Indian Spine Journal最新文献

{"title":"Eosinophilic granuloma of the thoracolumbar junction in the adult spine: A case report and review of literature","authors":"Saumyajit Basu, R. Gala, Aditya Banta, Anil M. Solanki","doi":"10.4103/isj.isj_17_20","DOIUrl":"https://doi.org/10.4103/isj.isj_17_20","url":null,"abstract":"Langerhans cell histiocytosis (LCH) is a common disease in the pediatric population with a peak incidence between 5 and 10 years of age. Eosinophilic granuloma (EG) accounts for less than 1% of all primary bone tumors primarily affecting the skull, pelvis, ribs and metaphyses of long bones and is a benign localized form of LCH. It is extremely rare in adults, more so in the spine, with a predilection for the thoracic spine than the lumbar and cervical region. A 35-year-old gentleman presented with transitional mid back pain for two months radiating to the right flank which worsened at night. There was no history of fever or trauma. Physical examination revealed right dorsolumbar tenderness without any neurological deficit. Serological parameters were normal and C-reactive protein (CRP) was negative. X-ray showed radiolucency in the right D12 pedicle with CT scan showing a lytic lesion in D12 body extending into the right pedicle. Magnetic resonance imaging (MRI) showed a hypointense lesion on T1 and hyperintense lesion on T2. Transpedicular biopsy was done and histopathology revealed Langerhans cell with abundant basophilic cytoplasm and a centrally placed nucleus with a groove. On further confirmation with IHC, a diagnosis of LCH was made. He then received radiotherapy for 12 days. PET CT done one year after diagnosis revealed near-total metabolic response of the tumor after comparing the PET CT done prior to diagnosis. The patient has reported complete relief since 2 years with recent radiological evidence of no recurrence. A precise diagnosis of LCH largely relies on biopsy and histopathology and once definitive diagnosis is established, EG can be managed by chemotherapy and/or radiotherapy in patients with no neurological deficit. Despite its rarity, EG should be considered as an important differential for solitary osteolytic lesions at the thoracolumbar junction in the adult spine.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"218 - 222"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42880163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of primary high cervical intramedullary cysticercosis: Uncomplicated surgery but a preoperative diagnostic predicament","authors":"S. Mediratta","doi":"10.4103/ISJ.ISJ_75_20","DOIUrl":"https://doi.org/10.4103/ISJ.ISJ_75_20","url":null,"abstract":"Neurocysticercosis (NCC) is the most common parasitic infection involving the central nervous system. The involvement of spine by this disease is extremely uncommon. When the spine does get affected, it generally develops as a synchronous infection with an existing cerebral cysticercosis and usually involves the intradural extramedullary space. Primary intramedullary involvement is rare. A case of primary high cervical intramedullary cysticercosis with non-progressive symptoms is described. In this case, a pre-operative diagnosis could not be ascertained. The patient underwent total surgical resection of the lesion and made excellent recovery. Post-operative evaluation did not reveal disease at other sites. This case highlights the safety and ease of surgical resection in intramedullary NCC.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"255 - 259"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42369864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An atypical presentation of metastatic Ewing sarcoma to the spine","authors":"Wei Tan, Hwei Yee Lee, W. Yap, C. Nolan, J. Oh","doi":"10.4103/ISJ.ISJ_2_21","DOIUrl":"https://doi.org/10.4103/ISJ.ISJ_2_21","url":null,"abstract":"Ewing sarcoma (ES) is a rare malignancy of the young, primarily arising from the bones. Uncommonly, it can arise extraskeletally and, among the rarest cases, from the spinal extradural tissues. The patient is a previously well 26-year-old male who presented with radicular low back pain. Magnetic resonance imaging revealed an L5-S1 spinal canal mass with possible metastases to the vertebral and pelvic bones. The initial diagnosis was challenging, with differentials of an intradural tumor, infection, solid organ tumor metastasis, and lymphoma. The patient subsequently underwent decompression and debulking of his spinal tumor, which was found to be extradural. Histological and pathological studies supported the diagnosis of metastatic ES. This case report highlights an atypical presentation of ES. Although exceedingly rare, young patients can still present with metastatic spinal disease. Clinicians should always consider more sinister diagnoses and investigate further, especially if red flag symptoms are present.