Charcot–Marie–Tooth (CMT) disease, the most common inherited neuropathy, is the most common neuromuscular disorder. It is associated with several orthopedic deformities. Neurophysiological monitoring during scoliosis surgery in these patients can be challenging due to baseline neurological abnormalities. Intraoperative neuromonitoring (IONM) provides vigilance against postoperative neurological deficits. Literature searches have revealed case reports and studies demonstrating difficulties in obtaining IONM potentials in these patients. This case report shares our experience with IONM using transcranial motor-evoked potentials in a case of CMT disease.
{"title":"Monitoring Transcranial Motor-Evoked Potentials in Charcot–Marie–Tooth Disease: A Case Report","authors":"Muhammed Ajmal, P. Pavithran, Pramod K. Sudarshan","doi":"10.4103/isj.isj_64_23","DOIUrl":"https://doi.org/10.4103/isj.isj_64_23","url":null,"abstract":"\u0000 Charcot–Marie–Tooth (CMT) disease, the most common inherited neuropathy, is the most common neuromuscular disorder. It is associated with several orthopedic deformities. Neurophysiological monitoring during scoliosis surgery in these patients can be challenging due to baseline neurological abnormalities. Intraoperative neuromonitoring (IONM) provides vigilance against postoperative neurological deficits. Literature searches have revealed case reports and studies demonstrating difficulties in obtaining IONM potentials in these patients. This case report shares our experience with IONM using transcranial motor-evoked potentials in a case of CMT disease.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853200","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}
{"title":"To Live in the Hearts of People who Love You, is Never to Die","authors":"S. Rajasekaran","doi":"10.4103/isj.isj_61_24","DOIUrl":"https://doi.org/10.4103/isj.isj_61_24","url":null,"abstract":"","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"26 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845753","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}
In patients diagnosed with nonspecific chronic low back pain (NCLBP), discernable discrepancies in pain perception have been observed. This study endeavors to assess alterations in left thalamic metabolites in patients with NCLBP following spinal manipulation, utilizing proton magnetic resonance spectroscopy (1H-MRS). A total of 16 individuals diagnosed with NCLBP and 16 healthy individuals volunteers of normal constitution (aged between 20 and 50 years) were recruited. All participants exhibited right-hand dominance. Before commencement of therapeutic intervention and at a 5-week interval thereafter, functional and radiological assessments were undertaken (Oswestry Disability Index, numerical rating scale, and 1H-MRS). The values were compared using independent and paired t tests. Following spinal manipulation, the patients experienced notable reductions in pain and disability (P < 0.05). The treatment group demonstrated significant increases in N-acetyl aspartate (NAA), choline (Cho), myo-inositol (Mio), and glutamate and glutamine (Glx) in the left thalamus region post-treatment compared with the baseline measures (P < 0.05). Before treatment, NAA, Cho, Glx, and Mio levels were significantly lower in the left thalamus of the patients compared with healthy subjects (P < 0.05). However, no significant differences in terms of metabolites were observed between the healthy control group and the patients after the treatment. In patients presenting with NCLBP, spinal manipulation has been observed to exert an effect on the brain, thereby inducing changes in thalamic metabolites.
