Hemangioblastomas are low-grade tumors that frequently occur in the posterior fossa. Only 1%–5% of these tumors occur in the spinal cord and there are a handful of cases of filum terminale hemangioblastomas described in the literature. Here, we present a case with two spinal hemangioblastomas at filum terminale and cervicodorsal junction of sporadic origin. A 28-year-old woman presented with low back pain radiating to right lower limb with weakness of both lower limbs and urinary incontinence. The findings of the examination revealed asymmetric quadriparesis with more weakness on the left side of the body. Magnetic resonance imaging revealed a cervicodorsal and lumbar T2 hyperintense lesion with flow voids. Imaging findings were suggestive of hemangioblastoma. En bloc excision of both the tumors was performed and the diagnosis was confirmed on histopathology. She had an uneventful postoperative course and complete neurological recovery at the final follow-up. Multiple sporadic spinal hemangioblastomas involving the filum terminale are a very rare entity. Complete surgical excision provides good relief of symptoms.
{"title":"Multiple sporadic spinal hemangioblastoma at the filum terminale and cervicodorsal junction: A case report and review of literature","authors":"H. Gurjar, V. Gaonkar, Tungish Bansal, S. Borkar","doi":"10.4103/isj.isj_27_22","DOIUrl":"https://doi.org/10.4103/isj.isj_27_22","url":null,"abstract":"Hemangioblastomas are low-grade tumors that frequently occur in the posterior fossa. Only 1%–5% of these tumors occur in the spinal cord and there are a handful of cases of filum terminale hemangioblastomas described in the literature. Here, we present a case with two spinal hemangioblastomas at filum terminale and cervicodorsal junction of sporadic origin. A 28-year-old woman presented with low back pain radiating to right lower limb with weakness of both lower limbs and urinary incontinence. The findings of the examination revealed asymmetric quadriparesis with more weakness on the left side of the body. Magnetic resonance imaging revealed a cervicodorsal and lumbar T2 hyperintense lesion with flow voids. Imaging findings were suggestive of hemangioblastoma. En bloc excision of both the tumors was performed and the diagnosis was confirmed on histopathology. She had an uneventful postoperative course and complete neurological recovery at the final follow-up. Multiple sporadic spinal hemangioblastomas involving the filum terminale are a very rare entity. Complete surgical excision provides good relief of symptoms.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"162 - 166"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49545212","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}
Karthik Ramachandran, A. Shetty, AshishShankar Naik, R. Kanna, S. Rajasekaran
Purpose: To determine various radiological parameters predicting spinal cord injury (SCI) in patients with cervicothoracic translational injury. Materials and Methods: Forty-four patients operated for cervicothoracic (C7-T1) translational injury between January 2009 and 2019 were reviewed to obtain demographic details, mechanism of injury (based on Allen Ferguson classification), and neurology at the time of presentation (American Spinal Injury Association [ASIA] grade). Preoperative computed tomography scans were used to measure parameters like anterior translation, local kyphotic angle, residual canal diameter (RCD) at injury level/cranial level/caudal level, and magnetic resonance imaging scans were used to measure maximum canal compromise (MCC), maximum spinal cord compression (MSCC), and length of cord edema. Patients were divided into group 1 (complete neurodeficit), group 2 (incomplete neurodeficit), and group 3 (normal neurology), and the radiological predictors were compared. Results: In our study, anterior translation (P < 0.001), RCD at the injury level (P < 0.001), RCD at the caudal level (P < 0.001), MSCC (P < 0.001), and MCC (P < 0.001) were associated with the increased risk of SCI at the time of presentation. Comparison among all three patient groups showed significant differences in the above parameters. The optimal cutoff for risk of SCI is 7.8 mm for anterior translation, 8.6 mm for RCD at the injury level, 11.9 mm for RCD at the caudal level, 30% for MCC, and 24% for MSCC. Conclusion: Our data highlight that in addition to the amount of anterior translation, canal diameter, and the degree of spinal cord compression at the injury level, the RCD at the caudal level also determines the incidence of SCI in cervicothoracic translational injuries.
