Background: The success and popularity of the transforaminal approach in the lumbar spine has bee... more Background: The success and popularity of the transforaminal approach in the lumbar spine has been made possible by the routine use of pedicle screws in the lumbar spine. Transforaminal approach in the cervical spine can give access to the disc and the vertebral body anteriorly and avoid an additional anterior approach in certain clinical situations. We report technical aspects of transforaminal approach in the lower cervical spine with the authors learning experience. Materials and Methods: Fifteen patients underwent transforaminal approach with cervical pedicle screw (CPS) instrumentation at our institute from July 2011 to October 2014. Five patients underwent foraminal decompression alone (Group-1); 9 patients underwent transforaminal cervical interbody fusion (TCIF) with foraminal decompression, discectomy, and interbody bone grafting (Group-2); and 1 patient underwent partial corpectomy (Group-3). All patients were evaluated for the placement of pedicle screws, for clinical improvement using modified Japanese Orthopaedic Association (mJOA) scoring and interbody graft positioning. The average follow-up was 34.6 months (22–64 months). Results: The average age was 45 years (25–80 years). The average blood loss was 198 ml (100–450 ml) and the average operative time was 142 min (90–200 min). Interbody graft pieces extruded anteriorly in 4 patients (Group-II). The preoperative average mJOA score of 11.4 (0–15) improved to 15.73 (0–18) at final followup. Conclusion: Transforaminal approach in lower cervical spine, though has a learning curve, seems to be a feasible technique along with the use of cervical pedicle screws. Safety and reproducibility of the approach needs to be substantiated with a larger study. Further, TCIF can avoid an additional anterior surgery in certain situations in the cervical spine.
Archives of Orthopaedic and Trauma Surgery, Sep 18, 2011
Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Va... more Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Various factors affect the outcome; with AVN (avascular necrosis) and non-union primarily contributing to adverse results in such patients. To identify factors affecting outcome of displaced fracture NOF, a prospective cohort study was carried out in the setting of a tertiary care centre in developing country. 27 consecutive patients with displaced fracture NOF suitable for osteosynthesis underwent closed reduction and fixation with three 6.5 mm cancellous cannulated screws. A record of posterior comminution and its extent (as seen on CT scan) and the intracapsular pressure difference between the fractured and the opposite side was kept in all the patients. The patients were followed-up for 1 year. The main outcomes measured at 1 year were non-union (as identified by CT scan) and AVN (as identified by bone scan). Cases with pressure difference >30 mm were found to have a higher rate of AVN and this result was found to be statistically significant (p value 0.034). The patients with significant posterior comminution were found to have higher non-union rates and this result was also found to be statistically significant (p value 0.04). Prognosis of displaced fracture NOF is significantly associated significant with posterior comminution and intracapsular pressure difference between fractured and normal side.
Clinical Orthopaedics and Related Research, Jul 1, 2007
In the absence of major deformity, the major goal of surgery in tuberculous spondylitis is to ach... more In the absence of major deformity, the major goal of surgery in tuberculous spondylitis is to achieve adequate cord decompression and débridement of diseased tissue. We asked whether video-assisted thoracoscopic surgery (VATS) could be undertaken in active tuberculosis of the spine with instrumentation and achieve good healing of the disease with fusion and with adequate decompression of the cord to achieve neural recovery. We retrospectively reviewed 23 patients (13 men and 10 women with an average age of 38.2 years) with single-level thoracic spinal tuberculosis (T4-T11) treated with VATS. Of the 23 patients, 18 had paraparesis/paraplegia. The procedures included: (1) débridement and drainage of prevertebral and paravertebral abscess (n = 4); (2) débridement, decompression, and reconstruction with rib graft (n = 8); (3) débridement, decompression, anterior vertical titanium mesh cage, and open posterior screw-rod fixation (n = 5); and (4) débridement, decompression, and anterior screw-rod fixation (n = 6). Twenty-two of 23 patients achieved fusion and there was no recurrence of the disease in any of the patients. No patient had neurological deterioration and 17 of the 18 neurologically compromised patients regained ambulatory power. Small scars (for surgical portals), early mobilization, and short hospital stays were the salient advantages.
