Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. M... more Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. Most of the culprit drugs are used for sedation or in general anesthesia. Proper understanding of the causative factors and pathophysiology is of utmost importance for adequate treatment. There have been conflicting evidences in the numerous studies and theories proposed regarding pathophysiology. We scoped the available literature to find out the cause of digital ischemia in one of the patients presented to us but could not find a convincing answer. Due to incomplete understanding of the pathophysiology, there is no specific treatment protocol. Most important is vigilance regarding risk factors, knowledge of typical medications, immediate recognition of the situation, assessment of the disease progression, anticoagulation, symptomatic treatment, and specific therapy (which varies from case to case) are mainstay of treatment. Further research is warranted to understand the etiopathogenesis so that proper treatment protocol could be established.
Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary,... more Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary, sclerosing bone lesion affecting the adjacent soft tissues. Long bones are commonly involved. About 50% of the cases are evident before 20 years of age. It is gradually progressive and involves the adjacent soft tissues resulting in pain, fibrosis, joint contractures, and limb length discrepancies. Various forms of clinical presentation such as hemimelic, monomelic, mono-ostotic, and polyostotic have been described in the literature. Similarly there are different radiological varients like classical, osteoma , osteopathic striatae , and myositis ossificans.. Treatment is mainly palliative. Case report: We describe a highly unusual and extensive involvement of the lower limb in a Melorheostotic patient of 35 years of age with a deformity and limb length discrepancy. X-rays are like that of myositis ossificans and mixed type of pattern with extensive involvement from the pelvis to the toe. There is also intra-articular extension of melorheostosis mimicking synovial chondromatosis. The patient is in our close follow-up and physiotherapy guidance. Such an extensive involvement, along with para-articular and intra-articular involvement, is very rare. Conclusion: Melorheostosis can extensively involve the whole of the limb right from the pelvis to the digits. It can also extend into the joints producing intra-articular loose bodies. Para-articular soft-tissue masses are also common. Radiologically, it can have a mixture of patterns described in the literature. Close follow-up of the patient is essential so as to provide palliative treatment, deal with the deformities, and to assess the progression of the diseases.
During the last 20 years, there have been remarkable advances in the field of spine surgery. Ultr... more During the last 20 years, there have been remarkable advances in the field of spine surgery. Ultrasonic bone scalpel is one of the most impactful advances. It is a unique surgical device which offers a controlled osteotomy which slices the hard bone while the soft tissues remain largely unaffected. The major benefits of using this modern instrument are the soft tissue sparing, controlled cutting, reduced bleeding, and thereby increasing the effectiveness. There are widespread studies in the literature propagating its use in various surgeries like thoracoplasties, osteotomies, vertebral column resections, laminectomies, corpectomies, laminotomy, facetectomy and scoliotic surgeries. It is one of the precise and finest instruments available for bone cutting which can be of great value while working near the vicinity of spinal cord, dura and nerve roots. Although not 100%, it can significantly minimise the risk of ripping the tissues as compared with osteotomes, Kerrison and the high-speed rotating burrs. It also has a distinct advantage of minimizing the thermal damage due to its attached irrigation component. Various studies have proven its efficiency in decreasing the operating time, increased fusion rates and decreasing the blood loss. Although it is a relatively easy technique to master on, a very basic training is required initially. So, we can safely say that ultrasonic bone scalpel is indispensable in the armamentarium of today's spine surgeon where minimally invasive surgeries are swiping in.
Journal of Postgraduate Medicine, Education and Research, 2020
Introduction: Despite the documented pros and cons of reaming, the reamed intramedullary interloc... more Introduction: Despite the documented pros and cons of reaming, the reamed intramedullary interlocking nail (IMILN) for closed shaft of femur fractures in adults is a worldwide standard procedure. Reaming requires a careful technique and instrumentation, despite that complications related to hardware, like breakage or incarceration, can occur. We present a peculiar case of uncoiling of the flexible reamer during closed nailing for a femoral shaft fracture in a 21-year-old male, discuss the causative factors, and highlight the precautions necessary to avoid it. Such an incident has only been reported once previously and ours is the second case ever to be reported. Case description: A 21-year-old male presented to the advanced trauma center of our institute with closed fracture of the left femur. He was posted for a reamed femoral interlocking nail, wherein, during the reaming procedure with the reamer size 9.5, it got stuck and uncoiled over the beaded guidewire. The reamer was extracted with back hammering and thereon the surgery went on smoothly. The patient did well postoperatively and had union at 4 months. Conclusion: Uncoiling of a flexible reamer is a rare complication of femoral intramedullary nailing. Sequential reaming, moderate force, and appropriate instrumentation are of paramount importance. Careful consideration must be given before using the same reamer for multiple surgeries.
