Computed Tomography Scan-Based Morphometric Analysis of Lateral Masses of Atlas Vertebrae in Normal Indian Population

Prajakta Charuchandra Bhide,Sudhirkumar Srivastava,Shaligram Purohit,Deepika Albert Pinto,Nandan Amrit Marathe 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: A cross-sectional observational study involved the analysis of computed tomography (CT) scan data from 125 Indian subjects of 18 years or older with normal imaging findings. Scans were obtained from patients with head injuries as a part of the screening process along with brain CT scans. Purpose: To establish the dimensions of lateral masses of the atlas vertebrae in normal disease-free Indian individuals. Overview of Literature: Lateral mass fixation has become the standard of care in fixation of the supra-axial cervical spine. Many studies have investigated the dimensions of lateral masses in cadaveric specimens; however, studies involving the radiological morphometric analysis of the lateral masses of the atlas vertebra in living patients are lacking. Methods: Subjects underwent craniovertebral junction CT scans during evaluations of head injury. All had normal radiology reports. The CT scans were obtained using a CT Philips Brilliance 64 machine (Philips, Amsterdam, Netherlands) with a slice thickness of 1 mm and then analyzed using Horos software ver. 2.0.2 (Horos Project, Annapolis, MD, USA) on a MacBook. Results: Lateral masses of the atlas vertebrae were found to be larger in males than females and larger on the right than the left side. The angle of permissible medialization was found to be larger on the right side. The analysis of the average dimensions indicated the conventionally described screw positions to be safe. Conclusions: The present study provides information that may help to establish standard dimensions of lateral masses of the atlas vertebrae among the normal Indian population. We demonstrate that there is no significant difference when compared with the Western population. The results presented here will be of use to clinicians as they may inform preoperative planning for lateral mass fixation surgeries.

Role of Additional Coronal Magnetic Resonance Imaging in Decompression and Reconstruction with or without Segment Salvage in Thoracic Spine Tuberculosis

Sudhir Srivastava,Nandan Marathe,Sunil Bhosale,Prajakta Bhide,Shaligram Purohit,Chetan Shende,Balgovind Raja 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Retrospective and observational study. Purpose: The present study aimed to develop guidelines for segment salvage or sacrifice based on the amount and status of the remnant portion of the vertebra as assessed by coronal magnetic resonance imaging (MRI) in addition to sagittal and axial images in thoracic spine tuberculosis (TB). Overview of Literature: Indications for surgery have not changed significantly since the ‘middle path regimen’ was proposed by Tuli. Goals of modern surgical management of spinal TB include debridement of diseased vertebrae, spinal cord decompression, deformity correction, and spine stabilization. However, the extent of decompression has not been defined previously. Too less decompression will lead to compromised neurological recovery, whereas large extent of decompression is associated with increased surgical morbidity and longer segment to reconstruct. Methods: Sixty-five patients with thoracic spine TB were divided into two groups (segment salvage/sacrifice) based on the thickness of the subchondral bone and endplate morphology of the vertebra as seen on MRI. The operative procedure in the form of instrumentation with Hartshill loop rectangle and sublaminar wire using the simultaneous anterior posterior approach in lateral position (versatile approach) was performed. The patients were analyzed for postoperative fusion, improvement in kyphosis angle, and followed up for development of complications. Results: This method of deciding the level of fixation and segment salvage based on coronal MRI in addition to the sagittal and axial images provided good result in 64 of 65 patients, except for one patient in the segment sacrifice group who had graft buckling and resultant kyphosis. Conclusions: For segment salvage, having a clear three-dimensional idea about the viable remnant bone is important. Viable salvaged segment reduces the morbidity of the procedure, length of the construct, and unnecessary debridement without compromising on the neural recovery and fusion rate. Hence, additional cone down coronal cuts must be required when MRI is suggestive for spinal TB because it will help in the decision making.

Computed Tomography- and Radiography-Based Morphometric Analysis of the Lateral Mass of the Subaxial Cervical Spine in the Indian Population

Nirmal D Patil,Sudhir K Srivastava,Sunil Bhosale,Shaligram Purohit 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.1

Study Design: This was a double-blinded cross-sectional study, which obtained no financial support for the research. Purpose: To obtain a detailed morphometry of the lateral mass of the subaxial cervical spine. Overview of Literature: The literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine. Methods: We assessed axial, sagittal, and coronal computed tomography (CT) cuts and anteroposterior and lateral X-rays of the lateral mass of the subaxial cervical spine of 104 patients (2,080 lateral masses) who presented to a tertiary care public hospital (King Edward Memorial Hospital, Mumbai) in a metropolitan city in India. Results: For a majority of the parameters, males and females significantly differed at all levels (p <0.05). Females consistently required higher (p <0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5<C4<C6<C3, the lateral angulation followed the order of C3<C5<C4<C6. The lateral mass becomes longer and narrower from C3 to C7. In axial cuts, the dimensions increased from C3 to C6. The sagittal cut thickness and diagonal length increased and the sagittal cut height decreased from C3 to C7. The sagittal cut height was consistently lower in the Indian population at all levels, especially at the C7 level, as compared with the Western population, thereby questioning the acceptance of a 3.5-mm lateral mass screw. A good correlation exists between X-ray- and CT-based assessments of the lateral mass. Conclusions: Larger lateral angulation is required for Indian patients, especially females. The screw length can be effectively calculated by analyzing the lateral X-ray. A CT scan should be reserved for specific indications, and a caution must be exercised while inserting C7 lateral mass screws.

Apical Vertebral Column Resection with Sagittal Rotation and Controlled Anterior Opening and Posterior Closing Maneuver for the Treatment of Severe Post-Tubercular Kyphosis: Case Series and Literature Review

Sudhir Kumar Srivastava,Rishi Anil Aggarwal,Sunil Krishna Bhosale,Kunal Roy,Pradip Sharad Nemade,Shaligram Purohit 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Retrospective case series. Purpose: Describe the technique and evaluate the outcome of apical vertebral column resection (VCR) with sagittal rotation and anterior opening and posterior closing (AOPC) maneuver for correction of severe post-tubercular kyphosis (PTK). Overview of Literature: The surgical procedures described for the correction of PTK are VCR, pedicle subtraction osteotomy, transpedicular decancellation osteotomy, and closing-opening osteotomy. Methods: We retrospectively evaluated 21 patients who had been operated on with single stage apical VCR with AOPC maneuver. Radiographs were obtained before surgery and at regular follow-up intervals. These were used to calculate the angle of kyphosis. Back pain was rated using the Visual Analog Scale (VAS) and neurological status was graded using Frankel grading. Radiological outcome was assessed by the improvement in the angle of kyphosis and fusion following surgery. Neurological status was assessed using Frankel grading. Results: The study included eight males and 13 females with a mean age of 21.9 and average follow-up time of 30.4 months. The average number of vertebral bodies destroyed was 2.57. Kyphosis was improved from a mean of 68.42°±13.23° preoperative to 8.71°±4.58° postoperative. The average correction achieved was 87.10%. Preoperative VAS score improved from a mean of 6.38±0.92 preoperative to 1.38±0.49 postoperative. No patients had any sign of neurological deterioration. Seven out of eight patients with a preoperative neurological deficit improved following surgery. Two patients developed superficial wound maceration, one had persistent postoperative hypotension, and the other developed hemothorax. All patients recovered fully without a need for additional surgery. Conclusions: Single stage simultaneous anterior column lengthening and posterior column shortening is an effective method for surgical correction of severe PTK.