{"title":"The Application of Spinal Manipulation Results in Alterations in Thalamic Neural Metabolite among Patients Experiencing Nonspecific Chronic Low Back Pain","authors":"D. Didehdar, Ameneh Kharazinejad","doi":"10.4103/isj.isj_74_23","DOIUrl":"https://doi.org/10.4103/isj.isj_74_23","url":null,"abstract":"\u0000 \u0000 \u0000 In patients diagnosed with nonspecific chronic low back pain (NCLBP), discernable discrepancies in pain perception have been observed. This study endeavors to assess alterations in left thalamic metabolites in patients with NCLBP following spinal manipulation, utilizing proton magnetic resonance spectroscopy (1H-MRS).\u0000 \u0000 \u0000 \u0000 A total of 16 individuals diagnosed with NCLBP and 16 healthy individuals volunteers of normal constitution (aged between 20 and 50 years) were recruited. All participants exhibited right-hand dominance. Before commencement of therapeutic intervention and at a 5-week interval thereafter, functional and radiological assessments were undertaken (Oswestry Disability Index, numerical rating scale, and 1H-MRS). The values were compared using independent and paired t tests.\u0000 \u0000 \u0000 \u0000 Following spinal manipulation, the patients experienced notable reductions in pain and disability (P < 0.05). The treatment group demonstrated significant increases in N-acetyl aspartate (NAA), choline (Cho), myo-inositol (Mio), and glutamate and glutamine (Glx) in the left thalamus region post-treatment compared with the baseline measures (P < 0.05). Before treatment, NAA, Cho, Glx, and Mio levels were significantly lower in the left thalamus of the patients compared with healthy subjects (P < 0.05). However, no significant differences in terms of metabolites were observed between the healthy control group and the patients after the treatment.\u0000 \u0000 \u0000 \u0000 In patients presenting with NCLBP, spinal manipulation has been observed to exert an effect on the brain, thereby inducing changes in thalamic metabolites.\u0000","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847236","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}
Low back pain (LBP) is a pervasive global issue causing substantial disability and significant economic burden. The primary etiological factor behind LBP is intervertebral disc (IVD) degeneration, initiated in early adolescence and potentially leading to multiple spinal pathologies. However, current treatments for discogenic LBP are mainly palliative or involve invasive surgery, lacking disease-modifying therapies. Regenerative strategies, including cell therapy, may offer promising avenues to address the underlying pathology of IVD degeneration. Preclinical studies and clinical trials have demonstrated the potential of intradiscal cell transplantation to alleviate disc degeneration and associated pain with an overall favorable safety profile. Nonetheless, clinical trials present challenges, such as varying patient inclusion criteria, lack of adequate control groups, and short follow-up periods, necessitating cautious interpretation of results. This narrative review aims to provide an overview of clinical trials published to date and discuss the progress and translational hurdles of cell-based therapies for IVD degeneration and discogenic pain.
{"title":"Cell Therapy for Intervertebral Disc Regeneration: Progress and Hurdles in Clinical Translation","authors":"Shota Tamagawa, Jordy Schol, Daisuke Sakai","doi":"10.4103/isj.isj_17_24","DOIUrl":"https://doi.org/10.4103/isj.isj_17_24","url":null,"abstract":"\u0000 Low back pain (LBP) is a pervasive global issue causing substantial disability and significant economic burden. The primary etiological factor behind LBP is intervertebral disc (IVD) degeneration, initiated in early adolescence and potentially leading to multiple spinal pathologies. However, current treatments for discogenic LBP are mainly palliative or involve invasive surgery, lacking disease-modifying therapies. Regenerative strategies, including cell therapy, may offer promising avenues to address the underlying pathology of IVD degeneration. Preclinical studies and clinical trials have demonstrated the potential of intradiscal cell transplantation to alleviate disc degeneration and associated pain with an overall favorable safety profile. Nonetheless, clinical trials present challenges, such as varying patient inclusion criteria, lack of adequate control groups, and short follow-up periods, necessitating cautious interpretation of results. This narrative review aims to provide an overview of clinical trials published to date and discuss the progress and translational hurdles of cell-based therapies for IVD degeneration and discogenic pain.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"17 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842593","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}
Lumbar discectomy is a common spinal surgery performed for slipped or herniated discs in the lumbar spine. However, postoperative discal pseudocysts are a rare complication, with an incidence rate of less than 1%, which can lead to failed back syndrome. Only 38 cases have been described in the literature so far. Clinicians must understand their pathophysiology, clinical presentation, and management to diagnose and treat these rare cases. Here, we present a case of a 29-year-old male with a recurrence of radicular pain in the lower limb within 2 weeks of microdiscectomy surgery due to postoperative lumbar discal pseudocyst.
