A retrospective clinical study for prognostic purposes. Objective: To study the morphological cha... more A retrospective clinical study for prognostic purposes. Objective: To study the morphological changes that dictate the variable progression of childhood spinal tuberculosis. Summary of Background Data: Posttuberculous kyphosis in children either improves or deteriorates during growth. Associated morphological changes in the kyphosis fusion mass and the uninvolved adjacent levels have not been described in literature. Methods: The study group consisted of 61 children with 63 spinal lesions selected from a prospective multicenter clinical trial. These children were followed up for a uniform period of 15 years at regular intervals. Anterior and posterior heights of the kyphosis fusion mass were measured. Relative difference in anteroposterior growth was analyzed by calculating the anteroposterior ratio of heights. Wedge angle and height-width ratio of uninvolved adjacent vertebrae along with changes in the morphology of disk spaces above and below the lesion were also analyzed. Results: An increase in the anteroposterior ratio of kyphosis fusion mass leading to a decrease in kyphosis was seen in 30 lesions. A decrease in the anteroposterior ratio leading to an increase in kyphosis was noticed in 16 lesions. Overgrowth of the kyphosis fusion mass resulting in formation of large vertebral bodies was noticed in 7 lesions. No change was noticed in 10 lesions. Interestingly, changes were also noticed in 234 adjacent vertebral bodies uninvolved by the disease process: anterior wedging (n = 53), growth alteration of ring apophysis (n = 26), decrease in anteroposterior diameter (n = 26), longitudinal overgrowth (n = 40), attrition at the point of contact resulting in irregular bodies (n = 44), and posterior wedging in the region of compensatory curve (n = 45). Changes in disk spaces were noted at 136 levels, the most common finding being an opening of the disk space anteriorly (n = 126) due to formation of compensatory lordotic curves. The secondary changes leading to an increase in deformity were observed significantly more in lesions with a deformity angle of more than 30 degrees and a vertebral body loss of more than 1, and in lesions of the thoracolumbar region. Children younger than 10 years differed from those 11 years or older by having a significantly more severe disease and more number of morphological changes with growth in both the fusion mass and the adjacent segments. Conclusions: Notable morphological changes occurred in both the kyphosis fusion mass and the uninvolved levels above and below the lesion in children with healed spinal tuberculosis. These changes occurred during growth, after complete healing of the disease was achieved, and were responsible for the variability in progression of the deformity during growth seen in these children. Our results imply that all children with spinal tuberculosis must be followed up regularly till the entire growth potential is completed.
Spinal fusion, first reported 100 years ago 17,18 for posttuberculosis spinal deformity, is now b... more Spinal fusion, first reported 100 years ago 17,18 for posttuberculosis spinal deformity, is now being used to manage trauma, deformity, instability, and degenerative conditions. Fusion for degenerative Research and education funding has been received from Stryker and Synthes.
Journal of Orthopedics and Joint Surgery, Jul 7, 2023
This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an earl... more This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an early imaging sign of inflammatory SpA, among chronic low backache patients in an Indian population. Materials a n d Methods A total of 200 consecutive MRI scans of the LS spine done at our center were analyzed by two radiologists and a fellow in spine surgery to ascertain the presence of sacroiliitis. All patients between the ages of 15-45 years who presented with chronic low backache and underwent an MRI scan at our center were included. Those
We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
Background: Intraspinal facet cyst or juxta-facet cyst is a term that includes synovial and gangl... more Background: Intraspinal facet cyst or juxta-facet cyst is a term that includes synovial and ganglion cysts in the spine. Facetal synovial cysts are fluid-containing synovial outpouchings arising from degenerated facet joints resulting from chronic hypermobility of the joints. These cysts can cause low back pain, radicular leg pain, and in rare cases cauda equina syndrome. Case description: In this report, we would like to present the occurrence of incomplete cauda equine syndrome resulting from a facet synovial cyst in a 65-year-old woman who presented with weakness in both lower limbs, difficulty in walking, and saddle anesthesia. The symptoms resolved following a posterior decompression, cyst excision, and instrumented fusion surgery. Conclusion: This report highlights the occurrence of acute cauda equina syndrome in a 65-year-old woman resulting from an L4-L5 facet synovial cyst. Prompt diagnosis and immediate surgical intervention in the form of decompression and fusion surgery lead to a favorable outcome. Clinical message: Acute cauda equina syndrome in a patient with a lumbar facet cyst is a relatively uncommon presentation. It requires early diagnosis and immediate surgical intervention in the form of decompression to prevent neurological deterioration and to have a favorable outcome.
