G. Pratheep, C. Murugan, S. Rajasekaran, A. Shetty, R. Kanna
Spine surgery has witnessed exponential technological innovation over the past few decades to overcome the challenges of complex surgeries, reduce complications, and increase safety. Advancements have occurred in biologics, implants, operative techniques, and equipment such as navigation and surgical robotics. In addition to patient safety, these technologies protect the operating personnel from the harmful effects of radiation. Navigation provides simultaneous and multiplanar visualization of anatomy, real-time feedback of instruments, and implant position, which, in turn, improves the accuracy and hand–eye coordination of the surgeon. Robotics further improves outcomes by reducing human error through increased precision in execution, indefatigability, motion scaling, and tremor filtration via mechanical actuation. This review provides an overview of the current navigation and robotic systems in spine surgeries and their role in the safety and prevention of surgical complications.
{"title":"Role of robotics and spinal navigation in reducing surgical complications","authors":"G. Pratheep, C. Murugan, S. Rajasekaran, A. Shetty, R. Kanna","doi":"10.4103/isj.isj_72_22","DOIUrl":"https://doi.org/10.4103/isj.isj_72_22","url":null,"abstract":"Spine surgery has witnessed exponential technological innovation over the past few decades to overcome the challenges of complex surgeries, reduce complications, and increase safety. Advancements have occurred in biologics, implants, operative techniques, and equipment such as navigation and surgical robotics. In addition to patient safety, these technologies protect the operating personnel from the harmful effects of radiation. Navigation provides simultaneous and multiplanar visualization of anatomy, real-time feedback of instruments, and implant position, which, in turn, improves the accuracy and hand–eye coordination of the surgeon. Robotics further improves outcomes by reducing human error through increased precision in execution, indefatigability, motion scaling, and tremor filtration via mechanical actuation. This review provides an overview of the current navigation and robotic systems in spine surgeries and their role in the safety and prevention of surgical complications.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"37 - 47"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48772795","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}
Spinal fusion is gold-standard treatment for degenerative disc disease (DDD) both at cervical and lumbar spine, and it is time tested. Perhaps it has its bundle of complications. Elimination of motion results in accentuated degeneration of adjacent segments leading to adjacent segment degeneration radiographically and, if symptomatic, leads to adjacent segment disease. There is still a debate on whether there is such an entity or whether it is a manifestation of natural history or an iatrogenic phenomenon. Motion preservation surgeries were developed to address the same issue, which includes total disc replacement, nucleus replacement, interspinous implants, and dynamic posterior stabilization systems. The primary goal of motion preservation surgery is to maintain normal or near-normal motion in an attempt to prevent adverse outcomes, which are commonly seen with conventional spinal fusion, most notably the development of adjacent-level DDD. A search was conducted in PubMed using the terms (“adjacent segment”) AND (“disease” OR “degeneration” or “pathology”). Then the articles were shortlisted based on time of publication (2005 onward), publication in English and inclusion of human subjects. This resulted in 253 articles. Another search for ((“Motion preservation”) AND (“Spine”)) OR (“Adjacent segment disease”) OR (“Adjacent segment pathology”) OR (“Adjacent segment degeneration”) yielded 76 articles. This narrative review discusses various issues pertaining to the current evidence regarding adjacent segment disease (ASD), including the controversy on whether ASD is actually an entity, its etiopathogenesis, clinical features, as well as the role of motion preservation technologies to reduce its incidence. There is still enthusiasm and concerns regarding the benefits of motion preservation surgery since it is still an area of ongoing research.