Background: The success and popularity of the transforaminal approach in the lumbar spine has bee... more Background: The success and popularity of the transforaminal approach in the lumbar spine has been made possible by the routine use of pedicle screws in the lumbar spine. Transforaminal approach in the cervical spine can give access to the disc and the vertebral body anteriorly and avoid an additional anterior approach in certain clinical situations. We report technical aspects of transforaminal approach in the lower cervical spine with the authors learning experience. Materials and Methods: Fifteen patients underwent transforaminal approach with cervical pedicle screw (CPS) instrumentation at our institute from July 2011 to October 2014. Five patients underwent foraminal decompression alone (Group-1); 9 patients underwent transforaminal cervical interbody fusion (TCIF) with foraminal decompression, discectomy, and interbody bone grafting (Group-2); and 1 patient underwent partial corpectomy (Group-3). All patients were evaluated for the placement of pedicle screws, for clinical improvement using modified Japanese Orthopaedic Association (mJOA) scoring and interbody graft positioning. The average follow-up was 34.6 months (22–64 months). Results: The average age was 45 years (25–80 years). The average blood loss was 198 ml (100–450 ml) and the average operative time was 142 min (90–200 min). Interbody graft pieces extruded anteriorly in 4 patients (Group-II). The preoperative average mJOA score of 11.4 (0–15) improved to 15.73 (0–18) at final followup. Conclusion: Transforaminal approach in lower cervical spine, though has a learning curve, seems to be a feasible technique along with the use of cervical pedicle screws. Safety and reproducibility of the approach needs to be substantiated with a larger study. Further, TCIF can avoid an additional anterior surgery in certain situations in the cervical spine.
Archives of Orthopaedic and Trauma Surgery, Sep 18, 2011
Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Va... more Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Various factors affect the outcome; with AVN (avascular necrosis) and non-union primarily contributing to adverse results in such patients. To identify factors affecting outcome of displaced fracture NOF, a prospective cohort study was carried out in the setting of a tertiary care centre in developing country. 27 consecutive patients with displaced fracture NOF suitable for osteosynthesis underwent closed reduction and fixation with three 6.5 mm cancellous cannulated screws. A record of posterior comminution and its extent (as seen on CT scan) and the intracapsular pressure difference between the fractured and the opposite side was kept in all the patients. The patients were followed-up for 1 year. The main outcomes measured at 1 year were non-union (as identified by CT scan) and AVN (as identified by bone scan). Cases with pressure difference >30 mm were found to have a higher rate of AVN and this result was found to be statistically significant (p value 0.034). The patients with significant posterior comminution were found to have higher non-union rates and this result was also found to be statistically significant (p value 0.04). Prognosis of displaced fracture NOF is significantly associated significant with posterior comminution and intracapsular pressure difference between fractured and normal side.
Clinical Orthopaedics and Related Research, Jul 1, 2007
In the absence of major deformity, the major goal of surgery in tuberculous spondylitis is to ach... more In the absence of major deformity, the major goal of surgery in tuberculous spondylitis is to achieve adequate cord decompression and débridement of diseased tissue. We asked whether video-assisted thoracoscopic surgery (VATS) could be undertaken in active tuberculosis of the spine with instrumentation and achieve good healing of the disease with fusion and with adequate decompression of the cord to achieve neural recovery. We retrospectively reviewed 23 patients (13 men and 10 women with an average age of 38.2 years) with single-level thoracic spinal tuberculosis (T4-T11) treated with VATS. Of the 23 patients, 18 had paraparesis/paraplegia. The procedures included: (1) débridement and drainage of prevertebral and paravertebral abscess (n = 4); (2) débridement, decompression, and reconstruction with rib graft (n = 8); (3) débridement, decompression, anterior vertical titanium mesh cage, and open posterior screw-rod fixation (n = 5); and (4) débridement, decompression, and anterior screw-rod fixation (n = 6). Twenty-two of 23 patients achieved fusion and there was no recurrence of the disease in any of the patients. No patient had neurological deterioration and 17 of the 18 neurologically compromised patients regained ambulatory power. Small scars (for surgical portals), early mobilization, and short hospital stays were the salient advantages.
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