A Comparative Analysis of the Metabolic and Coagulative Profiles in Patients with Idiopathic Scoliosis, Congenital Scoliosis and Healthy Controls: A Case–Control Study

Kaustubh Ahuja,Bhavuk Garg,Buddhadev Chowdhuri,Raj Kumar Yadav,Pradeep Kumar Chaturvedi 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.6

Study Design: Single-center, observational, case–control study. Purpose: Comparison and analysis of the metabolic and coagulative profiles in patients with idiopathic scoliosis, patients with congenital scoliosis, and healthy controls. Overview of Literature: Serum melatonin deficiency has been a controversial topic in the etiopathogenesis of scoliosis. Low bone mineral density, low vitamin D3 levels, and high parathyroid hormone levels are common metabolic abnormalities associated with scoliosis that may be responsible for its pathogenesis. In addition to metabolic defects, several studies have shown coagulation defects that either persist from the preoperative period or occur during surgery and usually lead to more than the expected amount of blood loss in patients undergoing deformity correction for scoliosis. Methods: The study population (n=73) was classified into those having congenital scoliosis (n=31), those with idiopathic scoliosis (n=30), and healthy controls (n=12). After detailed clinicoradiological evaluation of all the subjects, 10-mL blood samples were collected, measured, and analyzed for various metabolic and coagulation parameters. Results: The mean serum melatonin levels in patients with idiopathic scoliosis were significantly lower than those in the healthy controls. Although the mean serum melatonin level in the congenital group was also low, the difference was not statistically significant. Serum alkaline phosphatase and parathyroid hormone levels were higher in the scoliosis groups, whereas the vitamin D level was lower. No differences were observed in the coagulation profiles of the different groups. Conclusions: Low serum melatonin levels associated with scoliosis can be a cause or an effect of scoliosis. Moreover, low bone mineral density, high bone turn over, and negative calcium balance appear to play an important role in the progression, if not the onset, of the deformity.

Risk factors and epidemiological profile of hip fractures in Indian population: A case-control study

Kaustubh Ahuja,Sagnik Sen,Dinesh Dhanwal 대한골다공증학회 2017 Osteoporosis and Sarcopenia Vol.3 No.3

epidemiological profile of hip fractures among the Indian population with special importance to the mechanism of injuries. Methods: Patients of hip fractures (n ¼ 41) and age- and sex-matched healthy volunteers (n ¼ 41) were interviewed by a questionnaire regarding the occurrence of the fracture, past history of diseases and long-term medication usage, past and physical activity, supplements, smoking, and alcohol intake. The data were tabulated using descriptive statistics and logistic regression was used to determine significant risk factors. Results: Age group 60e69 was found to be most affected by hip fractures, though an early onset of fractures was noted in males. Falls due to slipping indoors from standing position was found very commonly. However, an increasing trend of falls was noted from lying down position in the older age groups which was more common during the morning and night hours. Logistic regression analysis for the detection of risk factors was applied to the various variables in the questionnaire. Active status in the past was inversely related (odds ratio [OR], 0.33; P < 0.05) to fracture risk while alternative medication usage in the past 1 year (OR, 4.086; P < 0.05) and significant alcohol consumption were directly associated with fracture risk (OR, 5.484; P < 0.05). A potential inverse relation of use of calcium supplements in the past 3 months and fracture risk (OR, 0.872) was seen, although this was not significant. A potential positive relation of smoking with hip fractures was also seen, but not found significant (OR, 2.204). Conclusions: Hip fractures in the elderly population are on a rising trend especially in the Indian subcontinent due to a number of factors both hereditary and acquired. Simple measures like routine usage of bedside railing, wall-side railings at an appropriate height, high friction tiles inside rooms and washrooms, and adequate lighting indoors can play a significant role in reducing falls and hip fractures among the elderly.

