed a reduction in 3, 6, and 12 weeks postoperatively. Conservative treatment of the cervical region was undertaken with a complete cure. Conclusion: Multiple noncontiguous spondylodiscitis after nonspinal surgery is a relatively rare complication requiring a high suspicion index. Surgery is recommended in case of failure of conservative measures, neurological deficit, or mechanical instability as in this case. Furthermore, both clinical examination and blood tests should be used to assess the treatment outcomes. (2021ESJ246)
{"title":"Multiple Noncontiguous Spondylodiscitis Following Mastectomy Secondary to Breast Carcinoma: Case Report and Literature Review","authors":"Ghazwan A. Hasan, A. Ali, A. Al-Jasim, Shahbaz Khan","doi":"10.21608/esj.2022.117288.1211","DOIUrl":"https://doi.org/10.21608/esj.2022.117288.1211","url":null,"abstract":"Background Data: Multiple noncontiguous spontaneous pyogenic spondylodiscitis is rare and has only been explained in the literature by case reports and case series. Purpose : We present a case report of multiple noncontiguous spontaneous spondylodiscitis caused by E. coli involving the cervical and lumbar spine following a mastectomy for breast cancer. We will explain the difficulties in diagnosis, treatment, and follow-up with the concomitant. Study Design: A case report and literature review. Case Report: A middle-aged patient with a history of breast carcinoma underwent surgery. Two weeks after mastectomy, the patient developed severe cervical and lumbar spine pain and a low-grade fever (37.5– 38.3 °C). Moreover, neurological examination revealed a right-sided antalgic gait, right-sided weakness, and a positive straight leg raising test. Upon presentation, elevated C-reactive protein (CRP) and white blood cells (WBC) were noted. Magnetic resonance imaging (MRI) showed consistent spondylodiscitis at C5-C6 and L3-L4 levels with stenotic features at L4-L5 levels. Surgical treatment of the lumbar region via posterior spinal instrumentation from L3 to L5 levels and decompression was done with a biopsy. Erythrocyte sedimentation rate (ESR) CRP titers were also performed for the follow-up plan, which showed a reduction in 3, 6, and 12 weeks postoperatively. Conservative treatment of the cervical region was undertaken with a complete cure. Conclusion: Multiple noncontiguous spondylodiscitis after nonspinal surgery is a relatively rare complication requiring a high suspicion index. Surgery is recommended in case of failure of conservative measures, neurological deficit, or mechanical instability as in this case. Furthermore, both clinical examination and blood tests should be used to assess the treatment outcomes. (2021ESJ246)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48707007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.21608/esj.2022.106163.1204
Essam Youssef, M. Samir, M. Makia, A. Eladawy, Mohamed Abdeen, A. Alawamry
Background Data: Cranial facet joint violation (FJV) by pedicle screws may increase stress to the level adjacent to the instrumentation and may contribute to adjacent segment disease (ASD). Purpose: This study determines the frequency and risk factors for cranial FJV during pedicle screw instrumentation in various lumbar spine disorders. Study Design: A retrospective study. Patients and Methods: The data and imaging of adult patients with pedicle screw instrumentation for lumbar disorders from June 2018 to June 2021 were retrospectively reviewed for cranial FJV rate and evaluated for the role of the technique of instrumentation (conventional open or percutaneous), the facet angle (FA), the lumbar level, and the type of the disorder as risk factors for this violation. Preoperative Magnetic Resonance Imaging (MRI) was reviewed to measure the FA using T2 axial images. Postoperative Computed Tomography (CT) scans were examined to determine and grade cranial FJV. Results: The study included 360 patients. The overall FJV rate was 17.6%. The FJV rate significantly increased among the percutaneous fixation group compared to that of the open one (29.2% vs. 15.9%, respectively, p = 0.001). Patients with FJV had significantly larger FAs (p < 0.001). Moreover, patients with significantly larger FAs had higher grades of FJV (p value < 0.001). The FJV rate significantly increased with FAs > 40.12° (p < 0.001). L5 level and degenerative disease were more prone to FJV and higher grades of violation. Conclusion: The method of fixation, FA, lumbar level, and the type of lumbar disorder were the independent predictors of cranial FJV. This study reported a higher rate of FJV among patients with percutaneous fixation. The larger the FA, the higher the FJV rate and grade, especially with FAs > 40.12°, L5 level, and degenerative disease. (2021ESJ242)
