Cervical Kyphosis

Akshay Gadia,Kunal Shah,Abhay Nene 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

Cervical kyphosis is a rare condition that can cause significant functional disability and myelopathy. Deciding the appropriate treatment for such deformities is challenging for the surgeon. Patients often present with axial neck pain, and it is not uncommon to find coexisting radiculopathy or myelopathy. The optimal approach for addressing this complex issue remains controversial. A comprehensive surgical plan based on knowledge of the pathology and biomechanics is important for kyphosis correction. Here we reviewed diagnoses of the cervical spine along with the literature pertaining to various approaches and management of cervical spine.

Outcomes of Various Treatment Modalities for Lumbar Spinal Ailments in Elite Athletes: A Literature Review

Akshay Gadia,Kunal Shah,Abhay Nene 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.4

Lumbar spinal injuries are common in elite athletes, who can present with a spectrum of ailments ranging from lumbar strain to prolapsed intervertebral discs. Sequelae can include neurological impairment and lumbar instability among other possible outcomes. This group of patients is unique in terms of their clinicoradiological presentation and treatment modalities. The primary goals of treatment are a rapid return to play and prevention of recurrence, thus prolonging the athlete’s professional career. Treatment modalities can range from activity restriction to nerve root blocks and surgery. A successful treatment outcome is based on timely diagnosis, treatment suiting the demands of the particular sport, and early rehabilitation. A multidisciplinary team approach involving the coach, rehabilitation specialist, pain management specialist, and spine surgeon helps in planning appropriate treatment. In this article, we review special considerations in the elite athletic population with lumbar spinal ailments as well as the outcomes of various treatment modalities.

Emergence of Three-Dimensional Printing Technology and Its Utility in Spine Surgery

Akshay Gadia,Kunal Shah,Abhay Nene 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

In the last decade, spine surgery has advanced tremendously. Tissue engineering and three-dimensional (3D) printing/additive manufacturing have provided promising new research avenues in the fields of medicine and orthopedics in recent literature, and their emergent role in spine surgery is encouraging. We reviewed recent articles that highlighted the role of 3D printing in medicine, orthopedics, and spine surgery and summarized the utility of 3D printing. 3D printing has shown promising results in various aspects of spine surgery and can be a useful tool for spine surgeons. The growing research on tissue bioengineering and its application in conjunction with additive manufacturing has revealed great potential for tissue bioengineering in the treatment of spinal ailments.

Short to Mid-Term Term Surgical Outcome Study with Posterior Only Approach on Tuberculous Spondylodiscitis in an Elderly Population

Manish Kothari,Kunal Shah,Agnivesh Tikoo,Abhay Nene 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.2

Study Design: Retrospective study. Purpose: To study short to mid-term outcome of surgically managed elderly patients of tuberculous spondylodiscitis with posterior only approach in terms of decision making and challenges in treatment, choice of implants and outcomes. Overview of Literature: Tuberculous spondylodiscitis in the elderly is increasing due to longer survival rates. It presents with varied clinical manifestations needing surgical management. Management in tuberculous spondylodiscitis has been scarcely reported in the elderly, with a paucity of data on the choice of implants and approach. Methods: Sixteen patients (five males, 11 females) older than 70-years-of-age culture and/or histopathology proven tuberculous spondylodiscitis were included in the study. All patients were operated using a single posterior approach. Pedicle screw with rods (PS/ rods) or spinal loop with sublaminar wires (SL/SLW) were used for fixation. Clinical and surgical details were recorded. Sagittal correction achieved postoperatively and loss of correction at follow-up were noted. Results: The mean age was 73.6 years (range, 70 to 80 years). The mean follow up was 44.5 months (range, 24 to 84 months). The mean immediate postoperative correction of sagittal deformity was 11.3 degrees; this correction was lost by a mean of 3.1 degrees at last follow-up. All 10 patients with deficit showed neurological recovery and all but one of the seven non-walkers were capable of independent ambulation at follow-up. Patients with SL/SLW and PS/rods had similar radiological outcome at final follow up. Conclusions: Operative management gives satisfactory results in elderly patients with tuberculous spondylodiscitis. The posterior approach provides adequate exposure for decompression and rigid fixation, providing satisfactory clinical and radiological outcomes. SSL/SLW and pedicle screw rod construct both give similar radiological results if used appropriately in patients.