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"240 - 242"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41479598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical and thoracolumbar radiological sagittal parameters in asymptomatic Indian population","authors":"Y. Pithwa, Sanjeev Chandran, V. Rudravaram","doi":"10.4103/ISJ.ISJ_92_20","DOIUrl":"https://doi.org/10.4103/ISJ.ISJ_92_20","url":null,"abstract":"Introduction: There is a dearth of normative data for radiological sagittal parameters of asymptomatic Indians. The present study aimed to address this lacuna. Materials and Methods: Sagittal radiological parameters were studied in asymptomatic volunteers: seven lumbopelvic, i.e., pelvic index (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), cranial LL (crLL), caudal LL (caLL), PI-LL; three thoracic and thoracolumbar, i.e., thoracolumbar alignment (TL), thoracic kyphosis (TK), T1 slope (TS0); five cervical, i.e., cervical sagittal vertical axis (cSVA), cervical lordosis (CL), TS-CL, C2 slope (CS), C2 T1 pelvic angle (CTPA); and lastly, five global parameters: SVA, T9 spinopelvic inclination (T9SPI), T1 spinopelvic inclination (T1SPI), T1 pelvic angle (TPA), C2 pelvic angle (CPA) were studied. Results: Volunteers (n = 125) aged 41.49±12.93 years were included. Mean PI, PT, SS, LL, crLL, caLL, PI-LL, TL, TK, TS, cSVA, CL, TS-CL, CS, CTPA, SVA, T9SPI, T1SPI, TPA, and CPA were 47.23±8.04°, 13.4±6.61°, 33.68±4.59°, −56.19±7.83°, −22.71±9.82°, −45.02±10.07°, −7.83±9.4°, 9.99±11.17°, 22±7.33°, 4.88±7.64°, 34.77±12.2 mm, −6.36±10.99°, −0.5±10.02°, 2.56±9.53°, 3.54±1.04°, −36.49±23.4 mm, −10.89±2.75°, −7.88±2.17°, 5.52±6.82°, and 10.72±6.69°, respectively. As per Roussouly’s classification, the distribution for types I, II, III, and IV was 32 (25.6%), 41 (32.8%), 45 (36%), and 7 (5.6%), respectively. LL correlated significantly with PI, SS, and TK. TS had significant correlation with CL and TS-CL. cSVA significantly correlated with CL. PI-LL significantly correlated with TS-CL. CS significantly correlated with cSVA and TS-CL. TS-CL significantly correlated with cSVA. TPA correlated significantly with PT, SVA, PI, and PI-LL. CTPA correlated significantly with CL, cSVA, TK, and TS-CL. Males had significantly different SVA (−35.3 mm), TK (22.4°), TS (6.2°), TPA (6.35°), cSVA (37.1 mm), and CTPA (3.95°) when compared with females (−58.4 mm, 17.2°, −0.15°, 0.3°, 24.95 mm, and 2.85°, respectively) (P = 0.008, 0.003, 0.002, 0.003, 0.002, and 0.0005, respectively). Conclusion: Normative data for sagittal profile in Indian volunteers, enunciated in this study, can be used to guide decisions in surgery.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"188 - 197"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49250311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic epidural cement leakage after percutaneous vertebroplasty: A case report of successful management by surgical excision with literature review","authors":"H. Modi, Utsab R. Shrestha, N. Bhandari, U. Patel","doi":"10.4103/ISJ.ISJ_78_20","DOIUrl":"https://doi.org/10.4103/ISJ.ISJ_78_20","url":null,"abstract":"The purpose of this case report was to present successfully treated case of symptomatic cement leakage after percutaneous vertebroplasty procedure (PVP) with technical tips to avoid such injury and to present literature review. PVP is a simple solution to treat osteoporotic vertebral compression fracture (OVCF) if it is performed with right indications. Cement leak into spinal canal during PVP can lead to catastrophic accident and cause severe neurological deficit that requires an urgent exploration and removal of cement. To avoid medial pedicle breach, there should be a definitive guideline during PVP. An 81-year-old lady had PVP after injury for OVCF at D12. She