References 1. Palesch YY. Some common misperceptions about P values. Stroke 2014;45:e244–6. 2. Hu... more References 1. Palesch YY. Some common misperceptions about P values. Stroke 2014;45:e244–6. 2. Huang WC, Tan EC, Chang CC, et al. Effect of tracheal intubation mode on cuff pressure during retractor splay and dysphonia recovery after anterior cervical spine surgery: a randomized clinical trial. Spine (Phila Pa 1976) 2020;45:565–72. 3. Danto J, DiCapua J, Nardi D, et al. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy. J Neurosurg Anesthesiol 2012;24:350–5. 4. Li HZ, Lin Z, Li ZZ, et al. Relationship between surgeon volume and outcomes in spine surgery: a dose-response meta-analysis. Ann Transl Med 2018;6:441. 5. Sperry RJ, Johnson JO, Apfelbaum RI. Endotracheal tube cuff pressure increases significantly during anterior cervical fusion with the Caspar instrumentation system. Anesth Analg 1993;76:1318– 21. 6. Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine (Phila Pa 1976) 2000;25:2906–12. 7. Fassett DR, Apfelbaum RI. Vocal cord paralysis after anterior cervical spine surgery. In: An HS, Jenis LG, editors. Complications of Spine Surgery: Treatment and Prevention., 1st ed Philadelphia: Lippincott Williams & Wilkins; 2006; 23-30. 8. Jaensson M, Olowsson LL, Nilsson U. Endotracheal tube size and sore throat following surgery: a randomized-controlled study. Acta Anaesthesiol Scand 2010;54:147–53. 9. Tan TP, Govindarajulu AP, Massicotte EM, et al. Vocal cord palsy after anterior cervical spine surgery: a qualitative systematic review. Spine J 2014;14:1332–4.
Journal of orthopaedic diseases and traumatology, 2021
The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are ... more The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are numerous studies in the literature advocating its use where bone cutting in the form of laminectomy, laminotomy, foraminotomy, or vertebral body resection is required. Its principal advantage is the relative sparing of the soft tissues. The literature mentioning the complications and technical difficulties of UBS use is scarce and scanty. We report a unique complication encountered during its use and discuss some of the technical difficulties which need to be addressed with the aim and intent to caution the surgeons regarding its proper use. While performing laminectomy we encountered a unique complication of breakage of the blade of UBS. Although well-known for greater accuracy, reduced bleeding, reduced operative time, and en bloc removal of the bone as compared to traditional bone cutting devices even then it has to be used with great caution, and there is a learning curve of the technique which needs to be mastered.
Introduction: Ozone therapy is one of the evolving, yet far from conclusive, alternative minimall... more Introduction: Ozone therapy is one of the evolving, yet far from conclusive, alternative minimally invasive treatment option in the management of herniated disc in the cervical and lumbar spine. It causes the decrease in the volume of herniated disc by dehydration. Case Report: We hereby present the first reported case of Mycobacterium infection of the spine secondary to ozone therapy with the aim to caution the surgeons regarding the complications of intradiscal ozone therapy. Conclusion: Lack of proper, adequate, and recommended precautions if not taken can inoculate the varied microorganisms into the intradiscal space leading to devastating and unforeseen complications. Keywords: tuberculosis, ozone therapy, infection.
