The ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy (TM) and most often occurs among East Asian countries such as Japan, Korea, and China. It is rare in other ethnic groups and in individuals below the age of 50 years. It is most often described at the lower thoracic level, being uncommon in the lumbar region and rare in the cervical region. Here, we present the case of a 48-year-old male patient who came to medical attention with a 2-month history of paresthesia of the lower limbs and progressive difficulty in walking. The clinical profile, together with computed tomography and nuclear magnetic resonance imaging of the spine, led to a diagnosis of compressive TM due to OLF in the thoracic spine. The patient underwent endoscopic over-the-top dorsal decompression and resection of the affected ligamentum flavum, without any intraoperative complications. After surgery, the patient had progressed favorably, having no sensory complaints and again becoming ambulatory.
Limited dorsal myeloschisis (LDM) is a rare form of spinal dysraphism characterized by two constant features: a focal “closed” midline skin defect and a fibro-neural tract connecting the skin lesion to the underlying spinal cord. Excision of the tract followed by reconstruction is the preferred management. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development. A 7-day-old male baby presented with a history of dorsal “cigarette burn” skin lesion noted at birth. Clinical assessment and imaging findings revealed a fibro-neural tract extending from the skin surface into the lumbar spinal canal at the level of L5-S1. Excision of skin lesion/tract and untethering of filum terminale with dural tube reconstruction under Intraoperative neurophysiological monitoring (IONM) was performed. The procedure went smoothly. Postoperatively, the child showed no neurological compromise or dermatological complications. In addition, the wound healed well, and the neonate was completely normal. This case demonstrates the successful management of LDM through an IONM-guided complex reconstruction surgery in a neonate and the effective use of IONM in such challenging cases.
Neuroenteric cysts (NCs) of the spinal cord are rare benign tumors which can progressively lead to cord compression and associated features such as parasthesia, weakness, and paralysis. The below-mentioned case discusses about a 39-year-old female patient with NC at the level of C6, C7, and D1 diagnosed on magnetic resonance imaging, followed by surgical excision of the tumor. Histopathology reports suggested NC. Following the surgery, the patient showed significant improvement in neurological symptoms within a week. This case report emphasizes on the importance of clinical examination, radiological examination, and surgical management with appropriate follow-up for NC.
Large intraspinal tumor with significant extra-spinal extension is rare entities, posing considerable surgical challenges. This was the case of an exceptionally large lumbar intraspinal tumor with retroperitoneal extension, highlighting the surgical management and favorable patient outcome. A 56-year-old female presented with lower back pain. Clinical examination revealed no focal neurological deficit or peripheral neurovascular deficits. Imaging revealed an extensive lumbar intraspinal tumor extending into the retroperitoneal space, measuring approximately 14 cm × 15 cm × 18 cm. The tumor occupied the spinal canal from D12 to L2 and extended laterally and anteriorly into the retroperitoneum, compressing adjacent structures. The patient underwent a complex surgical procedure involving collaboration between neurosurgeon, cardiothoracic surgeon, and urosurgeon. Gross total resection of the tumor was achieved. Histopathological analysis revealed Grade 1 schwannoma. Postoperatively, the patient experienced significant relief of preoperative symptoms. Importantly, there was no evidence of new neurological deficits or power loss. The patient was discharged home and has remained neurologically intact at follow-up. The surgical approach should be carefully planned to minimize the complications and achieve complete tumor removal. Postoperative care and long-term follow-up are crucial to ensure favorable outcomes and prevent recurrence.
Lumbar interbody fusion (LIF), either by open or minimally invasive tubular surgery, is the usual treatment for degenerative lumbar disease. It requires a relatively long recovery period. The various interbody fusion methods described have their advantages and disadvantages. Endoscopic LIF using our novel Asian Spine Hospital En bloc Resection of Facet technique described here offers advantages by being the least invasive, safe, and offers direct decompression of pathology under clear endoscopic vision, and uses autograft for interbody fusion. We intend to describe here the technique of endoscopic transformational lumbar fusion routinely done in our hospital. This technique is safe and effective for interbody fusion with excellent decompression of neural elements.
This case report presents a 74-year-old male with back pain and difficulty walking, initially suggestive of metastatic lesions. Radiographic and positron emission tomography scan findings raised suspicions, leading to surgical intervention for biopsy. Unexpectedly, histopathological examination, gene expert, and culture analysis revealed spinal tuberculosis (TB), highlighting the deceptive nature of TB and its potential to mimic other pathologies. The case underscores the importance of maintaining a high index of suspicion for TB, especially in endemic regions like India, where atypical presentations are common. Comprehensive evaluation, including biopsy, culture, and genetic testing, remains crucial for accurate diagnosis and timely initiation of appropriate treatment, as demonstrated in this case. Through this report, we emphasize the need for vigilance in considering TB in the differential diagnosis of spinal lesions, ultimately improving patient outcomes through prompt diagnosis and management.
