Primary malignant melanoma of central nervous system accounts for approximately 1% of all melanomas. Primary spinal melanomas are even more unusual. The clinico-radiological features of primary spinal melanoma are complex and non-specific, resulting in a high misdiagnosis rate. Here, primary cervico-thoracic spinal melanoma is presented in a 53-year-old woman which mimicked a hematoma on magnetic resonance imaging and an arteriovenous malformation intraoperatively. Histopathology and immunohistochemistry confirmed the diagnosis of malignant melanoma.
{"title":"Primary spinal melanoma: A radiological diagnostic dilemma confirmed by histopathology","authors":"Paramita Paul","doi":"10.4103/isj.isj_53_21","DOIUrl":"https://doi.org/10.4103/isj.isj_53_21","url":null,"abstract":"Primary malignant melanoma of central nervous system accounts for approximately 1% of all melanomas. Primary spinal melanomas are even more unusual. The clinico-radiological features of primary spinal melanoma are complex and non-specific, resulting in a high misdiagnosis rate. Here, primary cervico-thoracic spinal melanoma is presented in a 53-year-old woman which mimicked a hematoma on magnetic resonance imaging and an arteriovenous malformation intraoperatively. Histopathology and immunohistochemistry confirmed the diagnosis of malignant melanoma.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"246 - 250"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44133068","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. Jhaveri, Arth Patel, Sachin Patel, Sharan Jhaveri, Jignasu Yagnik
Background: Complete coccygectomy has proved to be a successful operation, with a success ratio of 70%–85%. Wound infection and dehiscence following coccygectomy ranges between 15% and 30%. The purpose of this article was to present improved outcomes following partial coccygectomy and to suggest modifications to mitigate wound complications. Methods: Seventeen patients (13 women and 4 men) underwent partial coccygectomy using a curved paramedian incision after failing nonoperative care for minimum of 6 months over the last 8 years. Twelve of these were posttraumatic, whereas five were of idiopathic origin. Patients were barred from sitting or sleeping supine for 2 weeks following the surgery. The use of water for cleaning post-defecation was also prohibited. Visual analog scale (VAS), Oswestry Disability Index (ODI), along with a novel Coccyx Disability Questionnaire (CDQ) as well as a truncated ODI (Coccyx Disability Index – CDI) were administered preoperatively, at 6 months and then at last follow-up. Wilcoxon signed rank tests were used as variables were nonparametric. Results: Fifteen patients completed questionnaires at a mean follow-up period of 68 months. Fourteen (93.33%) patients had good-to-excellent outcomes. VAS sitting improved from 9.27 to 0.79 (P = 0.001) and ODI improved from 68.89 to 8.27 (P = 0.001) postoperatively. Novel CDQ scores improved from 7.33 to 1.12 (P = 0.001) and CDI scores improved from 84.56 to 6.44 (P = 0.001). We compared outcomes of our partial coccygectomy cohort with those of complete or partial coccygectomy in literature, and found equivalent or superior results. Three (20%) of our patients developed wound infections, with only one (6.67%) requiring revision surgery, while the other two recovered with dressings. Conclusion: Partial coccygectomy provides equivalent or superior outcomes, compared to complete coccygectomy. Postoperative modifications for 2 weeks help mitigate wound complications. The proposed novel CDQ can be used by surgeons across the globe, once validated.