{"title":"Adjacent segment disease: Current evidence and the role of motion preservation technologies","authors":"N. Jagadeesh, Kuldeep Bansal, H. Chhabra","doi":"10.4103/isj.isj_61_22","DOIUrl":"https://doi.org/10.4103/isj.isj_61_22","url":null,"abstract":"Spinal fusion is gold-standard treatment for degenerative disc disease (DDD) both at cervical and lumbar spine, and it is time tested. Perhaps it has its bundle of complications. Elimination of motion results in accentuated degeneration of adjacent segments leading to adjacent segment degeneration radiographically and, if symptomatic, leads to adjacent segment disease. There is still a debate on whether there is such an entity or whether it is a manifestation of natural history or an iatrogenic phenomenon. Motion preservation surgeries were developed to address the same issue, which includes total disc replacement, nucleus replacement, interspinous implants, and dynamic posterior stabilization systems. The primary goal of motion preservation surgery is to maintain normal or near-normal motion in an attempt to prevent adverse outcomes, which are commonly seen with conventional spinal fusion, most notably the development of adjacent-level DDD. A search was conducted in PubMed using the terms (“adjacent segment”) AND (“disease” OR “degeneration” or “pathology”). Then the articles were shortlisted based on time of publication (2005 onward), publication in English and inclusion of human subjects. This resulted in 253 articles. Another search for ((“Motion preservation”) AND (“Spine”)) OR (“Adjacent segment disease”) OR (“Adjacent segment pathology”) OR (“Adjacent segment degeneration”) yielded 76 articles. This narrative review discusses various issues pertaining to the current evidence regarding adjacent segment disease (ASD), including the controversy on whether ASD is actually an entity, its etiopathogenesis, clinical features, as well as the role of motion preservation technologies to reduce its incidence. There is still enthusiasm and concerns regarding the benefits of motion preservation surgery since it is still an area of ongoing research.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"3 - 14"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49524560","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: Spinal cutaneous inclusion tumors are extremely rare, accounting for less than 1% of intraspinal tumors. The existing literature is scarce; in last two decades, only eight case series have documented more than 10 patients. We tried to figure out if intramedullary and extramedullary locations have an impact on outcomes in terms of extent of resection and neurological recovery. Materials and Methods: A retrospective review of intraspinal epidermoid and dermoid tumors operated at our Neurosurgical Department, between May 2006 and May 2021, was made. McCormick grading was used to evaluate the neurological status of all patients at presentation, after surgery, and at the follow-up visit in the outpatient clinic. The neurological status at the last follow-up was taken as final. Results: Of 15 cases, eight (53.3%) were males with the age at presentation ranging from 7 to 60 years (mean = 24.4 years). Spinal dysraphism was associated in four patients. The proportion of region involved in descending order was lumbar (46.6%), thoracic/thoracolumbar/lumbosacral (13.3% each) and cervicothoracic/sacrococcygeal (6.6% each) with 11 gross total resections (73.3%) and four subtotal resections (all intramedullary). Two-tailed Fischer’s exact test showed a significant correlation between location, extent of resection, and neurological recovery, whereas histological subtype and region had no significant impact on the outcome. Conclusions: To the best of our knowledge, this is the eighth largest study in the last two decades, reporting 15 cases with long-term follow-up. We attempt to bring clarity to the notion of location having no effect on resectablity by specifying location in terms of spinal compartment involved and describing spinal level as region. Overall, our gross total resection rate was lower (73.3%) than other contemporary studies (86.6%–92%), but a subgroup analysis with regard to the location of tumor revealed the intramedullary location to be the primary determinant of the extent of resection.
{"title":"Impact of location on resectability and neurological outcome in spinal cutaneous inclusion tumors","authors":"Sundus Ali, Fauzia Sajjad, Adnan Qasim, Anwar Chaudhary, Akmal Azeemi, A. Shabbir","doi":"10.4103/isj.isj_30_22","DOIUrl":"https://doi.org/10.4103/isj.isj_30_22","url":null,"abstract":"Background: Spinal cutaneous inclusion tumors are extremely rare, accounting for less than 1% of intraspinal tumors. The existing literature is scarce; in last two decades, only eight case series have documented more than 10 patients. We tried to figure out if intramedullary and extramedullary locations have an impact on outcomes in terms of extent of resection and neurological recovery. Materials and Methods: A retrospective review of intraspinal epidermoid and dermoid tumors operated at our Neurosurgical Department, between May 2006 and May 2021, was made. McCormick grading was used to evaluate the neurological status of all patients at presentation, after surgery, and at the follow-up visit in the outpatient clinic. The neurological status at the last follow-up was taken as final. Results: Of 15 cases, eight (53.3%) were males with the age at presentation ranging from 7 to 60 years (mean = 24.4 years). Spinal dysraphism was associated in four patients. The proportion of region involved in descending order was lumbar (46.6%), thoracic/thoracolumbar/lumbosacral (13.3% each) and cervicothoracic/sacrococcygeal (6.6% each) with 11 gross total resections (73.3%) and four subtotal resections (all intramedullary). Two-tailed Fischer’s exact test showed a significant correlation between location, extent of resection, and neurological recovery, whereas histological subtype and region had no significant impact on the outcome. Conclusions: To the best of our knowledge, this is the eighth largest study in the last two decades, reporting 15 cases with long-term follow-up. We attempt to bring clarity to the notion of location having no effect on resectablity by specifying location in terms of spinal compartment involved and describing spinal level as region. Overall, our gross total resection rate was lower (73.3%) than other contemporary studies (86.6%–92%), but a subgroup analysis with regard to the location of tumor revealed the intramedullary location to be the primary determinant of the extent of resection.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"89 - 95"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43575373","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. Vijayan, Christopher Gerber, Anindya Basu, Radhika Mhatre
Cysticercosis is the most common parasitic disease of the central nervous system but an isolated spinal intramedullary involvement is very rare. We present one such case of a 68-year-old female who had spastic paraplegia with bladder involvement. Magnetic resonance imaging (MRI) revealed D3 intramedullary space-occupying lesion. She was treated with surgical excision and her diagnosis was confirmed to be cysticercosis by histopathological examination. With appropriate post-operative rehabilitation and medical management, she was found to have significant recovery. At final follow-up, she was walking with aid and regained her bladder control. A high index of suspicion is required in endemic zones, like India, when the MRI shows an unusual picture of space-occupying intramedullary lesions. With early diagnosis and initiation of treatment, neurocysticercosis (NCC) shows better prognosis than what was previously known.
