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Morphometric Measurements of Cadaveric Thoracic Spine in Indian Population and Its Clinical Applications.

Roop SINGH ; Sunil Kumar SRIVASTVA ; Chittode Sachudanandam Vishnu PRASATH ; Rajesh Kumar ROHILLA ; Ramchander SIWACH ; Narender Kumar MAGU

Asian Spine Journal.2011;5(1):20-34. doi:10.4184/asj.2011.5.1.20

STUDY DESIGN: Analysis of morphometric data obtained from direct measurements of 100 cadaveric thoracic spines in Indian population. PURPOSE: To collect a base line morphometric data and analyze it in reference to the musculoskeletal anatomy and biomechanics of the spine; implants and instrumentations; and to suggest the requisite modification in spinal surgery instrumentations. OVERVIEW OF LITERATURE: Most of the previous studies in the world literature have focused primarily on the parameters of the pedicle and to the authors' knowledge; no study has been published from the Indian subcontinent reporting a detailed morphometry of the thoracic spine. METHODS: One thousand and two hundred thoracic vertebrae were studied by direct measurements for linear and angular dimensions of the vertebral body, spinal canal, pedicle, and spinous and transverse processes in 100 human cadavers. RESULTS: Thirty-five point five percent of all the pedicles; 71% of T5 pedicles; 54.6% of all the female pedicles; and 94.4% of the T5 pedicles in females were smaller than 5 mm in mid-pedicle width dimension. Transverse pedicle angle was more at all levels and pedicles were sagittaly angulated in cephalad direction in comparison to other studies. Minimum value of interpedicular distance was at T5 (15.48 +/- 1.24). Vertebral body width showed slight decrease from T1 to T4. The transverse process length was relatively constant between T2 to T10. The spinous process angle showed increasing trend from T1 to T6 and then gradually decreased to T12. CONCLUSIONS: Most of the trends in changes of the parameters from T1 to T12 can be explained on the basis of local musculoskeletal anatomy and biomechanical stresses. The smallest diameter screw and shortest available screw for adults may not be safe in majority of the Indian population in mid-thoracic region. The results of the present study can help in designing implants and instrumentations; understanding spine pathologies; and management of spinal disorders in this part of the world.
Adult ; Biomechanics ; Cadaver ; Female ; Humans ; Spinal Canal ; Spine ; Thoracic Vertebrae

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Percutaneous Thoracic Intervertebral Disc Nucleoplasty: Technical Notes from 3 Patients with Painful Thoracic Disc Herniations.

Nicholas H CHUA ; Ismail GULTUNA ; Patricia RIEZEBOS ; Tjemme BEEMS ; Kris C VISSERS

Asian Spine Journal.2011;5(1):15-19. doi:10.4184/asj.2011.5.1.15

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery.
Humans ; Intervertebral Disc ; Intervertebral Disc Displacement

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Diagnostic Accuracy of Clinical Examination in Cervical Spine Injuries in Awake and Alert Blunt Trauma Patients.

Manzar HUSSAIN ; Gohar JAVED

Asian Spine Journal.2011;5(1):10-14. doi:10.4184/asj.2011.5.1.10

STUDY DESIGN: Observational, case series. PURPOSE: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi. OVERVIEW OF LITERATURE: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny. METHODS: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of their trauma workup were included. The X-rays were read by a radiologist not aware of the history of the patients. We recorded demographic data along with mechanism of injury, associated neck signs or symptoms whether present or not, cervical spine range of motion, associated injuries and X-ray findings. The history and examination were carried out by the on-call neurosurgery team member. The sensitivity and specificity along with negative and positive predictive value of the clinical examination were calculated. Data were analyzed using SPSS ver. 16.0. RESULTS: Of 50 patients with positive signs and symptoms, 4 (8%) had positive X-rays while only 1 out of 324 (0.3%) with no associated signs and symptoms had positive X-ray findings. CONCLUSIONS: The clinical examination is 80% sensitive and 73.98% specific in detecting true cervical spine injuries as compared to C-spine X-rays in alert and awake patients with blunt trauma.
Emergencies ; Humans ; Judgment ; Neck ; Neurosurgery ; Range of Motion, Articular ; Sensitivity and Specificity ; Spine

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Revisional Percutaneous Full Endoscopic Disc Surgery for Recurrent Herniation of Previous Open Lumbar Discectomy.