{"title":"The Frequency and Risk Factors for Cranial Facet Joint Violation during Pedicle Screw Instrumentation in Lumbar Spine Disorders","authors":"Essam Youssef, M. Samir, M. Makia, A. Eladawy, Mohamed Abdeen, A. Alawamry","doi":"10.21608/esj.2022.106163.1204","DOIUrl":"https://doi.org/10.21608/esj.2022.106163.1204","url":null,"abstract":"Background Data: Cranial facet joint violation (FJV) by pedicle screws may increase stress to the level adjacent to the instrumentation and may contribute to adjacent segment disease (ASD). Purpose: This study determines the frequency and risk factors for cranial FJV during pedicle screw instrumentation in various lumbar spine disorders. Study Design: A retrospective study. Patients and Methods: The data and imaging of adult patients with pedicle screw instrumentation for lumbar disorders from June 2018 to June 2021 were retrospectively reviewed for cranial FJV rate and evaluated for the role of the technique of instrumentation (conventional open or percutaneous), the facet angle (FA), the lumbar level, and the type of the disorder as risk factors for this violation. Preoperative Magnetic Resonance Imaging (MRI) was reviewed to measure the FA using T2 axial images. Postoperative Computed Tomography (CT) scans were examined to determine and grade cranial FJV. Results: The study included 360 patients. The overall FJV rate was 17.6%. The FJV rate significantly increased among the percutaneous fixation group compared to that of the open one (29.2% vs. 15.9%, respectively, p = 0.001). Patients with FJV had significantly larger FAs (p < 0.001). Moreover, patients with significantly larger FAs had higher grades of FJV (p value < 0.001). The FJV rate significantly increased with FAs > 40.12° (p < 0.001). L5 level and degenerative disease were more prone to FJV and higher grades of violation. Conclusion: The method of fixation, FA, lumbar level, and the type of lumbar disorder were the independent predictors of cranial FJV. This study reported a higher rate of FJV among patients with percutaneous fixation. The larger the FA, the higher the FJV rate and grade, especially with FAs > 40.12°, L5 level, and degenerative disease. (2021ESJ242)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45080895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.21608/esj.2022.102741.1200
Abhishek Vijayan, P. Goswami, Sanu Vijayan, Arun Sathyababu, A. Peethambaran, Jyothish Laila Sivananda Panicker, Sunil Kumar Balakrishnan Sreemathy Amma
Background Data: Anterior cervical discectomy and fusion (ACDF) is accepted as a standard surgical treatment for cervical spondylotic myelopathy (CSM). The options for instrumentation in fusion include standalone cage (SC) and conventional cage and plate (CCP). However, there is no clear consensus regarding the superiority of the technique. Purpose: To compare the radiologic and clinical outcomes between SC and CCP in ACDF for the treatment of CSM. Study Design: Ambispective clinical case study. Patients and Methods: The patients who underwent ACDF for CSM using SC or CCP between January 2014 and December 2018 were included in the study. Forty-six patients out of 230 eligible patients were included in the study. Twenty-six patients underwent CCP, while 20 underwent SC. They were subjected to detailed neurologic and radiologic examination. Neurologic outcome was measured using the Nurick and mJOA scores and dysphagia using the Bazaz score. Fusion was assessed by the presence of bridging trabeculae and absence of movement between the spinous processes of the fused segments with lordosis by Cobbs’ angle. We also reported cage subsidence, adjacent segment degeneration (ASD), and implant complications. Results: Mean follow-up was for four years. The most common level operated was C5/C6. Neurologic status improved significantly in both groups following surgery. The rate of dysphagia was not different between the groups. Fusion was achieved in 92.3% of the CCP group and 90% of the SC group (p > 0.05). The rate of subsidence was higher in the SC group (p = .026). ASD changes were present in 57% of the CCP group and 80% of the SC group at final follow-up but were insignificant. In both groups, improved DOI: 10.21608/ESJ.2022.102741.1200
