Journal of Spine

Lateral recess stenosis (LRS) is a characteristic type of lumbar spinal canal stenosis, with symptoms of nerve root compression. The most common etiology is hypertrophy of the superior articular process. Conventional laminectomy and medial facetectomy are commonly used to treat LRS. This study investigated microendoscopic posterior decompression for the treatment of LRS. Microendoscopic decompression was performed on 28 patients. Computed tomography and magnetic resonance imaging were used to calculate the lateral recess angle and depth. A 16 mm diameter tubular retractor and endoscopic system were used. Unilateral paramedian approaches were performed in all patients. Even using a unilateral paramedian approach, both sides of the nerve roots were decompressed in patients with bilateral radiculopathy. Preand postoperative status was evaluated using the visual analogue scale (VAS). Patient’s mean age was 62.9 years; there was single-level involvement, mostly at L4-5 (85.7%). Intraoperative findings revealed that the most common cause of nerve root compression was hypertrophy of the superior articular process and ligamentum flavum. VAS score improved in all patients following posterior decompression. Pre- and postoperative mean VAS scores were 6.5 and 1.1, respectively (P value < 0.01). No intra- or postoperative complications were observed during a mean follow-up of 10.5 months.

Early complications such as dehiscence, seroma and flap failure requiring revision are a troubling aspect of flap repair surgery for Stage IV pressure ulcers. They increase patient suffering in an already difficult context and place a great burden on the health care provider as well. Reduction or elimination of the dead space between tissue planes has been shown to aid in wound healing in tissue flap procedures involving extensive undermining. In late 2013 we began using a new lysine-based urethane tissue adhesive to hold the tissue planes in approximation, in the belief that this could reduce rates of early complications. To confirm our positive initial impressions we undertook a retrospective study of consecutive cohorts, 22 with adhesive and 28 from an earlier period, with a focus on early (30 day) complications and time to discharge. We documented a 50% reduction in the need for revisions (p=0.186, ns) and an 8 day reduction in average length of stay (p=0.022, significant). This is the first series report of the use of this fixation method in decubitus flap surgery and suggests that this is an approach which merits further evaluation.

Introduction: An audit at our spinal unit in 2006 highlighted the need for a consistent approach to neurological observations in spinal surgery patients. A protocol was therefore introduced for use throughout the hospital. The aim of this audit was to assess compliance with protocol for post-operative neurological observations over the course of two subsequent audits.

Materials and Methods: This was a retrospective audit. Patients selected were those admitted to the spinal unit in May 2006, February 2012 and August 2014. The case notes of 39 patients who had spinal surgery were reviewed against our gold standards on post-operative neurological observations. The mean age of the patients was 46 years (17 years to 80 years). The procedures performed included decompression, fusion, scoliosis correction, discectomy and tumour excision. Each patient’s case notes were examined to identify whether an operation note was produced, whether neurological observations were requested and if so, how frequently and whether this requested was complied with during the post-operative period. The location of the patients was also noted, as well as if any deterioration was reported to a doctor and if they subsequently acted accordingly.

Results: Over the period of three consecutive audits an overall improvement was seen regarding compliance with the standards set out in the protocol.

Conclusion: Clinical audit was used to highlight problems with post-operative monitoring of neurological function in spinal patients; further evaluation and implementation of the recommendations resulted in sustained improvement in delivery of healthcare.

Emphysematous osteomyelitis is rare condition characterised by the presence of intraosseous gas. About 25 such cases have been reported in the literature with only 10 cases involving spine. These infections are commonly seen in elderly morbid patients and are highly fatal. We report a 65 year old female patient with history of sudden onset of back pain and weakness of both the lower limbs with radiological images revealing the features of emphysematous osteomyelitis of L5 vertebra, which was treated with surgical decompression and stabilisation, and post-operative antibiotics. We also review literature to describe the clinical and radiological features for diagnosis and the treatment options available for such infections.

