Journal of Spine Research and Surgery
Latest articles in this journal
Journal of Spine Research and Surgery, Volume 03, pp 91-98; https://doi.org/10.26502/fjsrs0033
This is a case report of an 40 years female patient with Scheuermann Kyphosis with a rigid thoracic hyperkyphosis of 90º and compensatory lumbar hyperlordosis of 92º, treated with a single posterior approach, Ponte osteotomy and instrumented posterolateral fusion. There is some discussion about the best surgical approach. Combined approach was classically considered the gold-standard, but recent studies revealed that posterior-only approach allows comparable corrections with less complications rate. Posterior-only approach good results are related with advances in posterior instrumentation combined with posterior column shortening techniques, such Ponte osteotomies. Preoperative planning is essential. Spine instrumentation should extend from proximal end vertebra to sagittal stable vertebra.
Journal of Spine Research and Surgery, Volume 03, pp 81-90; https://doi.org/10.26502/fjsrs0032
Ankylosing Spondylosis denotes seronegative arthritis that causes inflammation and eventual fusion of the spine and the spinal joints. Involvement of peripheral joints and extraarticular manifestations. it includes-Ankylosing spondylitis (AS); (DISH); End-stage spondylosis multiform (EASM); Ossified posterior longitudinal ligament (OPLL). The prevalence ranges from 0.1 to 1 percent of the population, M>F, between15- 40 years; 95% share the genetic marker HLA-B27. Numerous bony changes to spine include-Intraosseous bone loss; erosion; sclerosis; fractures; extra osseous squaring; syndesmo and enthesophytes . Incidence of ASVF is 3.5 times more than in general people, 75% in the cervical spine followed by thoracic and lumbar spine. There is 11 times more chance of Spinal cord injury than in general. Mean age of fracture is 63.4 years. Treatment is challenging due to kyphosis, osteoporosis, associated comorbities and cardiopulmonary restrictions. Treatment goals are to reduce or prevent- inflammation, ankylosis, abnormal posture. The principle is to treat the fracture as long bone osteoporotic diaphyseal fracture. Apart from 360* fracture fixation with long construct, MIS surgery, other fracture managements in AS are deformity correction, laminectomy, laminoplasty, rhizotomy, neuromodulation. Complication rates are high,wound infections up to16%,pulmonary complications up to 63%, 23% mechanical complications among various reports. A standard guideline should exist for ASVF workup, management and complications appraisal.
Journal of Spine Research and Surgery, Volume 03, pp 106-112; https://doi.org/10.26502/fjsrs0035
Purpose: Description of a non-operative technique for the repair of cerebrospinal (CSF) dural leaks after lumbar spine surgery. Methods: Two patients, thirty-nine and seventy-six years old respectively, were previously operated of lum- bar discectomy/decompression, and in the following days developed leakage of clear CSF fluid in their surgical wounds. They were treated by means of stitched pads to their wounds, creating continuous external compression reducing the dead space for the CSF to get in. Results: After, one and two weeks respectively and no evidence of leakage the sutures were removed. The patients were reviewed at 3 and 6-months post operation, where no clinical evidence of dural leaks was found and in one the MRI confirm their absence. At the end, the patients were asymptomatic of their original lumbar complaint. Conclusion: An alternative simple technique that avoids the necessity of reoperation in the case of post-operative dural tears.
Journal of Spine Research and Surgery, Volume 03, pp 10-16; https://doi.org/10.26502/fjsrs0025
Objective: To evaluate the concentration of essential trace elements in herniated lumbar intervertebral disc in relationship with age of patients and stages of lumbar degenerative disc disease. Material and methods: Prospective observational study. The specimens of the lumbar disc herniations were obtained from patients who underwent conventional transforaminal endoscopic discectomy. The instrumental neutron activation analysis was applied to determine the concentration of microelements in alumbar disc herniations. Statistical analyses performed by descriptive statistics and Student's t-tests. The level of significance was set to p < 0.05. Results: A total of 44 patients who underwent transforaminal endoscopic lumbar discectomy , of these 16 (38.09%) patients had lumbar disc herniation at the level of L3-L4, whereas 28 (62.01%) patinets had lumbar disc herniation at the level of L4-L5. The instrumental neutron activation analysis was demonstrated that the mean concentrations of essential trace elements such as Au, Br, Cr, Hg, Hf, Ni, Sc, Fe, and Co were declined by aging and progression the degenerative-destructive process, at the same time the content of other trace elements such as K, Se, Zn, Mn, Zn, Cl and Ca were increased, while the concentrations of Ag and La were relatively constant (all p values<.001). Conclusion: This study revealed that the significant differences in the trace element concentrations in lumbar herniated discs between different age groups of patients, as well as the different stages of lumbar degenerative disc disease.
Journal of Spine Research and Surgery, Volume 03, pp 17-23; https://doi.org/10.26502/fjsrs0026
Sacral chordomas pose a difficult challenge for physicians due to the close proximity of neural, vascular, and visceral structures. Patients and physicians must weigh the risks and benefits of operative versus non operative management when deciding on treatment of these lesions. We report a complication of single dose intent to treat SBRT for a sacral chordoma that should serve to remind oncologists that radiation therapy, like surgery, is not without serious potential complications and that surgical resection may still be the best option for patients whose tumor can be treated with en bloc resection.
Journal of Spine Research and Surgery, Volume 03, pp 37-44; https://doi.org/10.26502/fjsrs0028
Epistaxis is a rare complication following the endonasal approach of skull base surgery. Conservative methods like anterior and posterior nasal packing can be useful, but when these fail, a neuro-interventional technique can be used as a last-resort measure in cases of severe bleeding. The authors identify a 22-year-old female patient with recurrent epistaxis following resection of skull-base chordoma through an endonasal approach. An endovascular catheter digital subtraction angiogram identified the cause of epistaxis as a rupture of the left sphenopalatine artery branch of the left external carotid artery. A large dissecting aneurysm in the right intracerebral artery was also incidentally found. The unique co-occurrence of vascular problems was successfully managed by neuro-interventional techniques.