Background-Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esopha... more Background-Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report-A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum ve months prior to presentation. The lady presented with infrascapular chest wall pain of one month's duration and dyspnoea and wheezing of 15 days duration. Imaging showed a midesophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course of antibiotics led to the healing of both lesions. Conclusions-A Rokitansky mid-esophageal diverticulum with esophageo-spinal stula causing infective spondylodisciitis is a rare condition. A combined management of the leaking esophageal diverticulum using an esophageal endoluminal metallic stent and an extended course of antibiotics to treat the infective spondylodisciitis led to a good outcome.
Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperpa... more Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperparathyroidism. Primary hyperparathyroidism is caused by parathyroid adenomas or parathyroid hyperplasia while chronic renal failure is a common cause of secondary hyperparathyroidism. Elevated parathyroid hormone levels cause increased osteoclastic activity, bone resorption and reactive fibroblastic proliferation leading to the formation of Brown tumor. Although Brown tumors are more commonly seen in the maxilla and mandible, it can occur in the long, flat bones or any bone. It is less commonly seen in the spine. In this report, we discuss the presentation, management, difficulties with histopathological diagnosis, and follow-up of a Brown tumor in a 55-year-old gentleman undergoing renal dialysis who presented with thoracic compressive myelopathy. Our patient underwent a T4 laminectomy, tumor debulking, and T2–T6 instrumented posterior fusion. Based on histopathological examination of the tissue specimen and raised serum parathyroid hormone levels, we arrived at a diagnosis of Brown tumor. Our review of the literature revealed 62 cases of vertebral Brown tumor resulting in neurologic symptoms. The lesion was more common in females (58%), those aged between 40 and 49 years (26%), and in the thoracic spine (51.6%). Early surgical intervention and management of the underlying cause of hyperparathyroidism lead to sustained symptomatic improvement. Brown tumor should be considered in the differential diagnosis of expansile vertebral lesions in the presence of hyperparathyroidism or chronic kidney disease. Treatment of the underlying hyperparathyroidism and decompression of the neural structures with or without stabilization is recommended.
The International Journal of Spine Surgery, Dec 1, 2021
Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a sele... more Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of an SNRB in the management of lumbar disc herniation with radiculopathy because there is limited evidence regarding this issue in the published literature. Methods: This prospective study included 50 patients who underwent an SNRB and were followed for 3 months. Numerical Rating Scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and Depression Anxiety Stress Scales-21 (DASS-21) scores were collected. At the final follow-up at 3 months, the number of patients who underwent surgery was ascertained. Results: Forty-two of 50 (84%) patients avoided the surgery with a reduction in mean preinjection NRS for back and leg pain from 7.5 (SD 1.33) and 7.7 (SD 1.35) to 3.1 (SD 1.69) and 2.3 (SD 1.14) (P < 0.001), respectively, within the 30 minutes after injection. The pain relief was sustained until the last follow-up. The ODI score also decreased from a mean preinjection level of 59.4 (SD 14.69) to 26.3 (SD 9.43) (P < 0.001) at 3 months. The mean preinjection depression score was higher in patients who had recurrence of pain and eventually underwent surgery. Conclusion: Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients. Clinical Relevance: SNRB should be administered early in the course of management of lumbar radiculopathy and should not be delayed until after other non-surgical modalities have failed.
We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an earl... more This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an early imaging sign of inflammatory SpA, among chronic low backache patients in an Indian population. Materials a n d Methods A total of 200 consecutive MRI scans of the LS spine done at our center were analyzed by two radiologists and a fellow in spine surgery to ascertain the presence of sacroiliitis. All patients between the ages of 15-45 years who presented with chronic low backache and underwent an MRI scan at our center were included. Those
Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a sele... more Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of an SNRB in the management of lumbar disc herniation with radiculopathy because there is limited evidence regarding this issue in the published literature. Methods: This prospective study included 50 patients who underwent an SNRB and were followed for 3 months. Numerical Rating Scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and Depression Anxiety Stress Scales-21 (DASS-21) scores were collected. At the final follow-up at 3 months, the number of patients who underwent surgery was ascertained. Results: Forty-two of 50 (84%) patients avoided the surgery with a reduction in mean preinjection NRS for back and leg pain from 7.5 (SD 1.33) and 7.7 (SD 1.35) to 3.1 (SD 1.69) and 2.3 (SD 1.14) (P < 0.001), respectively, within the 30 minutes after injection. The pain relief was sustained until the last follow-up. The ODI score also decreased from a mean preinjection level of 59.4 (SD 14.69) to 26.3 (SD 9.43) (P < 0.001) at 3 months. The mean preinjection depression score was higher in patients who had recurrence of pain and eventually underwent surgery. Conclusion: Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients. Clinical Relevance: SNRB should be administered early in the course of management of lumbar radiculopathy and should not be delayed until after other non-surgical modalities have failed.
Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esoph... more Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course ...