{"title":"Cervicothoracic translational injury: Radiological analysis and risk factors of spinal cord injury","authors":"Karthik Ramachandran, A. Shetty, AshishShankar Naik, R. Kanna, S. Rajasekaran","doi":"10.4103/isj.isj_79_22","DOIUrl":"https://doi.org/10.4103/isj.isj_79_22","url":null,"abstract":"Purpose: To determine various radiological parameters predicting spinal cord injury (SCI) in patients with cervicothoracic translational injury. Materials and Methods: Forty-four patients operated for cervicothoracic (C7-T1) translational injury between January 2009 and 2019 were reviewed to obtain demographic details, mechanism of injury (based on Allen Ferguson classification), and neurology at the time of presentation (American Spinal Injury Association [ASIA] grade). Preoperative computed tomography scans were used to measure parameters like anterior translation, local kyphotic angle, residual canal diameter (RCD) at injury level/cranial level/caudal level, and magnetic resonance imaging scans were used to measure maximum canal compromise (MCC), maximum spinal cord compression (MSCC), and length of cord edema. Patients were divided into group 1 (complete neurodeficit), group 2 (incomplete neurodeficit), and group 3 (normal neurology), and the radiological predictors were compared. Results: In our study, anterior translation (P < 0.001), RCD at the injury level (P < 0.001), RCD at the caudal level (P < 0.001), MSCC (P < 0.001), and MCC (P < 0.001) were associated with the increased risk of SCI at the time of presentation. Comparison among all three patient groups showed significant differences in the above parameters. The optimal cutoff for risk of SCI is 7.8 mm for anterior translation, 8.6 mm for RCD at the injury level, 11.9 mm for RCD at the caudal level, 30% for MCC, and 24% for MSCC. Conclusion: Our data highlight that in addition to the amount of anterior translation, canal diameter, and the degree of spinal cord compression at the injury level, the RCD at the caudal level also determines the incidence of SCI in cervicothoracic translational injuries.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"132 - 140"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47787722","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. Chadha, Raskesh Malhotra, Lalit Bafna, Dheeraj Bhateja, N. Wadhwa
Background: Vertebral pathologies can be divided into degenerative, infective, or neoplastic. Infective and neoplastic lesions can progress rapidly and may lead to compression of the cord. Thus, rapid diagnosis for these lesions is important. Frozen section and fine-needle aspiration cytology techniques are less useful in hard bony tumors. Imprint cytology has been successfully used in the diagnosis of soft tissue tumors. The purpose of this study was to evaluate the role of imprint cytology in the early diagnosis of various spinal pathologies. Materials and Methods: Thirty-eight patients with suspected diagnosis of infection or tumor underwent transpedicular biopsy using Jamshidi needle. At least two imprint slides were made using core tissue obtained from biopsy. These slides were, thereafter, stained with the May-Grunwald–Giemsa method. The core biopsy sample was also sent for histopathological examination, after fixing it with 10% formalin. Paraffin-embedded blocks and slides were made for histopathology reporting, as per institution’s protocol. All imprint cytology slides were screened and reported by same pathologist. Results: The sensitivity of imprint cytology was 68.6%. Specificity, positive predictive value, negative predictive value, and overall accuracy of the imprint cytology were 100%, 100%, 21.4%, and 71%, respectively, when compared to histopathology. The mean duration of imprint cytology reporting was only 36 min while that for histopathological report was 15 days. Conclusion: Imprint cytology is a simple and rapid method for obtaining diagnosis in suspected vertebral lesions of infection or tumor. It is a reliable and cost-effective method in experienced hands. Although imprint cytology shows modest correlation in the ability to identify positive results, it forms a good diagnostic tool in confirming true negative cases with high diagnostic efficacy.
