Comparative Study of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screw for Adult Spine Deformities

Objective To evaluate the feasibility of O-arm navigation of bilateral dual sacral-alar-iliac (SAI) screws compared with conventional bilateral single SAI and S1 pedicle screws for pelvic anchors in cases of adult spinal deformity. Methods This retrospective, comparative study included 39 patients who underwent corrective fusion using SAI screws from T10 to the pelvis. Patients were divided into 2 groups according to the number of SAI screws placed during adult spinal deformity surgery: single SAI screw (group S, 17 cases) and dual SAI screws (group D, 22 cases). The incidence of rod breakage, proximal junctional kyphosis, screw loosening, reoperation, and global alignment in each group was estimated. Postoperative patient-reported outcomes were measured using the Oswestry Disability Index, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, and visual analog scale. Results The incidence of SAI screw loosening was significantly lower in group D than in group S (23% vs. 65%, P = 0.011). The rod breakage incidence was 0% and 12% in groups D and S, respectively (P = 0.17). There were no significant differences in the postoperative global alignment and clinical outcomes between the 2 groups. Conclusions Dual SAI screws were associated with a significantly reduced incidence of screw loosening compared with single SAI screws. The bilateral dual SAI screws technique for pelvic anchors is feasible for the treatment of patients with adult spinal deformity

O-arm Navigation-Guided Surgical Resection and Posterior Fixation for a Large Sacral Schwannoma

Sacral schwannoma is a rare tumor with relatively few symptoms; it thus tends to be large at diagnosis and is challenging to treat surgically. We present the case of a 12-year-old girl with a large sacral schwannoma that was successfully surgically resected using O-arm navigation in a two-stage operation. First, we performed tumor resection from the posterior aspect with assisted O-arm navigation. One week later, resection from the anterior aspect was conducted with posterior spinopelvic fixation and fibula graft. We performed partial resection of the tumor from the anterior and posterior aspects as much as possible. O-arm navigation contributed to precise and safe tumor resection and implant insertion

Anterior Percutaneous Endoscopic Cervical Discectomy, a Stitchless and Bloodless Surgery: Clinical and Radiological Results

Objective Anterior cervical discectomy with fusion [ACDF] has been considered gold standard for cervical disc herniation over period of time. Anterior percutaneous endoscopic cervical discectomy [PECD] is minimally invasive technique without need for implant or bone graft in properly selected cases. In this study we present clinical and radiological results of anterior PECD. Methods We retrospectively studied 31 patients treated with anterior PECD in our institute from January 2014 to December 2016. Patients’ clinical data, visual analogue score [VAS], neck disability index [NDI] and radiographs were collected. Cervical lordosis angle, focal angle and disc height of involved segment were measured using Medsynapse software. Statistical analysis was performed using paired T test, chi square test. Results There were 18 males, 13 females in this study. Mean follow up period was 28.5 months. VAS for neck pain reduced from 6.2±0.72 to 1.67±0.59; VAS for arm pain reduced from 7.25±0.71 to 1.5±0.61 at final follow up. NDI reduced from 64.7±7.62 to 13.48±5.42 at final follow up. Mean disc height of involved segment was 6.15 mm pre-operatively which reduced to 5.24 mm at final follow up showing reduction of 0.91 mm. This reduction is disc space is not clinically significant as VAS and NDI show significant fall. Cervical lordosis was well maintained which changed from 13.93°±3.7° to 15.58°±6.66°; [p-value is 0.060]. Pre-operative focal cervical angle of involved segment was 0.86°±1.66° which increased to 1.7°±1.81° at final follow up [p-value 0.0067]. Twenty out of 31 patients resumed their previous employment within 2 weeks. Conclusion Anterior PECD is excellent minimally invasive technique for cervical disc herniation in properly selected cases. Patients have good functional and clinical recovery after this procedure