Background: The epidemiology of cervical spine injuries in trauma patients of Northern India is l... more Background: The epidemiology of cervical spine injuries in trauma patients of Northern India is largely unknown. Study Design: Retrospective study. Objectives: To find out the epidemiology and demographic factors associated with patients of traumatic cervical spinal injury presented to a level 1 trauma center. Patients and Methods: The study sample includes patients with cervical spine injury admitted to our level one trauma centre from the period of July 2018 to June 2019. Those patients who succumbed to their injuries due to various reasons before imaging or brought dead having suspected cervical spine injury were excluded from the study. Results: During the study period, 83 patients having cervical spine injury were admitted and treated. Out of 83, 75.9% (63) were male and the remaining 24.1% (20) were female. The most common mode of injury was fall from height (66.3%) followed by road traffic accidents (24%). About 64% of the patient population belonged to rural areas. The most affected age group in this study was 20–39 years. The most common associated injury is Extremities fracture (9.6%) followed by head injury (8.4%). C5C6 was the most common level and 69.9% underwent surgery. Pressure sore was presented in 12% of cases. Conclusion: The epidemiology of cervical spine injury in Northern India is different from developed countries. In the present study, the most common cause of cervical spine injury was fall from height followed by motor vehicle accidents. Proper awareness program, educating people, national policymaking, and involvement of NGOs and training primary health care workers will help in reducing the incidence of cervical spine injuries in this region
The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are ... more The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are numerous studies in the literature advocating its use where bone cutting in the form of laminectomy, laminotomy, foraminotomy, or vertebral body resection is required. Its principal advantage is the relative sparing of the soft tissues. The literature mentioning the complications and technical difficulties of UBS use is scarce and scanty. We report a unique complication encountered during its use and discuss some of the technical difficulties which need to be addressed with the aim and intent to caution the surgeons regarding its proper use. While performing laminectomy we encountered a unique complication of breakage of the blade of UBS. Although well-known for greater accuracy, reduced bleeding, reduced operative time, and en bloc removal of the bone as compared to traditional bone cutting devices even then it has to be used with great caution, and there is a learning curve of the technique which needs to be mastered.
Objective: This study aimed to predict the absolute criteria for surgical intervention and study ... more Objective: This study aimed to predict the absolute criteria for surgical intervention and study the outcome of surgical intervention. Materials and Methods: A prospective study was conducted from June 2002 to July 2003. A total of 35 patients were included in the study. Pre- and postoperative Oswestry Disability Index (ODI) scores were evaluated for all the patients. All patients underwent magnetic resonance imaging (MRI). The surgical indications were disabling backache with radicular pain, limited walking capacity, and neurological deficits leading to a poor ODI score. Surgical procedures done were discectomy and laminectomy with or without fixation with pedicle screws on a case-to-case basis. Follow-up was done for up to 1 year at three-monthly intervals. The final ODI score was taken at the last follow-up and was compared with preoperative scores. Results: A 50 ± 10 years was the average age of patients included in the study. The average walking capacity was 40 m; the average duration of symptoms was 41 months. ODI improved from average score of 71% ± 4% preoperatively to 22% ± 6% postoperatively. L4–L5 was the level most severely narrowed, with a mean cross-sectional area of 75 mm2. The most common surgical interventions done were discectomy and laminectomy, which were performed in 54% of the cases. We had good-to-excellent results in all our cases. None of the cases deteriorated after surgery. Conclusion: The findings in this study have important implications in clinical practice. The radiological findings in the MRI correlated well with the clinical signs and symptoms of the patients, i.e., patients with significant findings in the MRI had profound clinical symptoms and neurological deficits. Clinical Significance: Lumbar canal stenosis is a clinicoradiological diagnosis. ODI score is related to canal narrowing on MRI. Clinical improvement is related to preoperative disability and canal narrowing on MRI.
Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. M... more Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. Most of the culprit drugs are used for sedation or in general anesthesia. Proper understanding of the causative factors and pathophysiology is of utmost importance for adequate treatment. There have been conflicting evidences in the numerous studies and theories proposed regarding pathophysiology. We scoped the available literature to find out the cause of digital ischemia in one of the patients presented to us but could not find a convincing answer. Due to incomplete understanding of the pathophysiology, there is no specific treatment protocol. Most important is vigilance regarding risk factors, knowledge of typical medications, immediate recognition of the situation, assessment of the disease progression, anticoagulation, symptomatic treatment, and specific therapy (which varies from case to case) are mainstay of treatment. Further research is warranted to understand the etiopathogenesi...
Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary,... more Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary, sclerosing bone lesion affecting the adjacent soft tissues. Long bones are commonly involved. About 50% of the cases are evident before 20 years of age. It is gradually progressive and involves the adjacent soft tissues resulting in pain, fibrosis, joint contractures, and limb length discrepancies. Various forms of clinical presentation such as hemimelic, monomelic, mono-ostotic, and polyostotic have been described in the literature. Similarly there are different radiological varients like classical, osteoma , osteopathic striatae , and myositis ossificans.. Treatment is mainly palliative. Case Report: We describe a highly unusual and extensive involvement of the lower limb in a Melorheostotic patient of 35 years of age with a deformity and limb length discrepancy. X-rays are like that of myositis ossificans and mixed type of pattern with extensive involvement from the pelvis to the toe...
performed in this study needs to be clarified by the authors. As described in the Method section,... more performed in this study needs to be clarified by the authors. As described in the Method section, complication rates were compared using odds ratios with the priori alpha value set at 0.05 for significance. The odds ratio is a measure of the effect size, thus describing the strength of the association or non-independence between two binary data values. It is used as a descriptive statistic; therefore, it is not able to compare the statistical significance directly. Furthermore, the chi-square test or Fisher exact test should be used when comparing the complication rates between two groups. We believe that addressing this question will strengthen this study and be more useful to readers.
