Single and Multiple Level One Stage Posterior Hemivertebrectomy and Short Segment Fixation: Experience with 22 Cases and Comparison of Single vs. Multilevel Procedures with Minimum 2-Year Follow-Up

Study DesignData of 22 patients with congenital scoliosis who underwent single stage posterior hemivertebrectomies and short segment fixation with a minimum follow-up of 2 years in our centre were studied retrospectively.PurposeTo report the efficacy of posterior hemivertebrectomy in single vs multiple level hemivertebra and compare their results.Overview of LiteratureSingle stage hemivertebrectomy is a standard procedure for single level hemivertebra. Results of multiple level hemivertebrectomies have not been reported.MethodsTwenty-two patients (9 male and 13 female) with the mean age of 11.2 years (range, 2 years 4 months to 24 years 10 months) and a mean follow up of 32 months (range, 4 to 73 months) were studied retrospectively and their results were compared.ResultsAverage number of hemivertebrae removed was 1.46 (range, 1 to 3). Mean preoperative and postoperative coronal cob angle was 48.7° (range, 22° to 80°) and 24.2° (range, 7° to 41°), respectively (p<0.001). Mean preoperative and postoperative sagittal cobb angle was 32.1° (range, 7° to 76°) and 13.6° (range, 0° to 23°), respectively (p<0.005). Mean coronal and sagittal cob correction percentage achieved was 50.2% and 51.8% respectively. Mean follow-up was 49 months (range, 30 to 84 months). Mean loss of coronal and sagittal correction at final follow-up was 4% (0% to 13.6%) degrees and 3.5% (0% to 20%), respectively.ConclusionsPosterior hemivertebrectomy in congenital scoliosis is a safe treatment option for up to 3-level hemivertebrae. Excision of thoracolumbar hemivertebrae results in better correction than thoracic and lumbar hemivertebrae

Intraoperative neuromonitoring in spine surgery: Does it reduce neural complications? Current evidence

Abstract The objectives were to review the evidence on whether intraoperative neurophysiological monitoring (IONM) sensitively and specifically detects intraoperative neurologic injury during spine surgery and whether it reduces neurological complications in spine surgery. A systematic literature review and meta-analysis were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and studies spanning 1990–2022 were searched. The diagnostic accuracy of somatosensory evoked potentials (SSEPs) and motor-evoked potential (MEP) in predicting postoperative neurologic outcomes in spine surgery was assessed. We also analyzed clinical comparative studies that compared patients who underwent spine surgery with and without IONM to determine the rate of new neurologic events. Fifty studies that provided exact SSEP or MEP changes and postoperative neurological outcomes were analyzed. The features of SSEP changes included low sensitivity (67.7%), high specificity (94.1%), and strong negative predictive value (NPV) (92.1%). For the assessed alarm criteria of a 50% reduction, a 65% reduction, an 80% reduction in amplitude, and a total signal loss, the sensitivity and specificity values for MEP were 87.4%, 100%, 100%, and 100%, and 94.8%, 97%, 94.5%, and 90.5%, respectively. A random effects model was used to assess six research that compared neurological events with and without the use of IONM. The pooled Odds ratio was 0.5746 (confidence interval = 0.48; 0.67), z = 6.637, and the P value was 0.0001. The usefulness of IONM in detecting neurological events during spine surgery is well demonstrated by a growing body of research. However, prospective trials with high-level data are lacking to establish its efficacy in preventing new neurological deficits

Adjacent level spondylodiscitis after anterior cervical decompression and fusion

Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF) is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7) followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin) were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup

Posterior scoliosis correction for adolescent idiopathic scoliosis using side-opening pedicle screw-rod system utilizing the axial translation technique

<b>Background</b> : Though adequate literature is present depicting the results of pedicle screw-rod instrumentation using top loading systems for correction of adolescent idiopathic scoliosis (AIS), using the rod rotation technique, few published data is available regarding side loading systems used for a similar purpose. We report a retrospective study of a cohort of patients with strict inclusion criteria who underwent surgical correction of AIS with side-opening pedicle screw-rod posterior instrumentation using the axial translation technique of curve correction to assess the efficacy of side opening system for scoliosis correction with regards to patient satisfaction, Cobb&#x2032;s angle correction and spinal balance. <b> Materials and Methods</b> : Clinical and radiological outcomes were measured in 14 consecutive patients (3 males, 11 females) with an average age of 14.0 years (range 9 to 23 years). They were followed up for an average period of 13.0 months (range - 2.2 to 28.5). All patients underwent posterior instrumentation only with pedicle screws used as anchor points. Hybrid constructs using hooks/wires or curves requiring anterior release were excluded from the study. All levels were not instrumented - more screws were put on the concavity and in the peri-apical region. Radiological evaluation was done by whole spine standing AP, lateral radiograms preoperatively and 1, 3, 6 and12 months after surgery. Cobb&#x2032;s angles were measured and the spinal balance was noted. Clinical evaluation was done by SRS questionnaire. The complications were documented. <b> Results</b> : The mean preoperative Cobb&#x2032;s angle was 58.35&#906; (range - 44 to 72&#906;), which came down postoperatively to 23.45&#906; (range - 10 to 38&#906;) signifying a mean correction of 59.57&#x0025; (range - 26.92 to 76.17&#x0025;). Clinical outcomes were evaluated using the SRS - 30 questionnaires. The values of mean pre- and postoperative scores are 3.68 and 4.18, showing an improvement of 0.5 points. Other than one patient of superficial wound infection, which healed with antibiotics, there was no major complication. No patient had neurological deterioration. <b>Conclusion</b> : Side-opening spinal instrumentation systems, using the axial translation technique, achieved good clinical and radiological outcome for patients of AIS