{"title":"Isolated spinal intramedullary neurocysticercosis: Case report and review of literature","authors":"S. Vijayan, Christopher Gerber, Anindya Basu, Radhika Mhatre","doi":"10.4103/isj.isj_100_21","DOIUrl":"https://doi.org/10.4103/isj.isj_100_21","url":null,"abstract":"Cysticercosis is the most common parasitic disease of the central nervous system but an isolated spinal intramedullary involvement is very rare. We present one such case of a 68-year-old female who had spastic paraplegia with bladder involvement. Magnetic resonance imaging (MRI) revealed D3 intramedullary space-occupying lesion. She was treated with surgical excision and her diagnosis was confirmed to be cysticercosis by histopathological examination. With appropriate post-operative rehabilitation and medical management, she was found to have significant recovery. At final follow-up, she was walking with aid and regained her bladder control. A high index of suspicion is required in endemic zones, like India, when the MRI shows an unusual picture of space-occupying intramedullary lesions. With early diagnosis and initiation of treatment, neurocysticercosis (NCC) shows better prognosis than what was previously known.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"96 - 100"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43172225","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}
Complications are neither entirely predictable nor preventable in the practice of spinal surgery. Communications, particularly the pre-operative consent, play an important role in the management of complications. Patient dissatisfaction leading to complaints and legal proceedings are common and expected sequelae to complications. This article is an overview of important aspects of doctor–patient communication and the relevant legal issues including the principles followed by the judicial system in India while adjudicating on alleged medical negligence.
{"title":"Managing complications: Communication and medicolegal aspects","authors":"K. Mukherjee, R. Mukherjee, Jayanta R. Das","doi":"10.4103/isj.isj_56_22","DOIUrl":"https://doi.org/10.4103/isj.isj_56_22","url":null,"abstract":"Complications are neither entirely predictable nor preventable in the practice of spinal surgery. Communications, particularly the pre-operative consent, play an important role in the management of complications. Patient dissatisfaction leading to complaints and legal proceedings are common and expected sequelae to complications. This article is an overview of important aspects of doctor–patient communication and the relevant legal issues including the principles followed by the judicial system in India while adjudicating on alleged medical negligence.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"48 - 53"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70779562","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}
A 60-year-old male who underwent commando surgery for oral cancer in a supine position and 20-degree neck extension developed sensory ataxia with a loss of proprioception in bilateral lower limbs and hands in the immediate postoperative period. The magnetic resonance imaging (MRI) of brain and screening of spine done within 6 h of surgery indicated a degenerative cervical canal stenosis from C3 to C7 level. A final diagnosis of posterior spinal cord syndrome (PCS) was made after excluding other causes clinically and radiologically. Emergency surgical decompression in the form of C3–C7 laminectomy and intravenous methylprednisolone were administered within 12 h of index surgery. An early diagnosis and treatment resulted in a good neurological recovery by the seventh postoperative day and he was ambulatory with minimal support at 3-month follow-up.