Assessment of Outcomes of Spine Surgery in Indian Athletes Involved in High-End Contact Sports

Shah Kunal,Bharuka Anuj,Gadiya Akshay,Nene Abhay 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2

Study Design: This study was a retrospective analysis.Purpose: This study aimed to analyze the functional outcome following spinal surgery in elite athletes using return-to-play criteria.Overview of Literature: Spinal ailments are relatively common in athletes and are bound to increase due to the ever-growing popularity of contact sports. An elite athlete is highly motivated to make a rapid recovery and return to full participation in sports. Although the criteria for diagnosis and surgical treatment of various spinal disorders in athletes have been well defined in the literature, there is no clear definition about the factors determining the return to play in athletes.Methods: This study was a retrospective analysis of the data of 10 elite athletes who underwent spinal surgery for symptomatic degenerative disorder of the spine. Eight patients underwent lumbar spine surgery (two patients of microdiscectomy and six patients of fusion), and the remaining two patients underwent cervical spine surgery (one each anterior cervical discectomy and fusion and anterior cervical disc replacement). Outcome measures were investigated using return-to-training and return-to-sports criteria, as indicated by the length of time between surgery and return to competitive sports as parameters.Results: Of the 10 patients, eight were males and two were females. The average age of the patients at the time of surgery was 32.4 years (range, 25–41 years). All patients returned to active participation of their sports. The average time for return to training was 7.3 weeks (range, 3–12 weeks). The average time for return to sports was 45.6 weeks (range, 36–72 weeks), and the average follow-up period was 59 months (range, 27–120 months).Conclusions: Spine surgery in an elite athlete involved in contact sports is safe and effective. Currently, there is a lack of standardized guidelines for return to sports after spine injuries. An athlete needs to be symptom-free, with full range of motion and full strength before returning to sports.

Non-Surgical Management of Cord Compression in Tuberculosis: A Series of Surprises

Sanganagouda Shivanagouda Patil,Sheetal Mohite,Raghuprasad Varma,Shekhar Y Bhojraj,Abhay Madhusudan Nene 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.3

Study Design: Prospective study. Purpose: We present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery. Overview of Literature: Spinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis. Methods: Fifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit (<than Frankel grade C) and children below the age of maturity. All patients were treated with a fixed, methodically applied non-surgical protocol including hospital admission, antitubercular medications, baseline somatosensory evoked potentials and a regular clinicoradiological follow-up. Results: At the time of presentation, 10 patients had a motor deficit, 18 had clinically detectable hyper-reflexia and 22 had normal neurology. Forty-seven of the 50 patients responded completely to non-operative treatment and healed with no residual neurological deficit. Three patients with progressive neurological deficit while on treatment were operated on with eventual excellent recovery. Conclusions: Radiological evidence of cord compression and early neurological signs need not be an emergency surgical indication in the management of spinal tuberculosis.

Recurrent Spinal Giant Cell Tumors: A Study of Risk Factors and Recurrence Patterns

Sanganagouda Patil,Kunal Chandrakant Shah,Shekhar Yeshwant Bhojraj,Abhay Madhusudhan Nene 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.1

Study Design: Retrospective study. Purpose: To highlight risk factors, recurrence patterns and multimodal treatment in management of recurrent giant cell tumors (GCTs). Overview of Literature: GCTs of the spine are rare and challenging entities. Recurrences are very common and warrant complex management to prevent multiple recurrences. Gross total resection is preferred over subtotal procedures to prevent recurrences. However, resection is associated with morbidity and mortality. Proper understanding of risk factors and a high index of suspicion helps to spot recurrences early and aids in subsequent management. Methods: Ten patients (six females, four males) with recurrent GCTs underwent 17 interventions. There were six lesions in the thoracic spine, two in the cervical spine and two in the lumbar spine. Recurrences were managed with preoperative digital subtraction embolization, intralesional curettage and postoperative radiotherapy. Results: The average age at intervention was 31.3 years. The average duration of recurrence in patients following index surgery in a tertiary care hospital and surgery elsewhere was 7.3 years and was 40 months, respectively. The minimum recurrence-free interval after the last recurrent surgery was 10 years. Conclusions: Our study reports the largest recurrence-free interval for GCTs. Recurrent GCTs are challenging entities. Understanding of risk factors and meticulous planning is required to prevent recurrences. Intralesional surgery could be a safer and effective modality in managing recurrences.