Variability in Management Practices and Surgical Decision Making in Spinal Tuberculosis: An Expert Survey-Based Study

Ahuja Kaustubh,Gupta Tushar,Ifthekar Syed,Mittal Samarth,Yadav Gagandeep,Kandwal Pankaj 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.1

Study Design: Electronic survey–based study.Purpose: The aim of the study was to objectively review the variability in the prevailing treatment protocols and surgical decision making in the management of patients with spinal tuberculosis (TB) among spine surgeons with expertise in spinal TB across the country.Overview of Literature: A lack of good-quality evidence, ambiguities in the national spinal TB guidelines, and the demand for early rehabilitation and a better quality of life in patients with spinal TB has led to the emergence of various gray zones in the management of spinal TB.Methods: Seventeen fellowship-trained spinal TB experts representing different geographical regions of India completed an online survey consisting of questions pertaining to the conservative management of spinal TB (antitubercular therapy) and 30 clinical case vignettes including a wide spectrum of presentations of spinal TB with no or minimal neurological deficit. The variability in the responses for questions and case wise variability with respect to surgical decision making was assessed using the index of qualitative variation (IQV). The average tendency to operate (TTO) was calculated for various groups of respondents.Results: High variability was observed in all questions regarding conservative spinal TB management (IQV > 0.8). Among the 30 case vignettes, 14 were found to have high variability with respect to surgical decision making (IQV > 0.8). With respect to levels of fixation, all but two cases had poor or slight agreement. Younger age and practice in a government or tertiary care teaching hospital were factors associated with a higher TTO.Conclusions: Significant variability was detected in treatment practices for the management of spinal TB among experts. Most of the case vignettes were found to have significant heterogeneity with respect to surgical decision making, which reflects a significant lack of consensus and lacunae in literature.

Intraoperative assessment of the adequacy of the graft length for semitendinosus-alone anterior cruciate ligament reconstruction: a technical note

Kaustubh Ahuja,Hira Lal Nag 대한정형외과 스포츠의학회 2017 Arthroscopy and Orthopedic Sports Medicine Vol.4 No.2

Anterior cruciate ligament (ACL) reconstruction surgery rate has widely increased over past few years. Various graft options have been described in literature for reconstruction of ACL. Patellar tendon, semitendinosus alone, semitendinosus with gracilis are commonly used as graft materials. A number of recent studies suggest sacrifice of gracilis tendon for ACL reconstruction adversely affects hamstring strength. Many studies done in this regard have suggested the use of preoperative anthropometric data for estimating the adequacy of semitendinosus tendon alone being used in ACL reconstruction procedures. However there are no studies describing intraoperative assessment of the adequacy of graft length for semitendinosus alone graft for ACL reconstruction. In this note we describe a technique for intraoperative assessment of the adequacy of graft length of semitendinosus tendon for quadrupled semitendinosus alone graft or the need for harvesting gracilis along with semitendinosus tendon.

Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

Sethy Siddharth Sekhar,Ahuja Kaustubh,Ifthekar Syed,Sarkar Bhaskar,Kandwal Pankaj 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.1

Study Design: Retrospective case series.Purpose: To analyze the clinical and functional outcomes of patients who have undergone anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) for a three-column cervical spine injury (CSI).Overview of Literature: The treatment of choice for a three-column CSI is an area of contention; however, combined anterior and posterior fixation is the preferred method explored in the literature. Studies have shown the superior biomechanical stability of posterior fixation over that of anterior fixation, but anterior-only approach in CSI has been proving its efficacy in recent times by providing reasonable stability with the maximum achievable decompression and fusion.Methods: Twenty-one patients undergoing ACDF/ACCF with a bone graft/metallic cage treatment for cervical injuries involving all three columns from January 2016 to July 2018 were included in the study. All of the patients were followed up monthly for the first 3 months and then every 6 months, until their last follow-up visit.Results: Nineteen patients had AO type C injuries and were managed with ACDF, and two patients with AO type B injuries were managed with ACCF. Fifteen had a complete spinal cord injury, while six had an incomplete spinal cord injury (American Spinal Injury Association B, C, and D). The mean segmental kyphosis at presentation of 12.2°±4.4° improved in the postoperative period to -7.2°±2.5°. At their final follow-up, all the patients showed clinical improvements when assessed by the Visual Analog Scale (6.8–1.8), Oswestry Disability Index score (59.7–34.9), and Spinal Cord Independence Measure score (24.8–36.4). One patient in the ACDF group needed a secondary posterior fixation because of instability.Conclusions: An anterior approach to the cervical spine in cervical fracture dislocations is an effective treatment showing an optimal recovery rate in terms of patient-reported outcomes and structural stability, with the added advantages of less blood loss and the fact that the technique requires less instrumentation.