{"title":"A Comparison between Standalone Cage and Conventional Cage and Plate in Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Spondylotic Myelopathy: An Ambispective Study","authors":"Abhishek Vijayan, P. Goswami, Sanu Vijayan, Arun Sathyababu, A. Peethambaran, Jyothish Laila Sivananda Panicker, Sunil Kumar Balakrishnan Sreemathy Amma","doi":"10.21608/esj.2022.102741.1200","DOIUrl":"https://doi.org/10.21608/esj.2022.102741.1200","url":null,"abstract":"Background Data: Anterior cervical discectomy and fusion (ACDF) is accepted as a standard surgical treatment for cervical spondylotic myelopathy (CSM). The options for instrumentation in fusion include standalone cage (SC) and conventional cage and plate (CCP). However, there is no clear consensus regarding the superiority of the technique. Purpose: To compare the radiologic and clinical outcomes between SC and CCP in ACDF for the treatment of CSM. Study Design: Ambispective clinical case study. Patients and Methods: The patients who underwent ACDF for CSM using SC or CCP between January 2014 and December 2018 were included in the study. Forty-six patients out of 230 eligible patients were included in the study. Twenty-six patients underwent CCP, while 20 underwent SC. They were subjected to detailed neurologic and radiologic examination. Neurologic outcome was measured using the Nurick and mJOA scores and dysphagia using the Bazaz score. Fusion was assessed by the presence of bridging trabeculae and absence of movement between the spinous processes of the fused segments with lordosis by Cobbs’ angle. We also reported cage subsidence, adjacent segment degeneration (ASD), and implant complications. Results: Mean follow-up was for four years. The most common level operated was C5/C6. Neurologic status improved significantly in both groups following surgery. The rate of dysphagia was not different between the groups. Fusion was achieved in 92.3% of the CCP group and 90% of the SC group (p > 0.05). The rate of subsidence was higher in the SC group (p = .026). ASD changes were present in 57% of the CCP group and 80% of the SC group at final follow-up but were insignificant. In both groups, improved DOI: 10.21608/ESJ.2022.102741.1200","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43628254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.21203/rs.3.rs-1031443/v1
Ü. T. Börü, Cem Bölük, A. Özdemir, H. Demirbaş, M. Taşdemir, Tuğçe Gezer Karabacak, F. Şahbaz, Ahmet Dumanlı
BackgroundThe most common cause of trigeminal neuralgia (TN) is neurovascular compression. However, a number of patients present with unknown etiology. This study aims to investigate the relationship between TN and cervical pathology in patients previously diagnosed with idiopathic TN. MethodsWe designed an observational case-control study. A study group consisting of patients previously diagnosed with idiopathic TN and a control group was included in the study. Cranial MRI’s of TN patients were re-evaluated by a blinded neuroradiologist. Once it was confirmed that no signs of neurovascular compression or any secondary causes were present, a cervical MRI was performed to evaluate cervical pathologies. Results20 patients and 20 controls were investigated. The mean age of TN patients was 64.9±12.6, and the mean age of the control group was 61.3±9.1 (p=0.305). Whilst indentation on the trigeminal spinal tract above C4 spinal level was observed in 12 out of 20 patients, none of the controls had any involvement in the same region (p<0.001). ConclusionsThe results of this study suggest that extramedullary indentation on the trigeminal spinal tract caused by upper cervical discopathy may be one of the possible etiological factors in TN.
