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Journal of Spine

ISSN: 2165-7939

Open Access

Current Issue

Volume 9, Issue 6 (2020)

    Research Pages: 1 - 5

    Results Following Posterior Cervical Microforaminotomy and Discectomy using McCulloch Retractors for Cervical Radiculopathy

    Chetan Ram* and Satyen Mehta

    DOI: 10.37421/jsp.2020.9.458

    Cervical radiculopathy frequently occurs secondary to degeneration of cervical disc and cervical spondylosis. The herniated disc material and the osteophytes compress the spinal cord and the nerve roots, resulting in clinical symptoms. Severe pain and neurological deficits often requires surgical intervention. Surgical management for radiculopathy of the cervical spine includes Anterior Cervical Discectomy with Fusion (ACDF), cervical foraminotomy via an anterior (ACF) or posterior approach, and Anterior Cervical Decompression and Arthroplasty (ACDA). Surgeons tend to choose the surgical method that is appropriate to the patient’s needs, the pathological characteristic of the case, and the surgeon’s skill.

    Research Pages: 1 - 6

    Adjustable Lordotic Expandable Spacers: How Do They Compare to Traditional Static Spacers in Lateral Lumbar Interbody Fusion?

    Yan Michael Li, Richard F. Frisch, Zheng Huang, James Towner, Yan Icy Li, Amber L. Edsall and Charles Ledonio

    DOI: 10.37421/jsp.2020.9.459

    Introduction: Expandable interbody spacers with adjustable lordosis were designed to expand in situ and avoid complications such as endplate damage, excessive trialing and forceful impaction associated with static spacers. This study compares the clinical and radiographic two-year outcomes between patients treated with static or expandable interbody spacers with adjustable lordosis for Minimally Invasive Lateral Lumbar Interbody Fusion (MIS LLIF). Methods: This is a retrospective, multi-site, multi-surgeon, Institutional Review Board-exempt chart review of patients who underwent MIS LLIF using either a static (27 patients) or expandable spacer with adjustable lordosis (66 patients). Radiographs, complications and patient-reported outcomes were collected and compared from preoperative up to 24-month postoperative follow-up. Results: Mean improvement of Visual Analogue Scale back pain at 6, 12 and 24 months, as well as Oswestry Disability Index scores at 3, 6, 12, and 24 months, were significantly higher in the expandable group compared to the static group. The mean improvement of ODI scores from preoperative to 3, 6, 12, and 24 months was significantly greater in the expandable group by 55.6%, 75.6%, 77.4%, and 108.9% and by 48.2%, 34.6%, and 71.5% at 6, 12, and 24 months postoperatively for VAS pain scores, compared to the static group and (p<0.05) Disc height mean improvement from preoperative to 24 months was more significant in the static group compared to the expandable group. Implant subsidence was significantly greater in the static group (18.5%, 5/27 patients) compared to the expandable group (0/66 patients) (all p<0.05). Conclusion: This study showed significant positive clinical and radiographic outcomes for patients who underwent MIS LLIF using static or expandable interbody spacers with adjustable lordosis. Both static and expandable groups demonstrated long-term maintenance of significant radiographic improvements, with minimal complications reported and sustained significant clinical improvements at 24-month follow-up. There was a 0% subsidence rate in the expandable group, compared to an 18.5% subsidence rate in the static group. The use of expandable spacers with adjustable lordosis was safe and effective for the studied patient population.

    Case Series Pages: 1 - 3

    Primary Melanocytomas of the Spinal Cord: Case Studies and Rehabilitation Perspectives

    Stephen Covington, Matthew Severson, Patrick Shaeffer, Derek McGaffey and Kristin Garlanger

    DOI: 10.37421/jsp.2020.9.460

    Primary melanocytomas of the central nervous system are rare tumors arising from leptomeningeal melanocytes. Only 29 cases have been reported in the literature to date. Presenting symptoms may include insidious onset of back pain, slowly progressive neurological deficits such as weakness and sensory changes, in addition to bowel and bladder dysregulation. Advanced imaging including magnetic resonance imaging can be helpful in lesion localization but does not distinguish between primary and metastatic melanoma. In this case series, we present three patients with non-traumatic spinal cord injuries secondary to primary CNS malignant melanocytomas, who were admitted to a single inpatient rehabilitation facility within a 12-month time frame. These cases highlight the importance of the rehabilitation team in the continuum of care for patients undergoing resection of primary melanocytomas of the spinal cord. The rehabilitation team should be involved in the pre-operative counseling setting, immediately post-operatively and in follow up care. A comprehensive multidisciplinary approach including physical and occupational therapists, rehabilitation nurses, rehabilitation neuropsychologists and physiatrists is important for recovery of these patients.