{"title":"Usefulness of imprint cytology for early diagnosis in vertebral lesions","authors":"M. Chadha, Raskesh Malhotra, Lalit Bafna, Dheeraj Bhateja, N. Wadhwa","doi":"10.4103/isj.isj_4_23","DOIUrl":"https://doi.org/10.4103/isj.isj_4_23","url":null,"abstract":"Background: Vertebral pathologies can be divided into degenerative, infective, or neoplastic. Infective and neoplastic lesions can progress rapidly and may lead to compression of the cord. Thus, rapid diagnosis for these lesions is important. Frozen section and fine-needle aspiration cytology techniques are less useful in hard bony tumors. Imprint cytology has been successfully used in the diagnosis of soft tissue tumors. The purpose of this study was to evaluate the role of imprint cytology in the early diagnosis of various spinal pathologies. Materials and Methods: Thirty-eight patients with suspected diagnosis of infection or tumor underwent transpedicular biopsy using Jamshidi needle. At least two imprint slides were made using core tissue obtained from biopsy. These slides were, thereafter, stained with the May-Grunwald–Giemsa method. The core biopsy sample was also sent for histopathological examination, after fixing it with 10% formalin. Paraffin-embedded blocks and slides were made for histopathology reporting, as per institution’s protocol. All imprint cytology slides were screened and reported by same pathologist. Results: The sensitivity of imprint cytology was 68.6%. Specificity, positive predictive value, negative predictive value, and overall accuracy of the imprint cytology were 100%, 100%, 21.4%, and 71%, respectively, when compared to histopathology. The mean duration of imprint cytology reporting was only 36 min while that for histopathological report was 15 days. Conclusion: Imprint cytology is a simple and rapid method for obtaining diagnosis in suspected vertebral lesions of infection or tumor. It is a reliable and cost-effective method in experienced hands. Although imprint cytology shows modest correlation in the ability to identify positive results, it forms a good diagnostic tool in confirming true negative cases with high diagnostic efficacy.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"125 - 131"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46963777","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}
N. Palliyil, Jim Vellara, Sai Sailendra, Jyotsna Yesodharan
Gangliocytic paragangliomas are rare, benign, encapsulated, and slow-growing tumors arising from the neuro-ectodermal ganglion or spindle cells. We describe the case of a 47-year-old male patient who presented to our department with intractable lower back pain with occasional radiation to the lower limbs over the past two months. His magnetic resonance imaging scan showed an intradural extramedullary lesion at L2–L3 level. He underwent total surgical excision of the tumor with no perioperative complications. The histopathological examination and immunohistochemistry was suggestive of gangliocytic paraganglioma. He had complete resolution of his symptoms following the surgery. In addition to the case presentation, we have also performed a review of the literature.
{"title":"Gangliocytic paraganglioma of the cauda equina: A rare tumor case report with literature review","authors":"N. Palliyil, Jim Vellara, Sai Sailendra, Jyotsna Yesodharan","doi":"10.4103/isj.isj_9_23","DOIUrl":"https://doi.org/10.4103/isj.isj_9_23","url":null,"abstract":"Gangliocytic paragangliomas are rare, benign, encapsulated, and slow-growing tumors arising from the neuro-ectodermal ganglion or spindle cells. We describe the case of a 47-year-old male patient who presented to our department with intractable lower back pain with occasional radiation to the lower limbs over the past two months. His magnetic resonance imaging scan showed an intradural extramedullary lesion at L2–L3 level. He underwent total surgical excision of the tumor with no perioperative complications. The histopathological examination and immunohistochemistry was suggestive of gangliocytic paraganglioma. He had complete resolution of his symptoms following the surgery. In addition to the case presentation, we have also performed a review of the literature.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"190 - 193"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42199616","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}
S. Rajasekaran, AshishShankar Naik, C. Murugan, SriVijay K S Anand
Neurofibromatosis type 1 (NF-1) with extensive intraspinal involvement seldom presents with isolated radiculopathy. We report the case of a young male with NF-1 having dumbbell tumors along the entire extent of the spine presenting with isolated lower limb radiculopathy. The surgical goals for such tumors primarily involve symptom control, rather than “cure” of a specific lesion, with intervention typically reserved for lesions that significantly compress vital structures symptomatically. Clinical examination and magnetic resonance imaging clinched the symptomatic level in our patient to be L4–L5 and L5–S1, who significantly improved following a decompression surgery.