{"title":"Tailbone: Is partial coccygectomy the way to go?","authors":"S. Jhaveri, Arth Patel, Sachin Patel, Sharan Jhaveri, Jignasu Yagnik","doi":"10.4103/isj.isj_34_21","DOIUrl":"https://doi.org/10.4103/isj.isj_34_21","url":null,"abstract":"Background: Complete coccygectomy has proved to be a successful operation, with a success ratio of 70%–85%. Wound infection and dehiscence following coccygectomy ranges between 15% and 30%. The purpose of this article was to present improved outcomes following partial coccygectomy and to suggest modifications to mitigate wound complications. Methods: Seventeen patients (13 women and 4 men) underwent partial coccygectomy using a curved paramedian incision after failing nonoperative care for minimum of 6 months over the last 8 years. Twelve of these were posttraumatic, whereas five were of idiopathic origin. Patients were barred from sitting or sleeping supine for 2 weeks following the surgery. The use of water for cleaning post-defecation was also prohibited. Visual analog scale (VAS), Oswestry Disability Index (ODI), along with a novel Coccyx Disability Questionnaire (CDQ) as well as a truncated ODI (Coccyx Disability Index – CDI) were administered preoperatively, at 6 months and then at last follow-up. Wilcoxon signed rank tests were used as variables were nonparametric. Results: Fifteen patients completed questionnaires at a mean follow-up period of 68 months. Fourteen (93.33%) patients had good-to-excellent outcomes. VAS sitting improved from 9.27 to 0.79 (P = 0.001) and ODI improved from 68.89 to 8.27 (P = 0.001) postoperatively. Novel CDQ scores improved from 7.33 to 1.12 (P = 0.001) and CDI scores improved from 84.56 to 6.44 (P = 0.001). We compared outcomes of our partial coccygectomy cohort with those of complete or partial coccygectomy in literature, and found equivalent or superior results. Three (20%) of our patients developed wound infections, with only one (6.67%) requiring revision surgery, while the other two recovered with dressings. Conclusion: Partial coccygectomy provides equivalent or superior outcomes, compared to complete coccygectomy. Postoperative modifications for 2 weeks help mitigate wound complications. The proposed novel CDQ can be used by surgeons across the globe, once validated.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"99 - 105"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45764796","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}
Subaxial cervical spine injuries are common and encompass a spectrum of injuries ranging from a minor ligamentous sprain to fracture dislocation with spinal cord injury. These injuries are often missed in the initial evaluation, and a high index of suspicion is needed to evaluate and diagnose these injuries, which otherwise could lead to spinal cord injury. Computed tomography scans are the gold standard in the evaluation of fractures as plain radiographs have limited sensitivity. Magnetic resonance imaging (MRI) is necessary to identify injury to the disco-ligamentous complex and to assess cord injury. The principles of the treatment of cervical spine injuries include early immobilization to prevent secondary neurological injury, achieving alignment by reduction and stabilization of the unstable injured segment and decompression of the cord in the presence of cord injury. Owing to a broad spectrum of injuries, there is no unified approach, and the management plan depends on the morphology of injury, the extent of structures damaged, and the presence of neurological impairment. Various classifications grade and help assess the severity of the injury. Minor injuries are conservatively managed with cervical orthoses, and unstable injuries require stabilization either anterior, posterior, or combined approaches, depending on the injury morphology. Controversy exists over the safety of closed reduction in facetal subluxations, need for pre-reduction MRI, and the ideal approach for each injury. This review presents the current evidence and guidelines on the management of subaxial cervical spine injuries.