Journal of Orthopaedic Diseases and Traumatology, 2020
The prime cause of low backache with radiculopathy is prolapsed intervertebral disc, but in condi... more The prime cause of low backache with radiculopathy is prolapsed intervertebral disc, but in conditions where the radiology and scans of the lumbosacral spine are insignificant and the symptoms are progressive, it can be a tumor involving the sciatic nerve. Here, we present a case of a 26-year-old female managed conservatively for her low backache with radiculopathy which ultimately turned out to be an undifferentiated malignant nerve sheath tumor of the sciatic nerve. It is one of the largest nerve sheath tumors reported in the literature. Combined transabdominal and Kocher–Langenbeck approaches were used to resect the tumor. Histopathology confirmed the diagnosis of the undifferentiated malignant nerve sheath tumor. Through this case report, we emphasize to screen the pelvis early if symptoms of sciatica are progressive along with insignificant scans of the spine.
Journal of Orthopaedic Diseases and Traumatology, 2020
Failed Back surgery syndrome or persistent low back pain following lumbar surgery is a known comp... more Failed Back surgery syndrome or persistent low back pain following lumbar surgery is a known complication of lumbosacral spine surgery. The incidence of FBSS ranges from 5% to 10% postlumbosacral surgery. It is characterized by disabling pain resistant to usual analgesic and physiotherapy. Epidural fibrosis is found to be the most common cause of FBSS. Various treatment modalities such as spinal canal stimulation, epidural corticosteroids injection, Non steriodal antiinflammatory drugs, opioids, and repeat surgery have been tried for the management of FBSS, but none of them have shown a promising result. The second surgery in such patients has a poor success rate of only 30%–35%. 15%–20% patients even reported worsening of symptoms after a second surgery. Gabapentin which is an analog of gamma-aminobutyric acid has shown good results in few studies in reducing pain in patients with failed back surgery syndrome FBSS. Few case reports and randomized control trials published in recent past has shown good efficacy of gabapentin in reducing low back pain as well as leg pain associated with failed back surgery syndrome FBSS. To conclude, gabapentin can be tried in a patient with FBSS, but its efficacy needs to be established with a large multicentric study.
We came across the article entitled "All Patients Should Be Screened for Diabetes Before Total Jo... more We came across the article entitled "All Patients Should Be Screened for Diabetes Before Total Joint Arthroplasty" by Shohat Noam et al [1] in your journal in the July 2018 issue. The purpose of the study was to assess the role of diabetic screening in all patients undergoing total joint arthroplasty. The authors performed a preadmission testing of HbA1c levels and fasting blood glucose (FBG) levels in patients undergoing elective total hip and knee arthroplasty 1-3 weeks before surgery, with 4-6 weeks of followup of prosthetic joint infection and wound complications. We will like to seek response from the authors regarding a few points. The total prevalence of diabetes in this study was 20.7%, which is double to that given in literature [2,3]. The authors excluded the cases with HbA1c > 8. In the study period, how many cases did the authors exclude was unknown, which will decrease the total prevalence of diabetic patients in a group of known diabetics. Prediabetic patients were classified as having HbA1c levels of 5.7%-6.4% or FBG levels of 100 mg/dL-125 mg/dL. The authors did not comment on the outcome of the prediabetic group. Was there any case of infection or systemic complications or did they have postoperative fluctuation of fasting blood sugar levels. Finally, patients with HbA1c <6.4% but with FBG 126 mg/dL or higher were included in the group of undiagnosed diabetes. Should we consider only fasting blood sugar levels for labeling a patient with undiagnosed diabetes? Were the values of FBG found to be repeatedly high before surgery in these patients? In conclusion, we would like to congratulate the authors for this article. We would like to have response regarding patients with HbA1c > 8 and the prediabetic group.
Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. M... more Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. Most of the culprit drugs are used for sedation or in general anesthesia. Proper understanding of the causative factors and pathophysiology is of utmost importance for adequate treatment. There have been conflicting evidences in the numerous studies and theories proposed regarding pathophysiology. We scoped the available literature to find out the cause of digital ischemia in one of the patients presented to us but could not find a convincing answer. Due to incomplete understanding of the pathophysiology, there is no specific treatment protocol. Most important is vigilance regarding risk factors, knowledge of typical medications, immediate recognition of the situation, assessment of the disease progression, anticoagulation, symptomatic treatment, and specific therapy (which varies from case to case) are mainstay of treatment. Further research is warranted to understand the etiopathogenesis so that proper treatment protocol could be established.
Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary,... more Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary, sclerosing bone lesion affecting the adjacent soft tissues. Long bones are commonly involved. About 50% of the cases are evident before 20 years of age. It is gradually progressive and involves the adjacent soft tissues resulting in pain, fibrosis, joint contractures, and limb length discrepancies. Various forms of clinical presentation such as hemimelic, monomelic, mono-ostotic, and polyostotic have been described in the literature. Similarly there are different radiological varients like classical, osteoma , osteopathic striatae , and myositis ossificans.. Treatment is mainly palliative. Case report: We describe a highly unusual and extensive involvement of the lower limb in a Melorheostotic patient of 35 years of age with a deformity and limb length discrepancy. X-rays are like that of myositis ossificans and mixed type of pattern with extensive involvement from the pelvis to the toe. There is also intra-articular extension of melorheostosis mimicking synovial chondromatosis. The patient is in our close follow-up and physiotherapy guidance. Such an extensive involvement, along with para-articular and intra-articular involvement, is very rare. Conclusion: Melorheostosis can extensively involve the whole of the limb right from the pelvis to the digits. It can also extend into the joints producing intra-articular loose bodies. Para-articular soft-tissue masses are also common. Radiologically, it can have a mixture of patterns described in the literature. Close follow-up of the patient is essential so as to provide palliative treatment, deal with the deformities, and to assess the progression of the diseases.
During the last 20 years, there have been remarkable advances in the field of spine surgery. Ultr... more During the last 20 years, there have been remarkable advances in the field of spine surgery. Ultrasonic bone scalpel is one of the most impactful advances. It is a unique surgical device which offers a controlled osteotomy which slices the hard bone while the soft tissues remain largely unaffected. The major benefits of using this modern instrument are the soft tissue sparing, controlled cutting, reduced bleeding, and thereby increasing the effectiveness. There are widespread studies in the literature propagating its use in various surgeries like thoracoplasties, osteotomies, vertebral column resections, laminectomies, corpectomies, laminotomy, facetectomy and scoliotic surgeries. It is one of the precise and finest instruments available for bone cutting which can be of great value while working near the vicinity of spinal cord, dura and nerve roots. Although not 100%, it can significantly minimise the risk of ripping the tissues as compared with osteotomes, Kerrison and the high-speed rotating burrs. It also has a distinct advantage of minimizing the thermal damage due to its attached irrigation component. Various studies have proven its efficiency in decreasing the operating time, increased fusion rates and decreasing the blood loss. Although it is a relatively easy technique to master on, a very basic training is required initially. So, we can safely say that ultrasonic bone scalpel is indispensable in the armamentarium of today's spine surgeon where minimally invasive surgeries are swiping in.
Journal of Postgraduate Medicine, Education and Research, 2020
Introduction: Despite the documented pros and cons of reaming, the reamed intramedullary interloc... more Introduction: Despite the documented pros and cons of reaming, the reamed intramedullary interlocking nail (IMILN) for closed shaft of femur fractures in adults is a worldwide standard procedure. Reaming requires a careful technique and instrumentation, despite that complications related to hardware, like breakage or incarceration, can occur. We present a peculiar case of uncoiling of the flexible reamer during closed nailing for a femoral shaft fracture in a 21-year-old male, discuss the causative factors, and highlight the precautions necessary to avoid it. Such an incident has only been reported once previously and ours is the second case ever to be reported. Case description: A 21-year-old male presented to the advanced trauma center of our institute with closed fracture of the left femur. He was posted for a reamed femoral interlocking nail, wherein, during the reaming procedure with the reamer size 9.5, it got stuck and uncoiled over the beaded guidewire. The reamer was extracted with back hammering and thereon the surgery went on smoothly. The patient did well postoperatively and had union at 4 months. Conclusion: Uncoiling of a flexible reamer is a rare complication of femoral intramedullary nailing. Sequential reaming, moderate force, and appropriate instrumentation are of paramount importance. Careful consideration must be given before using the same reamer for multiple surgeries.