Only 25% of patients with Low Back Pain (LBP) have a clear clinical and radiological evidence of a lumbar spine disease and about 30% of patients surgically treated for LBP develop a Failed Back Surgery Syndrome (FBSS). So in the light of this is necessary to ask some questions: is the origins of the LBP always located in the lumbar spine or are there any other pain generators which can provoke it? Why so many patients operated for lumbar disease develop FBSS? Is the FBSS always related to a failure of the procedure or may it be attributable to other causes? The sacroiliitis is responsible for about ¼ of cases of LBP and FBSS. This is due to the fact that the lumbosacral fusion alters the biomechanics of complex sacrum-pelvis causing a joint overload that ends in a real adjacent segment disease. The LBP is a multifactorial condition in which the pain generator must be carefully studied before planning any therapeutic strategy.

Oligodendrocyte apoptosis is the leading cause of demyelination in the central nervous system after compressed spinal cord injury (CSCI). Curcumin, which belongs to the curcuminoid family, is a phenolic yellow pigment derived from the powdered rhizome of Curcuma longa. It has been proved that curcumin exhibits neuroprotective effects against traumatic spinal cord injury by inhibiting neuronal apoptosis. However, whether curcumin has a protective effect on demyelination after CSCI by inhibiting the apoptosis of oligodendrocytes has not been reported. Therefore this study was designed to investigate whether curcumin has a reparative effect on CSCI-induced demyelination and, if so, how it does so. First, we found that the administration of 100 mg/kg curcumin intraperitoneally (IP) 60 minutes after CSCI at days 1, 3, and 7 could significantly relieve neurological deficits. After staining with osmic acid, we found that the swelling of myelin sheaths in the treated group was milder than that in the vehicle group. The results of luxol fast blue staining also indicated that the number of remaining myelin sheaths was significantly higher in the treated group. Next we detected the expressions of active caspase-3, caspase-12, cytochrome C, and myelin basic protein (MBP) by Western blot. This revealed that the expression of MBP was significantly enhanced in the curcumin-treated group, consistent with the number of remaining myelin sheaths found on luxol fast blue staining. But the expression of caspase-12, cytochrome C, and active caspase-3 was reduced; in addition, double immunofluorescence showed that active caspase-3–positive oligodendrocytes in the treatment group were fewer in number as compared with the vehicle group. These results suggested that curcumin did have a protective effect on demyelination—mainly through its mediating effects on the endoplasmic reticulum–mitochondrial pathway—to significantly reduce the expression of active caspase-3. In this way cucurmin reduced both the apoptosis of oligodendrocytes and demyelination, thus ameliorating the consequences of CSCI.

Mobile intradural tumors are very rare. In most cases, mobile tumors such as nerve sheath tumors or ependymomas are located in the cauda equina. Only few cases of mobile neurinoma have been reported in the cervical and thoracic region. Here we report a rare case of a mobile intradural schwannoma initially located at lower cervical region that had caudal migration on subsequent scan.

This study describes the utilization of spinal manipulation in a case of Adolescent Idiopathic Scoliosis (AIS). A 15- year-old female presented to the clinic with musculoskeletal back pain, and cosmetic concerns regarding progression of her scoliosis. After clinical exam and radiographic studies, an angle of 18° of Idiopathic Dextroconvex Scoliosis of the thoracolumbar spine was recognized, with obvious muscle asymmetry and body deconditioning. Spinal manipulation was utilized as primary interventional procedure for a 6-month period of treatment. Adjunctive therapies for body conditioning, such as therapeutic exercises, and nutritional counselling was suggested. By the end of the treatment plan, the magnitude of the scoliotic curve was reduced by 7°, remaining virtually unnoticeable, and asymptomatic.

Tethered cord syndrome (TCS) or occult spinal dysraphism sequence is a collection of neurological conditions that potentially result from the abnormal fixation of the spinal cord secondary to a developmentally acquired or postoperative pathology. We present a schema for TCS consisting of etiology, embryology, pathophysiology, presentation, and classification in order to facilitate the comprehension and discussion of this complex topic. Our review focuses on closed rather than open spinal dysraphisms because those cases are generally more inconspicuous in presentation and, for that reason, likely to create diagnostic delays that can adversely affect patients.

