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.

척추 종양수술에서 적절한 수술적 절제연을 얻기 위한 수술 중 네비게이션의 역할: 증례 연구

김상일,Samarth Mittal,고영일,고명섭,김영훈 대한척추외과학회 2024 대한척추외과학회지 Vol.31 No.1

연구 계획: 증례 연구목적: 본 연구는 척추 종양 수술 시 O-arm 네비게이션을 이용하였을 때 적절한 수술 절제연을 얻는 비율과 종양학적결 과에 대하여 확인하고자 하였다. 선행 연구문헌의 요약: 최근 척추 종양 수술 영역에서 수술 중 컴퓨터 단층촬영(CT) 기반의 네비게이션을 이용한 수술이 이루어지고 있다. 하지만 이러한수술방법이 수술 과정에 실제로 도움이 되고 더 나은 임상결과를 보여주는지 여부는 명확하지 않다. 결과: 네비게이션과 관련된 수술 중 합병증은 발생하지 않았다. 종양학적 결과에서는 6명의 환자가 생존하였으며, 이 중 5명은 질병의 증거가 없는 상태로 생존하였으며, 한명의 환자는 질병을 가진 채로 생존하였다. 한명의 환자는 6개월 추시 후 사망하였다. 네비게이션 이용 수술은 7명 중 6명의 환자에서(85.7%) 외과적 음성 절제연을 얻는데 도움이 되는 것으로 확인 되었으며, 종양의 단독 전이가 있는 환자 중 한명에서 절제연이 종양을 포함한 것으로확인되었다. 생존한 환자 6명 중에서 천골 골육종 환자 1명이(16.7%) 위성병변으로 국소재발이 발생하였고, 재수술을 실시했다. 결론: 척추 종양에 대한 CT 기반 네비게이션 수술은 정확한 재건술 뿐만 아니라 수술적 절제연의 결정에 유용할 수 있다. 수술 전 철저한 영상의학적 검토와 수술 중 네비게이션의 이용은 안전한 절제연을 얻는데 도움이 될 수 있다. 약칭 제목: 네비게이션을 이용한 척추 종양 절제술 Study Design: Case series Objective: This study aimed to assess the proportion of adequate surgical margins in spine tumor resection procedures using O-arm navigation-assisted surgery, and to examine the associated oncologic outcomes. Summary of Literature Review: Computed tomography (CT)-based intraoperative navigation has been relatively recently adopted for spine tumor surgery. However, whether navigation-assisted surgery shortens procedures and leads to better clinical outcomes remains unclear. Materials and Methods: A retrospective review was conducted on seven patients who underwent tumor resection with O-arm navigation assistance. Clinical data such as general demographic characteristics, intraoperative efficacy of this system for reconstruction, perioperative complications, oncologic outcomes, and pathological reviews of the surgical margins were collected. Results: No intraoperative complications were associated with the use of the navigation system. In terms of oncological outcomes, six patients survived, with five showing no evidence of disease and one remaining alive with disease. One patient died after a 6-month follow-up period. Navigation proved beneficial in achieving negative resection margins in six out of seven patients (85.7%), while only one patient with solitary metastasis showed margin involvement of the tumor. Among the six surviving patients, one with sacral osteosarcoma (16.7%) experienced local recurrence due to a satellite lesion, leading to revision surgery. Conclusions: CT-based navigation-assisted surgery for spinal tumors could be useful not only for accurate reconstruction, but also for determining the surgical margin. A thorough preoperative radiological review and intraoperative navigation could provide additional benefits for a safe resection margin.

Injury Mechanisms of Hip Fractures in India

( Jaiben George ),( Vijay Sharma ),( Kamran Farooque ),( Samarth Mittal ),( Vivek Trikha ),( Rajesh Malhotra ) 대한고관절학회 2021 Hip and Pelvis Vol.33 No.2

Purpose: Hip fractures are a major cause of morbidity and mortality in the elderly; however, the current literature on the injury patterns of hip fractures in India is lacking. Understanding the injury profile of these patients is important to develop targeted interventions to prevent hip fractures. Materials and Methods: This was a prospective study of all hip fracture patients aged 50 years or older admitted from February 2019 to December 2019. Details about the injury were recorded by an in-person interview. Multivariate logistic regression analysis was used to identify the factors associated with any particular injury mechanism. Results: Two hundred and eighty-three hip fractures were included. The mechanism of injury for the majority of patients was a fall from a standing height (n=217, 76.7%) while 60 patients (21.2%) were injured as the result of a road traffic accident (RTA). Slipping on a wet floor (n=49, 22.6%) and change in posture (n=35, 16.1%) were the most commonly reported reasons for falling. Pedestrian injuries were the most common form of RTA (n=29, 48.3%). Increasing age (P<0.001) and female sex (P=0.001) were associated with fall as the mode of injury while sustaining another fracture in addition to hip fracture (P=0.032) was associated with RTA as the mode of injury. Conclusion: A fall from standing height is the predominant mode of injury among elderly hip fractures especially among women. Environmental hazards and postural changes are responsible for the majority of falls while pedestrian accidents contribute to a majority of the RTAs.

The Impact of Surgical Timing of Hip Fracture on Mortality: Do the Cause and Duration of Delay Matter?

Jaiben George,Vijay Sharma,Kamran Farooque,Samarth Mittal,Vivek Trikha,Rajesh Malhotra 대한고관절학회 2023 Hip and Pelvis Vol.35 No.3

Purpose: Delay in performance of hip fracture surgery can be caused by medical and/or administrative reasons. Although early surgery is recommended, it is unclear what constitutes a delayed surgery and whether the impact of delayed surgery can differ depending on the reason for the delay. Materials and Methods: A total of 269 consecutive hip fracture patients over 50 years of age who underwent surgery were prospectively enrolled. They were divided into two groups: early and delayed (time from reaching the hospital to surgery less than or more than 48 hours). Patients were also categorized as fit or unfit based on anesthetic fitness. One-year mortality was recorded, and regression analyses were performed to assess the impact of delay on mortality. Results: A total of 153 patients (56.9%) had delayed surgery with a mean time to surgery of 87±70 hours. A total of 115 patients (42.8%) were considered medically fit to undergo surgery. No difference in one-year mortality was observed between patients with early surgery and those with delayed surgery (P=0.854). However, when assessment of the time to surgery was performed in a continuous manner, mortality increased with prolonged time to surgery, particularly in unfit patients, and higher mortality was observed when the delay exceeded six days (fit: P=0.117; unfit: P=0.035). Conclusion: The effect of delay on mortality was predominantly observed in patients who were not considered medically fit, suggesting that surgical delays might have a greater impact on patients with medical reasons for delay.

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.