{"title":"Approach and considerations for surgery in subaxial cervical spine injury: A narrative review","authors":"K. Vijay Anand, A. Shetty, S. Rajasekaran","doi":"10.4103/isj.isj_39_21","DOIUrl":"https://doi.org/10.4103/isj.isj_39_21","url":null,"abstract":"Subaxial cervical spine injuries are common and encompass a spectrum of injuries ranging from a minor ligamentous sprain to fracture dislocation with spinal cord injury. These injuries are often missed in the initial evaluation, and a high index of suspicion is needed to evaluate and diagnose these injuries, which otherwise could lead to spinal cord injury. Computed tomography scans are the gold standard in the evaluation of fractures as plain radiographs have limited sensitivity. Magnetic resonance imaging (MRI) is necessary to identify injury to the disco-ligamentous complex and to assess cord injury. The principles of the treatment of cervical spine injuries include early immobilization to prevent secondary neurological injury, achieving alignment by reduction and stabilization of the unstable injured segment and decompression of the cord in the presence of cord injury. Owing to a broad spectrum of injuries, there is no unified approach, and the management plan depends on the morphology of injury, the extent of structures damaged, and the presence of neurological impairment. Various classifications grade and help assess the severity of the injury. Minor injuries are conservatively managed with cervical orthoses, and unstable injuries require stabilization either anterior, posterior, or combined approaches, depending on the injury morphology. Controversy exists over the safety of closed reduction in facetal subluxations, need for pre-reduction MRI, and the ideal approach for each injury. This review presents the current evidence and guidelines on the management of subaxial cervical spine injuries.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"24 - 38"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48454110","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}
Upper cervical spine injuries are relatively common and are often the result of blunt trauma. These injuries can be neurologically devastating and can have a high mortality. Management of these injuries requires an in-depth understanding of the complex anatomy of this region, delineation of the injury morphology, and classification after appropriate imaging. The treatment, surgical or conservative, is based on the neurological injury and structural instability.Bony injuries of the upper cervical spine, such as the occipital condylar fractures, fractures of the atlas, majority of odontoid fractures, and traumatic spondylolisthesis of the axis, respond well to nonsurgical management by external immobilization. In contrast, ligamentous injuries of the atlanto-occipital joints or the transverse atlantal ligament (TAL) have a poorer prognosis for healing and often require surgical intervention.
{"title":"Approach to upper cervical trauma","authors":"G. Vijay Kumar","doi":"10.4103/isj.isj_31_21","DOIUrl":"https://doi.org/10.4103/isj.isj_31_21","url":null,"abstract":"Upper cervical spine injuries are relatively common and are often the result of blunt trauma. These injuries can be neurologically devastating and can have a high mortality. Management of these injuries requires an in-depth understanding of the complex anatomy of this region, delineation of the injury morphology, and classification after appropriate imaging. The treatment, surgical or conservative, is based on the neurological injury and structural instability.Bony injuries of the upper cervical spine, such as the occipital condylar fractures, fractures of the atlas, majority of odontoid fractures, and traumatic spondylolisthesis of the axis, respond well to nonsurgical management by external immobilization. In contrast, ligamentous injuries of the atlanto-occipital joints or the transverse atlantal ligament (TAL) have a poorer prognosis for healing and often require surgical intervention.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"10 - 23"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42200447","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}
Zahir Abbas, S. Asati, Vishal G. Kundnani, Sanyam Jain, Ankit Patel, Saijyot Raut
Background: The freehand method of inserting thoracic pedicle screw has become one of the most popular techniques; however, data on its learning curve are scanty. The purpose of this study was to delineate the learning curve and to evaluate the safety of freehand technique of thoracic pedicle screw placement in nondeformed spine. Materials and Methods: A total of 92 consecutive patients who underwent thoracic posterior stabilization with pedicle screws using freehand technique between 2012 and 2017 in various pathologies of nondeformed spine from T1 to T10 at a single institution by a single surgeon were analyzed. Patients were divided into four quartiles (Q1, Q2, Q3, Q4, with 23 patients each) with each consecutive group serving as control for its prior. Demographics (age, sex, pathology involved) and complications were evaluated. Postoperative computed tomography (CT) scan was taken for evaluation of screws perforation including level, direction, grade, and severity of perforation. Results: Of total of 735 screws inserted in 92 patients, 72 screws were perforated with a perforation rate of 9.79%. Of the total perforations, more than half (63.88%) were of Grade 2 and maximum perforations were seen in the lateral direction (58.3%). Total three critical perforations were noted but none of them were symptomatic. The highest rate of perforation was evident at T4 vertebra (18.29%), whereas it was lowest at T9 (3.79%). The perforation rate showed a statistically significant (P < 0.05) decline in Q2 as compared to Q1 achieving asymptote in Q1 after approximately 80–100 screws. Conclusion: A steep learning curve is associated with the freehand technique of thoracic pedicle screws and asymptote can be achieved after approximately 80–100 screws. Novice surgeons can reduce the learning curve by doing practice on saw bone models and cadaveric dissection learning to avoid perforations and other complications with understanding the complex anatomy and variations encountered in the typical thoracic spine.