Atypical Radiographic Presentation of Aggressive Vertebral Haemangioma: Experience of Two Cases

Samarth Mittal,Syed Ifthekar,Kaustubh Ahuja,Gagandeep Yadav,Subhajit Maji,Sonal Saran,Pankaj Kandwal 대한척추외과학회 2021 대한척추외과학회지 Vol.28 No.1

Study Design: Case report Objective: We report two cases of vertebral body haemangioma with atypical radiological features causing neurological deficit. Summary of Literature Review: Vertebral haemangiomas are usually asymptomatic and are discovered incidentally during imaging. However, complications such as pain, neurological deficit, vertebral body fracture can arise due to different mechanisms. Materials and Method: We report two cases of vertebral hemangioma of dorsal spine with atypical radiological features. Results: Good pain relief, neurological recovery and functional outcome was achieved by embolization and surgical decompression/ tumor resection along with stabilization in case of aggressive vertebral hemangioma. Aggressive vertebral hemangioma may present with atypical radiographic features. Conclusions: Aggressive vertebral haemangioma may have atypical radiographic presentation. Surgical decompression is one of the preferred treatment of it.

Deformity Correction with Interbody Fusion Using Lateral versus Posterior Approach in Adult Degenerative Scoliosis: A Systematic Review and Observational Meta-analysis

Mittal Samarth,Sudhakar Pudipeddi Venkata,Ahuja Kaustubh,Ifthekar Syed,Yadav Gagandeep,Sinha Shivendra,Goyal Nikhil,Verma Vishal,Sarkar Bhaskar,Kandwal Pankaj 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

This study was designed to systematically review and meta-analyze the functional and radiological outcomes between lateral and posterior approaches in adult degenerative scoliosis (ADS). Both lateral (lumbar, extreme, and oblique) and posterior interbody fusion (posterior lumbar and transforaminal) are used for deformity correction in patients with ADS with unclear comparison in this cohort of patients in the existing literature. A literature search using three electronic databases was performed to identify studies that reported outcomes of lateral (group L) and posterior interbody fusion (group P) in patients with ADS with curves of 10°–40°. Group P was further subdivided into minimally invasive surgery (MIS-P) and open posterior (Op-P) subgroups. Data on functional, radiological, and operative outcomes, length of hospital stay (LOHS), fusion rates, and complications were extracted and meta-analyzed using the random-effects model. A total of 18 studies (732 patients) met the inclusion criteria. No significant difference was found in functional and radiological outcomes between the two groups on data pooling. Total operative time in the MIS-P subgroup was less than that of group L (233.86 minutes vs. 401 minutes, p <0.05). The total blood loss in group L was less than that in the Op-P subgroup(477 mL vs. 1,325.6 mL, p <0.05). Group L had significantly less LOHS than the Op-P subgroup (4.15 days vs. 13.5 days, p <0.05). No significant difference was seen in fusion rates, but complications were seen except for transient sensorimotor weakness (group L: 24.3%, group P: 5.6%; p <0.05). Complications, such as postoperative thigh pain (7.7%), visceral injuries (2%), and retrograde ejaculation (3.7%), were seen only in group L while adjacent segment degeneration was seen only in group P (8.6%). Lateral approach has an advantage in blood loss and LOHS over the Op-P subgroup. The MIS-P subgroup has less operative time than group L, but with comparable blood loss and LOHS. No significant difference was found in functional, radiological, fusion rates, pseudoarthrosis, and complications, except for transient sensorimotor deficits. Few complications were approach-specific in each group.