Injuries of the upper cervical spine: A series of 28 cases

<b>Background: </b> There are very few published reports of upper cervical spine injuries from our country and there is a heavy bias towards operative treatment of these injuries. We present below our experience of upper cervical injuries over the last four years. <b> Materials and Methods: </b> Twenty eight patients (20 males, 8 females) with upper cervical spine injury (including Occiput, Atlas and Axis) were treated and were followed-up for an average of 11.2 months. The data was analyzed retrospectively with regards to the location and type of injury, the treatment offered (conservative or operative) as well as the final clinical and radiological outcome. <b> Results: </b> The clinico-radiological outcome of treatment of these injuries is mostly very good with few complications. Other than a single case of mortality due to associated head injury there were no major complications. <b> Conclusion: </b> Management of these patients needs a proper evaluation to arrive at the type of injury and prompt conservative or operative treatment. Treatment is usually safe and effective with good clinical and radiological outcome

Deep neural network for automated simultaneous intervertebral disc (IVDs) identification and segmentation of multi-modal MR images

Background and objective: Lower back pain in humans has become a major risk. Classical approaches follow a non-invasive imaging technique for the assessment of spinal intervertebral disc (IVDs) abnormalities, where identification and segmentation of discs are done separately, making it a time-consuming phenomenon. This necessitates designing a robust automated and simultaneous IVDs identification and segmentation of multi-modality MRI images. Methods: We introduced a novel deep neural network architecture coined as ‘RIMNet’, a Region-to-Image Matching Network model, capable of performing an automated and simultaneous IVDs identification and segmentation of MRI images. The multi-modal input data is being fed to the network with a dropout strategy, by randomly disabling modalities in mini-batches. The performance accuracy as a function of the testing dataset was determined. The execution of the deep neural network model was evaluated by computing the IVDs Identification Accuracy, Dice coefficient, MDOC, Average Symmetric Surface Distance, Jaccard Coefficient, Hausdorff Distance and F1 Score. Results:Proposed model has attained 94% identification accuracy, dice coefficient value of 91.7±1% in segmentation and MDOC 90.2±1%. Our model also achieved 0.87±0.02 for Jaccard Coefficient, 0.54±0.04 for ASD and 0.62±0.02 mm Hausdorff Distance. The results have been validated and compared with other methodologies on dataset of MICCAI IVD 2018 challenge. Conclusions: Our proposed deep-learning methodology is capable of performing simultaneous identification and segmentation on IVDs MRI images of the human spine with high accuracy

The Management of Intraoperative Spinal Cord Injury - A Scoping Review

STUDY DESIGN: Scoping Review. OBJECTIVE: To review the literature and summarize information on checklists and algorithms for responding to intraoperative neuromonitoring (IONM) alerts and management of intraoperative spinal cord injuries (ISCIs). METHODS: MEDLINE® was searched from inception through January 26, 2022 as were sources of grey literature. We attempted to obtain guidelines and/or consensus statements from the following sources: American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), American Academy of Neurology (AAN), American Clinical Neurophysiology Society, NASS (North American Spine Society), and other spine surgery organizations. RESULTS: Of 16 studies reporting on management strategies for ISCIs, two were publications of consensus meetings which were conducted according to the Delphi method and eight were retrospective cohort studies. The remaining six studies were narrative reviews that proposed intraoperative checklists and management strategies for IONM alerts. Of note, 56% of included studies focused only on patients undergoing spinal deformity surgery. Intraoperative considerations and measures taken in the event of an ISCI are divided and reported in three categories of i) Anesthesiologic, ii) Neurophysiological/Technical, and iii) Surgical management strategies. CONCLUSION: There is a paucity of literature on comparative effectiveness and harms of management strategies in response to an IONM alert and possible ISCI. There is a pressing need to develop a standardized checklist and care pathway to avoid and minimize the risk of postoperative neurologic sequelae

Management and prognosis of acute traumatic cervical central cord syndrome: systematic review and Spinal Cord Society—Spine Trauma Study Group position statement

PURPOSE : Spinal Cord Society (SCS) and Spine Trauma Study Group (STSG) established a panel tasked with reviewing management and prognosis of acute traumatic cervical central cord syndrome (ATCCS) and recommend a consensus statement for its management. METHODS : A systematic review was performed according to the PRISMA 2009 guidelines. Delphi method was used to identify key research questions and achieve consensus. PubMed, Scopus and Google Scholar were searched for corresponding keywords. The initial search retrieved 770 articles of which 37 articles dealing with management, timing of surgery, complications or prognosis of ATCCS were identified. The literature review and draft position statements were compiled and circulated to panel members. The draft was modified incorporating relevant suggestions to reach consensus. RESULTS : Out of 37 studies, 15 were regarding management strategy, ten regarding timing of surgery and 12 regarding prognosis of ATCCS. CONCLUSION : There is reasonable evidence that patients with ATCCS secondary to vertebral fracture, dislocation, traumatic disc herniation or instability have better outcomes with early surgery (< 24 h). In patients of ATCCS secondary to extension injury in stenotic cervical canal without fracture/fracture dislocation/traumatic disc herniation/instability, there is requirement of high-quality prospective randomized controlled trials to resolve controversy regarding early surgery versus conservative management and delayed surgery if recovery plateaus or if there is a neurological deterioration. Until such time decision on surgery and its timing should be left to the judgment of physician, deliberating on pros and cons relevant to the particular patient and involving the well-informed patient and relatives in decision making.https://link.springer.com/journal/5862020-07-31hj2020Orthopaedic Surger