{"title":"Cervical Discopathy in Idiopathic Trigeminal Neuralgia: More than Coincidence?","authors":"Ü. T. Börü, Cem Bölük, A. Özdemir, H. Demirbaş, M. Taşdemir, Tuğçe Gezer Karabacak, F. Şahbaz, Ahmet Dumanlı","doi":"10.21203/rs.3.rs-1031443/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-1031443/v1","url":null,"abstract":"\u0000 BackgroundThe most common cause of trigeminal neuralgia (TN) is neurovascular compression. However, a number of patients present with unknown etiology. This study aims to investigate the relationship between TN and cervical pathology in patients previously diagnosed with idiopathic TN. MethodsWe designed an observational case-control study. A study group consisting of patients previously diagnosed with idiopathic TN and a control group was included in the study. Cranial MRI’s of TN patients were re-evaluated by a blinded neuroradiologist. Once it was confirmed that no signs of neurovascular compression or any secondary causes were present, a cervical MRI was performed to evaluate cervical pathologies. Results20 patients and 20 controls were investigated. The mean age of TN patients was 64.9±12.6, and the mean age of the control group was 61.3±9.1 (p=0.305). Whilst indentation on the trigeminal spinal tract above C4 spinal level was observed in 12 out of 20 patients, none of the controls had any involvement in the same region (p<0.001). ConclusionsThe results of this study suggest that extramedullary indentation on the trigeminal spinal tract caused by upper cervical discopathy may be one of the possible etiological factors in TN.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46123559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.21608/esj.2022.124934.1220
Hazem Alkosha
Background Data: Degenerative scoliosis in adults is a growing health problem due to the steady increase in lifespans globally. It is a benign health problem, but it develops slowly in nature. Purpose: To review the available data about degenerative scoliosis in adults and the recent concepts and treatment options. Study Design: A narrative literature review. Patients and Methods: The author reviewed the English literature published through the last two decades for recent and relevant data about the pathogenesis, presentation, and management of adult degenerative scoliosis. A PubMed search was conducted using both phrase searching and combined searching using Boolean operators. The most relevant articles according to the study aim and spine surgeon’s practice were extracted. Results: Adult degenerative scoliosis is a triplanar deformity affecting coronal and sagittal parameters and axial spinal dimensions. The condition starts with age-related disc degeneration and progresses slowly over the years with worsening back pain and neurological deficits in advanced stages. Selected stable patients with early deformities can be managed nonsurgically through various pharmacological, physical, and interventional measures. However, most cases with degenerative scoliosis are best treated surgically via various open or minimally invasive procedures, reserving the conservative measures for nonsurgical candidates or as preoperative palliation. Conclusion: Adult degenerative scoliosis is best managed by a multidisciplinary team of neurosurgeons and orthopedic surgeons in a patient-specific manner. Further studies are required for comparing and identifying the best surgical strategies in a patient-specific approach. (2021ESJ249)
{"title":"Adult Degenerative Scoliosis: A Literature Review of Current Concepts and New Trends","authors":"Hazem Alkosha","doi":"10.21608/esj.2022.124934.1220","DOIUrl":"https://doi.org/10.21608/esj.2022.124934.1220","url":null,"abstract":"Background Data: Degenerative scoliosis in adults is a growing health problem due to the steady increase in lifespans globally. It is a benign health problem, but it develops slowly in nature. Purpose: To review the available data about degenerative scoliosis in adults and the recent concepts and treatment options. Study Design: A narrative literature review. Patients and Methods: The author reviewed the English literature published through the last two decades for recent and relevant data about the pathogenesis, presentation, and management of adult degenerative scoliosis. A PubMed search was conducted using both phrase searching and combined searching using Boolean operators. The most relevant articles according to the study aim and spine surgeon’s practice were extracted. Results: Adult degenerative scoliosis is a triplanar deformity affecting coronal and sagittal parameters and axial spinal dimensions. The condition starts with age-related disc degeneration and progresses slowly over the years with worsening