{"title":"A rare case of posterior spinal cord syndrome following commando surgery: A case report and review of literature","authors":"B. Dave, Saral J Patel, Ravi Patel, Akruti Dave","doi":"10.4103/isj.isj_103_21","DOIUrl":"https://doi.org/10.4103/isj.isj_103_21","url":null,"abstract":"A 60-year-old male who underwent commando surgery for oral cancer in a supine position and 20-degree neck extension developed sensory ataxia with a loss of proprioception in bilateral lower limbs and hands in the immediate postoperative period. The magnetic resonance imaging (MRI) of brain and screening of spine done within 6 h of surgery indicated a degenerative cervical canal stenosis from C3 to C7 level. A final diagnosis of posterior spinal cord syndrome (PCS) was made after excluding other causes clinically and radiologically. Emergency surgical decompression in the form of C3–C7 laminectomy and intravenous methylprednisolone were administered within 12 h of index surgery. An early diagnosis and treatment resulted in a good neurological recovery by the seventh postoperative day and he was ambulatory with minimal support at 3-month follow-up.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"6 1","pages":"106 - 109"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41834451","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}
Ankylosing spondylitis (AS) is a progressive systemic chronic inflammatory rheumatic disease that causes arthritis of spine and sacroiliac joints and finally results in contracture or bony fusion of these joints. The ankylosed spine has increased propensity to fracture due to rigidity, long lever arms, and osteoporosis. However, iatrogenic fracture occurring in AS patients with chin-on-chest deformity during positioning has not been reported. A 46-year-old male, known case of AS, presented with progressive deformity of neck for the last 6 months due to C5 fracture with C4/5 dislocation. He had chin-on-chest deformity with chin-brow vertical angle of 106o with spastic tetraparesis (mJOA score 6, Nurick grade-3). The patient was put on sustained halo-gravity traction by gradually increasing the weight up to 30 lbs for 4 weeks and then was planned for deformity correction. After intubation and application of same traction, we found anterior wedge opening and fracture through C6/7 disc space. His neurology was found to be same as in the preoperative state on neural monitoring and wake up test. Front and back instrumented fusion was done with anterior bone grafting. Postoperatively, he was maintained on halo-vest immobilization for three months. By the end of first year, the fracture had united well and he was mobilizing well with mJOA score 13 and Nurick grade-1. AS patients are at higher risk of fracture and need utmost care while positioning during surgery. Traction or any corrective maneuver must be done carefully.
{"title":"Iatrogenic fracture in a patient of ankylosing spondylitis planned for surgical correction of chin-on-chest deformity: A case report and review of literature","authors":"Kushal Gohil, Saumyajit Basu, Aayushee Gupta, JallipalliRanga Sai Gowtham, Dheeraj Manikanta, Gokul Bandagi, Amitava Biswas","doi":"10.4103/isj.isj_66_21","DOIUrl":"https://doi.org/10.4103/isj.isj_66_21","url":null,"abstract":"Ankylosing spondylitis (AS) is a progressive systemic chronic inflammatory rheumatic disease that causes arthritis of spine and sacroiliac joints and finally results in contracture or bony fusion of these joints. The ankylosed spine has increased propensity to fracture due to rigidity, long lever arms, and osteoporosis. However, iatrogenic fracture occurring in AS patients with chin-on-chest deformity during positioning has not been reported. A 46-year-old male, known case of AS, presented with progressive deformity of neck for the last 6 months due to C5 fracture with C4/5 dislocation. He had chin-on-chest deformity with chin-brow vertical angle of 106o with spastic tetraparesis (mJOA score 6, Nurick grade-3). The patient was put on sustained halo-gravity traction by gradually increasing the weight up to 30 lbs for 4 weeks and then was planned for deformity correction. After intubation and application of same traction, we found anterior wedge opening and fracture through C6/7 disc space. His neurology was found to be same as in the preoperative state on neural monitoring and wake up test. Front and back instrumented fusion was done with anterior bone grafting. Postoperatively, he was maintained on halo-vest immobilization for three months. By the end of first year, the fracture had united well and he was mobilizing well with mJOA score 13 and Nurick grade-1. AS patients are at higher risk of fracture and need utmost care while positioning during surgery. Traction or any corrective maneuver must be done carefully.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"231 - 234"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42433902","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}
Naresh Kumar, A. Thomas, Sean Lee, K. Lopez, Sarah Tang, J. Hallinan
The incidence of metastatic spine disease (MSD) is on the rise and is currently present in 70% of patients presenting with systemic cancer. The majority of patients with MSD present with clinical symptoms such as neurological deficit, pathological fracture causing pain and spinal instability. Management of MSD is a multidisciplinary endeavor that involves surgery, radiotherapy (RT), and chemotherapy. The conventional open spine surgery approach has evolved into a less invasive surgery model categorized as minimally invasive spine surgery (MISS) or minimal access spine surgery. This evolution was brought about to address the complications associated with open surgery such as longer hospital stays and wound-related problems. MISS has been now widely explored in MSD due to lower wound-related complications, decreasing operative time, less neurological complications, and shorter hospital stays. Decompression and stabilization still remain the core concepts in MISS. Kyphoplasty/vertebroplasty, percutaneous pedicle screw fixation, separation surgery, and radiofrequency ablation are some of the minimally invasive techniques and procedures for surgical management of MSD. MISS is used in conjunction with other modern techniques like intraoperative neuromonitoring to help identify any adverse neurological events. MIS techniques will evolve with time, extending their application for the management of hypervascular tumors with significant anterior cord compression and recurrent tumors in which the open surgery currently remains the choice of approach.