Kyung Hyun SHIN ; Ho Guen CHANG ; Nam Kyou RHEE ; Kwahn Sue LIM

Asian Spine Journal.2011;5(1):1-9. doi:10.4184/asj.2011.5.1.1

STUDY DESIGN: A retrospective study. PURPOSE: To determine the feasibility and effectiveness of revisional percutaneous full endoscopic discectomy for recurrent herniation after conventional open disc surgery. OVERVIEW OF THE LITERATURE: Repeated open discectomy with or without fusion has been the most common procedure for recurrent lumbar disc herniation. Percutaneous endoscopic lumbar discectomy for recurrent herniation has been thought of as an impossible procedure. Despite good results with open revisional surgery, major problems may be caused by injuries to the posterior stabilized structures. Our team did revisional full endoscopic lumbar disc surgery on the basis of our experience doing primary full endoscopic disc surgery. METHODS: Between February 2004 and August 2009 a total of 41 patients in our hospital underwent revisional percutaneous endoscopic lumbar discectomy using a YESS endoscopic system and a micro-osteotome (designed by the authors). Indications for surgery were recurrent disc herniation following conventional open discectomy; with compression of the nerve root revealed by Gadolinium-enhanced magnetic resonance imaging; corresponding radiating pain which was not alleviated after conservative management over 6 weeks. Patients with severe neurologic deficits and isolated back pain were excluded. RESULTS: The mean follow-up period was 16 months (range, 13 to 42 months). The visual analog scale for pain in the leg and back showed significant post-treatment improvement (p < 0.001). Based on a modified version of MacNab's criteria, 90.2% showed excellent or good outcomes. There was no measurable blood loss. There were two cases of recurrence of and four cases with complications. CONCLUSIONS: Percutaneous full-endoscopic revisional disc surgery without additional structural damage is feasible and effective in terms of there being less chance of fusion and bleeding. This technique can be an alternative to conventional repeated discectomy.
Back Pain ; Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Hemorrhage ; Humans ; Leg ; Magnetic Resonance Spectroscopy ; Neurologic Manifestations ; Recurrence ; Retrospective Studies

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Vertebroplasty in Patients with Tumour-Related Vertebral Fractures: Is Rehabilitation Needed?.

Massimiliano POLASTRI ; Alessandro GASBARRINI

Asian Spine Journal.2013;7(3):248-252. doi:10.4184/asj.2013.7.3.248

For about 20 years, vertebroplasty has been used to achieve relief from pain and improve function in eligible patients affected by vertebral fractures. The procedure is also performed in patients with tumours of the vertebral body. The aim of this study was to investigate, by means of a literature review, correlations between vertebroplasty and the need for rehabilitation after patients with tumour-related vertebral fractures were operated on. This review was based on literature from the US National Library of Medicine, National Institutes of Health (PubMed), using the following Medical Subject Headings (MeSH) terms: "vertebroplasty," "surgical procedures minimally invasive," "bone neoplasm," "spine," "postoperative care," "rehabilitation," and "exercise." In total, 14 citations were retrieved: potentially relevant studies were identified by searching titles and abstracts, and then the full text of the selected articles was reviewed. From this review, the postoperative course of vertebroplasty today does not strictly indicate the need for rehabilitation.
Bone Neoplasms ; Humans ; Medical Subject Headings ; National Institutes of Health (U.S.) ; National Library of Medicine (U.S.) ; Postoperative Care ; PubMed ; Spine ; Surgical Procedures, Minimally Invasive ; Vertebroplasty

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Gorham's Disease of Spine.

Vijay SEKHARAPPA ; Justin AROCKIARAJ ; Rohit AMRITANAND ; Venkatesh KRISHNAN ; Kenny Samuel DAVID ; Sundararaj Gabriel DAVID

Asian Spine Journal.2013;7(3):242-247. doi:10.4184/asj.2013.7.3.242

Gorham's disease is a rare disorder characterized by clinical and radiological disappearance of bone by proliferation of non-neoplastic vascular tissue. The disease was first reported by Jackson in 1838 in a boneless arm. The disease was then described in detail in 1955 by Gorham and Stout. Since then, about 200 cases have been reported in the literature, with only about 28 cases involving the spine. We report 2 cases of Gorham's disease involving the spine and review related literature to gain more understanding about this rare disease.
Arm ; Rare Diseases ; Spine

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Lumbar Spinal Stenosis Due to a Large Calcified Mass in the Ligamentum Flavum.