back pain and neurological deficits in advanced stages. Selected stable patients with early deformities can be managed nonsurgically through various pharmacological, physical, and interventional measures. However, most cases with degenerative scoliosis are best treated surgically via various open or minimally invasive procedures, reserving the conservative measures for nonsurgical candidates or as preoperative palliation. Conclusion: Adult degenerative scoliosis is best managed by a multidisciplinary team of neurosurgeons and orthopedic surgeons in a patient-specific manner. Further studies are required for comparing and identifying the best surgical strategies in a patient-specific approach. (2021ESJ249)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"15 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41268936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.21608/esj.2022.77575.1209
K. Krishnamurthy
Background Data: Management of cervical spine fractures has no individualized treatment protocol. Most guidelines are based on the fracture types; our study, being done in a developing nation, has taken into consideration the socioeconomic factors and their implication in making a final treatment plan. Purpose: To compare socioeconomic and functional outcomes of surgical and nonsurgical management of acute cervical spine fractures with severe (ASIA-A and ASIA-B) neurological deficit at a minimum of 12 months postinjury. Study Design: A retrospective observational study. Patients and Methods: The study included a total of 42 patients: 22 were treated operatively (group A) and 20 treated conservatively (group B). Functional outcomes were assessed at a minimum of 12 months postinjury using the SCIM scoring scale. Other parameters, including the number of hospital days, total expenditure at discharge, ICU-related events, deaths within one year, and rehabilitation details, were analyzed. Results: The mean hospital stay in group A was 26 days, with one patient requiring ICU admission with an expenditure of $2707, whereas in group B, the mean days of hospital admission was 40 days with two patients requiring ICU admission incurring an expenditure of $850. ICU-related comorbidities were high in group A. One patient in group A and five in group B died within the first 12 months. Overall mortality within the twelve months following ASIA-A and ASIA-B cervical spine injury was 16.6%, with higher mortality in group B during the early (0–3 months) period. The mean SCIM functional score at 12 months in group A and B was 36.5 and 41.6, respectively (p = 0.2). No statistically significant difference was found in the functional outcome between survivors in both groups at 12 months. Conclusion: One-year survival was better in surgically treated patients with no difference (p = 0.09) in the functional outcome of both groups. Only an early and sustained rehabilitation in both groups help improving their quality of life. (2021ESJ247)
{"title":"Socioeconomic and Functional Outcomes after Severe Traumatic Cervical Spinal Cord Injuries: A Comparison of Surgical and Nonsurgical Patients","authors":"K. Krishnamurthy","doi":"10.21608/esj.2022.77575.1209","DOIUrl":"https://doi.org/10.21608/esj.2022.77575.1209","url":null,"abstract":"Background Data: Management of cervical spine fractures has no individualized treatment protocol. Most guidelines are based on the fracture types; our study, being done in a developing nation, has taken into consideration the socioeconomic factors and their implication in making a final treatment plan. Purpose: To compare socioeconomic and functional outcomes of surgical and nonsurgical management of acute cervical spine fractures with severe (ASIA-A and ASIA-B) neurological deficit at a minimum of 12 months postinjury. Study Design: A retrospective observational study. Patients and Methods: The study included a total of 42 patients: 22 were treated operatively (group A) and 20 treated conservatively (group B). Functional outcomes were assessed at a minimum of 12 months postinjury using the SCIM scoring scale. Other parameters, including the number of hospital days, total expenditure at discharge, ICU-related events, deaths within one year, and rehabilitation details, were analyzed. Results: The mean hospital stay in group A was 26 days, with one patient requiring ICU admission with an expenditure of $2707, whereas in group B, the mean days of hospital admission was 40 days with two patients requiring ICU admission incurring an expenditure of $850. ICU-related comorbidities were high in group A. One patient in group A and five in group B died within the first 12 months. Overall mortality within the twelve months following ASIA-A and ASIA-B cervical