    Review Pages: 1 - 3

    Recent Trends and its Effect in Incomplete Spinal Cord Injury Loco-Motor Rehabilitation ??? A Review

    Niharika Aswal and Sanghamitra Jena

    DOI: 10.37421/jsp.2020.9.461

    Objective: The purpose of this study is to find out the current trends and its effects in locomotor rehabilitation of individuals with incomplete spinal cord. Methods: Articles were searched through PubMed and Google scholar (year 2016-2020) written in English literature was performed regarding recent advances in the rehabilitation technologies of incomplete SCI patients. Results: Results of this research were according to the based on the clinical findings: Exoskeleton-assisted Gait Training (EGT), Virtual Reality (VR), Robot-Assisted Locomotor Training (RALT), Home based Virtual Reality, Dynamic weight shifting into treadmill, are currently being used. Conclusion: As per the study, there has been advancement in rehabilitation technologies and a significant improvement was noticed in incomplete spinal cord injury patients. More clinical trials and further study is needed for better improvement.

    Review Pages: 1 - 8

    Assessment of Functional Outcome and Complications in the Surgical Decompression of Lumbar Spinal Stenosis: A Systematic Review

    Vamsi Reddy, Luca H. Debs and Samuel D. Macomson

    DOI: 10.37421/jsp.2020.9.462

    Background: Surgical intervention may become necessary for chronic pain secondary to Lumbar Spinal Stenosis (LSS). It can be effectively achieved by using Conventional Decompression Surgery (CDS) or Minimally Invasive Spine Surgery (MISS). This study aimed to compare the functional outcome and complications associated with these two techniques. Methods: Online database sources (PMC and Cochrane Library) were utilized to identify 1,050 publications, which were narrowed down to 18 studies included in this systematic review. The mean postoperative improvement in Oswestry Disability Index (ODI) and Visual Analog Scale/ Numeric Pain Rating Scale (VAS/NPRS) scores was statistically evaluated by using SPSS-23 and compared for the two techniques through independent t-test. A p-value <0.05 was considered significant. Results: A total of 1,724 patients [CDS=705; MISS=1019] were included in the study. MISS cases had a significantly greater mean ODI preoperatively and the mean ODI improvement was significantly better in this cohort. The patients undergoing MISS also had a significant decline in the VAS/NPRS scores for Low Back Pain (LBP) and Leg Pain (LP). A significantly higher rate of operative complications and reoperation were seen in CDS patients. Conclusion: In cases of LSS, this review suggests that MISS carries a lower risk of complications and appears to yield better functional outcomes when compared to CDS.

    Volume 9, Issue 4 (2020)

      Research Pages: 1 - 4

      Hanging Radiograph in Idiopathic Scoliosis Patients: Significance as a Preoperative Stress X-Ray

      Hiroshi Kuroki*, Takuya Nagai , Etsuo Chosa and Naoya Tajima

      DOI: 10.37421/jsp.2020.9.447

      Introduction: Before corrective surgery for idiopathic scoliosis, the stress x-rays are indispensable to collect information regarding the reducibility of deformity, deciding fusion levels, and categorizing curve types and so on. The hanging radiograph has not been conducted preoperatively so far as known. The objective of this study was to investigate retrospectively the significance of the hanging radiograph for prediction of the curve correction with surgical procedure by comparing with the side-bending and the traction radiographs.

      Methods: The subjects enrolled in current study were 22 cases of idiopathic scoliosis who performed posterior instrumentation and fusion by ISOLA method between 2008 and 2014. They included 2 males and 20 females, with a mean age of 16 years and 8 months. The type of curves by Lenke classification were type 1 in 20 cases, type 2 in 1 case, and type 3 in 1 case. We investigated the correction rates of main thoracic curves in side-bending, traction, and hanging positions and compared them with that after surgery. In addition, correction indices were also calculated and compared among these stress x-rays.

      Results: The correction rate after surgery was 65.9% that was statistically higher than those in side-bending (44.2%), traction (46.6%), and hanging (22.1%) positions. There were statistical correlations between the correction rates after surgery and in side-bending position (R=0.73) and those after surgery and in traction position (R=0.57). However, there was no statistical correlation between the correction rates after surgery and in hanging position (R=-0.01). With regard to the correction indices, that in hanging position (3.67) was statistically higher than those in side-bending (1.51) and traction (1.45) positions.

      Conclusion: The correction rates in side-bending and traction positions seem to be useful to estimate the amount of curve correction before surgery whereas, that in hanging position did not have any significance as preoperative evaluation.