A retrospective clinical study for prognostic purposes. Objective: To study the morphological cha... more A retrospective clinical study for prognostic purposes. Objective: To study the morphological changes that dictate the variable progression of childhood spinal tuberculosis. Summary of Background Data: Posttuberculous kyphosis in children either improves or deteriorates during growth. Associated morphological changes in the kyphosis fusion mass and the uninvolved adjacent levels have not been described in literature. Methods: The study group consisted of 61 children with 63 spinal lesions selected from a prospective multicenter clinical trial. These children were followed up for a uniform period of 15 years at regular intervals. Anterior and posterior heights of the kyphosis fusion mass were measured. Relative difference in anteroposterior growth was analyzed by calculating the anteroposterior ratio of heights. Wedge angle and height-width ratio of uninvolved adjacent vertebrae along with changes in the morphology of disk spaces above and below the lesion were also analyzed. Results: An increase in the anteroposterior ratio of kyphosis fusion mass leading to a decrease in kyphosis was seen in 30 lesions. A decrease in the anteroposterior ratio leading to an increase in kyphosis was noticed in 16 lesions. Overgrowth of the kyphosis fusion mass resulting in formation of large vertebral bodies was noticed in 7 lesions. No change was noticed in 10 lesions. Interestingly, changes were also noticed in 234 adjacent vertebral bodies uninvolved by the disease process: anterior wedging (n = 53), growth alteration of ring apophysis (n = 26), decrease in anteroposterior diameter (n = 26), longitudinal overgrowth (n = 40), attrition at the point of contact resulting in irregular bodies (n = 44), and posterior wedging in the region of compensatory curve (n = 45). Changes in disk spaces were noted at 136 levels, the most common finding being an opening of the disk space anteriorly (n = 126) due to formation of compensatory lordotic curves. The secondary changes leading to an increase in deformity were observed significantly more in lesions with a deformity angle of more than 30 degrees and a vertebral body loss of more than 1, and in lesions of the thoracolumbar region. Children younger than 10 years differed from those 11 years or older by having a significantly more severe disease and more number of morphological changes with growth in both the fusion mass and the adjacent segments. Conclusions: Notable morphological changes occurred in both the kyphosis fusion mass and the uninvolved levels above and below the lesion in children with healed spinal tuberculosis. These changes occurred during growth, after complete healing of the disease was achieved, and were responsible for the variability in progression of the deformity during growth seen in these children. Our results imply that all children with spinal tuberculosis must be followed up regularly till the entire growth potential is completed.
Spinal fusion, first reported 100 years ago 17,18 for posttuberculosis spinal deformity, is now b... more Spinal fusion, first reported 100 years ago 17,18 for posttuberculosis spinal deformity, is now being used to manage trauma, deformity, instability, and degenerative conditions. Fusion for degenerative Research and education funding has been received from Stryker and Synthes.
Journal of Orthopedics and Joint Surgery, Jul 7, 2023
This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an earl... more This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an early imaging sign of inflammatory SpA, among chronic low backache patients in an Indian population. Materials a n d Methods A total of 200 consecutive MRI scans of the LS spine done at our center were analyzed by two radiologists and a fellow in spine surgery to ascertain the presence of sacroiliitis. All patients between the ages of 15-45 years who presented with chronic low backache and underwent an MRI scan at our center were included. Those
We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
Background: Intraspinal facet cyst or juxta-facet cyst is a term that includes synovial and gangl... more Background: Intraspinal facet cyst or juxta-facet cyst is a term that includes synovial and ganglion cysts in the spine. Facetal synovial cysts are fluid-containing synovial outpouchings arising from degenerated facet joints resulting from chronic hypermobility of the joints. These cysts can cause low back pain, radicular leg pain, and in rare cases cauda equina syndrome. Case description: In this report, we would like to present the occurrence of incomplete cauda equine syndrome resulting from a facet synovial cyst in a 65-year-old woman who presented with weakness in both lower limbs, difficulty in walking, and saddle anesthesia. The symptoms resolved following a posterior decompression, cyst excision, and instrumented fusion surgery. Conclusion: This report highlights the occurrence of acute cauda equina syndrome in a 65-year-old woman resulting from an L4-L5 facet synovial cyst. Prompt diagnosis and immediate surgical intervention in the form of decompression and fusion surgery lead to a favorable outcome. Clinical message: Acute cauda equina syndrome in a patient with a lumbar facet cyst is a relatively uncommon presentation. It requires early diagnosis and immediate surgical intervention in the form of decompression to prevent neurological deterioration and to have a favorable outcome.