{"title":"Plexiform intra-spinal neurofibromatosis in a young male with lower limb radiculopathy: A case report and review of literature","authors":"S. Rajasekaran, AshishShankar Naik, C. Murugan, SriVijay K S Anand","doi":"10.4103/isj.isj_78_22","DOIUrl":"https://doi.org/10.4103/isj.isj_78_22","url":null,"abstract":"Neurofibromatosis type 1 (NF-1) with extensive intraspinal involvement seldom presents with isolated radiculopathy. We report the case of a young male with NF-1 having dumbbell tumors along the entire extent of the spine presenting with isolated lower limb radiculopathy. The surgical goals for such tumors primarily involve symptom control, rather than “cure” of a specific lesion, with intervention typically reserved for lesions that significantly compress vital structures symptomatically. Clinical examination and magnetic resonance imaging clinched the symptomatic level in our patient to be L4–L5 and L5–S1, who significantly improved following a decompression surgery.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"198 - 201"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44672842","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}
Arul Nehru, R. Kanna, A. Shetty, R. Shanmuganathan
Background: Although microtrauma, gene polymorphisms, or subclinical infection could initiate lumbar disc herniation (LDH), the final pathway culminating in herniation can involve two possible trajectories—degeneration of nucleus pulposus or vertebral end plate (EP) damage. We performed a retrospective case–control study to understand the relative role played by disc degeneration (DD) and EP changes in acute LDH. Materials and Methods: MRI of 300 consecutive patients with acute LDH (<6 weeks) was evaluated for the type of LDH, severity of DD by Pfirrmann’s grading, and EP Modic changes (MC) for its type, distribution, and location in EPs. Among the1500 discs evaluated in 300 patients, 308 had disc herniation (cases) and 1192 acted as controls. Results: 98.8% of LDH had grade ≥3 DD (P < 0.001). The mean DD was higher in herniated discs (P < 0.05). From a mean 1.98 in normal discs, it increased to 3.31 in disc bulges, 3.73 in disc protrusions/extrusions, and 3.83 in sequestrations. Herniated discs had more MCs than normal discs (38.3%, 118/308) (P < 0.001). Although in normal discs, only 7.7% had MC, herniated disc subtypes showed a progressive increase in the incidence of MC (26.2% in disc bulges, 37.5% in disc protrusion/extrusions, and 58.3% in sequestrations). MC on both EP was strongly associated with LDH (odds ratio = 9.76). Posterior corner MC had a significant association with LDH (72.72%, P < 0.001). Conclusion: DD seems to be a common thread in all patients (98.8%) with LDH, whereas EP damage seems to be specific pathway in a subset (38.3%). The study showed a significant degeneration of nucleus pulposus in most (98.8%) herniated discs. Compared with nonherniated discs, vertebral MC had a higher incidence in herniated discs (38%), and interestingly these were of subacute fatty type 2.
{"title":"Intervertebral disc degeneration and vertebral end plate damage in acute lumbar disc herniation","authors":"Arul Nehru, R. Kanna, A. Shetty, R. Shanmuganathan","doi":"10.4103/isj.isj_11_22","DOIUrl":"https://doi.org/10.4103/isj.isj_11_22","url":null,"abstract":"Background: Although microtrauma, gene polymorphisms, or subclinical infection could initiate lumbar disc herniation (LDH), the final pathway culminating in herniation can involve two possible trajectories—degeneration of nucleus pulposus or vertebral end plate (EP) damage. We performed a retrospective case–control study to understand the relative role played by disc degeneration (DD) and EP changes in acute LDH. Materials and Methods: MRI of 300 consecutive patients with acute LDH (<6 weeks) was evaluated for the type of LDH, severity of DD by Pfirrmann’s grading, and EP Modic changes (MC) for its type, distribution, and location in EPs. Among the1500 discs evaluated in 300 patients, 308 had disc herniation (cases) and 1192 acted as controls. Results: 98.8% of LDH had grade ≥3 DD (P < 0.001). The mean DD was higher in herniated discs (P < 0.05). From a mean 1.98 in normal discs, it increased to 3.31 in disc bulges, 3.73 in disc protrusions/extrusions, and 3.83 in sequestrations. Herniated discs had more MCs than normal discs (38.3%, 118/308) (P < 0.001). Although in normal discs, only 7.7% had MC, herniated disc subtypes showed a progressive increase in the incidence of MC (26.2% in disc bulges, 37.5% in disc protrusion/extrusions, and 58.3% in sequestrations). MC on both EP was strongly associated with LDH (odds ratio = 9.76). Posterior corner MC had a significant association with LDH (72.72%, P < 0.001). Conclusion: DD seems to be a common thread in all patients (98.8%) with LDH, whereas EP damage seems to be specific pathway in a subset (38.3%). The study showed a significant degeneration of nucleus pulposus in most (98.8%) herniated discs. Compared with nonherniated discs, vertebral MC had a higher incidence in herniated discs (38%), and interestingly these were of subacute fatty type 2.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"118 - 124"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45090375","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}