{"title":"Failed Back Syndrome Due to Postoperative Lumbar Discal Pseudocyst: A Case Report and a Review of the Literature","authors":"Manish Garg, Samarth Mittal, Puneet Girdhar, Gnana Shankar Kanamarlapudi","doi":"10.4103/isj.isj_68_23","DOIUrl":"https://doi.org/10.4103/isj.isj_68_23","url":null,"abstract":"\u0000 Lumbar discectomy is a common spinal surgery performed for slipped or herniated discs in the lumbar spine. However, postoperative discal pseudocysts are a rare complication, with an incidence rate of less than 1%, which can lead to failed back syndrome. Only 38 cases have been described in the literature so far. Clinicians must understand their pathophysiology, clinical presentation, and management to diagnose and treat these rare cases. Here, we present a case of a 29-year-old male with a recurrence of radicular pain in the lower limb within 2 weeks of microdiscectomy surgery due to postoperative lumbar discal pseudocyst.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"25 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853575","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}
M. P. Kanhangad, Balamurugan Thirugnanam, Abhishek Soni, Vidyadhara Srinivasa
Sacroplasty is one of the surgical modalities described in the treatment of sacral insufficiency fractures that don’t respond to non-operative treatment. While the percutaneous procedure is generally done under sedation, complications can arise from cement leakage into the spinal canal and sacral foramina. We present a case of Robotic-Assisted Percutaneous Balloon Sacroplasty in a patient with unilateral sacral insufficiency fracture using the MazorX stealth edition. A 55-year-old female presented with a left-sided sacral insufficiency fracture which was not responding to non-operative treatment. She underwent Robotic-Assisted Percutaneous Balloon Sacroplasty using the robotic arm and navigation capabilities of the MazorX stealth edition. About 9 mL of bone cement with hydroxyapatite was injected into the S1 body and left ala. The patient was mobilized post-operatively with minimal pain, 2 h after the procedure. Robotic assistance in percutaneous balloon sacroplasty ensures proper tracks for injection of bone cement with reduced chances of cement leakage.
{"title":"Second generation robotic-assisted percutaneous balloon sacroplasty","authors":"M. P. Kanhangad, Balamurugan Thirugnanam, Abhishek Soni, Vidyadhara Srinivasa","doi":"10.4103/isj.isj_78_23","DOIUrl":"https://doi.org/10.4103/isj.isj_78_23","url":null,"abstract":"\u0000 Sacroplasty is one of the surgical modalities described in the treatment of sacral insufficiency fractures that don’t respond to non-operative treatment. While the percutaneous procedure is generally done under sedation, complications can arise from cement leakage into the spinal canal and sacral foramina. We present a case of Robotic-Assisted Percutaneous Balloon Sacroplasty in a patient with unilateral sacral insufficiency fracture using the MazorX stealth edition.\u0000 A 55-year-old female presented with a left-sided sacral insufficiency fracture which was not responding to non-operative treatment. She underwent Robotic-Assisted Percutaneous Balloon Sacroplasty using the robotic arm and navigation capabilities of the MazorX stealth edition.\u0000 About 9 mL of bone cement with hydroxyapatite was injected into the S1 body and left ala. The patient was mobilized post-operatively with minimal pain, 2 h after the procedure. Robotic assistance in percutaneous balloon sacroplasty ensures proper tracks for injection of bone cement with reduced chances of cement leakage.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"18 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853635","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}
Management of patients implanted with growing rods who reach skeletal maturity (growing rod “graduates”) often poses challenging situation for spine surgeons. A 14-year-old female was implanted with traditional growing rods (TGR) – and presented to us with a coronally decompensated deformity. Imaging investigations revealed lumbosacral take-off due to a hemivertebra at the lumbosacral junction distal to the construct and “adding on” of the curve proximal to the construct. Autofusion of the spine was noted intraoperatively – correction was achieved whilst retaining the TGR, and using separate proximal and distal extensions of the construct to correct the deformity, connecting these to the previously implanted TGR. Improvement was noted in lumbosacral take-off angle, coronal shift, and T1 tilt, with no implant-related complications at final follow-up. The case describes a rational thought process and surgical strategy to deal with a challenging presentation of a patient with implanted TGR reaching skeletal maturity.