References 1. Palesch YY. Some common misperceptions about P values. Stroke 2014;45:e244–6. 2. Hu... more References 1. Palesch YY. Some common misperceptions about P values. Stroke 2014;45:e244–6. 2. Huang WC, Tan EC, Chang CC, et al. Effect of tracheal intubation mode on cuff pressure during retractor splay and dysphonia recovery after anterior cervical spine surgery: a randomized clinical trial. Spine (Phila Pa 1976) 2020;45:565–72. 3. Danto J, DiCapua J, Nardi D, et al. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy. J Neurosurg Anesthesiol 2012;24:350–5. 4. Li HZ, Lin Z, Li ZZ, et al. Relationship between surgeon volume and outcomes in spine surgery: a dose-response meta-analysis. Ann Transl Med 2018;6:441. 5. Sperry RJ, Johnson JO, Apfelbaum RI. Endotracheal tube cuff pressure increases significantly during anterior cervical fusion with the Caspar instrumentation system. Anesth Analg 1993;76:1318– 21. 6. Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine (Phila Pa 1976) 2000;25:2906–12. 7. Fassett DR, Apfelbaum RI. Vocal cord paralysis after anterior cervical spine surgery. In: An HS, Jenis LG, editors. Complications of Spine Surgery: Treatment and Prevention., 1st ed Philadelphia: Lippincott Williams & Wilkins; 2006; 23-30. 8. Jaensson M, Olowsson LL, Nilsson U. Endotracheal tube size and sore throat following surgery: a randomized-controlled study. Acta Anaesthesiol Scand 2010;54:147–53. 9. Tan TP, Govindarajulu AP, Massicotte EM, et al. Vocal cord palsy after anterior cervical spine surgery: a qualitative systematic review. Spine J 2014;14:1332–4.
Journal of orthopaedic diseases and traumatology, 2021
The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are ... more The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are numerous studies in the literature advocating its use where bone cutting in the form of laminectomy, laminotomy, foraminotomy, or vertebral body resection is required. Its principal advantage is the relative sparing of the soft tissues. The literature mentioning the complications and technical difficulties of UBS use is scarce and scanty. We report a unique complication encountered during its use and discuss some of the technical difficulties which need to be addressed with the aim and intent to caution the surgeons regarding its proper use. While performing laminectomy we encountered a unique complication of breakage of the blade of UBS. Although well-known for greater accuracy, reduced bleeding, reduced operative time, and en bloc removal of the bone as compared to traditional bone cutting devices even then it has to be used with great caution, and there is a learning curve of the technique which needs to be mastered.
Introduction: Ozone therapy is one of the evolving, yet far from conclusive, alternative minimall... more Introduction: Ozone therapy is one of the evolving, yet far from conclusive, alternative minimally invasive treatment option in the management of herniated disc in the cervical and lumbar spine. It causes the decrease in the volume of herniated disc by dehydration. Case Report: We hereby present the first reported case of Mycobacterium infection of the spine secondary to ozone therapy with the aim to caution the surgeons regarding the complications of intradiscal ozone therapy. Conclusion: Lack of proper, adequate, and recommended precautions if not taken can inoculate the varied microorganisms into the intradiscal space leading to devastating and unforeseen complications. Keywords: tuberculosis, ozone therapy, infection.