Vertebroplasty is a commonly done procedure in osteoporotic compression fracture. Cement leakage is the most common complication associated with vertebroplasty. Infection following vertebroplasty is rare. Fungal spondylodiscitis following vertebroplasty has not been reported in the literature. The objective of this clinical case report was to highlight this rare fungal spondylodiscitis following vertebroplasty. A 67-year-old woman was diagnosed with osteoporotic compression fracture for which vertebroplasty was done. During the procedure, the primary surgeon noticed the cement leakage without any neurological complication. The patient was referred to us. The patient was diagnosed with spondylodiscitis with cement leakage. We performed an open biopsy with cement removal with posterior thoracic decompression and interbody fusion. On microbiological examination, Aspergillus fumigatus were isolated from multiple samples that were susceptible to voriconazole. On 1-month follow-up, patient’s pain significantly reduced with normalized inflammatory markers. Presence of immunocompromised status with diabetes mellitus and lack of quality operating theater with inadequate maintenance of sterility protocols during the procedure could be the reason for the infection.
{"title":"Rare case of post-vertebroplasty fungal spondylodiscitis: Case report","authors":"Avinash K C, Satyen S. Mehta","doi":"10.4103/isj.isj_17_23","DOIUrl":"https://doi.org/10.4103/isj.isj_17_23","url":null,"abstract":"Vertebroplasty is a commonly done procedure in osteoporotic compression fracture. Cement leakage is the most common complication associated with vertebroplasty. Infection following vertebroplasty is rare. Fungal spondylodiscitis following vertebroplasty has not been reported in the literature. The objective of this clinical case report was to highlight this rare fungal spondylodiscitis following vertebroplasty. A 67-year-old woman was diagnosed with osteoporotic compression fracture for which vertebroplasty was done. During the procedure, the primary surgeon noticed the cement leakage without any neurological complication. The patient was referred to us. The patient was diagnosed with spondylodiscitis with cement leakage. We performed an open biopsy with cement removal with posterior thoracic decompression and interbody fusion. On microbiological examination, Aspergillus fumigatus were isolated from multiple samples that were susceptible to voriconazole. On 1-month follow-up, patient’s pain significantly reduced with normalized inflammatory markers. Presence of immunocompromised status with diabetes mellitus and lack of quality operating theater with inadequate maintenance of sterility protocols during the procedure could be the reason for the infection.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"194 - 197"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44811119","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}
Background: The aim of the study was to compare awake supine manual traction radiograph with standing side bending radiograph in adolescent idiopathic scoliosis (AIS) patients and to analyze, which one among them is the best predictor of spinal flexibility index in varying degrees of AIS curves with minimal to severe Cobb angle. Materials and Methods: AIS patients, who underwent surgery during the period from 2015 to 2018, were retrospectively analyzed. Supine manual traction anteroposterior radiograph were taken with the patient in the supine position, with traction applied by a person with the head halter at the chin and counter traction applied with pelvic belt, leg straps. Patients were divided into three groups A, B, and C based on Cobb angle of the major structural curve. Patients with Cobb angles between 40° to 65°, 65° to 90°, and more than 90° were included in Groups A, B, and C, respectively. Flexibility indices obtained from both traction and bending radiographs were correlated with percent change in Cobb angle correction post-surgery. Statistical analysis was done to find Pearson correlation coefficient (r) between variables and results were tabulated. Results: There were 36, 16, and 16 patients in Group A, B, and C, respectively. The mean age of the cohort was 13.38 years. Group A had a positive correlation to traction radiographs (r = + 0.188, P = 0.455). Group B had a statistically significant positive correlation to bending radiographs (r = + 0.729, P = 0.04). A statistically significant positive correlation with traction radiographs (r = + 0.769, P = 0.016) was seen in Group C. Conclusion: Awake supine manual traction radiographs reveal better flexibility index in severe stiff (Cobb more than 90°) curves. In moderately stiffer curves (Cobb 65°–90°) standing side bending radiographs provide a better flexibility index than traction radiographs. Supine manual traction radiographs should always accompany bending radiographs in evaluating AIS patients, especially with severe stiff curves.
