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Context: Cervical disc arthroplasty (CDA) was developed for the treatment of cervical disc disease with the potential advantages of preservation of physiological motion at a discal level, thereby potentially reducing adjacent level stresses and degeneration, which were a known complication of anterior cervical arthrodesis. The objective of this study was the assessment of long-term functional and radiological outcomes overtime in all the patients who underwent CDA from 2011 to 2019 at our institute. Materials and Methods: Forty-eight patients who underwent CDA (2011-2019) with a minimum 2-year follow-up were retrospectively evaluated. The functional outcome included the Visual Analog Score (VAS) and Neck Disability Index (NDI). Radiographs were assessed for range of motion (ROM) at the index surgical level, presence of heterotopic ossification (HO), and adjacent segment degeneration. Results: The mean follow-up was 5.79 ± 2.96 (2.16-11.75) years. Significant improvement (P < 0.05) was observed in the VAS (8.91 ± 2.52 [preoperative] to 0.89 ± 1.27 [follow-up]) and NDI (65.5% ±23.06% [preoperative] to 4.79 ± 3.87 [follow-up]) score. Motion at index level increased significantly from 5.53° preoperatively to 7.47°, and 92% of the implanted segments were still mobile (referring to the threshold of ROM > 3°). HOs are responsible for the fusion of 4/50 (8%) levels at the last follow-up. Distal and proximal adjacent disc degeneration occurred in 36% and 28% of patients, respectively. No migration of the implant was observed on the radiograph. Conclusion: Our study showed favorable clinical outcome of CDA with preservation of ROM at the index surgical level. CDA can be a promising alternative to anterior cervical arthrodesis when properly indicated.
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STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To compare the accuracy of intra-operative navigation-assisted percutaneous pedicle screw insertion between bone fixed and skin fixed dynamic reference frame (DRF) in Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS: Between October 2018 and September 2022, patients who underwent MIS-TLIF were included in this study with DRF fixed either on bone (group B) or skin (group S). Pedicle screws were inserted under the guidance of intra-operative Cone bean Computed tomography (cbCT) based navigation. Accuracy of pedicle screw placement was immediately checked by a final intra-operative cbCT Spin. RESULTS: Among 170 patients, group B included 91 patients and group S included 79 patients. Out of total 680 screws, 364 screws (group B) and 316 screws (group S) were placed. Patient's demographic data and distribution of screws showed no statistically significant difference. The accuracy showed no significant difference between both the groups (94.5% in group B and 94.3% in group S). CONCLUSION: Skin fixed DRF can serve as an alternate way for placement and avoids extra incision with similar accuracy in pedicle screw insertions with bone fixed DRF using intra-operative CT guided navigation in MIS TLIF.
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Introduction: Tuberculosis (TB) is one of the main diseases impacting humanity. Fifty percent of all the cases of skeletal TB belong to spinal TB (STB), and it is also the most common form of TB. In India, patients usually present late after the onset of neurological symptoms, for which surgical management is essential for recovery. In our study, we have evaluated the outcome of forty patients of STB who underwent posterior decompression and instrumentation. Methods: Forty patients with STB who underwent posterior decompression and instrumentation were reviewed. All cases were followed up for 18 months. The groups were compared by parameters such as improvement in pain, improvement in kyphosis, and neurological recovery. Visual Analog Scale (VAS) score and american spinal cord injury assosciation (ASIA) score are used for the assessment. Results: VAS score was significantly decreased postoperatively (mean: 1.28) as compared to preoperative values (mean: 7.25). Erythrocyte sedimentation rate (ESR) was significantly decreased postoperatively (mean: 30.95) as compared to preoperative values (76.15). Cobb's angle was significantly decreased immediate postoperatively (mean: 7.8) as compared to preoperative values (mean: 24.8). There was no deterioration of neurological symptoms in any of the patients. Conclusion: Surgical intervention in Pott's spine with posterior decompression and stabilization, whenever indicated, gives good improvement in pain, decreases kyphotic deformity, and in most cases, also improves neurology.
RésuméIntroduction: La tuberculose (TB) est l'une des principales maladies affectant l'humanité. Cinquante pour cent de tous les cas de tuberculose squelettique appartiennent à la colonne vertébrale TB (STB), et c'est aussi la forme la plus courante de TB. En Inde, les patients se présentent généralement tardivement après l'apparition des symptômes neurologiques, pour lesquels la prise en charge chirurgicale est essentielle à la guérison. Dans notre étude, nous avons évalué les résultats de quarante patients de STB qui ont subi une décompression et instrumentation. Méthodes: Quarante patients atteints de STB qui ont subi une décompression postérieure et une instrumentation ont été revu. Tous les cas ont été suivis pendant 18 mois. Les groupes ont été comparés par des paramètres tels que l'amélioration de la douleur, l'amélioration de la la cyphose et la récupération neurologique. Le score de l'échelle visuelle analogique (EVA) et le score de l'association américaine des lésions de la moelle épinière (ASIA) sont utilisés pour l'évaluation. Résultats: Le score EVA était significativement diminué en postopératoire (moyenne : 1,28) par rapport aux valeurs préopératoires (moyenne : 7,25). La vitesse de sédimentation des érythrocytes (VS) était significativement diminuée en postopératoire (moyenne : 30,95) par rapport aux valeurs préopératoires (76,15). L'angle de Cobb était significativement diminué en postopératoire immédiat (moyenne : 7,8) par rapport aux valeurs préopératoires (moyenne : 24,8). Il n'y avait pas détérioration des symptômes neurologiques chez l'un des patients. Conclusion: Intervention chirurgicale dans le rachis de Pott avec décompression postérieure et la stabilisation, chaque fois qu'elle est indiquée, améliore la douleur, diminue la déformation cyphotique et, dans la plupart des cas, améliore également la neurologie.