Background: The epidemiology of cervical spine injuries in trauma patients of Northern India is l... more Background: The epidemiology of cervical spine injuries in trauma patients of Northern India is largely unknown. Study Design: Retrospective study. Objectives: To find out the epidemiology and demographic factors associated with patients of traumatic cervical spinal injury presented to a level 1 trauma center. Patients and Methods: The study sample includes patients with cervical spine injury admitted to our level one trauma centre from the period of July 2018 to June 2019. Those patients who succumbed to their injuries due to various reasons before imaging or brought dead having suspected cervical spine injury were excluded from the study. Results: During the study period, 83 patients having cervical spine injury were admitted and treated. Out of 83, 75.9% (63) were male and the remaining 24.1% (20) were female. The most common mode of injury was fall from height (66.3%) followed by road traffic accidents (24%). About 64% of the patient population belonged to rural areas. The most affected age group in this study was 20–39 years. The most common associated injury is Extremities fracture (9.6%) followed by head injury (8.4%). C5C6 was the most common level and 69.9% underwent surgery. Pressure sore was presented in 12% of cases. Conclusion: The epidemiology of cervical spine injury in Northern India is different from developed countries. In the present study, the most common cause of cervical spine injury was fall from height followed by motor vehicle accidents. Proper awareness program, educating people, national policymaking, and involvement of NGOs and training primary health care workers will help in reducing the incidence of cervical spine injuries in this region
The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are ... more The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are numerous studies in the literature advocating its use where bone cutting in the form of laminectomy, laminotomy, foraminotomy, or vertebral body resection is required. Its principal advantage is the relative sparing of the soft tissues. The literature mentioning the complications and technical difficulties of UBS use is scarce and scanty. We report a unique complication encountered during its use and discuss some of the technical difficulties which need to be addressed with the aim and intent to caution the surgeons regarding its proper use. While performing laminectomy we encountered a unique complication of breakage of the blade of UBS. Although well-known for greater accuracy, reduced bleeding, reduced operative time, and en bloc removal of the bone as compared to traditional bone cutting devices even then it has to be used with great caution, and there is a learning curve of the technique which needs to be mastered.
Objective: This study aimed to predict the absolute criteria for surgical intervention and study ... more Objective: This study aimed to predict the absolute criteria for surgical intervention and study the outcome of surgical intervention. Materials and Methods: A prospective study was conducted from June 2002 to July 2003. A total of 35 patients were included in the study. Pre- and postoperative Oswestry Disability Index (ODI) scores were evaluated for all the patients. All patients underwent magnetic resonance imaging (MRI). The surgical indications were disabling backache with radicular pain, limited walking capacity, and neurological deficits leading to a poor ODI score. Surgical procedures done were discectomy and laminectomy with or without fixation with pedicle screws on a case-to-case basis. Follow-up was done for up to 1 year at three-monthly intervals. The final ODI score was taken at the last follow-up and was compared with preoperative scores. Results: A 50 ± 10 years was the average age of patients included in the study. The average walking capacity was 40 m; the average duration of symptoms was 41 months. ODI improved from average score of 71% ± 4% preoperatively to 22% ± 6% postoperatively. L4–L5 was the level most severely narrowed, with a mean cross-sectional area of 75 mm2. The most common surgical interventions done were discectomy and laminectomy, which were performed in 54% of the cases. We had good-to-excellent results in all our cases. None of the cases deteriorated after surgery. Conclusion: The findings in this study have important implications in clinical practice. The radiological findings in the MRI correlated well with the clinical signs and symptoms of the patients, i.e., patients with significant findings in the MRI had profound clinical symptoms and neurological deficits. Clinical Significance: Lumbar canal stenosis is a clinicoradiological diagnosis. ODI score is related to canal narrowing on MRI. Clinical improvement is related to preoperative disability and canal narrowing on MRI.
Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. M... more Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. Most of the culprit drugs are used for sedation or in general anesthesia. Proper understanding of the causative factors and pathophysiology is of utmost importance for adequate treatment. There have been conflicting evidences in the numerous studies and theories proposed regarding pathophysiology. We scoped the available literature to find out the cause of digital ischemia in one of the patients presented to us but could not find a convincing answer. Due to incomplete understanding of the pathophysiology, there is no specific treatment protocol. Most important is vigilance regarding risk factors, knowledge of typical medications, immediate recognition of the situation, assessment of the disease progression, anticoagulation, symptomatic treatment, and specific therapy (which varies from case to case) are mainstay of treatment. Further research is warranted to understand the etiopathogenesi...
Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary,... more Introduction: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary, sclerosing bone lesion affecting the adjacent soft tissues. Long bones are commonly involved. About 50% of the cases are evident before 20 years of age. It is gradually progressive and involves the adjacent soft tissues resulting in pain, fibrosis, joint contractures, and limb length discrepancies. Various forms of clinical presentation such as hemimelic, monomelic, mono-ostotic, and polyostotic have been described in the literature. Similarly there are different radiological varients like classical, osteoma , osteopathic striatae , and myositis ossificans.. Treatment is mainly palliative. Case Report: We describe a highly unusual and extensive involvement of the lower limb in a Melorheostotic patient of 35 years of age with a deformity and limb length discrepancy. X-rays are like that of myositis ossificans and mixed type of pattern with extensive involvement from the pelvis to the toe...
performed in this study needs to be clarified by the authors. As described in the Method section,... more performed in this study needs to be clarified by the authors. As described in the Method section, complication rates were compared using odds ratios with the priori alpha value set at 0.05 for significance. The odds ratio is a measure of the effect size, thus describing the strength of the association or non-independence between two binary data values. It is used as a descriptive statistic; therefore, it is not able to compare the statistical significance directly. Furthermore, the chi-square test or Fisher exact test should be used when comparing the complication rates between two groups. We believe that addressing this question will strengthen this study and be more useful to readers.
