Intervertebral Disc Characteristic on Progressive Neurological Deficit

Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI) in lumbar herniated disc (LHD) patients with progressive neurological deficit.Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination.Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females) suffered from progressive neurological deficit with an average age of (52.07±10.9) years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01). Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients.Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients.Keywords: Lumbar herniated disc, magnetic resonance imaging, progressive neurological deficit DOI: 10.15850/ijihs.v5n2.1042 

Principles of Spine Instrumentation

Introduction : Spinal implants were initially, and are still, used for the supplementation of bony fusion. However, bony fusion operations were initially performed without implants.1 In the US, Wire and screw fixation of the unstable spine techniques remained to use until the pre-World War II years. 20 years after World War II, there were two major breakthroughs in spine surgery: the Harrington system for spine stabilization and deformity correction and the interspinous wiring technique of Rogers. Rogers described the technique of cervical interspinous wiring in the early 1940s. Harrington introduced his instrumentation system in 1962. Discussion : Since then, modifications of both techniques have been devised to increase their security of fixation. The next significant advance in dorsal spinal stabilization was the development of multisegmental spinal instrumentation. Multisegmental instrumentation permits sharing of the load applied to the instrumentation construct with multiple vertebrae, so that decreasing the chance of failure at the metal–bone interface.The Luque segmental wiring technique, developed in the early 1970s, was the first of this class of implants to achieve wide clinical application. Subsequent modifications have been used. Conclusion : Further modifications were the forerunners of more complex, currently used systems of universal spinal instrumentation (USI)

The Role of Minimally Invasive Spine Surgery

Introduction :In the past half of century, the spinal surgery techniques has advanced significantly. Along with the improvement and various of techniques and technologies in general, there has been a big movement to reduce the morbidity of surgery. Case review : As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. The minimally invasive spine surgery also need to make an efficient target of surgery. The roots in minimally invasive spine surgery (MISS) are based primarily on technique modifications. Discussion: The Williams microdiscectomy, described in 1978, revolutionized MISS by starting the evolution of lumbar discectomy from an open surgery through a 6-inch incision to a microsurgical approach through as small an opening as possible. Conclusion :We don’t use the MISS technique when the extension of tumor is more than 2 levels; extension of the tumor is 20% longer than diameter of largest retractor; the tumor &gt; 3cm for interlaminary approach, the wide durotomy is needed; and also the case with intramedullary tumor with 80% extention, from left to the right side; en bloc as the the goal of surgery for extradural tumo

Comparison of Superficial Surgical Site Infection in Simple Interrupted and Hybrid Mattress Suture after Posterior Approach for Spine Surgery

Objective: To compare the incidences of superficial surgical site infection after posterior approach procedures in simple interrupted suture groups compared with hybrid mattress suture group. Methods: A number of 38 patients who underwent posterior approach procedure were randomized into two groups. First group was sutured using simple interrupted suture while the second was using hybrid mattress suture. Bivariate statistical analysis was performed using Chi square test and Mann Whitney test. The superficial surgical site infection incidence was evaluated and recorded for both groups.Results: A superficial surgical site infection was found in 26.3% of the simple interrupted group and no infection was found in the hybrid mattress group. Statistical analysis showed a p value of 0.046.Conclusions: Compared to simple interrupted suture, hybrid mattress suture has less superficial surgical site infection in posterior approach for spine surgery.Keywords: Hybrid mattress suture, simple interrupted suture, superficial surgical site infection, wound healing DOI: 10.15850/ijihs.v3n2.58

Cervical Spine Trauma

Cervical trauma is a serious condition, that may cause permanent disability or even death. Cervical trauma occurs in 2-7% of blunt trauma patients. In Europe, the incidence of cervical trauma is approximately 9-17/100,000 annually,. The most common mechanisms of injury causing cervival trauma are traffic accidents and falls, which the most commonly injured vertebra is vertebral C2 (axis). Diagnostics of cervical trauma are based on good clinical assessment and prompt radiological imaging. Several patient groups, such as the elderly and patients with traumatic brain injury are highly susceptible to cervical trauma. The diagnostics of cervivcal trauma remain challenging for clinical practitioners and failure to diagnose cervical trauma in acute care may have serious consequences

Comparison of Superficial Surgical Site Infection in Simple Interrupted and Hybrid Mattress Suture after Posterior Approach for Spine Surgery

Objective: To compare the incidences of superficial surgical site infection after posterior approach procedures in simple interrupted suture groups compared with hybrid mattress suture group. Methods: A number of 38 patients who underwent posterior approach procedure were randomized into two groups. First group was sutured using simple interrupted suture while the second was using hybrid mattress suture. Bivariate statistical analysis was performed using Chi square test and Mann Whitney test. The superficial surgical site infection incidence was evaluated and recorded for both groups.Results: A superficial surgical site infection was found in 26.3% of the simple interrupted group and no infection was found in the hybrid mattress group. Statistical analysis showed a p value of 0.046.Conclusions: Compared to simple interrupted suture, hybrid mattress suture has less superficial surgical site infection in posterior approach for spine surgery.Keywords: Hybrid mattress suture, simple interrupted suture, superficial surgical site infection, wound healing DOI: 10.15850/ijihs.v3n2.58