Background-Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esopha... more Background-Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report-A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum ve months prior to presentation. The lady presented with infrascapular chest wall pain of one month's duration and dyspnoea and wheezing of 15 days duration. Imaging showed a midesophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course of antibiotics led to the healing of both lesions. Conclusions-A Rokitansky mid-esophageal diverticulum with esophageo-spinal stula causing infective spondylodisciitis is a rare condition. A combined management of the leaking esophageal diverticulum using an esophageal endoluminal metallic stent and an extended course of antibiotics to treat the infective spondylodisciitis led to a good outcome.
Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperpa... more Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperparathyroidism. Primary hyperparathyroidism is caused by parathyroid adenomas or parathyroid hyperplasia while chronic renal failure is a common cause of secondary hyperparathyroidism. Elevated parathyroid hormone levels cause increased osteoclastic activity, bone resorption and reactive fibroblastic proliferation leading to the formation of Brown tumor. Although Brown tumors are more commonly seen in the maxilla and mandible, it can occur in the long, flat bones or any bone. It is less commonly seen in the spine. In this report, we discuss the presentation, management, difficulties with histopathological diagnosis, and follow-up of a Brown tumor in a 55-year-old gentleman undergoing renal dialysis who presented with thoracic compressive myelopathy. Our patient underwent a T4 laminectomy, tumor debulking, and T2–T6 instrumented posterior fusion. Based on histopathological examination of the tissue specimen and raised serum parathyroid hormone levels, we arrived at a diagnosis of Brown tumor. Our review of the literature revealed 62 cases of vertebral Brown tumor resulting in neurologic symptoms. The lesion was more common in females (58%), those aged between 40 and 49 years (26%), and in the thoracic spine (51.6%). Early surgical intervention and management of the underlying cause of hyperparathyroidism lead to sustained symptomatic improvement. Brown tumor should be considered in the differential diagnosis of expansile vertebral lesions in the presence of hyperparathyroidism or chronic kidney disease. Treatment of the underlying hyperparathyroidism and decompression of the neural structures with or without stabilization is recommended.
The International Journal of Spine Surgery, Dec 1, 2021
Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a sele... more Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of an SNRB in the management of lumbar disc herniation with radiculopathy because there is limited evidence regarding this issue in the published literature. Methods: This prospective study included 50 patients who underwent an SNRB and were followed for 3 months. Numerical Rating Scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and Depression Anxiety Stress Scales-21 (DASS-21) scores were collected. At the final follow-up at 3 months, the number of patients who underwent surgery was ascertained. Results: Forty-two of 50 (84%) patients avoided the surgery with a reduction in mean preinjection NRS for back and leg pain from 7.5 (SD 1.33) and 7.7 (SD 1.35) to 3.1 (SD 1.69) and 2.3 (SD 1.14) (P < 0.001), respectively, within the 30 minutes after injection. The pain relief was sustained until the last follow-up. The ODI score also decreased from a mean preinjection level of 59.4 (SD 14.69) to 26.3 (SD 9.43) (P < 0.001) at 3 months. The mean preinjection depression score was higher in patients who had recurrence of pain and eventually underwent surgery. Conclusion: Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients. Clinical Relevance: SNRB should be administered early in the course of management of lumbar radiculopathy and should not be delayed until after other non-surgical modalities have failed.
We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an earl... more This study aims at ascertaining the prevalence of sacroiliitis, which is considered to be an early imaging sign of inflammatory SpA, among chronic low backache patients in an Indian population. Materials a n d Methods A total of 200 consecutive MRI scans of the LS spine done at our center were analyzed by two radiologists and a fellow in spine surgery to ascertain the presence of sacroiliitis. All patients between the ages of 15-45 years who presented with chronic low backache and underwent an MRI scan at our center were included. Those
Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a sele... more Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of an SNRB in the management of lumbar disc herniation with radiculopathy because there is limited evidence regarding this issue in the published literature. Methods: This prospective study included 50 patients who underwent an SNRB and were followed for 3 months. Numerical Rating Scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and Depression Anxiety Stress Scales-21 (DASS-21) scores were collected. At the final follow-up at 3 months, the number of patients who underwent surgery was ascertained. Results: Forty-two of 50 (84%) patients avoided the surgery with a reduction in mean preinjection NRS for back and leg pain from 7.5 (SD 1.33) and 7.7 (SD 1.35) to 3.1 (SD 1.69) and 2.3 (SD 1.14) (P < 0.001), respectively, within the 30 minutes after injection. The pain relief was sustained until the last follow-up. The ODI score also decreased from a mean preinjection level of 59.4 (SD 14.69) to 26.3 (SD 9.43) (P < 0.001) at 3 months. The mean preinjection depression score was higher in patients who had recurrence of pain and eventually underwent surgery. Conclusion: Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients. Clinical Relevance: SNRB should be administered early in the course of management of lumbar radiculopathy and should not be delayed until after other non-surgical modalities have failed.
Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esoph... more Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course ...
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Papers by Thomas Kishen