developed severe neurological deficit immediately after the procedure; however, she was managed conservatively. On presentation to us, urgent investigations with CT scan revealed cement leak into spinal canal from medial pedicle breach extending from D10-12 level with severe cord compression. Her surgery was performed with wide laminectomy at D10-D12 levels with transpedicular stabilization D9-L2 along with neuromonitoring. Cement mass was isolated from the dura and removed achieving decompression of the cord. Postoperatively, patient showed significant neurological improvement and walked independently with the help of stick in three months. In conclusion, although PVP is a convenient solution for painful OVCF, care must be taken while considering this option such as timing, insertion of needle, viscosity of cement, and C-arm monitoring. If neurological deficit occurs, urgent CT scan for the diagnosis and exploration with removal of cement with or without stabilization is mandatory.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"243 - 249"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49257298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractured cervical facet osteophyte causing acute traumatic myelopathy: Case report","authors":"Bharat C Patel, M. Bapat, Arpit Upadhyay","doi":"10.4103/isj.isj_44_20","DOIUrl":"https://doi.org/10.4103/isj.isj_44_20","url":null,"abstract":"A 52-year-old gentleman presented with acute onset quadriparesis of ten days duration after a trivial fall. Both extremities had grade-2 power. Bilateral hand grip was poor with interossei weakness. The sensation was reduced below C6 with positive Lhermitte’s sign. Deep tendon reflexes were exaggerated except absent bilateral biceps jerk. The bowel and bladder had urgency and frequency. Neck movements were terminally painful. CT and MRI showed a floating bony spicule adjacent to left C5-6 facet joint encroaching the spinal canal causing cord compression. A focal left C5 hemi-laminectomy and foraminotomy were performed. A onecm floating bony spicule adjoining to left C5-6 facet joint was excised. Biopsy ruled out osteochondroma and synovial cyst. The power improved to grade-4 in both extremities with moderate grip and he became dependent ambulatory within three months of surgery. At the end of two years, he recovered almost completely with residual mild left-hand grip weakness.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"214 - 217"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41562801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Surgical management of high-grade spondylolisthesis: Current recommendations","authors":"","doi":"10.4103/2589-5079.321592","DOIUrl":"https://doi.org/10.4103/2589-5079.321592","url":null,"abstract":"","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"265 - 265"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42879275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoliosis associated with HGPPS syndrome: What do we know?","authors":"V. Menon, N. Tahasildar, T. Sivaraman, B. Venkateshappa","doi":"10.4103/ISJ.ISJ_17_21","DOIUrl":"https://doi.org/10.4103/ISJ.ISJ_17_21","url":null,"abstract":"Horizontal gaze palsy with progressive scoliosis (HGPPS) syndrome is a rare genetic abnormality causing cranial dysinnervation manifesting as absence of conjugate lateral eye movements, nystagmus, and scoliosis. While the genetics, imaging abnormalities, and ocular manifestations have been well described in literature, the spinal deformity has not been addressed adequately. An 11-year-old girl presented with progressive thoracic scoliosis who on evaluation was detected to have all the features of HGPPS syndrome. The patient underwent posterior correction of scoliosis uneventfully. A thorough literature search was performed to understand the descriptors of spinal deformity and its surgery in HGPPS syndrome. The spinal deformity in HGPPS resembles adolescent idiopathic scoliosis. Rapidly progressive right thoracic scoliosis was the usual pattern. Surgical and anesthetic considerations during surgery are similar to idiopathic scoliosis. These children tolerate surgery and anesthesia well. Neuromonitoring changes during surgery need to be interpreted correctly in the background of uncrossed sensory and motor tracts.