{"title":"Surgical Strategy to Correct Coronal Decompensation in an Autofused Growing Rod “Graduate”: A Case Report","authors":"B. Garg, Nishank Mehta","doi":"10.4103/isj.isj_11_24","DOIUrl":"https://doi.org/10.4103/isj.isj_11_24","url":null,"abstract":"\u0000 Management of patients implanted with growing rods who reach skeletal maturity (growing rod “graduates”) often poses challenging situation for spine surgeons. A 14-year-old female was implanted with traditional growing rods (TGR) – and presented to us with a coronally decompensated deformity. Imaging investigations revealed lumbosacral take-off due to a hemivertebra at the lumbosacral junction distal to the construct and “adding on” of the curve proximal to the construct. Autofusion of the spine was noted intraoperatively – correction was achieved whilst retaining the TGR, and using separate proximal and distal extensions of the construct to correct the deformity, connecting these to the previously implanted TGR. Improvement was noted in lumbosacral take-off angle, coronal shift, and T1 tilt, with no implant-related complications at final follow-up. The case describes a rational thought process and surgical strategy to deal with a challenging presentation of a patient with implanted TGR reaching skeletal maturity.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850276","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}
G. Gnanaprakash, Sreeharsha Peddireddy, R. Kanna, A. Shetty, S. Rajasekaran
Traumatic spinal injuries (TSIs) due to falls from heights are characterized by unique injury mechanisms, morphological features, and severity. In this study, we conducted an analysis of the epidemiological, clinical, and radiological data of TSI patients caused by falls from heights. We compared these findings with those of patients injured by other mechanisms. During a five-year period (2015–2019), all patients with traumatic spinal injuries who received treatment at a tertiary-level trauma center were categorized into two groups: those injured by falls from height (group 1) and those injured by other modes (group 2). Their medical records were reviewed for analysis. Falls from height (group 1) constituted the predominant cause of TSI, affecting 51.8% (1069/2065) of spine trauma patients. The average age in group 1 (44.45 ± 16.76) was significantly higher than in group 2 (42.33 ± 15.81) (P = 0.003). In group 1, the most common level of injury was the lumbar spine (48.6%, n = 520), whereas in group 2, it was the cervical spine (48%, n = 478). Multiple levels of injury were more common in group 1 than in group 2 (25.2% vs. 19.2%, P = 0.002). The most common type of spine injury was AO type B in group 1 (35.43%, n = 377) and AO type C in group 2 (32%, n = 319). Other associated organ system injuries were significantly higher in group 2 than in group 1 (P < 0.05), except for pelvic injuries. Additionally, spinal injury-related complications were higher in group 2 (16.7%) than in group 1 (11.6%) (P = 0.001). The length of hospital stay was significantly higher in group 2 (9.71 ± 9.03 days) compared to group 1 (8.09 ± 7.26 days). Our study has revealed significant demographic and epidemiological variances in TSI caused by falls from heights compared to other injury mechanisms. This information is crucial in understanding the mechanism and injury pattern in TSI due to falls from height, as well as for formulating effective management strategies.
