Journal of Craniovertebral Junction and Spine最新文献

Introduction: Brucellosis of the spine has emerged as a significant health concern in developing countries. Spinal brucellosis shares identical clinical and radiological features with tubercular spondylodiscitis. A wide range of nonspecific symptoms, chronicity of this disease, and tissue culture which is mostly invasive and time-consuming, pose a challenge in definitive diagnosis. In this study, we aim to report the clinical, radiological, and microbiological features of this disease and analyze the outcome of patients treated for spinal brucellosis.

Materials and methods: This retrospective study was conducted from 2018 to 2022 on confirmed cases of brucellosis of the spine who had adequate follow-up of at least 2 years after completion of treatment.

Results: In this retrospective analysis, 10 patients had spinal brucellosis. All of them had presented with chronic history of low back pain for a period of 3-6 months. Occupational exposure was present in six patients (60%). Five (50%) of them underwent surgical intervention due to failed/doubtful diagnosis. Except for one patient, microbiological evidence of the infection was seen within 10 days from the tissue biopsy. All patients were treated with a triple regimen (gentamycin, doxycycline, and rifampin) for a period of 3 months as per World Health Organization protocol. All patients were healed of the disease with good functional outcome.

Conclusion: Culture, either blood or tissue, is the gold standard method for diagnosis of this zoonotic disease. Only 50% of the study patients underwent surgical debridement. All patients in the study had good outcome with 3 months of antibiotic therapy.

The omohyoid muscle is frequently encountered during anterior cervical spine surgery, particularly at the C5-C7 levels, yet it has received limited emphasis in spinal literature. Its superior belly often crosses the operative corridor, leading surgeons to choose between preservation, retraction, or sectioning. This narrative review synthesizes anatomical and clinical evidence regarding omohyoid variability, surgical handling, and postoperative outcomes in anterior cervical discectomy and fusion procedures. Anatomical studies reveal substantial muscle variation, including accessory slips and aberrant insertions, which can influence exposure. Emerging clinical data suggest that sectioning the superior belly when obstructive improves visualization and may reduce operative time and blood loss without significantly increasing dysphagia, dysphonia, or cosmetic concerns. However, prospective studies with standardized outcome measures remain limited. Understanding this "forgotten anatomy" may enhance operative planning, optimize exposure, and refine technique in lower cervical approaches.

Background: Spinal tuberculosis (STB) is a major cause of spinal deformity, instability, and neurological deficits. While antitubercular therapy (ATT) is the primary treatment, surgery is indicated in advanced disease or complications. This study evaluates surgical management and outcomes in cervical, thoracic, and thoracolumbar STB at a single Indian center.

Methodology: Retrospective review of 84 patients (cervical 17, thoracic 37, thoracolumbar 14, and lumbar 16) who underwent surgery from 2015 to 2023. Data included demographics, clinical presentation, neurological status (American Spinal Injury Association [ASIA] scale), pain (Visual Analogue Scale [VAS]), surgical approach, fusion technique, complications, and postoperative outcomes. Surgical strategy was individualized based on lesion location, vertebral involvement, and deformity.

Results: Mean age ranged from 36.5 (cervical) to 49.3 (lumbar) years; males predominated. Pain (90%), fever (80%), and fatigue (66%) were common; neurological deficits occurred in 51%. Anterior approaches were used in cervical (76%) and thoracic (59%) cases, posterior in thoracolumbar (86%) and lumbar (100%), with combined anterior-posterior in 4%. Operative time and blood loss were lowest for cervical (96 ± 15 min; 70 ± 23 mL) and highest for thoracolumbar cases (156 ± 40 min; 264 ± 81 mL). Postoperatively, most patients improved neurologically (ASIA D/E), with significant pain reduction (VAS 7.1-7.6 → 2.2-2.9) and functional recovery (ODI 49-63 → 19-27). Complications were infrequent and manageable.

Conclusion: Tailored surgical intervention for STB, guided by anatomical site and disease severity, achieves excellent neurological, functional, and radiological outcomes. Early, appropriately planned surgery remains essential for patients with progressive deficits, instability, or inadequate response to ATT.

Postoperative Ileus (POI) and other gastrointestinal (GI) complications comprise a significant portion of medical complications seen in spine surgery patients. Experts hypothesize that ileus can occur due to a combination of anesthetic agents, opioid-induced intestinal dysmotility, and decreased mobility. POI and GI complications lead to longer lengths of stay, increased hospital costs, and increased risk of readmission and reoperation in spine surgery patients. A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 59 primary articles met the inclusion criteria. The reported incidence of POI following spine surgery varied significantly from 0.2% to 35.4%, with the middle 50% of studies ranging from 5.1% to 13.6%. Cumulative GI complication rates ranged from 2.1% to 16.2%, with more severe pathologies such as acute colonic pseudo-obstruction (ACPO) having expectedly low incidences of <1%. Conclusions regarding potential risk factors were highly variable. Male sex, increased levels fused, and lumbar level fusions were the only unanimous variables. Intraoperatively, increased surgical time, certain intraoperative opioids (remifentanil, sufentanil), and increased opiate dosages are associated with increased rates of ileus. Early feeding as a prevention strategy has demonstrated variable efficacy, while early mobilization and gum-chewing have been shown to stimulate bowel function. If ileus does occur, symptoms typically resolve with conservative management including NPO, intravenous fluid maintenance, electrolyte replacement, laxatives, and adding nasogastric suctioning when bloating and nausea are more severe. If patients fail conservative treatment, physicians can add promotility agents such as neostigmine. The incidence of POI after spinal surgery is high. Identification and appropriate mitigation of risk factors, as well as early ambulation for prevention and early recognition for treatment are important in the event of ileus.