spine injury was 16.6%, with higher mortality in group B during the early (0–3 months) period. The mean SCIM functional score at 12 months in group A and B was 36.5 and 41.6, respectively (p = 0.2). No statistically significant difference was found in the functional outcome between survivors in both groups at 12 months. Conclusion: One-year survival was better in surgically treated patients with no difference (p = 0.09) in the functional outcome of both groups. Only an early and sustained rehabilitation in both groups help improving their quality of life. (2021ESJ247)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47500652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.21608/esj.2022.98944.1192
Ahmed Nagaty, Osama Dawood, Ahmed Elsabaa
Background Data: Application of either longor short-segment instrumentation with intermediate screw to correct thoracolumbar spine fracture is still controversial. Both surgical techniques have their advantages and disadvantages. Even though early clinical results of these surgeries are usually satisfactory, a high failure rate and progressive kyphosis remain a concern. Purpose: To assess the efficiency and safety of short-segment pedicle screw fixation in thoracolumbar junction fracture with an intermediate screw placement compared to the more popular long-segment technique. Study Design: A retrospective comparative study Patients and Methods: A total of 61 patients were reported in this study and divided into two groups: Group I (33 patients) in which patients were surgically treated by short-segment instrumentation with intermediate screw placement at the fractured level and Group II in which all patients were surgically treated using long-segment instrumentation excluding the fracture level (28 patients). Outcome parameters included Visual Analogue Score (VAS) score of back pain and American Spinal Injury Association (ASIA) score of neurological status. Results: Although the VAS of back pain rapidly improved in Group I compared to Group II during the one-year follow-up, both had the same end results with no significant difference between both groups (P > 0.05). In Group I, the preoperative Cobb’s angle was 19.3 ± 3.7, which was corrected in the immediate postoperative X-ray to 6.8 ± 2.6 and maintained on the final follow-up at one year at 7.97 ± 1.67. In Group II, the mean preoperative Cobb’s angle was 18.7 ± 3.8, which was corrected in the immediate postoperative X-ray to 5.8 ± 1.6 and maintained on the final follow-up at one year at 7.89 ± 1.67. However, there was no statistically significant difference between both groups regarding angle correction (P > 0.05). In perioperative data, Group I showed less operative time (137.73 ± 16.96) than Group II (153.57 ± 19.525) with a highly significant statistical difference (P < 0.001). In addition,
{"title":"Posterior Short-Segment Instrumentation with Intermediate Screw versus Long-segment Instrumentation in Thoracolumbar Fracture Treatment","authors":"Ahmed Nagaty, Osama Dawood, Ahmed Elsabaa","doi":"10.21608/esj.2022.98944.1192","DOIUrl":"https://doi.org/10.21608/esj.2022.98944.1192","url":null,"abstract":"Background Data: Application of either longor short-segment instrumentation with intermediate screw to correct thoracolumbar spine fracture is still controversial. Both surgical techniques have their advantages and disadvantages. Even though early clinical results of these surgeries are usually satisfactory, a high failure rate and progressive kyphosis remain a concern. Purpose: To assess the efficiency and safety of short-segment pedicle screw fixation in thoracolumbar junction fracture with an intermediate screw placement compared to the more popular long-segment technique. Study Design: A retrospective comparative study Patients and Methods: A total of 61 patients were reported in this study and divided into two groups: Group I (33 patients) in which patients were surgically treated by short-segment instrumentation with intermediate screw placement at the fractured level and Group II in which all patients were surgically treated using long-segment instrumentation excluding the fracture level (28 patients). Outcome parameters included Visual Analogue Score (VAS) score of back pain and American Spinal Injury Association (ASIA) score of neurological status. Results: Although the VAS of back pain rapidly improved in Group I compared to Group II during the one-year follow-up, both had the same end results with no significant difference between both groups (P > 0.05). In Group I, the preoperative Cobb’s angle was 19.3 ± 3.7, which was corrected in the immediate postoperative X-ray to 6.8 ± 2.6 and maintained on the final follow-up at one year at 7.97 ± 1.67. In Group II, the mean preoperative Cobb’s angle was 18.7 ± 3.8, which was corrected in the immediate postoperative X-ray to 5.8 ± 1.6 and maintained on the final follow-up at one year at 7.89 ± 1.67. However, there was no statistically significant difference between both groups regarding angle correction (P > 0.05). In perioperative data, Group I showed less operative time (137.73 ± 16.96) than Group II (153.57 ± 19.525) with a highly significant statistical difference (P < 0.001). In addition,","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41842067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.21608/esj.2021.79421.1179