Surgical Management in Elderly Patients with Tuberculous Spondylodiscitis: Ten Year Mortality Audit Study

Manish Kundanmal Kothari,Kunal Chandrakant Shah,Agnivesh Tikoo,Abhay Madhusudan Nene 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.5

Study Design: Retrospective study. Purpose: To evaluate the factors affecting immediate postoperative mortality in elderly patients with tuberculous spondylodiscitis. Overview of Literature: Treatment of spinal tuberculosis in the elderly involves consideration of age and co-morbidities, and often leads to an extended conservative management. Surgical intervention in these patients becomes a complex decision. There are no studies on risk factors of mortality in surgically treated elderly with tuberculous spondylodiscitis. Methods: Two hundred and seventy-six patients with spondylodiscitis were operated between 2005 and 2015. 20 consecutive patients over 70 years of age with and proven tuberculosis who met the inclusion/exclusion criteria were included. Demographic, clinical and radiological profile data with operative details of instrumentation, blood loss, surgical duration, and mortality were noted. There were 20 patients (6 males, 14 females) with a mean age of 73.5 years. The patients were divided into those with mortality (M) and those who survived (non-mortality, NM). Various variables were statistically tested for immediate postoperative medical complications and mortality. Results: There were four mortalities (20%). Age, sex, number of medical co-morbidities, American Society of Anaesthesiologists grade, Frankel grade C or worse, number of vertebrae involved, number of levels fused, blood loss and operative time did not have statistically significant impact on immediate postoperative mortality. Only preoperative immobility duration was statistically higher in the M group (p =0.016) than in the NM group. Conclusions: Preoperative immobility is associated with immediate postoperative mortality in elderly patients with spinal tuberculosis undergoing surgery. The findings identify preoperative immobility as a risk factor for mortality, which could contribute to a more detailed prognostic discussion between surgeon and patient before surgery.

Does Three-Dimensional Printed Patient-Specific Templates Add Benefit in Revision Surgeries for Complex Pediatric Kyphoscoliosis Deformity with Sublaminar Wires in Situ? A Clinical Study

Shah Kunal,Gadiya Akshay,Shah Munjal,Vyas Devarsh,Patel Priyank,Bhojraj Shekhar,Nene Abhay 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.1

Study Design: Case-control study.Purpose: To evaluate the accuracy of three-dimensional (3D) printed patient-specific templates (PSTs) for placement of pedicle screws (PAs) in patients undergoing revision surgeries for complex kyphoscoliosis deformity with sublaminar wires in situ.Overview of Literature: Revision kyphoscoliosis correction surgery in pediatric patients is a challenging task for the treating surgeon. In patients with sublaminar wires in situ, the native anatomical landmarks are obscured, thus making the freehand screw placement technique a highly specialized task. Hence, the concept of using PSTs for insertion of PAs in such surgeries is always intriguing and attractive.Methods: Five consecutive patients undergoing revision deformity correction with sublaminar wires in situ were included in this study. Patients were divided in two groups based on the technique of PA insertion. A total of 91 PAs were inserted using either a freehand technique (group A) or 3D printed templates (group B) (34 vs. 57). The placement of PAs was classified according to a postoperative computed tomography scan using Neo’s classification. Perforation beyond class 2 (>2 mm) was termed as a misplaced screw. The average time required for the insertion of screws was also noted.Results: Mean age, surgical time, and blood loss were recorded. The change in mean Cobb’s angle in both groups was also recorded. The difference in rates of misplaced screws was noted in group A and group B (36.21% vs. 2.56%); however, the mean number of misplaced PAs per patient in group A and group B was statistically insignificant (6.5±3.54 vs. 4.67±1.53, p =0.4641). The mean time required to insert a single PA was also statistically insignificant (120±28.28 vs. 90±30 seconds, p =0.3456).Conclusions: Although 3D printed PSTs help to avoid the misplacement of PAs in revision deformity correction surgeries with sublaminar wires in situ, the mean number of misplaced screws per patient using this technique was found to be statistically insignificant when compared with the freehand technique in this study.