{"title":"Learning curve of thoracic pedicle screw fixation by freehand technique","authors":"Zahir Abbas, S. Asati, Vishal G. Kundnani, Sanyam Jain, Ankit Patel, Saijyot Raut","doi":"10.4103/isj.isj_11_21","DOIUrl":"https://doi.org/10.4103/isj.isj_11_21","url":null,"abstract":"Background: The freehand method of inserting thoracic pedicle screw has become one of the most popular techniques; however, data on its learning curve are scanty. The purpose of this study was to delineate the learning curve and to evaluate the safety of freehand technique of thoracic pedicle screw placement in nondeformed spine. Materials and Methods: A total of 92 consecutive patients who underwent thoracic posterior stabilization with pedicle screws using freehand technique between 2012 and 2017 in various pathologies of nondeformed spine from T1 to T10 at a single institution by a single surgeon were analyzed. Patients were divided into four quartiles (Q1, Q2, Q3, Q4, with 23 patients each) with each consecutive group serving as control for its prior. Demographics (age, sex, pathology involved) and complications were evaluated. Postoperative computed tomography (CT) scan was taken for evaluation of screws perforation including level, direction, grade, and severity of perforation. Results: Of total of 735 screws inserted in 92 patients, 72 screws were perforated with a perforation rate of 9.79%. Of the total perforations, more than half (63.88%) were of Grade 2 and maximum perforations were seen in the lateral direction (58.3%). Total three critical perforations were noted but none of them were symptomatic. The highest rate of perforation was evident at T4 vertebra (18.29%), whereas it was lowest at T9 (3.79%). The perforation rate showed a statistically significant (P < 0.05) decline in Q2 as compared to Q1 achieving asymptote in Q1 after approximately 80–100 screws. Conclusion: A steep learning curve is associated with the freehand technique of thoracic pedicle screws and asymptote can be achieved after approximately 80–100 screws. Novice surgeons can reduce the learning curve by doing practice on saw bone models and cadaveric dissection learning to avoid perforations and other complications with understanding the complex anatomy and variations encountered in the typical thoracic spine.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"106 - 111"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41427551","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}
U. Debnath, Sishir Kumar, R. Thakral, T. Chabra, Gourab Chatterjee
Background: The objective of this study was to evaluate the functional outcome after lumbar discectomy in Cauda equina syndrome—retention type (CESR) patients with delayed presentation. Materials and Methods: Fourteen patients with CESR presenting after 48 h (i.e., 2–42 days) from the onset of symptoms were included in the study. Acute lumbar disc prolapse was the cause of CESR in all patients. A detailed history including age, sex, onset of back pain, bladder and bowel symptoms, neurological signs, level of lesion, timing of surgery, and neurologic recovery (resolution of pain, sensory and motor deficits, and urinary, rectal, and sexual dysfunction [SD]) were recorded and analyzed. Bladder dysfunction was assessed using the urinary symptom profile (USP) questionnaire. Bowel dysfunction was assessed using the neurogenic bowel dysfunction (NBD) questionnaire. SD in men was analyzed using the international index of erectile function (IIEF) questionnaire and Female SD was analyzed using the female sexual function index (FSFI) questionnaire. Physical and mental health was assessed by short-form 12 (SF-12). Results: 9M:5F with a mean age of 35 years (range 26–45 years) presented with back and leg pain, parasthesia in the limbs, and retention of urine. Nine patients had acute backache and five had chronic back pain. All patients were catheterized on admission. The disc herniation levels were L4/L5 (seven patients), L5/S1 (six patients), and one had L3/4. The mean time of onset of symptoms to presentation at the hospital was 9.7 days (range 2–42 days). Preoperative mean Oswestry disability index (ODI) was 67.4 (range 58–80), mean visual analog score (VAS) for back pain was 2.8 (range 0–7) and mean VAS for leg pain was 6.5 (range 5–9). Preoperatively, motor power was affected in 12 patients. At presentation, perianal sensation (PAS) was labeled as “decreased,” in 12 patients (85.7%), and “absent” in two patients (14.3%). Voluntary