Background:Tandem spinal stenosis (TSS) is a rare presentation leading to combined clinical features of upper motor neuron and lower motor neuron lesion which includes intermittent neurogenic claudication with or without neurological deficit, progressive gait imbalance and gait disturbances. In literature, there is controversy whether stage surgery or single-stage surgery should be done.Materials and Methods:From June 2009 to November 2016 in a series of 1381 patients who underwent surgery for various degenerative spinal conditions, 82 patients were diagnosed with having symptomatic TSS with an incidence of 5.93%. All patients diagnosed with TSS underwent single-stage surgical intervention by one surgical team. The perioperative factors were recorded for each patient. All patients were evaluated preoperatively and postoperatively at each followup with the modified Japanese Orthopaedic Association (mJOA) score, Nurick's grading, Oswestry disability index (ODI) and Cooper scale.Results:In this study, 82 patients including 70 males and 12 females underwent simultaneous surgical intervention for symptomatic TSS. The mean age of patients was 61.78 ± 10.48 years. There was a significant improvement in mJOA score, Nuricks grading, ODI and Coopers scale postoperatively as compared to preoperative values (P < 0.05).Conclusion:Symptomatic TSS can be safely managed by single-stage surgical intervention with good postoperative results or without a significant increase in complication rates. Single-stage surgical intervention helps to relieve the symptoms of both cervical and lumbar spinal cord compression, avoids the risk of repeated anesthesia, reduce the duration of surgery, repeated hospitalization hence, reducing the cost for hospitalization and also reducing the rehabilitation, recuperation time and early functional recovery justifies single-stage surgical intervention.
Early onset scoliosis (EOS) is deformity of the spine below the age of 5 years. Children with EOS are at risk of impaired thoracic cage development and pulmonary maturation. Initial evaluation consists of determining the etiological cause for EOS, i.e., congenital, neurogenic, idiopathic, or syndromic. The advent of magnetic resonance imaging in recent times has lead to increased awareness of neurogenic causes leading to EOS. Evaluation of spinal cord anomalies in EOS is very important as early diagnosis and treatment can help in deformity stabilization and regression. Also, any surgical or nonsurgical intervention to correct the deformity without prior treatment of spinal cord anomalies can lead to disastrous neurological complications.
Background:Anterior cervical decompression and fusion is the standard procedure used for treating patients with cervical myelopathy. However, these procedures are associated with complications such as pseudarthrosis, construct failure, and neurological complications. Posterior cervical laminectomy and instrumentation is an alternative procedure to treat multilevel cervical myelopathy. In this study, we raised questions whether instrumentation is required at all levels and whether stabilizing the spine in neutral or lordotic contour with indirect decompression leads to neurological improvement with radiological evidence of anterior decompression. The results of posterior cervical laminectomy and instrumentation with lateral mass screw in terms of radiological and functional outcome in patients with multilevel cervical myelopathy are prospectively evaluated.Materials and Methods:In this prospective study conducted between June 2006 and December 2015, we have evaluated 112 patients with multilevel cervical myelopathy who underwent multilevel cervical laminectomy and instrumentation with lateral mass screw. All patients were evaluated preoperatively and postoperatively with Nurick's grading and Modified Japanese Orthopaedic Association (mJOA) scale for neurological function. Cooper scale and British Medical Research Council grading system for motor function. Curvature index was used to measure the alignment of cervical spine preoperatively and postoperatively. Alignment of the cervical spine was done preoperatively and postoperatively by calculating the curvature index. Axial MRI was used to calculate the severity of compression preoperatively which was calculated as per Singh's criteria and postoperatively to assess the adequacy of decompression at the operated level.Results:In our study, there were 112 patients including 99 males and 13 females, with mean age of 59.53 years. The mean duration of followup of patients was 33.24 months. In total, cervical laminectomy was performed at 342 levels in 112 patients with an average of 3.05 laminectomies, and in total, 112 lateral mass screws were inserted. On postoperative followup, the mJOA and Nurick's grading showed improvement in all cases as compared to preoperative findings. The mean mJOA improved significantly from 8.56 preoperatively to 13.57 postoperatively (P < 0.001). The mean Nurick's grading also improved significantly from 2.59 preoperatively to 0.66 postoperatively (P < 0.001). The mean Cooper scale also showed significant improvement in both upper and lower limbs postoperatively (P < 0.001). The mean preoperative Cooper scale was 1.75 and postoperative was 0.31 for upper limbs, and the mean Cooper scale was 2.14 preoperatively and 0.56 postoperatively for lower limbs. X-rays done on routine followups showed good alignment of the cervical spine with maintenance of curvature index in all patients. The mean grade of compression as seen on preoperative MRI was 2.46 which reduced significantly postoperatively to 0.16 (P < 0.001).Conclusion:The multilevel cervical...
Study DesignProspective case series.PurposeTo study the safety, efficacy, and long-term outcomes of single-stage surgical intervention for congenital spinal deformity and intraspinal anomalies.Overview of literatureCongenital spinal deformities associated with intraspinal anomalies are usually treated sequentially, first by treating the intraspinal anomalies followed by deformity correction after a period of 3–6 months. Recently, a single-stage approach has been reported to show better postoperative results and reduced complication rates.MethodsThirty patients (23 females and seven males) were prospectively evaluated for the simultaneous surgical treatment of congenital spinal deformity with concurrent intraspinal anomalies from May 2006 to October 2016. The average age at presentation was 9.8±3.7 years, with the average follow-up duration being 49.06±8.6 months. Clinical records were evaluated for clinical, radiological, perioperative, and postoperative data.ResultsThe average angle of deformity was 56.53°±25.22° preoperatively, 21.13°±14.34° postoperatively, and 23.93°±14.99° at the final follow-up. The average surgical time was 232.58±53.56 minutes (range, 100–330 minutes), with a mean blood loss of 1,587.09±439.09 mL (range, 100–2,300 mL).ConclusionsSingle stage surgical intervention for intraspinal anomalies with congenital spinal deformity correction, including adequate intra-operative wake-up test, is a viable option in appropriately selected patients and has minimum complication rates.
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