{"title":"Spinal Injuries Due to Falls from Height","authors":"G. Gnanaprakash, Sreeharsha Peddireddy, R. Kanna, A. Shetty, S. Rajasekaran","doi":"10.4103/isj.isj_75_23","DOIUrl":"https://doi.org/10.4103/isj.isj_75_23","url":null,"abstract":"\u0000 \u0000 \u0000 Traumatic spinal injuries (TSIs) due to falls from heights are characterized by unique injury mechanisms, morphological features, and severity. In this study, we conducted an analysis of the epidemiological, clinical, and radiological data of TSI patients caused by falls from heights. We compared these findings with those of patients injured by other mechanisms.\u0000 \u0000 \u0000 \u0000 During a five-year period (2015–2019), all patients with traumatic spinal injuries who received treatment at a tertiary-level trauma center were categorized into two groups: those injured by falls from height (group 1) and those injured by other modes (group 2). Their medical records were reviewed for analysis.\u0000 \u0000 \u0000 \u0000 Falls from height (group 1) constituted the predominant cause of TSI, affecting 51.8% (1069/2065) of spine trauma patients. The average age in group 1 (44.45 ± 16.76) was significantly higher than in group 2 (42.33 ± 15.81) (P = 0.003). In group 1, the most common level of injury was the lumbar spine (48.6%, n = 520), whereas in group 2, it was the cervical spine (48%, n = 478). Multiple levels of injury were more common in group 1 than in group 2 (25.2% vs. 19.2%, P = 0.002). The most common type of spine injury was AO type B in group 1 (35.43%, n = 377) and AO type C in group 2 (32%, n = 319). Other associated organ system injuries were significantly higher in group 2 than in group 1 (P < 0.05), except for pelvic injuries. Additionally, spinal injury-related complications were higher in group 2 (16.7%) than in group 1 (11.6%) (P = 0.001). The length of hospital stay was significantly higher in group 2 (9.71 ± 9.03 days) compared to group 1 (8.09 ± 7.26 days).\u0000 \u0000 \u0000 \u0000 Our study has revealed significant demographic and epidemiological variances in TSI caused by falls from heights compared to other injury mechanisms. This information is crucial in understanding the mechanism and injury pattern in TSI due to falls from height, as well as for formulating effective management strategies.\u0000","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"2006 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851604","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}
Sourav Chatterjee, Samir Dalvie, Joseph N. Monteiro, Rohan Parihar, Pawan Kumar, Dileepan Chakrawarthi, Kshitij R. Chaudhary
Age and general health status are major points of concern in the decision-making process when it comes to cervical spine surgeries in the elderly. While there have been studies on the various frailty indices in their ability to predict outcomes in spine surgery, there have been few articles that have investigated the utility of the 5-point modified Frailty Index (mFI-5) for this purpose. Our study attempts to have a granular view of the problem of frailty in the elderly and study the correlation between the mFI-5 and American society of anesthesiologists (ASA) classes, and the 90-day surgical outcome of patients of 60 years and above, operated for degenerative cervical spine pathologies. This is a single-center retrospective study of prospectively collected data on 41 patients aged 60 years and above who were operated at our institute between January 1, 2017, and December 31, 2022. We studied the correlation of mFI-5, ASA class and the Spinal Surgical Invasiveness Index (SII) with various outcome variables like length of hospital stay, need for ICU stay, complications, severe adverse events (Clavien Dindo grade 4 and above), re-intubation, unplanned re-admission, and need for re-operation. Statistical analysis showed a significant correlation between ASA class and mFI-5 scores (Chi square test, P value: 0.0401) and between ASA scores and the need for an ICU stay (Chi square test, P value: 0.0047). SII was found to correlate with length of hospital stay (Spearman rank test, P value: 0.0037) and with need for ICU care (Mann–Whitney U test, P value 0.0422). However, there was no significant correlation between the mFI-5 scores and the outcome variables. Although there was no significant correlation between mFI-5 and the 90-day surgical outcome, variables like ASA and SII had a bearing on it. Thus, it can be stated that the outcome of cervical spine surgery in the elderly is multifactorial. While frailty should put the healthcare team on alert while dealing with such patients, it should not discourage them from offering a surgical solution when required, as efficient peri-operative management by the surgical, anesthesia, and critical care teams can lead to favorable 90-day outcomes.