Shoji SEKI ; Yoshiharu KAWAGUCHI ; Hirokazu ISHIHARA ; Takeshi OYA ; Tomoatsu KIMURA

Asian Spine Journal.2013;7(3):236-241. doi:10.4184/asj.2013.7.3.236

We describe a rare case of lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum. This patient presented with a 12-month history of severe right leg pain and intermittent claudication. A computed tomography scan was performed, revealing a large calcified mass on the ligamentum flavum at the right-hand side of the lumbar spinal canal. We performed a laminotomy at the L4/5 level with resection of the calcified mass from the ligamentum flavum. The findings of various analyses suggested that the calcified mass consisted mostly of Ca3(PO4)2 and calcium phosphate intermixed with protein and water. The calcified mass in the ligamentum flavum was causing lumbar spinal stenosis. Surgical decompression by resection of the mass was effective in this patient. The calcified material was composed mainly of elements derived from calcium phosphate. Degenerative changes in the ligamentum flavum of the lumbar spine may have been involved in the production of this calcified mass.
Calcium ; Calcium Phosphates ; Decompression, Surgical ; Humans ; Intermittent Claudication ; Laminectomy ; Leg ; Ligamentum Flavum ; Spinal Canal ; Spinal Stenosis ; Spine ; Water

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Delayed Diagnosis of Cauda Eqina Syndrome with Perineural Cyst after Combined Spinal-Epidural Anesthesia in Hemodialysis Patient.

Shigeo ISHIGURO ; Koji AKEDA ; Masaya TSUJII ; Akihiro SUDO

Asian Spine Journal.2013;7(3):232-235. doi:10.4184/asj.2013.7.3.232

Symptomatic Tarlov (perineural cysts) are uncommon. In the following hemodialysis case, cauda equina syndrome was not detected after combined spinal-epidural anesthesia untilthe patient reported a lack of sensation in the perianal area 14 days postoperatively. She had normal motor function of her extremities. A laminectomy and cyst irrigation was performed. After the operation, her sphincter disturbance subsided gradually and her symptoms had disappeared.
Anesthesia ; Delayed Diagnosis ; Humans ; Hypesthesia ; Laminectomy ; Renal Dialysis ; Tarlov Cysts

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Giant Invasive Sacral Schwannoma Showing Chromosomal Numerical Aberrations -14,+18,+22.

Masahiko KANAMORI ; Taketoshi YASUDA ; Takeshi HORI ; Kayo SUZUKI

Asian Spine Journal.2013;7(3):227-231. doi:10.4184/asj.2013.7.3.227

Here, we report on a rare case of a giant invasive sacral schwannoma. The patient was a 58-year-old woman who had a 6-year history of non-specific buttock pain. Histological investigation confirmed the diagnosis of cellular schwannoma. The following numerical aberration was detected using the GTG-banding method for karyotypes: 47,XX,-14,+18,+22. Cytogenetic studies of schwannomas have indicated a complete or partial loss of chromosome 22 as the most common abnormality, but this case is cytogenetically rare because of the recurrence of trisomy 22.
Buttocks ; Chromosomes, Human, Pair 22 ; Cytogenetics ; Female ; Humans ; Middle Aged ; Neurilemmoma ; Recurrence ; Sacrum ; Trisomy

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Tuberculosis Affecting Multiple Vertebral Bodies.

Hideo BABA ; Atsushi TAGAMI ; Shinji ADACHI ; Takeshi HIURA ; Makoto OSAKI

Asian Spine Journal.2013;7(3):222-226. doi:10.4184/asj.2013.7.3.222

Spinal tuberculosis usually occurs in a single vertebral body or two to three adjacent vertebrae; it rarely occurs in multiple vertebral bodies. Surgery is indicated in cases that do not improve with conservative therapy, or when paralysis is evident. Two cases regarding patients with spinal tuberculosis in multiple vertebral bodies on whom surgery was performed are reported. Case 1, the patient was a 77-year-old woman with spinal tuberculosis in four vertebral bodies from the lower thoracic to the lumbar spine. As she had pronounced lower back pain, posterolateral fusion with a pedicle screw was performed. Case 2, the patient was a 29-year-old Indonesian man with spinal tuberculosis in 17 vertebral bodies of the spine who was unable to stand due to paralysis of both legs, thus posterolateral fusion with a pedicle screw was performed. Good results were obtained from tuberculostatic drug therapy and surgical instrumentation.
Adult ; Aged ; Antitubercular Agents ; Female ; Humans ; Low Back Pain ; male ; Paraplegia ; Spine ; Surgical Instruments ; Tuberculosis ; Tuberculosis, Spinal

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