1.Traumatic Cervical Spondyloptosis of the Subaxial Cervical Spine: A Case Series with a Literature Review and a New Classification.
Jayprakash Vrajlal MODI ; Shardul Madhav SOMAN ; Shaival DALAL
Asian Spine Journal 2016;10(6):1058-1064
STUDY DESIGN: This is a retrospective study on patients with traumatic subaxial cervical spondyloptosis and includes a review of the available literature regarding the management of this injury. PURPOSE: This study aimed to assess the biomechanics and varied clinical presentations of this rare but devastating injury. OVERVIEW OF LITERATURE: This is a case series of three patients and a review of the available literature on subaxial cervical spondyloptosis. Traumatic cervical spondyloptosis of the subaxial spine is rare, with varied clinical presentations. METHODS: The management of cervical subaxial spondyloptosis represents a challenge to all spine care specialists, and there is a paucity of literature on the best methods for managing this condition. Our experience includes three such patients who visited our tertiary trauma center. This article explains the diverse clinical features of the injury as well as the management of these patients and includes a review of the available literature. RESULTS: Subaxial cervical spondyloptosis is a devastating injury with diverse clinical features. We present a classification of these fractures based on clinical presentation and magnetic resonance imaging results, which can help in decision-making regarding the management of such patients. CONCLUSIONS: This article may help physicians assess this injury in an evidence-based manner and also elucidates the management strategies available for such patients.
Classification*
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Decompression
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Humans
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Magnetic Resonance Imaging
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Neurology
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Retrospective Studies
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Specialization
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Spine*
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Trauma Centers
2.Results of Single-Staged Posterior Decompression and Circumferential Fusion Using a Transpedicular Approach to Correct a Kyphotic Deformity due to Thoracolumbar Spinal Tuberculosis.
Shaival DALAL ; Jayprakash MODI ; Shardul SOMAN ; Harshil PATEL ; Shrikant DHANANI
Asian Spine Journal 2016;10(6):1106-1114
STUDY DESIGN: This is a prospective study. PURPOSE: The aim of this study was to investigate the results of single-staged posterior decompression and circumferential fusion using a transpedicular approach to correct a kyphotic deformity due to thoracolumbar spinal tuberculosis. OVERVIEW OF LITERATURE: Surgical management is frequently an imperative choice to achieve spinal decompression and deformity correction due to tuberculosis to relieve pain, improve neurology, and reconstruct the spine stability. Since the time anterior radical debridement and noninstrumented fusion was described, it has become apparent that even anterior debridement and bone grafting was often unsatisfactory in correcting or preventing the progression of kyphosis deformity. With the advent of modern segmental spinal instrumentation systems, isolated posterior instrumentation; combined anterior and posterior fusion; and single-staged posterior decompression and circumferential fusion have been described by many authors for correcting angular deformity and stabilizing the spine; however, there is a lack of consensus regarding the most effective means of correcting the deformity due to thoracolumbar spinal tuberculosis. METHODS: This is a prospective study of 20 patients with thoracolumbar spinal tuberculosis who underwent surgery at our institute. RESULTS: Twenty patients who were started on antituberculosis treatment underwent surgery using a single-staged posterior approach involving fixation, decompression, and kyphosis correction. Preoperatively, all patients had varying degrees of neurological deficit and a 27.45° average kyphotic angle, which improved. At the 1-year follow-up, correction was maintained at 6.9°, and 55% of patients showed neurological improvement. None of the patients experienced neurological deterioration. Two patients with lumbar spine tuberculosis underwent revision surgery because of nonunion. CONCLUSIONS: The procedure of posterior decompression, fixation, and circumferential fusion using a transpedicular approach performed for thoracolumbar spinal tuberculosis is effective, safe, and excellent in correcting and maintaining kyphosis.
Bone Transplantation
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Congenital Abnormalities*
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Consensus
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Debridement
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Decompression*
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Follow-Up Studies
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Humans
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Kyphosis
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Neurology
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Prospective Studies
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Spine
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Tuberculosis
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Tuberculosis, Spinal*