anal contraction (VAC) was reported as “weak” in 10 patients (71.5%) and “absent” in 4 patients (28.5%).At a mean follow-up of 30 months, five patients had complete and five patients had partial recovery of motor and sensory deficit. Complete restoration of bladder status was experienced in eight patients after a mean duration of 6 months following surgery (ranging from 3 to 10 months). Three patients had partial recovery of bladder function (stress or nocturnal incontinence or signs of post-voiding residual urine) after a mean duration of 10 months following surgery (range 7–15 months). The return of bowel functions was determined as “complete” in seven (50%), “partial” in five (35.7%) and “no recovery” in two patients (14.3%). All patients had varying grades of SD. The mean SD scores in the nine male patients were 36.1 ± 20.4. In the five female patients, the mean SD scores were 22.9 ± 6.2. The mean physical component summary (PCS) and mental component summary (MCS) scores were 44.7 ± 8.8 and 40.1 ± 10.7, respectively. The gr
{"title":"Cauda Equina Syndrome—retention type (CESR): Outcome after delayed discectomy and decompression for lumbar disc herniation","authors":"U. Debnath, Sishir Kumar, R. Thakral, T. Chabra, Gourab Chatterjee","doi":"10.4103/isj.isj_89_20","DOIUrl":"https://doi.org/10.4103/isj.isj_89_20","url":null,"abstract":"Background: The objective of this study was to evaluate the functional outcome after lumbar discectomy in Cauda equina syndrome—retention type (CESR) patients with delayed presentation. Materials and Methods: Fourteen patients with CESR presenting after 48 h (i.e., 2–42 days) from the onset of symptoms were included in the study. Acute lumbar disc prolapse was the cause of CESR in all patients. A detailed history including age, sex, onset of back pain, bladder and bowel symptoms, neurological signs, level of lesion, timing of surgery, and neurologic recovery (resolution of pain, sensory and motor deficits, and urinary, rectal, and sexual dysfunction [SD]) were recorded and analyzed. Bladder dysfunction was assessed using the urinary symptom profile (USP) questionnaire. Bowel dysfunction was assessed using the neurogenic bowel dysfunction (NBD) questionnaire. SD in men was analyzed using the international index of erectile function (IIEF) questionnaire and Female SD was analyzed using the female sexual function index (FSFI) questionnaire. Physical and mental health was assessed by short-form 12 (SF-12). Results: 9M:5F with a mean age of 35 years (range 26–45 years) presented with back and leg pain, parasthesia in the limbs, and retention of urine. Nine patients had acute backache and five had chronic back pain. All patients were catheterized on admission. The disc herniation levels were L4/L5 (seven patients), L5/S1 (six patients), and one had L3/4. The mean time of onset of symptoms to presentation at the hospital was 9.7 days (range 2–42 days). Preoperative mean Oswestry disability index (ODI) was 67.4 (range 58–80), mean visual analog score (VAS) for back pain was 2.8 (range 0–7) and mean VAS for leg pain was 6.5 (range 5–9). Preoperatively, motor power was affected in 12 patients. At presentation, perianal sensation (PAS) was labeled as “decreased,” in 12 patients (85.7%), and “absent” in two patients (14.3%). Voluntary anal contraction (VAC) was reported as “weak” in 10 patients (71.5%) and “absent” in 4 patients (28.5%).At a mean follow-up of 30 months, five patients had complete and five patients had partial recovery of motor and sensory deficit. Complete restoration of bladder status was experienced in eight patients after a mean duration of 6 months following surgery (ranging from 3 to 10 months). Three patients had partial recovery of bladder function (stress or nocturnal incontinence or signs of post-voiding residual urine) after a mean duration of 10 months following surgery (range 7–15 months). The return of bowel functions was determined as “complete” in seven (50%), “partial” in five (35.7%) and “no recovery” in two patients (14.3%). All patients had varying grades of SD. The mean SD scores in the nine male patients were 36.1 ± 20.4. In the five female patients, the mean SD scores were 22.9 ± 6.2. The mean physical component summary (PCS) and mental component summary (MCS) scores were 44.7 ± 8.8 and 40.1 ± 10.7, respectively. The gr","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"112 - 119"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48167409","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}