{"title":"Can Frailty Predict 90-Day Postoperative Outcome in Elderly Patients with Degenerative Cervical Spine Pathology?","authors":"Sourav Chatterjee, Samir Dalvie, Joseph N. Monteiro, Rohan Parihar, Pawan Kumar, Dileepan Chakrawarthi, Kshitij R. Chaudhary","doi":"10.4103/isj.isj_61_23","DOIUrl":"https://doi.org/10.4103/isj.isj_61_23","url":null,"abstract":"\u0000 \u0000 \u0000 Age and general health status are major points of concern in the decision-making process when it comes to cervical spine surgeries in the elderly. While there have been studies on the various frailty indices in their ability to predict outcomes in spine surgery, there have been few articles that have investigated the utility of the 5-point modified Frailty Index (mFI-5) for this purpose. Our study attempts to have a granular view of the problem of frailty in the elderly and study the correlation between the mFI-5 and American society of anesthesiologists (ASA) classes, and the 90-day surgical outcome of patients of 60 years and above, operated for degenerative cervical spine pathologies.\u0000 \u0000 \u0000 \u0000 This is a single-center retrospective study of prospectively collected data on 41 patients aged 60 years and above who were operated at our institute between January 1, 2017, and December 31, 2022. We studied the correlation of mFI-5, ASA class and the Spinal Surgical Invasiveness Index (SII) with various outcome variables like length of hospital stay, need for ICU stay, complications, severe adverse events (Clavien Dindo grade 4 and above), re-intubation, unplanned re-admission, and need for re-operation.\u0000 \u0000 \u0000 \u0000 Statistical analysis showed a significant correlation between ASA class and mFI-5 scores (Chi square test, P value: 0.0401) and between ASA scores and the need for an ICU stay (Chi square test, P value: 0.0047). SII was found to correlate with length of hospital stay (Spearman rank test, P value: 0.0037) and with need for ICU care (Mann–Whitney U test, P value 0.0422). However, there was no significant correlation between the mFI-5 scores and the outcome variables.\u0000 \u0000 \u0000 \u0000 Although there was no significant correlation between mFI-5 and the 90-day surgical outcome, variables like ASA and SII had a bearing on it. Thus, it can be stated that the outcome of cervical spine surgery in the elderly is multifactorial. While frailty should put the healthcare team on alert while dealing with such patients, it should not discourage them from offering a surgical solution when required, as efficient peri-operative management by the surgical, anesthesia, and critical care teams can lead to favorable 90-day outcomes.\u0000","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"70 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845314","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}
Lumbar total disk replacement (TDR) has been in use since the 1980s, yet its adoption has not paralleled that of hip or knee arthroplasty or cervical TDR, which was introduced years after lumbar arthroplasty. If the lack of adoption is related to concerns about the safety and/or effectiveness of these implants, these issues have been extensively addressed in the literature. This narrative review aims to concisely report on the evidence published in the peer-reviewed literature related to lumbar TDR. Literature was identified from online databases such as PubMed, Scopus, and ScienceDirect, supplemented by the authors’ institution’s comprehensive database of TDR articles. By the end of 2023, there were at least 816 articles published on lumbar TDR covering all aspects of this technology, including biomechanics, clinical outcome, radiographic outcome, safety as assessed by re-operations and complications, and the cost related to this treatment intervention. Consistently, the evidence indicates that TDR yields outcomes similar or superior to fusion for treating painful disk degeneration unresponsive to non-operative care in appropriately selected patients.
{"title":"The Scientific Evidence for Lumbar Total Disk Replacement Surgery","authors":"S. Blumenthal, D. Ohnmeiss","doi":"10.4103/isj.isj_13_24","DOIUrl":"https://doi.org/10.4103/isj.isj_13_24","url":null,"abstract":"\u0000 Lumbar total disk replacement (TDR) has been in use since the 1980s, yet its adoption has not paralleled that of hip or knee arthroplasty or cervical TDR, which was introduced years after lumbar arthroplasty. If the lack of adoption is related to concerns about the safety and/or effectiveness of these implants, these issues have been extensively addressed in the literature. This narrative review aims to concisely report on the evidence published in the peer-reviewed literature related to lumbar TDR. Literature was identified from online databases such as PubMed, Scopus, and ScienceDirect, supplemented by the authors’ institution’s comprehensive database of TDR articles. By the end of 2023, there were at least 816 articles published on lumbar TDR covering all aspects of this technology, including biomechanics, clinical outcome, radiographic outcome, safety as assessed by re-operations and complications, and the cost related to this treatment intervention. Consistently, the evidence indicates that TDR yields outcomes similar or superior to fusion for treating painful disk degeneration unresponsive to non-operative care in appropriately selected patients.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"239 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839853","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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