{"title":"Comparison of standing, side bending and awake supine manual traction dynamic radiographs for predicting spinal flexibility with postoperative correction rate in adolescent idiopathic scoliosis","authors":"M. Subramaniam, M. Venkatesan, S. Hegde","doi":"10.4103/isj.isj_12_23","DOIUrl":"https://doi.org/10.4103/isj.isj_12_23","url":null,"abstract":"Background: The aim of the study was to compare awake supine manual traction radiograph with standing side bending radiograph in adolescent idiopathic scoliosis (AIS) patients and to analyze, which one among them is the best predictor of spinal flexibility index in varying degrees of AIS curves with minimal to severe Cobb angle. Materials and Methods: AIS patients, who underwent surgery during the period from 2015 to 2018, were retrospectively analyzed. Supine manual traction anteroposterior radiograph were taken with the patient in the supine position, with traction applied by a person with the head halter at the chin and counter traction applied with pelvic belt, leg straps. Patients were divided into three groups A, B, and C based on Cobb angle of the major structural curve. Patients with Cobb angles between 40° to 65°, 65° to 90°, and more than 90° were included in Groups A, B, and C, respectively. Flexibility indices obtained from both traction and bending radiographs were correlated with percent change in Cobb angle correction post-surgery. Statistical analysis was done to find Pearson correlation coefficient (r) between variables and results were tabulated. Results: There were 36, 16, and 16 patients in Group A, B, and C, respectively. The mean age of the cohort was 13.38 years. Group A had a positive correlation to traction radiographs (r = + 0.188, P = 0.455). Group B had a statistically significant positive correlation to bending radiographs (r = + 0.729, P = 0.04). A statistically significant positive correlation with traction radiographs (r = + 0.769, P = 0.016) was seen in Group C. Conclusion: Awake supine manual traction radiographs reveal better flexibility index in severe stiff (Cobb more than 90°) curves. In moderately stiffer curves (Cobb 65°–90°) standing side bending radiographs provide a better flexibility index than traction radiographs. Supine manual traction radiographs should always accompany bending radiographs in evaluating AIS patients, especially with severe stiff curves.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"152 - 161"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48685021","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}
R. Gala, Saumyajit Basu, Amitava Biswas, Anil M. Solanki
Purpose: Cement distribution in spinal stabilization with fenestrated screws is unpredictable in patients with osteoporosis. The objective of our study was an assessment of cement distribution while using fenestrated screws and to establish an association between cement distribution and the Dual Emission X-ray Absorptiometry (DEXA) scan T scores. Materials and Methods: Osteoporotic patients who underwent spinal stabilization with fenestrated screws by a single surgeon with a minimum follow-up of one year were included. Cement distribution (four zones comprising the vertebral body and the pedicle), a pattern of distribution (concentrated or scattered) and cement leakage were assessed on CT scans. Patients were categorized into two groups based on their DEXA scan T scores to test an association between the pattern of distribution of cement and the scores. Clinical improvement was determined using visual analogue scale and Oswestry disability index scores. Results: A total of 126 screws were analyzed in 20 patients with a mean age of 69 years and a mean follow-up of 18 months. Out of 126 screws, 114 (90.47%) had cement in Zones 1 and 2. In total, 58 screws had a concentrated pattern of distribution of cement, whereas 68 screws had a scattered distribution, and the odds ratio of a scattered pattern of distribution was 6.31:1 if the DEXA scan T score was “below (−)3.0.” Clinical improvement was calculated in percentage of change from the preoperative value (mean % visual analogue scale change = 65.13 ± 7.59 and mean % Oswestry disability index change = 43.14 ± 7.24). Conclusion: The pattern of cement distribution in fenestrated screws relates well with the DEXA scan T scores and their usage should be strongly considered in patients with poorer scores. However, there is no relevant difference between the pattern of distribution and the clinical outcome.