Journal of Orthopaedic Diseases and Traumatology, 2020
The prime cause of low backache with radiculopathy is prolapsed intervertebral disc, but in condi... more The prime cause of low backache with radiculopathy is prolapsed intervertebral disc, but in conditions where the radiology and scans of the lumbosacral spine are insignificant and the symptoms are progressive, it can be a tumor involving the sciatic nerve. Here, we present a case of a 26-year-old female managed conservatively for her low backache with radiculopathy which ultimately turned out to be an undifferentiated malignant nerve sheath tumor of the sciatic nerve. It is one of the largest nerve sheath tumors reported in the literature. Combined transabdominal and Kocher–Langenbeck approaches were used to resect the tumor. Histopathology confirmed the diagnosis of the undifferentiated malignant nerve sheath tumor. Through this case report, we emphasize to screen the pelvis early if symptoms of sciatica are progressive along with insignificant scans of the spine.
Journal of Orthopaedic Diseases and Traumatology, 2020
Failed Back surgery syndrome or persistent low back pain following lumbar surgery is a known comp... more Failed Back surgery syndrome or persistent low back pain following lumbar surgery is a known complication of lumbosacral spine surgery. The incidence of FBSS ranges from 5% to 10% postlumbosacral surgery. It is characterized by disabling pain resistant to usual analgesic and physiotherapy. Epidural fibrosis is found to be the most common cause of FBSS. Various treatment modalities such as spinal canal stimulation, epidural corticosteroids injection, Non steriodal antiinflammatory drugs, opioids, and repeat surgery have been tried for the management of FBSS, but none of them have shown a promising result. The second surgery in such patients has a poor success rate of only 30%–35%. 15%–20% patients even reported worsening of symptoms after a second surgery. Gabapentin which is an analog of gamma-aminobutyric acid has shown good results in few studies in reducing pain in patients with failed back surgery syndrome FBSS. Few case reports and randomized control trials published in recent past has shown good efficacy of gabapentin in reducing low back pain as well as leg pain associated with failed back surgery syndrome FBSS. To conclude, gabapentin can be tried in a patient with FBSS, but its efficacy needs to be established with a large multicentric study.
We came across the article entitled "All Patients Should Be Screened for Diabetes Before Total Jo... more We came across the article entitled "All Patients Should Be Screened for Diabetes Before Total Joint Arthroplasty" by Shohat Noam et al [1] in your journal in the July 2018 issue. The purpose of the study was to assess the role of diabetic screening in all patients undergoing total joint arthroplasty. The authors performed a preadmission testing of HbA1c levels and fasting blood glucose (FBG) levels in patients undergoing elective total hip and knee arthroplasty 1-3 weeks before surgery, with 4-6 weeks of followup of prosthetic joint infection and wound complications. We will like to seek response from the authors regarding a few points. The total prevalence of diabetes in this study was 20.7%, which is double to that given in literature [2,3]. The authors excluded the cases with HbA1c > 8. In the study period, how many cases did the authors exclude was unknown, which will decrease the total prevalence of diabetic patients in a group of known diabetics. Prediabetic patients were classified as having HbA1c levels of 5.7%-6.4% or FBG levels of 100 mg/dL-125 mg/dL. The authors did not comment on the outcome of the prediabetic group. Was there any case of infection or systemic complications or did they have postoperative fluctuation of fasting blood sugar levels. Finally, patients with HbA1c <6.4% but with FBG 126 mg/dL or higher were included in the group of undiagnosed diabetes. Should we consider only fasting blood sugar levels for labeling a patient with undiagnosed diabetes? Were the values of FBG found to be repeatedly high before surgery in these patients? In conclusion, we would like to congratulate the authors for this article. We would like to have response regarding patients with HbA1c > 8 and the prediabetic group.
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