Minimally Invasive Surgery vs. Open Surgery for Infectious Spondylodiscitis: A Systematic Review and Meta-Analysis

Objective Minimally Invasive Spinal (MIS) Procedure has long been used for treating degenerative spinal disorders, however its usage for infectious diseases of the spine has not been described a lot in literatures. Through this meta-analysis, we aim to objectively describe the efficacy of MIS as compared to traditional open surgery (OS) in treating infectious spondylodiscitis. Methods A systematic search was conducted based on PRISMA guideline to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 4 studies (301 patients) were included, divided into 8 meta-analysis, processed using Review Manager 5.3. Results OS requires significantly longer hospital length of stay (p=0.0009, I2=0%, MD=–6.64) and higher blood loss (p<0.00001, I2=40%, MD=–264.31) as well as more postoperative blood transfusion (p<0.00001, I2=0%, MD=–1.58). Moreover, MIS has benefit in significantly shorter operation time (p<0.00001, I2=46%, MD=–30.07) and less complication rate (p=0.0002, I2=38%, MD=0.32). However, the two procedures do not differ significantly in terms of neurological improvement, recurrence rate, and mortality rate. Conclusion Current systematic review and meta-analysis suggest that MIS offers comparable efficacy as well as less hospital length of stay, blood loss, operation time, and complication rate compared to OS

Outcome following cervicothoracic junction fusion in T1 pathological fracture of breast cancer spinal metastases: a case report

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer

Multiple Segments Thoracal Spinal Canal Stenosis Caused by Ossification of Ligamentum Flavum: A Case Report

Background: Thoracal spinal canal stenosis (SCS) that refers to multiple segments of the thoracic spine is a peculiar clinical condition. Various factors can cause thoracic SCS, including ossification of the ligamentum flavum (OLF). The aim of this study is to explain about the diagnosis for multiple segment thoracal spinal canal stenosis and management properly to prevent further complications.Case Presentation: A 58-year-old male came to Orthopaedic Outpatient Clinic in Prof. I.G.N.G Ngoerah Hospital, complaining back pain since one year prior to admission. Pain aggravated when he was bending his back. The patient was diagnosed with Thoracal Spinal Canal Stenosis Th 8-9, Th9-10, Th10-11. Patient underwent decompression, stabilization, fusion and biopsy surgery.Results: Patient underwent decompression, stabilization, fusion and biopsy surgery at RSUP Prof. I.G.N.G Ngoerah. In durante operation, already done laminectomy and eight pieces of pedicle screw was applied in Th8-Th11 (55mm x 40 mm Monoaxial on right side Th8, 55mm x 40 mm Polyaxial on left side Th8; 55mm x 40 mm Monoaxial on right side Th9, 55mm x 35 mm Monoaxial on left side Th9; 55mm x 40 mm Monoaxial on right and left side Th10; 55mm x 40 mm Monoaxial on right and left side Th11). There were no complications found in this patient after 4th day following surgery.Conclusion: The goal of surgical intervention for SCS is decompression by removing the calcific areas that are responsible for the spinal canal narrowing and subsequent cord compression. Although the diagnosis and choice of intervention can be difficult, early detection and management are critical to postoperative success. Postoperative results are variable and often unsatisfactory.Keywords: Spinal canal stenosis, ligamentum flavum, spine, surgeryCorrespondence: I Gusti Lanang Ngurah Artha Wiguna. Division of Spine, Department of Orthopaedic and Traumatology, Prof. I.G.N.G Ngoerah Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia. Email:[email protected]. Mobile: 0811388859.Indonesian Journal of Medicine (2022), 07(03): 278-288https://doi.org/10.26911/theijmed.2022.07.03.0

Atypical Spinal Tuberculosis of Upper Thoracic Spine: A Rare Case Report

Background: Tuberculous infection is one of the most common pulmonary infection in developing countries, including Indonesia. Spinal tuberculosis is one of the most common extra¬pulmonary tuberculosis manifestation, accounting for 5% of all extrapulmonary spread, and 50% of all osteoarticular involvement. The aim of this study is to evaluate and how diagnosis and treatment to prevent over or under-diagnosis and explain about excellent management without any late complication further.Case Presentation: A 20-year-old male with a history of weakness of both of his leg for 20 days prior to admission. From these examinations, patient was then diagnosed with pathological fracture 2nd thoracic vertebral body suspected due to atypical spinal tuberculosis. Patient was then undergone surgical debridement, decompression, stabilization and fusion.Results: Patient was then undergone surgical debridement, decompression stabilization fusion. During the exposure at level C6 through Th4, no abscess was found. Transpedicular debridement at level Th2 was then done after the insertion of pedicle screws at level C6-Th1 and Th3-Th4, and again no abscess was present, however, a granulomatous mass was present on the location of 2nd thoracic vertebral body, located on the anterior right side of the spinal cord outside the dura mater.Conclusion: Atypical presentation of spinal tuberculosis with the sole clinical manifestation of neurological deficit below affected level. The definitive treatment such as surgical debridement, stabilization and fusion must be consider.Keywords: spinal, infection, tuberculosis, young patient.Correspondence: I Gusti Lanang Ngurah Agung Artha Wiguna. Division of Spine, Department of Orthopaedic & Traumatology, Prof. I.G.N.G Ngoerah Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia. Email:[email protected]. Mobile: 0811388859.Indonesian Journal of Medicine (2022), 07(03): 289-297https://doi.org/10.26911/theijmed.2022.07.03.0

Comparative Effectiveness and Functional Outcome of Open-Door versus French-Door Laminoplasty for Multilevel Cervical Myelopathy: A Meta-Analysis: Comparative Effectiveness and Functional Outcome of Open-door versus French-door Laminoplasty for Multilevel Cervical Myelopathy

BACKGROUND: At present, few reports are comparing these 2 major cervical posterior laminoplasty methods with Open-door and French-door Laminoplasty in terms of neurological recovery, cervical alignment, and surgical complications. Moreover, most of the research has not been well designed. AIM: This study aims to determine comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy. METHODS: The Meta-analysis is used in this study. The study sample is a published research articles on comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy on the internet through databases on PubMed and ProQuest and published between 1997 until December 2018. Weighted mean difference and pooled weighted mean difference are calculated by using the fixed-effect model or random-effect model. Data is processed by using Review Manager 5.3 (RevMan 5.3). RESULTS: This study reviews 58 articles. There are 6 studies conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant higher postoperative Japanese Orthopaedic Association (JOA) score in open-door laminoplasty (ODL) than French-door laminoplasty (FDL) (weighted mean difference [WMD] = 0.71; 95% confidence interval [CI]: 0.35 to 1.07; p &lt; 0.05). The outcome of procedures treatment of multilevel cervical myelopathy revealed the operative time, cervical range of motion, axial canal diameter postoperative, axial pain reduction and complications events in ODL and FDL there was no significant difference. But for a cervical lordotic angle in ODL and FDL, there was a significant difference; the ODL group were significantly lesser than the FDL group. The recovery rate in ODL and FDL, there was a significant difference; the ODL was shown to be significantly higher than FDL (p &lt; 0.05). CONCLUSION: This analysis suggests that neither cervical laminoplasty approach is superior, based on the postoperative radiological data and complication rate. But the open-door laminoplasty resulted in a higher functional outcome and recovery rate as compared to the French-door laminoplasty