      Research Pages: 1 - 8

      Risk Factors for Atherothrombotic Disease and Lumbar Spinal Stenosis: Results from the PREFACE Study

      Emilia Ruggiero, Simona Costanzo, Augusto Di Castelnuovo, Mariarosaria Persichillo, Simona Esposito, Sara Magnacca, Ettore Carpineta, Chiara Cerletti, Marialaura Bonaccio, Maria Benedetta Donati, Sergio Paolini, Vincenzo Esposito, Giovanni de Gaetano, Gualtiero Innocenzi and Licia Lacoviello*

      DOI: 10.37421/jsp.2020.9.448

      Background and aim: Atherothrombotic disease of feeding arteries of lumbar spine could be an underlying mechanism for Lumbar Spinal Stenosis (LSS). We aimed at evaluating the association of a large panel of risk factors for atherothrombotic disease, alone or in combination, with LSS in multivariable models.

      Methods: Case-control study: 213 consecutive patients with LSS, eligible for surgery at the Neurosurgery Department of IRCCS Neuromed, were enrolled in the PREFACE study; 426 controls, matched 1: 2 for sex, age (± 6 months) and physical activity, without a history or clinical evidence of LSS were selected from the general population. Odds Ratios (ORs) and their 95% Confidence Intervals (CIs) were calculated using conditional-tomatch (for age and sex) logistic regression.

      Results: Manual occupation, current smoking, high waist-to-hip ratio, history of hypertension, diabetes and dyslipidemia were independently associated with higher odds of developing LSS in multivariable analysis (p<0.001). Only 1.5% of patients with LSS showed absence of risk factors, in comparison with 6.7% in controls (p<0.001). The risk of LSS linearly increased with the increased presence of risk factors. The presence of 3 or more risk factors compared with none was associated with 13 times higher risk of LSS (OR: 13.04; 95% CI: 2.87-59.27)

      Conclusion: Risk factors for cardiovascular disease and in particular metabolic risk factors are associated with increased risk of LSS. Management of LSS should take into consideration the control of modifiable atherothrombotic risk factors.

      Case Report Pages: 1 - 2

      Turning a Challenge into an Advantage: A Technical Report on Kyphoplasty for Multiple Myeloma

      Natan Silver* and Yair Barzilay

      DOI: 10.37421/jsp.2020.9.449

      Kyphoplasty, a procedure first described in 2001 for the treatment of osteoporotic Vertebral Compression Fractures (VCFs) has since been used successfully for pathological vertebral compression fractures, including those caused by multiple myeloma. Whilst the evidence base for kyphoplasty remains incomplete, there is a general consensus that it is safe and significantly reduces pain in up to 84% of patients in whom nonsurgical management has failed.

      Editorial Pages: 1 - 1

      Editorial on Laminectomy

      Sarita Mon*

      DOI: 10.37421/jsp.2020.9.451

      Laminectomy is a surgical operation method to cure spine cord and relieve pain in nerves. It creates a space by removing lamina that is present on the back part of the vertebrate that covers spine. It removes the bone spurs or segments that put pressure pain on nerves. It is also known as decompression surgery, laminectomy surgery enlarges your spinal canal to relieve pressure on the spinal cord or nerves.

      Editorial Comment Pages: 1 - 1

      A Short Note on Spinal Arthritis

      Sarita Mon*

      DOI: 10.37421/jsp.2020.9.452

      Spinal arthritis leads to inflammation of the facet joints in the spine or sacroiliac joints between the spine and pelvis. It causes stiffness and low back pain upon waking up in the morning. Fluid built up in the joint due to inactivity overnight causes more swelling. Pain is mostly > 80% - in the back, runs into the buttocks, and often really feels like it’s in the hip. As it gets even worse people will feel burning on the outer aspect of the thigh, and sometimes pain down the leg and nerve root pain some times.

      Volume 9, Issue 5 (2020)

        Editorial Note Pages: 1 - 1

        Editor Note on Spine Research

        Kasim Ratna*

        DOI: 10.37421/jsp.2020.9.453

        Spine is the one that helps in maintaining the posture of the body, provide support and protect our spinal cord from any injuries. It allows you to move and bend. Strength of the muscles and bones, ligaments and flexibility of the tendons, sensitive nerves will help in maintaining the healthy spine. It keeps us straight and connects the different parts of our skeleton to each other. Length of a person will depend on their height. Adult human being spine is S-shaped and its curve will help in maintaining balance and to allow motion throughout the spinal column.