Ayman Mohamed Basha, A. Elnaggar, A. Moustafa, M. Abdel Bary
Background Data: Multiple surgical techniques have been used to treat spinal canal stenosis, including open, microscopic, and endoscopic decompression and fusion surgery. Purpose: This article investigates the safety and the efficacy of unilateral endoscopic decompression for patients with monosegmental degenerative lumbar spinal canal stenosis (LCS). Study Design: Prospective clinical case series. Patients and Methods: Thirty consecutive patients with degenerative LCS were treated with endoscopic laminotomy with medial facetectomy. Patients were treated with the EasyGO! 2nd Generation system (Karl Storz, Tuttlingen, Germany) at our institutions between March 2018 and September 2020. Primary outcomes parameters included the Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. The length of the incision, the duration of surgery, the operative blood loss, and the duration of hospital stay were calculated. The mean follow-up period for patients was 10.5 ± 2.3 (range, 6–12) months. Results: The mean age was 56.5 ± 5.7 years. All thirty patients had neurogenic claudication. 63% of the patients had bilateral leg pain, 37% had unilateral leg pain, and 66% had low back pain. Seven patients (23%) had motor weakness preoperatively. The spinal segments affected were as follows: L4-L5 in 22 cases; L3-L4 in 6 cases; L2-L3, one case; L5-S1, one case. There was a statistically significant reduction in the mean values of NPRS for both leg and back pain in the follow-up period (P < 0.001). Moreover, the ODI mean value was statistically significantly reduced in the follow-up period (P < 0.001). the mean operative blood loss was 147.2 ± 68.3 ml, the mean operative time was 134.7 ± 28.34 minutes, and the mean hospital stay was 1.4 ± 0.8 days. We had four patients with intraoperative dural tears (13%) with no postoperative CSF leak, three patients (10%) had superficial wound infection, no patients had deep wound infection or discitis, and no reoperation was reported in the follow-up period. Conclusion: The unilateral uniportal endoscopic approach is a safe and effective technique in patients with degenerative lumbar canal stenosis. It allows for adequate decompression of the neural elements and preserves spinal stability. (2021ESJ236)
{"title":"Efficacy of the Unilateral Uniportal Endoscopic Approach in Management of Monosegmental Lumbar Canal Stenosis","authors":"Ayman Mohamed Basha, A. Elnaggar, A. Moustafa, M. Abdel Bary","doi":"10.21608/esj.2021.79421.1179","DOIUrl":"https://doi.org/10.21608/esj.2021.79421.1179","url":null,"abstract":"Background Data: Multiple surgical techniques have been used to treat spinal canal stenosis, including open, microscopic, and endoscopic decompression and fusion surgery. Purpose: This article investigates the safety and the efficacy of unilateral endoscopic decompression for patients with monosegmental degenerative lumbar spinal canal stenosis (LCS). Study Design: Prospective clinical case series. Patients and Methods: Thirty consecutive patients with degenerative LCS were treated with endoscopic laminotomy with medial facetectomy. Patients were treated with the EasyGO! 2nd Generation system (Karl Storz, Tuttlingen, Germany) at our institutions between March 2018 and September 2020. Primary outcomes parameters included the Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. The length of the incision, the duration of surgery, the operative blood loss, and the duration of hospital stay were calculated. The mean follow-up period for patients was 10.5 ± 2.3 (range, 6–12) months. Results: The mean age was 56.5 ± 5.7 years. All thirty patients had neurogenic claudication. 