Dr. Saijyot Raut

Background: Andersson lesion (AL), also known as aseptic spondylodiscitis, is a pathological condition characterized by a destructive lesion in the vertebral or discovertebral region. The aim of this study was to assess functional, radiological, and neurological outcome of midline posterior surgery with transfacetal/transpedicular decompression and long-segment instrumentation and fusion in all patients with AL. Materials and Methods: A total of 36 consecutive patients with AL with or without neurodeficit were managed with midline posterior approach with long-segment fixation, decompression and anterior vertebral reconstruction added by same midline approach. The demographic data, visual analogue scale (VAS), modified Oswestry Disability Index (mODI), ankylosing spondylitis quality of life (ASQoL), local and global kyphosis angle, Frankel neurological grade, blood loss, duration of surgery, perioperative complications, and fusion rate were compiled and assessed. Results: The mean age of the patients was 52 years (26 males and 10 females). Among the patients, 9 patients had thoracic, 25 patients had thoracolumbar, and 2 patients had lumbar vertebral involvement. All patients in the study achieved fusion at final follow-up period of 24 months. The mean duration of hospital stay, intraoperative blood loss, and surgery duration was 6.17 days, 252 mL, and 130 min, respectively. VAS improved from mean 7.69 ± 0.98 to 1.67 ± 0.72, mODI from mean 70.28 ± 3.55 to 21.14 ± 2.13, ASQoL from mean 14.22 ± 1.59 to 7.17 ± 1.25, local kyphosis from 23.61 ± 1.67 to 18.52 ± 1.05, and global kyphosis from 57.02 ± 0.72 to 36.16 ± 1.23, leading to better sagittal balance. Except two patients all had full neurological recovery. Conclusions: Posterior midline approach with long-segment instrumentation and anterior decompression by transpedicular/transfacetal approach and bone grafting with selective use of cages can give satisfactory results with excellent fusion rates and good functional outcomes.

Study Design: Retrospective analysis of prospectively collected data. Objective: To assess functional outcome of patients irrespective of timing of surgical intervention in cases with cauda equina syndrome. Background: Cauda equina syndrome (CES) is a spinal emergency requiring immediate surgical intervention. CES presents with constellation of symptoms like saddle anaesthesia, bladder or bowel dysfunction, sexual dysfunction, lower limb motor power loss having deep socioeconomic consequences on part of patients and medicolegal consequences on part of clinicians. Methodology: 40 patients data were collected and compiled retrospectively. Demographic data, Surgical data, Functional data in the form of bladder, bowel, sexual and motor power recovery were collected at 3 weeks, 6 months , 12 months follow-up and analysed based on Urinary symptom prole score, Neurogenic bowel dysfunction score, Arizona sexual experience scale, Medical Research Council grading respectively. Results: Though early presentation by the patient and emergent surgical intervention by clinician does play a decisive role in full and faster recovery of symptoms but our study suggests that even when patients presented with delay at our outpatient department and surgery was done on emergency basis, desired outcome was achieved in maximum number of cases presenting with incomplete CES.

Background : Spinal anaesthesia carries the advantage of having rapid onset, lesser blood loss, early recovery and hospital stay as compared to general anaesthesia. The present study evaluated outcomes of awake spinal fusion i.e., minimal invasive single level transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anaesthesia. Current study is a retrospective analysis of prospectively collected data carried to assess patient related outcome benefits for a single level transforaminal lumbar interbody fusion done under spinal anaesthesia. Methods : Patients who fit deemed criteria not responding to 6 weeks of conservative treatment to lumbar degenerative pathologies underwent MIS-TLIF. The demographic data, visual analogue pain scale (VAS), Oswestry disability index (ODI), blood loss, time from entering operation theatre to time of incision, time of bandaging to exit from operation theatre, time of stay in post anaesthesia care unit (PACU), duration of surgery, nausea/vomiting, urinary retention, requirement of analgesics, duration of stay in hospital, peri-operative complications, fusion rate and satisfaction score were compiled and assessed. Results: 150 patients were operated with MISTLIF under spinal anaesthesia. VAS and ODI score improved significantly at final follow up (p<0.05). The mean duration of surgery was 148±18.24 minutes and blood loss were 109.64±110.45 ml. The average time from entering OT to incision and bandaging to exit was respectively 27.32±8.44 and 6.43±3.28 minutes. Mean PACU time was 36.74±6.32 minutes while duration of stay averaged 1.58±0.67 days. Post operative analgesia requirement was in 10.6% patients and radiographic fusion was observed in 96.6% patients. 90.6% patients were fully satisfied with spinal anaesthesia. Conclusions: Awake spinal fusion should be considered as a novel surgical approach with newer minimal invasive surgical techniques and regional anaesthesia to improve patient satisfaction and overall surgical outcome.

Objective:To study theincidence, risk factors, surgical outcomes of accidental durotomies (ADT)in patients of microendoscopic lumbar decompression surgeries (MLDS) and the postoperativepatientmobilizationprotocol. Methods:Atotalof550patientswhounderwentMLDSfromJanuary2012tomarch2020un- dersinglesurgeonandsingleinstitutewereincludedinthestudyandincidenceofADTriskfac- torslikeage,BMI,smokingstatus,diabetesmellitus,surgeon’sexperiencewerestudiedforthesamean dearlymobilizationprotocolforallthepatientswasfollowed. Results:Age>60years(p=0.0062),bilateraldecompressionwithunilateralapproach,sur- geons experience in the first3 years over next 5 years (p = 0.037) were the statistically signifi- cantriskfactorsforincreasedincidenceofADT.MostoftheADTweresmallwhichdidnotre- quireprimaryrepairandmanagedwithsealantslikegelfoamandfibringlue.Postoperativere- coveryinJOAandODIscoresinbothADTandnonADTcohortsweresame. Conclusion:MISShaslowincidenceofADTandage>60yearsandsurgicaltechniqueofbilat- eraldecompressionwithunilateralapproachandsurgeonsexpertisearethesignificantriskfac-tors. MISS also has less risk of CSF leak symptoms and pseudomeningocele formation becauseoflimiteddeadspaceformationinthesofttissuewhichhelpsinearlypostoperativemobiliza- tionandreducesthedurationofhospitalstay. Key Words:Accidental durotomy, Microendoscopic disectomy, Gelfoam, Cerebrospinal fluidleak,Surgeonsexperience