        Editor Note Pages: 1 - 1

        Editorial Note on Spine Disorders

        Sarita Mon*

        DOI: 10.37421/jsp.2020.9.454

        Spine or backbone is made of small bones called vertebrae which is stacked with discs one on the top of another. These vertebras protects our spinal cord and allow us to stand, move and bend. There are number of issues related with spine and damage the vertebrae are infections, injuries, tumors and some changes related to age like spinal stenosis and herniated disks. Another problem is related to the structure of the spine; usually spine will be having S shaped curvature in some cases or damages the curvature of the spine changes. There are three main types of spine curvature disorders i.e., lordosis is also called as swayback in this case the spine of the person will have spine significantly inward at the lower back. Secondly kyphosis, in this case upper back will be abnormally rounded

        Case Report Pages: 1 - 4

        New-Onset Radiculopathy on Unaffected Side Post Spine Surgery-S1 Screw Irritating L5 Nerve Root: A Case Report

        Manoj D. Singrakhia and Ibad Sha

        DOI: 10.37421/jsp.2020.9.455

        Acute onset of neuropathic pain after lumbosacral fusion spine surgery can be due to multiple causes including a laterally directed bicortical S1 pedicle screw. We here are reporting a case where a laterally directed S1 pedicle screw irritating the L5 nerve root and producing a postoperative acute onset radicular pain on an unaffected side. After the failure of 1-month conservative treatment, the patient was operated and S1 screw was revised. While placing bicortical sacral screw, surgeons should stick to safe window described on cadaveric studies and MRI is a non-invasive and reliable method to identify anay nerve root irritation by bicortical sacral screws. 

        Review Pages: 1 - 10

        A Systematic Review of Complications Associated with Initial Learning Curve of Endoscopic Spine Surgery Highlighting the Necessity of Introducing an Effective Fellowship to Train Competent Endoscopic Spine Surgeons

        Pang Hung Wu, Hyeun Sung Kim, Dong Hwa Heo, Gamaliel Yu Heng Tan and Tae Jang

        DOI: 10.37421/jsp.2020.9.456

        Background: There is an increase in interest of endoscopic spine surgery as an option of minimally invasive spine surgery. Complications associated with learning curve are a big obstacle to starting a successful endoscopic career. A good endoscopic spine surgery fellowship can mitigate the risk of practice in early phase in endoscopic spine surgery. Methods: We conducted a systematic review in the PubMed database using the terms using three successive searches.10 articles met the criteria of learning curve in endoscopic surgeries evaluation of complications and operation timing. The most consistent parameters used in these studies to evaluate the learning curve were procedure time and complication rate as a function of chronologic case number, our analysis focused on these. The search strategy identified 10 original studies that included 618 endoscopic spine surgery procedures. Results: In the 10 studies, total number of complications was 45 cases (7.2%). 33 cases (5.3%) occurred in the early phase of learning curve. The most frequent reported complications were incomplete decompression (18 cases, 2.9%), incidental durotomies (13 cases; 2.1%), nerve root injuries (11 cases; 1.77%), discitis (2 cases; 0.32% of complications) and hematoma (1 case; 0.16%). The operative time was observed to decrease throughout these case series with no general consensus of number of cases required to reach asymptote. Conclusion: There is steep learning curve with high complications in the initial learning phase of endoscopic spine surgery. It is recommended to have an effective training or fellowship programme to train competent endoscopic spine surgeons.

        Editorial Pages: 1 - 1

        An Editorial Note on Scoliosis

        Khaja Mano

        DOI: 10.37421/jsp.2020.9.457

        It the medical condition related to a person’s spine curve which is having sideways curve, usually S or C shaped over three dimensions. In some cases the degree of curve is stable and in others it increases over time. Cause of the most cases is not clear but believes that different factors involved like genetic and environmental factors. There are different types and causes of scoliosis, such as idiopathic, degenerative, congenital, neuromuscular, thoracogenic and syndromic. Idiopathic meaning itself says there is no specific cause but it is the most common form among 80 percent of the scoliosis cases, degenerative case is also fairly common like it affects around 39 percent of the population, rare forms includes congenital scoliosis which affects one in ten thousand newborns. Infantile idiopathic scoliosis will be diagnosed in children of ages 0-3, juvenile idiopathic scoliosis will be diagnosed in children of age 4-10, adolescent idiopathic scoliosis is diagnosed in young people ages 11-18, girls are experienced this much more frequently than boys at ratio of 10:1. Adult idiopathic or degenerative scoliosis is diagnosed in people older than 18. Degenerative scoliosis results from asymmetrical disc degeneration over time this type of scoliosis tends to affect the lumbar spine region, people with this problem will experience difficulty in standing upright and pain in the back.

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