Journal of Spine Research and Surgery, Volume 3, pp 1-9; https://doi.org/10.26502/fjsrs0024
Introduction: Spondylodiscitis is a rare infection of the intervertebral disc and nearby bone structures, which incidence has been increasing in the past decades. Conservative treatment is the gold standard, but sometimes surgery is needed to relief the symptoms and eradicate the infection, preserve the neurological function, and restore structural alignment and stability. Case presentation: The authors present a clinical case of a 73-year-old-male with T11-12 and L4-L5 spondylodiscitis with an epidural collection at this last level, treated surgically with an interlaminar endoscopic debridement and posterior percutaneous instrumentation after failing of isolated medical treatment. Discussion: The diagnosis of spondylodiscitis may sometimes be difficult due to its non-specific symptoms and sometimes inconclusive blood tests. Endoscopic surgery along with posterior percutaneous instrumentation provides a minimally invasive surgical option in multimorbid patients and/or in early stages of the disease, reducing the surgical trauma, complications and fastening the recovery. Conclusion: Spondylodiscitis is a highly heterogeneous disease, remaining its diagnosis and treatment a complex challenge. With this case report the authors expect to raise awareness to the use of minimally invasive techniques in treating diseases of this type.
Journal of Spine Research and Surgery, Volume 03, pp 24-36; https://doi.org/10.26502/fjsrs0027
Objective: Anterior spinal artery syndrome (ASAS) has been rarely reported as a complication of intervertebral disc herniation (IVDH). Precipitation factors, presentation, evaluation, treatment strategy, and degrees of recovery have not yet been well documented. Methods: Systematic review was conducted according to PRISMA guidelines to review and summarize for the qualitative synthesis of the data from reported cases of anterior spinal artery syndrome due to intervertebral disc herniation from 1980 to February 2021. Results: A total of 12 cases were reviewed, the median age was 48.5 years. Motor weakness with or without pain was the most frequent presenting symptom accompanying bowel or bladder incontinence (25%) or diminished pain and temperature sensation with spared dorsal column sensation. 40% of conservatively treated patients had complete recovery without any residual deficit. Whereas all patients who managed surgically regained fully functional status with shorter recovery intervals. Conclusion: Abrupt onset of motor weakness is a potential warning symptom of spinal cord infarction, rarely attributed to ASA compression by a herniated disc. Moreover, an accompanying diminished pain and temperature sensation with spared dorsal column sensation is further intimation. Reestablishment of blood flow may bear a favorable outcome.
Journal of Spine Research and Surgery, Volume 03, pp 45-57; https://doi.org/10.26502/fjsrs0029
Aneurysms originating from the Artery of Adamkiewicz are incredibly uncommon, with very few reported cases in the current literature. Here, we perform a systematic review of the few cases available in the literature, yielding a total of 15 eligible patients. We extracted certain procedural information and outcomes from these patients, including how this Artery of Adamkiewicz aneurysm was treated and outcomes from this surgery. We find that a slight majority of patients are treated surgically and that there is some improvement in regard to complete recovery for patients who have been surgically managed. Although there is insufficient evidence to make any definitive conclusions about treatments for this rare aneurysm, this information remains exciting and relevant for patients who may present with this and for whom surgical versus conservative treatment options may not be a clear decision. We hope that this will provide more information on how this unique finding has been treated based on the current literature and that this will help to guide patient care in rare cases such as these aneurysms.
Journal of Spine Research and Surgery, Volume 03, pp 71-80; https://doi.org/10.26502/fjsrs0031
Introduction: Degenerative spondylolisthesis produces abnormal intervertebral movement associated with back pain. Standard surgical treatment consists of decompression with or without fusion. There is no consensus about the method of choice. Purpose of this study: avoiding decompression, a semi-rigid, minimally invasive device that reduces movement was used, removing the necessity for fusion and reducing fixation-loosening, or breakage. Methods: Analytical prospective observational study. The clinical assessment included the Oswestry Disability Index (ODI) and SF-12 (Short Form-12 Health Survey), X-Rays and MRIs (Magnetic Resonance Imaging) were taken preoperatively and at follow-up. Overall, the mean postoperative follow-up was 3.8 years. It is about a posterior intrapedicular device introduced percutaneously under X-Ray control. The device consists of two semi-rigid bars, allowing 5º multiplanar movement, and 1mm compressive-spring movement. Through manipulation and distraction, reduction of listhesis is possible, increasing disc and lateral recesses height. Results: At final follow-up, ODI and SF-12 scores significantly improved. ODI from 47.4 ± 14.9 to 22.8 ± 19.7 (p<0.001). In terms of SF-12, PHS (Physical Health Score) improved from 27.9 ± 6.3 to 37.5 ± 11.1 (p<0.001) and MHS (Mental Health Score) from 34.4 ± 11.3 to 42.7 ± 13.2 (p<0.002). The results give the message that despite generalized disc disease, a spondylolisthesis that moves is likely to be the symptomatic level. Reduction, increases spinal diameters, decompresses the neural elements and reduces movement sufficiently to stop movement-related pain. Conclusion: Semi-rigid percutaneous minimally invasive fixation is effective in the treatment of degenerative spondylolisthesis. Evident preoperative abnormal movement and reduction of the listhesis at operation are crucial factors. Due to minimal intervention and hence lack of access related injury no patient was made worse.