The author illustrates the first ever reported case of voriconazole-induced periostitis of vertebral body. A 66-year-old immunocompetent male patient was diagnosed with multilevel invasive aspergillus spondylodiscitis of dorsal spine and was put on long-term voriconazole therapy for the same. Initially, the patient showed a good response to treatment but later on paradoxically the patient started to deteriorate symptomatically as well as radiologically. Differential diagnosis of misdiagnosis or co-infection with an another mold, inadequate voriconazole blood levels, voriconazole-induced periostitis were thought. After a detailed radiological and serological investigation, the patient was diagnosed with voriconazole-induced vertebral periostitis. Based on thorough literature review, discontinuation of voriconazole therapy was opted as treatment. Clinically, the patient started improving within four weeks of cessation of therapy and was symptom-free by the end of four months. Hence, to conclude, clinicians and spine surgeons should be aware of the fact that long-term voriconazole treatment of invasive aspergillosis can be complicated by skeletal fluorosis and painful periostitis. Once the symptoms of periostitis develop, investigations such as skeletal imaging and measurement of serum fluoride levels should be performed and if periostitis deformans is confirmed, reducing the dose or ceasing voriconazole should be considered.
{"title":"A rare case of voriconazole-induced vertebral periostitis in a patient with invasive aspergillus spondylodiscitis","authors":"A. Jain, A. Kashikar, P. Nagad, S. Bhojraj","doi":"10.4103/isj.isj_8_21","DOIUrl":"https://doi.org/10.4103/isj.isj_8_21","url":null,"abstract":"The author illustrates the first ever reported case of voriconazole-induced periostitis of vertebral body. A 66-year-old immunocompetent male patient was diagnosed with multilevel invasive aspergillus spondylodiscitis of dorsal spine and was put on long-term voriconazole therapy for the same. Initially, the patient showed a good response to treatment but later on paradoxically the patient started to deteriorate symptomatically as well as radiologically. Differential diagnosis of misdiagnosis or co-infection with an another mold, inadequate voriconazole blood levels, voriconazole-induced periostitis were thought. After a detailed radiological and serological investigation, the patient was diagnosed with voriconazole-induced vertebral periostitis. Based on thorough literature review, discontinuation of voriconazole therapy was opted as treatment. Clinically, the patient started improving within four weeks of cessation of therapy and was symptom-free by the end of four months. Hence, to conclude, clinicians and spine surgeons should be aware of the fact that long-term voriconazole treatment of invasive aspergillosis can be complicated by skeletal fluorosis and painful periostitis. Once the symptoms of periostitis develop, investigations such as skeletal imaging and measurement of serum fluoride levels should be performed and if periostitis deformans is confirmed, reducing the dose or ceasing voriconazole should be considered.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"133 - 136"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42752393","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. Nanda, S. Srivastava, A. Shetty, B. Dave, H. Chhabra, R. Onders, Jitesh Manghwani, N. Marathe, R. Karthik, M. Muttha
This section of the symposium deals with different clinical situations related to the management of traumatic cervical spine cord injury (SCI) and its complications. These cases give an overview of the clinical dilemmas that test our decision-making abilities in dealing with patients with cervical SCI and its associated complications. The patients were managed in various centers across India with different infrastructures and facilities. They are managed by different experts in the field of spine surgery. This should help the reader in providing a wider perspective in the management of vertebral lesions of traumatic cervical SCI. This section also helps in understanding the newer advances in dealing with the dreaded complication of invasive long-term ventilation in a patient with cervical SCI. The spine clinic ends with comments by the authors on key takeaway points from each case scenario, and some literature supported recommendations for the management of traumatic cervical SCI.