{"title":"Minimally invasive surgery for spinal metastases: Principles, techniques, and outcomes","authors":"Naresh Kumar, A. Thomas, Sean Lee, K. Lopez, Sarah Tang, J. Hallinan","doi":"10.4103/isj.isj_72_21","DOIUrl":"https://doi.org/10.4103/isj.isj_72_21","url":null,"abstract":"The incidence of metastatic spine disease (MSD) is on the rise and is currently present in 70% of patients presenting with systemic cancer. The majority of patients with MSD present with clinical symptoms such as neurological deficit, pathological fracture causing pain and spinal instability. Management of MSD is a multidisciplinary endeavor that involves surgery, radiotherapy (RT), and chemotherapy. The conventional open spine surgery approach has evolved into a less invasive surgery model categorized as minimally invasive spine surgery (MISS) or minimal access spine surgery. This evolution was brought about to address the complications associated with open surgery such as longer hospital stays and wound-related problems. MISS has been now widely explored in MSD due to lower wound-related complications, decreasing operative time, less neurological complications, and shorter hospital stays. Decompression and stabilization still remain the core concepts in MISS. Kyphoplasty/vertebroplasty, percutaneous pedicle screw fixation, separation surgery, and radiofrequency ablation are some of the minimally invasive techniques and procedures for surgical management of MSD. MISS is used in conjunction with other modern techniques like intraoperative neuromonitoring to help identify any adverse neurological events. MIS techniques will evolve with time, extending their application for the management of hypervascular tumors with significant anterior cord compression and recurrent tumors in which the open surgery currently remains the choice of approach.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"168 - 175"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42883854","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}
Spinal metastatis is a diagnostic and treatment challenge for the spine surgeon and must be addressed through multidisciplinary, multimodal, and individualized management. The presence of tumor cells in bone metastases results in homeostatic disruption between bone formation and remodeling and leads to osteolytic, osteoblastic, or mixed bone lesions. Spinal metastases are a significant cause for morbidity characterized by severe pain, impaired mobility, pathological fractures, spinal instability, and neurological involvement. Radiographs, magnetic resonance imaging, computed tomography, and positron emission tomography are widely used for the detection and staging of the disease. Histopathological examination is crucial to establish an oncological diagnosis. Our review focuses on epidemiology, pathogenesis, clinical presentation, and diagnosis of spinal metastasis.
{"title":"Epidemiology, pathogenesis, clinical presentation, and diagnostic approach","authors":"Pratik Patel, Kshitij Chaudhary, S. Dalvie","doi":"10.4103/isj.isj_77_21","DOIUrl":"https://doi.org/10.4103/isj.isj_77_21","url":null,"abstract":"Spinal metastatis is a diagnostic and treatment challenge for the spine surgeon and must be addressed through multidisciplinary, multimodal, and individualized management. The presence of tumor cells in bone metastases results in homeostatic disruption between bone formation and remodeling and leads to osteolytic, osteoblastic, or mixed bone lesions. Spinal metastases are a significant cause for morbidity characterized by severe pain, impaired mobility, pathological fractures, spinal instability, and neurological involvement. Radiographs, magnetic resonance imaging, computed tomography, and positron emission tomography are widely used for the detection and staging of the disease. Histopathological examination is crucial to establish an oncological diagnosis. Our review focuses on epidemiology, pathogenesis, clinical presentation, and diagnosis of spinal metastasis.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"150 - 157"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45000180","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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