C1-C2 fixation is a commonly performed procedure for treating cervical spine instabilities, such as Atlanto-axial dislocation (AAD). Although it is generally safe, it can be associated with rare complications, including vertebral artery (VA) injury, which may lead to pseudoaneurysm formation. This case report describes a 12-year-old child who presented with neck pain and was diagnosed with AAD with Basilar invagination. The patient underwent C1-C2 fixation and the post-op hospital stay was uneventful and the patient was discharged. Patient presented again 4 months later with difficulty walking and hand grip weakness. Imaging revealed a VA pseudoaneurysm at the site of left C1 screw placement. The patient was successfully treated with endovascular intervention with flow diverter, leading to clinical improvement. The case highlights the importance of preoperative vascular anatomy assessment, the potential complications of VA injury, and the effectiveness of endovascular management in treating such complications.
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is an uncommon, benign fibro-osseous lesion that can occur anywhere within the central nervous system. First described in 1978 by Rhodes and Davis, CAPNON has approximately 80 reported cases involving the spinal cord. This paper aims to summarize the key histological, radiological, and clinical features of CAPNON, discuss its potential pathogenesis, and report our first case of spinal CAPNON treated at our institute.
Background and Objective: Spinal arachnoid cysts (SACs) is an uncommon entity with ambiguous explanations for origin, diagnostic dilemma and surgical management of choice till date. Surgery is recommended in patients with evident neurological symptomatology or gradual progression of symptoms. In the current case series, we analyze the strategies to improve the surgical outcome of SACs. Materials and Methods: Twenty three consecutive patients who underwent surgery of all SACs patients between 2005 and 2020 a tertiary referral center, formed the study population. In this ambispective observational study, we report the strategies to improve surgical outcome of patients with SACs Results: The average age of the study population was 37.1 ± 6.81 years with 14 (60.86%) women. The most common symptom at presentation was localized pain in back reported by 12 (52.2%) patients, followed by paraesthesia and pain in 7 (30.4%) and limb weakness and incontinence in two (8.7%) patients each. The mean duration of symptoms was 33.7 months (0.25 to 144). The etiology was history of trauma in three patients; history of spinal injection, congenital SAC or meningocele operation in childhood were reported in one patient each. The most common location of cyst was in the dorsal region (65%), followed by the dorso-lumbar region (17 %), lumbar (13%) and one patient had SAC in lumbosacral region. Three patients underwent laminectomy with marsupialization of cyst and in rest laminoplasty was performed. Cyst was found to be intradural in five patients and extradural in 18 patients. Complete excision of cyst was achieved in 13 patients. Ligation of dural connection was performed if found. Post operatively patient were followed up for an average of 18 months (3 - 135). One patient developed weakness postoperatively. One patient suffered a delayed wound infection and one patient had recurrence and was again operated after 6 months. Conclusion: Surgical exploration with identificaiton of cyst connection in extradural and excision with closure of dural defect in intradural SACs is well tolerated and provides optimal surgical outcome.
Cervicothoracic junction disc herniations are rare. Degeneration at this level is rare due to the distinct biomechanical characteristics between the cervical spine and thoracic spine. In this article, we present three patients with a C7-T1 disc herniation, and we review the literature on this rare disease. We find that most patients present with neck pain, hand grip weakness, and a C8 radiculopathy that mostly resolves with surgery. We review the impact of the unique biomechanics of the area and the length of the neck on the degeneration at the C7-T1 level.
Dear Friends, It is the time to prepare for the Annual Conference of the Neuro Spinal Surgeons Association – ”NSSA Spine 2023” to be held at New Delhi in September that is fast approaching. As usual, we expect a large number of members and neurospinal surgeons from all over India and abroad to join and share knowledge. The best papers and lectures will be peer-reviewed and published in Journal of Spinal Surgery (JOSS). Faculties and presenters are requested to format the articles with JOSS guidelines available in https://journals.lww.com/joss and upload in our website. With all your support and encouragement, JOSS is now upgraded and moved to Wolters Kluwer’s e-journal platform and the full articles are now available online at https://journals.lww.com/joss as well. The journal is registered with the following abstracting partners: Baidu Scholar, China National Knowledge Infrastructure, EBSCO Publishing’s Electronic Databases, Ex Libris – Primo Central, Google Scholar, Hinari, Infotrieve, Netherlands ISSN Centre, ProQuest, TDNet, and Wanfang Data. I must thank all the contributors at this time of transformation. We are also working hard and initiating changes that are needed to take the Journal of Spinal Surgery to new heights. Thanking you Warm regards
A young female in her late 20s presented to us with the inability to move both her lower limbs after being involved in a go-karting accident. On examination, the patient has no power in bilateral lower limbs, the sensation was decreased below D7, and the bowel bladder was involved. The perianal sensations were present and the patient had ASIA B neurology. On investigation, the computed tomography scans revealed a coronal split fracture of the D5 vertebrae without any involvement of the posterior vertebral wall or any canal compromise. There was a subtle facetal subluxation at D5–D6. A magnetic resonance imaging was performed which showed contusion of the cord at D6 vertebral level with edema and possible disruption of the posterior ligamentous complex at D5–D6 level. The patient was operated by posterior decompression with pedicle screw fixation. At the final follow-up, the patients showed neurological recovery with improvement to ASIA D neurology.