{"title":"Traumatic cervical spine injury: Clinical scenarios","authors":"A. Nanda, S. Srivastava, A. Shetty, B. Dave, H. Chhabra, R. Onders, Jitesh Manghwani, N. Marathe, R. Karthik, M. Muttha","doi":"10.4103/isj.isj_105_21","DOIUrl":"https://doi.org/10.4103/isj.isj_105_21","url":null,"abstract":"This section of the symposium deals with different clinical situations related to the management of traumatic cervical spine cord injury (SCI) and its complications. These cases give an overview of the clinical dilemmas that test our decision-making abilities in dealing with patients with cervical SCI and its associated complications. The patients were managed in various centers across India with different infrastructures and facilities. They are managed by different experts in the field of spine surgery. This should help the reader in providing a wider perspective in the management of vertebral lesions of traumatic cervical SCI. This section also helps in understanding the newer advances in dealing with the dreaded complication of invasive long-term ventilation in a patient with cervical SCI. The spine clinic ends with comments by the authors on key takeaway points from each case scenario, and some literature supported recommendations for the management of traumatic cervical SCI.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"82 - 98"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43993841","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}
Brian A. Karamian, Hannah A. Levy, P. Minetos, Michael Smith, A. Vaccaro
The upper cervical spine not only consists of intricate bony and ligamentous anatomy affording unique flexibility but also has increased susceptibility to injuries. The upper cervical spine trauma can result in a wide spectrum of injuries that can be managed both operatively and nonoperatively. Several existing classification systems have been proposed to describe injuries of the upper cervical spine, many of which rely on anatomic descriptions of injury location. Prior fracture classifications are limited in scope, characterizing fractures restricted to a single region of the upper cervical spine, and fail to provide insight into injury management. The AO Spine Upper Cervical Injury Classification System (AO Spine UCCS) has recently been developed as a comprehensive, yet concise classification scheme to describe all injuries of the upper cervical spine. The AO Spine UCCS represents a significant development in the classification of upper cervical spine injuries, with the potential to serve as a decision-making instrument to aid in patient management.
{"title":"Innovations in cervical spine trauma: Developing the next generation upper cervical spine injury classification system","authors":"Brian A. Karamian, Hannah A. Levy, P. Minetos, Michael Smith, A. Vaccaro","doi":"10.4103/isj.isj_28_21","DOIUrl":"https://doi.org/10.4103/isj.isj_28_21","url":null,"abstract":"The upper cervical spine not only consists of intricate bony and ligamentous anatomy affording unique flexibility but also has increased susceptibility to injuries. The upper cervical spine trauma can result in a wide spectrum of injuries that can be managed both operatively and nonoperatively. Several existing classification systems have been proposed to describe injuries of the upper cervical spine, many of which rely on anatomic descriptions of injury location. Prior fracture classifications are limited in scope, characterizing fractures restricted to a single region of the upper cervical spine, and fail to provide insight into injury management. The AO Spine Upper Cervical Injury Classification System (AO Spine UCCS) has recently been developed as a comprehensive, yet concise classification scheme to describe all injuries of the upper cervical spine. The AO Spine UCCS represents a significant development in the classification of upper cervical spine injuries, with the potential to serve as a decision-making instrument to aid in patient management.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"4 - 9"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44510137","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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