Introduction: The spino-pelvic complex in humans helps to maintain an upright posture, by balancing the spinal sagittal alignment with the hip joints and pelvic girdle. The extent of how the hip joint may influence the spino-pelvic alignment is not fully understood. Hip joint cam femoro-acetabular impingement is a common source of hip and groin disability in young athletes and has been linked to abnormal joint morphology from repetitive loading of the proximal femoral head abutting against the acetabulum. The aim of this study was to compare the radiological parameters of spino-pelvic sagittal alignment and spinal types according to Roussouly’s classification in relation to hip joint cam femoro-acetabular impingement.

Methods: The sample group (n=102), mean age (17.7 ± 1.4) years, consisted of elite skiers (n=75) and nonathletes (n=27). Hip joints were examined for increased morphological cam deformity, (alpha angle greater than 55o) with Magnetic Resonance Imaging and standing lateral plain radiographs were taken for measurements of the spinopelvic sagittal alignment.

Results: A significant difference was shown in a mixed population (skiers and non-athletes) for an increased Pelvic Tilt angle (13°, SD 10.2) in the presence of morphological hip joint cam deformity compared with participants without cam deformity (8.5°, SD 7.1, P=0.036). Type II Roussouly spines occurred more frequently in skiers in the presence of increased cam (67%) compared with no cam (33%), however, this was not significant (P=0.19). Secondary findings highlighted significant differences shown for the prevalence of cam in a mixed-population for gender; males 60% (n=26) shown to have significantly more cam deformity compared with females 22% (n=10, P=0.001). Similar for height, with taller participants being shown to have significantly more cam deformity >177cm (SD 7.6) compared with no cam deformity <170 cm (SD 7.5, P=0.001).

Conclusion: A significant difference was shown with an increased Pelvic Tilt angle for an age-matched mixedgroup of elite skiers and non-athletes in the presence of increased morphological hip joint cam type femoro-acetabular impingement. Moreover, Elite skiers were shown to have an increased distribution of spinal Type II classification according to Roussouly in the presence of an increased frequency of cam femoro-acetabular impingement.

Background: Spinal fusion and instrumentations are performed in a wide spectrum of spinal disorders including trauma, infections, degenerative deformities and spinal tumors. The application of pedicular screws is often associated with some complications which may be related to the misuse of the device, the surgeon’s skills and/or directly related to the screws themselves.

Aim of the work: was to analyze different types of complications in 240 patients with transpedicular screw and rod fixation for non-traumatic lumbar spondylolithesis with follow up period up to three years.

Methods: This retrospective study included 240 patients (160 females and 80 males with F: M ratio 2:1) with age group between 30 to 65 years old (mean age was 47.5) who underwent transpedicular screws and rod fixation for nontraumatic lumbar spondylilthesis in Al-Menoufia University Hospitals between May 2008 and April 2011.

Results: There were 20 patients (8.3%) developed different complications among 240 patients included in the study with higher incidence in males (12 cases of 80 patients) than in females (8 cases among 160 patients).

The most frequent complications reported in our study were related to insufficient surgical skills in 7 cases (35%) that lead to malposition of screws and/or permanent root injury.

Other complications include implant related complications in 6 cases (30%), adjacent level disease in 4 cases (20%) and general complications in 3 cases (15%).

Conclusion: Pedicular screw fixation significantly improved the outcome of spinal reconstruction, but it may be associated with some potential complications which include medical complications, hardware complications and longterm changes of motion segments.

Inflammation plays important roles in the early steps of fracture healing including, the recruitment, expansion, growth and differentiation of mesenchymal stem cells (MSCs), the coordinated interplay of many other cell types, growth factors, and extracellular matrix (ECM) components, as well as the production of cartilage and bone matrix in a temporally controlled manner.

Percutaneous Endoscopic Cervical Discectomy (PECD) has evolved as an efficient and minimally invasive procedure for both contained and non-contained cervical disc herniations in the recent years. With the advent of new working channel endoscopes and instruments design, the PECD is gaining popularity among spine surgeons and is becoming an alternative to the fusion surgery. The insertion of the working channel is the key to PECD which has to be placed very meticulously without injuring the vital structure in the neck anteriorly. We wish to present a technical report and brief discussion about the new instruments design and procedure that will enhance the safety measures in PECD.