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"250 - 254"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45952127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of posterior cervical laminectomy for multilevel cervical ossification of posterior longitudinal ligament","authors":"S. Asati, Vishal G. Kundnani, S. Sagane, Sanyam Jain, Saijyot Raut","doi":"10.4103/ISJ.ISJ_84_20","DOIUrl":"https://doi.org/10.4103/ISJ.ISJ_84_20","url":null,"abstract":"Study Design: This study design includes retrospective study of prospectively collected data. Introduction: The purpose is to determine the efficacy of posterior cervical laminectomy for multilevel cervical ossified posterior longitudinal ligament (OPLL). Laminectomy has been a preferred surgical treatment for multilevel cervical OPLL since a long time. Because of the risk associated with progressive kyphosis, the trend is shifted from laminectomy alone to laminoplasty and laminectomy with fusion. The data regarding the efficacy of laminectomy alone in terms of clinical and radiological parameters in multilevel cervical OPLL are scanty. Materials and Methods: We reviewed 82 patients with multilevel cervical OPLL who underwent posterior cervical laminectomy from January 2008 to December 2014. Patients with age ≥45 years, C2–C7 Cobb’s angle ≥ 10º, compression at ≥3 levels, and a minimum of 5 years of follow-up were included in the study. Demographics, pre and postoperative clinical parameters (visual analog scale (VAS), Nurick’s grading, and modified Japanese orthopedic association (mJOA) score), radiological parameters (C2–C7 Cobb’s angle, C2–C7 sagittal vertical axis (SVA)), perioperative parameters, complications, and recovery rate were evaluated. Results: The mean age of the patients was 56.4 (46–72) with M: F of 52:30. The mean blood loss and mean operative time were 93.9 mL and 96.6 min, respectively. There was significant improvement (P < 0.05) in VAS (3.6 ± 1.4 to 1.8 ± 0.8), Nurick’s grading (3.2 ± 0.9 to 1.9 ± 0.6), and mJOA score (8.4 ± 1.4 to 13.8 ± 1.9). C2–C7 Cobb’s angle increased from ‒14.4 ± 1.7º preoperatively to ‒8.2 ± 1.5º postoperatively and C2–C7 SVA from 18.4 ± 12.5 to 29.8 ± 15.8. Intraoperatively four patients had a dural tear. Three patients showed neurological deterioration postoperatively and three had unilateral C5 palsy which improved within a period of 6 months. 18.3% had an excellent outcome, 40.3% had good, 34.1% had fair, and 7.3% of the patients had a poor outcome. Conclusion: Multilevel cervical laminectomy is an effective surgical procedure in properly selected patients with multilevel OPLL. The outcomes are satisfactory in terms of radiological and clinical parameters. The risk of postlaminectomy kyphosis is not too high, and we found no correlation of kyphosis with clinical affection.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"181 - 187"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44218110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular stents––boon or bane? A case report of spondylodiscitis following aorto-illiac stent insertion","authors":"Sushma Krishna, S. Kaiwar, Amrithlal A. Mascarenhas, Adarsh Raghurama","doi":"10.4103/isj.isj_33_20","DOIUrl":"https://doi.org/10.4103/isj.isj_33_20","url":null,"abstract":"Spondylodiscitis after aorto-illiac stent insertion for the management of peripheral vascular disease is a rare but serious complication. We report the first case that we encountered as it provided insight into the device-related infections and the treatment dilemma that we went through. Within a week following insertion, a 43-year-old patient developed symptoms of infection. Imaging, laboratory cultures, and inflammatory markers were sought. The patient was treated with antibiotics for over six months to achieve a complete cure. Acute stent-graft infections require prompt and aggressive management. Centers specialized in carrying out endovascular stent insertions should monitor this device-related infection as a health-care-associated infection. The case may be looked on as a learning experience for the spine surgeons, vascular surgeons, microbiologists, and the infection control team of the hospital.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"223 - 228"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41602047","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}