Myelopathy caused by Ossification of Thoracic Ligamentum Flavum

Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological,metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Spinal ligaments, such as the ligamentum flavum (LF), are prone to degeneration and can lead to back pain and nerve dysfunction. Ossification of ligamentum flavum (OLF) is a pathological condition that cause neurological symptoms and usually occurs in the thoracic spine and less frequently in the cervical spine. However the disease is now being increasingly recognized as acause of thoracic myelopathy. We report a rare case of thoracic myelopathy caused by OLF. A 48-year-old male presented with a chief complaint of weakness of bilateral lower extremities. Neurological examination revealed sensory deficit at Th 11 level below. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9–11 level. Thoracicmyelopathy caused by OLF was consider and surgical intervention was performed. Posterior decompression and laminoplasty has been performed for this patient. Keywords: ossification of ligamentum flavum, thoracic myelopathy, laminoplast

Morphometric Analysis of the Corpus, Spinal Canal and Torg Ratio Using Midsagittal Cervical Vertebrae Computed Tomography Scan: Indonesian Population

Objective: To determine the normal ranges of cervical spinal canal morphometry in Indonesian population and to compare the acquired data collected from other populationsMethods: Computed tomography measurements on the diameter of midsagital spinal canal and corpus of cervical vertebrae and its Torg ratio from the lower cervical (C3-C7) canal from 24 normal Indonesian adults were performed at the Radiology Department of Dr. Hasan Sadikin General Hospital. Patients who had cervical spine disorders and those under 20 years old were exluded.  We used computed tomography scan midsagittal view to measure the aforementioned parameters.    Results: The average diameter for the cervical spinal canals for the Indonesian population is comparable with those of other Asian populations such as Hongkong and India, albeit with smaller Torg ratio.     Conclusions: This study reports the normal radiological anatomy of the midsagital spinal canal and corpus of cervical vertebrae as well as Torg ratio from the lower cervical vertebrae among Indonesian population. The measurements result of this study shows that, although slightly smaller, the measurement results for those parameters are identical with other Asian populations.    Keywords: Corpus cervical vertebrae, midsagittal cervical spinal canal, Torg ratio DOI: 10.15850/ijihs.v2n1.28

Robotic Surgery for Giant Presacral Dumbbell-Shape Schwannoma

Objective: To demonstrate the feasibility of using da Vinci robotic surgical system to perform spinal surgery.Methods: Magnetic resonance imaging (MRI) of a 29-year-old female patient complaining right pelvic pain for 1 month revealed a 17x8x10 cm non-homogeneous dumbbell shape encapsulated mass with cystic change located in the pelvic cavity and caused an anterior displacement of urinary bladder and colon.Results: There was no systemic complication and pain decrease 24 hours after surgery and  during 2 years of follow up. The patient started a diet 6 hours after the surgery and was discharged 72 hours after the surgery. The pathological diagnosis of the tumor was schwannoma. Conclusions: Giant dumbbell shape presacral schwannomas are rare tumours and their surgical treatment is challenging because of the complex anatomy of the presacral. Clinical application of da Vinci robotic surgical system in the spinal surgical field is currently confined to the treatment of some specific diseases or procedures. However, robotic surgery is expected to play a practical future role as it is minimally invasive. The advent of robotic technology will prove to be a boon to the neurosurgeon.Keywords: da Vinci robotic surgical system, presacral, schwannoma DOI: 10.15850/ijihs.v3n1.40

Morphometric Analysis of the Corpus, Spinal Canal and Torg Ratio Using Midsagittal Cervical Vertebrae Computed Tomography Scan: Indonesian Population

Objective: To determine the normal ranges of cervical spinal canal morphometry in Indonesian population and to compare the acquired data collected from other populationsMethods: Computed tomography measurements on the diameter of midsagital spinal canal and corpus of cervical vertebrae and its Torg ratio from the lower cervical (C3-C7) canal from 24 normal Indonesian adults were performed at the Radiology Department of Dr. Hasan Sadikin General Hospital. Patients who had cervical spine disorders and those under 20 years old were exluded.  We used computed tomography scan midsagittal view to measure the aforementioned parameters.    Results: The average diameter for the cervical spinal canals for the Indonesian population is comparable with those of other Asian populations such as Hongkong and India, albeit with smaller Torg ratio.     Conclusions: This study reports the normal radiological anatomy of the midsagital spinal canal and corpus of cervical vertebrae as well as Torg ratio from the lower cervical vertebrae among Indonesian population. The measurements result of this study shows that, although slightly smaller, the measurement results for those parameters are identical with other Asian populations.    Keywords: Corpus cervical vertebrae, midsagittal cervical spinal canal, Torg ratio DOI: 10.15850/ijihs.v2n1.28