63% of the patients had bilateral leg pain, 37% had unilateral leg pain, and 66% had low back pain. Seven patients (23%) had motor weakness preoperatively. The spinal segments affected were as follows: L4-L5 in 22 cases; L3-L4 in 6 cases; L2-L3, one case; L5-S1, one case. There was a statistically significant reduction in the mean values of NPRS for both leg and back pain in the follow-up period (P < 0.001). Moreover, the ODI mean value was statistically significantly reduced in the follow-up period (P < 0.001). the mean operative blood loss was 147.2 ± 68.3 ml, the mean operative time was 134.7 ± 28.34 minutes, and the mean hospital stay was 1.4 ± 0.8 days. We had four patients with intraoperative dural tears (13%) with no postoperative CSF leak, three patients (10%) had superficial wound infection, no patients had deep wound infection or discitis, and no reoperation was reported in the follow-up period. Conclusion: The unilateral uniportal endoscopic approach is a safe and effective technique in patients with degenerative lumbar canal stenosis. It allows for adequate decompression of the neural elements and preserves spinal stability. (2021ESJ236)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46206585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.21608/esj.2022.102265.1197
Walid Abouzeid, Mohamed Abdel Tawab, B. Hanna, Tamer Niazy, S. Hussein, M. Almamoun
Background Data: Spinal cord ependymomas can arise in different locations throughout the spinal cord, with the most frequent location being the cervical spine. Ependymomas usually grow slowly, compressing rather than infiltrating spinal tumors. Among different prognostic and predictor factors, the extent of resection has been the strongest predictor of outcomes. Multimodal intraoperative neurophysiological monitoring (IONM) helps maximize the extent of resection with minimal postoperative neurological complications. Purpose: To assess the impact of IONM on the extent of surgical resection and outcomes of spinal cord ependymomas. Study Design: A retrospective cohort study. Patients and Methods: Twenty-five patients who underwent spinal cord ependymoma resection in 4 centers between March 2014 and February 2018 were eligible for the inclusion criteria of this study. Patients were divided into two groups: the IONM group and the non-IONM group. IONM consisted of electromyography (EMG), transcranial motor evoked potentials (tcMEP), and somatosensory evoked potentials (SSEP). All patients were submitted for full neurological examination and MRI of the spine both preoperatively and at the postoperative routine follow-up. Postoperative radiotherapy was conducted routinely by our radiotherapists. The secondary outcomes were the correlation between the warning criteria of IONM and postoperative neurological outcomes and their impact on the extent of tumor resection. Also, a recurrence rate during the follow-up period was reported. DOI: 10.21608/ESJ.2022.102265.1197
{"title":"Impact of Intraoperative Neurophysiological Monitoring on the Extent of Resection and Postoperative Neurological Outcomes in Patients with Spinal Cord Ependymoma: A Retrospective Multicenter Comparative Study","authors":"Walid Abouzeid, Mohamed Abdel Tawab, B. Hanna, Tamer Niazy, S. Hussein, M. Almamoun","doi":"10.21608/esj.2022.102265.1197","DOIUrl":"https://doi.org/10.21608/esj.2022.102265.1197","url":null,"abstract":"Background Data: Spinal cord ependymomas can arise in different locations throughout the spinal cord, with the most frequent location being the cervical spine. Ependymomas usually grow slowly, compressing rather than infiltrating spinal tumors. Among different prognostic and predictor factors, the extent of resection has been the strongest predictor of outcomes. Multimodal intraoperative neurophysiological monitoring (IONM) helps maximize the extent of resection with minimal postoperative neurological complications. Purpose: To assess the impact of IONM on the extent of surgical resection and outcomes of spinal cord ependymomas. Study Design: A retrospective cohort study. Patients and Methods: Twenty-five patients who underwent spinal cord ependymoma resection in 4 centers between March 2014 and February 2018 were eligible for the inclusion criteria of this study. Patients were divided into two groups: the IONM group and the non-IONM group. IONM consisted of electromyography (EMG), transcranial motor evoked potentials (tcMEP), and somatosensory evoked potentials (SSEP). All patients were submitted for full neurological examination and MRI of the spine both preoperatively and at the postoperative routine follow-up. Postoperative radiotherapy was conducted routinely by our radiotherapists. The secondary outcomes were the correlation between the warning criteria of IONM and postoperative neurological outcomes and their impact on the extent of tumor resection. Also, a recurrence rate during the follow-up period was reported. DOI: 10.21608/ESJ.2022.102265.1197","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48120135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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