Background: Foramen magnum decompression (FMD) is the primary modality of treatment for symptomatic Chiari I malformation. However, the surgery is associated with cerebrospinal fluid (CSF) dynamic complications which may include non-improvement of symptoms, progression of syrinx, or cerebellar slump which are related to the size of decompression.

Objective: The objective of the study was to define the limits of FMD to prevent CSF dynamic complications, including cerebellar ptosis.

Materials and methods: Anatomical relations of cerebellar tonsils and occipital bone were studied in 42 sagittal cut sections and 105 sagittal magnetic resonance imaging (MRI) sections. The limits of decompression were defined by our proposition of decompressing till the inferior semilunar fissure. In total, 27 patients underwent FMD and 21 were followed up.

Results: Occipital bone in cut sections and MRI sections showed four configurations termed as single cusp, bicuspid, straight, and question-mark. Of these, straight and question-mark configurations were more commonly seen. Of the 21 patients who were followed up after FMD, all had good improvement with none developing features of CSF dynamic complications.

Conclusion: The FMD surgery for Chiari I malformation should be performed with limits tailored to individual patients. Decompression should stop at the inferior semilunar fissure so as to prevent CSF dynamic complications, including cerebellar ptosis.

Study design: Retrospective observational study of patients with spinal cord injuries (SCI) caused by civilian gunshot wounds (GSW) surgically treated at a tertiary hospital between 2017 and 2024.

Purpose: The purpose of the study was to evaluate surgical indications, techniques, complications, and neurological outcomes in CGWSCI and assess the role of surgery in this setting.

Overview of literature: Gunshot injuries represent up to 17% of spinal cord trauma, mainly affecting young men. Civilian lesions differ from military due to reduced projectile velocity and cavitation effects. Literature shows that prognosis depends primarily on initial American Spinal Injury Association Impairment (ASIA) grade, while the neurological benefit of surgery remains controversial and potentially overestimated.

Materials and methods: Medical records of 24 patients were reviewed. Data included demographics, level of injury, projectile location, neurological status (ASIA scale), surgical procedure, intraoperative cerebrospinal fluid (CSF) leak, repair technique, complications, and neurological outcome. Statistical analysis employed Fisher's exact and Mann-Whitney tests, with significance at P < 0.05.

Results: Patients were mostly male (87.5%), mean age 29.7 years. Thoracic lesions predominated (58.3%). Projectiles were intracanal in 50% and fragments in 33.3%. At admission, 70.8% were ASIA A, and 29.2% had incomplete deficits. Neurological improvement occurred in 16.7%, exclusively in incomplete injuries, with a significant association between initial ASIA and recovery (P = 0.003). Injury level, projectile location, and surgical type showed no prognostic correlation. Laminectomy was the most frequent (62.5%). CSF leaks were found intraoperatively in 79.2%, repaired with grafts or primary closure; the repair technique was not associated with recurrence. Complications were rare (8.3%), with one infection and one persistent CSF leak requiring reoperation. Mean follow-up was 348 days.

Conclusions: CGWSCI predominantly affect young men and often results in complete deficits, with limited potential for neurological recovery. Surgery did not benefit ASIA A patients but may aid selected cases with incomplete deficits, neural compression, instability, or CSF fistula. Initial ASIA grade remains the strongest prognostic factor.

Introduction: Cervical radiculomyelopathy may result from degenerative, traumatic, or infectious causes, leading to spinal cord compression. Anterior cervical corpectomy and fusion (ACCF) is a well-established surgical technique for decompressing the spinal cord and stabilizing the cervical spine. This study aims to evaluate the clinical and radiological outcomes of ACCF in patients with cervical spondylotic myelopathy (CSM), traumatic cervical spine injuries, and infectious conditions.

Methodology: A retrospective study was conducted on 86 patients who underwent ACCF at a tertiary care center, between May 2019 and April 2023. Patients were grouped into three categories based on etiology: CSM, trauma, and infection. Surgical reconstruction was performed using either autologous iliac crest grafts with anterior plate and screw fixation or titanium mesh cage (TMC) with/without additional instrumentation. All patients were followed clinically and radiologically at 3 months and 1 year postoperatively.

Results: Neck pain was the most common symptom across all groups. Significant improvement in neck pain and neurological deficits was observed at follow-up, especially in the CSM and trauma groups. Radiologically, proper graft alignment was achieved in the majority, with minimal graft migration noted in a few cases. Two patients required revision surgery due to instability. Complications included dysphagia, cerebrospinal fluid leak, recurrent laryngeal nerve palsy, and donor site infection. Fusion was achieved in all cases by the 1-year follow-up.

Conclusion: ACCF is a safe and effective procedure for managing cervical spine pathologies, offering good neurological recovery and high fusion rates. TMCs reduce donor site morbidity and are a viable alternative to autografts.

Traumatic posterior atlantoaxial dislocation (PAAD) without odontoid fracture is exceptionally rare. We report the first documented case entirely asymptomatic at presentation. A 78-year-old woman, evaluated after a motor vehicle collision, presented with no neck pain, neurological deficits, or loss of consciousness. Computed tomography scan revealed PAAD without odontoid fracture. Closed reduction was successfully performed, followed by posterior C1-C2 fixation with the Goel technique, extended to C3 due to C2-C3 instability. Postoperative imaging confirmed complete reduction, and the patient remained neurologically intact at 6-month follow-up. This case highlights the potential for silent presentation and the need for individualized management.