Surgical Management of Spinal Tuberculosis—The Past, Present, and Future

Tuberculosis is endemic in many parts of the world. With increasing immigration, we can state that it is prevalent throughout the globe. Tuberculosis of the spine is the most common form of bone and joint tuberculosis; the principles of treatment are different; biology, mechanics, and neurology are affected. Management strategies have changed significantly over the years, from watchful observations to aggressive debridement, to selective surgical indications based on well-formed principles. This has been possible due to the development of various diagnostic tests for early detection of the disease, effective anti-tubercular therapy, and associated research, which have revolutionized treatment. This picture is rapidly changing with the advent of minimally invasive spine surgery and its application in treating spinal infections. This review article focuses on the past, present, and future principles of surgical management of tuberculosis of the spine

An unusual occurrence of stromal keratitis in dengue fever

Dengue is a mosquito-borne infection endemic in the tropical and subtropical regions of the world. Classic dengue fever is a self-limiting, influenza-like illness transmitted by Aedes aegypti mosquito. Ophthalmic manifestations though rare can involve both the anterior and posterior segments and are usually associated with the thrombocytopenic state. However, ophthalmic complications such as anterior uveitis and vasculitis suggest immune-mediated pathogenesis. Herein, we report a rare case of stromal keratitis and an unusual occurrence of simultaneous bilateral blindness following dengue fever in a young girl

Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy

C-arm Free O-arm Navigated Posterior Atlantoaxial Fixation in Down Syndrome: A Technical Note

The surgical treatment of pediatric atlantoaxial subluxation (AAS) in Down syndrome (DS) remains technically challenging due to radiation exposure and complications such as vertebral artery injury and nonunion. The established treatment is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique). However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation we present here a new C-arm free O-arm navigated surgical procedure for pediatric AAS in DS. A 5-year-old male DS patient had neck pain and unsteady gait. Radiograms showed AAS with an atlantodental interval of 10 mm, and irreducible subluxation on extension. CT scan showed Os odontoideum and AAS. MRI demonstrated spinal cord compression between the C1 posterior arch and odontoid process. We performed a C-arm free O-arm navigated modified Goel procedure with postoperative halo-vest immobilization. At oneyear follow-up, good neurological recovery and solid bone fusion were observed. The patient had no complications such as epidural hematoma, infection, or nerve or vessel injury. This novel procedure is a useful and safe technique that protects surgeons and staff from radiation risk

Comparative evaluation of screw accuracy and complications of new C-arm free O-arm navigated minimally invasive cervical pedicle screw fixation (MICEPS) with conventional cervical screw fixation

Study design: Retrospective comparative study. Objective: Comparative study of C-arm free O-arm navigated minimally invasive cervical pedicle screw (MICEPS) fixation with conventional cervical pedicle screw fixation. Methods: Twenty-five patients with different cervical spine pathologies were operated with MICEPS with O-arm navigation (group M; 18 patients) and conventional pedicle screw (group C; 7 patients) from June 2017 to January 2020. Operative time, blood loss were recorded. Preoperative and postoperative radiograms, CT scans and MRI were evaluated. Postoperatively screw position accuracy and angulation was determined on CT. Breach rate was evaluated on CT scan and classified according to Neo grading. Complications if any were noted. Results: The average blood loss in group M and group C was 129 ml and 329 ml, respectively. The average operative time in group M and group C was 77.4 min and 82.3 min, respectively. A total of 148 screws were inserted. In group M, no patient showed grade 2 and 3 breach while in group C, grade 0 and 1 breach was found in 85.7% screws and grade 2 in 14.3% screws. Mean screw medial angulation was 45.2 degrees in group M and 33.4 degrees in group C. There was one dural tear and two C5 palsies in each group. Conclusion: With C -arm free O-arm navigated MICEPS fixation operative time and blood loss are less though not statistically significant. It has less pedicle breach rate, less incidence of neurovascular complications than conventional technique. There is no radiation exposure to operating surgeon and staff