{"title":"Fenestrated screws in osteoporotic spine—Is there an association between the cement distribution and DEXA scan T score?","authors":"R. Gala, Saumyajit Basu, Amitava Biswas, Anil M. Solanki","doi":"10.4103/isj.isj_90_22","DOIUrl":"https://doi.org/10.4103/isj.isj_90_22","url":null,"abstract":"Purpose: Cement distribution in spinal stabilization with fenestrated screws is unpredictable in patients with osteoporosis. The objective of our study was an assessment of cement distribution while using fenestrated screws and to establish an association between cement distribution and the Dual Emission X-ray Absorptiometry (DEXA) scan T scores. Materials and Methods: Osteoporotic patients who underwent spinal stabilization with fenestrated screws by a single surgeon with a minimum follow-up of one year were included. Cement distribution (four zones comprising the vertebral body and the pedicle), a pattern of distribution (concentrated or scattered) and cement leakage were assessed on CT scans. Patients were categorized into two groups based on their DEXA scan T scores to test an association between the pattern of distribution of cement and the scores. Clinical improvement was determined using visual analogue scale and Oswestry disability index scores. Results: A total of 126 screws were analyzed in 20 patients with a mean age of 69 years and a mean follow-up of 18 months. Out of 126 screws, 114 (90.47%) had cement in Zones 1 and 2. In total, 58 screws had a concentrated pattern of distribution of cement, whereas 68 screws had a scattered distribution, and the odds ratio of a scattered pattern of distribution was 6.31:1 if the DEXA scan T score was “below (−)3.0.” Clinical improvement was calculated in percentage of change from the preoperative value (mean % visual analogue scale change = 65.13 ± 7.59 and mean % Oswestry disability index change = 43.14 ± 7.24). Conclusion: The pattern of cement distribution in fenestrated screws relates well with the DEXA scan T scores and their usage should be strongly considered in patients with poorer scores. However, there is no relevant difference between the pattern of distribution and the clinical outcome.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"141 - 145"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46029137","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}
Sidheshwar S. Thosar, Bharat K. Patel, Mallidi Reddy, M. Bapat, Amandeep Gujral
The posterior epidural migration of lumbar disc herniation is a rare condition, and the overall reported incidence is 0.4%–1.04%. Most of these cases present with cauda equina syndrome or polyradiculopathy on ipsilateral side. We report a case of posterior epidural migration of lumbar disc causing contralateral neurodeficit. A 66-year-old gentleman presented with axial pain radiating to the left anterolateral thigh since 15 days after heavy weight lifting. Neurological examination revealed hypoesthesia over left L3 dermatome and left knee extensor weakness (Medical Research Council grade 3/5). Magnetic resonance imaging with contrast showed L2–L3 right-side extruded disc fragment migrated posteriorly in epidural space. Contralateral monoradiculopathy was an unusual presentation. Interlaminar decompression and discectomy were able to achieve complete neurological recovery at three months. To the best of our knowledge, this is the second case with contralateral neurodeficit due to posteriorly migrated lumbar disc herniation.
{"title":"Posteriorly migrated epidural lumbar disc extrusion with contralateral neurodeficit: An unusual presentation","authors":"Sidheshwar S. Thosar, Bharat K. Patel, Mallidi Reddy, M. Bapat, Amandeep Gujral","doi":"10.4103/isj.isj_81_22","DOIUrl":"https://doi.org/10.4103/isj.isj_81_22","url":null,"abstract":"The posterior epidural migration of lumbar disc herniation is a rare condition, and the overall reported incidence is 0.4%–1.04%. Most of these cases present with cauda equina syndrome or polyradiculopathy on ipsilateral side. We report a case of posterior epidural migration of lumbar disc causing contralateral neurodeficit. A 66-year-old gentleman presented with axial pain radiating to the left anterolateral thigh since 15 days after heavy weight lifting. Neurological examination revealed hypoesthesia over left L3 dermatome and left knee extensor weakness (Medical Research Council grade 3/5). Magnetic resonance imaging with contrast showed L2–L3 right-side extruded disc fragment migrated posteriorly in epidural space. Contralateral monoradiculopathy was an unusual presentation. Interlaminar decompression and discectomy were able to achieve complete neurological recovery at three months. To the best of our knowledge, this is the second case with contralateral neurodeficit due to posteriorly migrated lumbar disc herniation.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"171 - 174"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45299351","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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