case new srvertebroplasty procedure 3rd ganga operative spine course 2013 notes surgeon: ganga spine...

Surgeon: Dr Munish GuptaProfessor &Co-Director of Spine CentreChief of Orthopaedic Spinal Disorders ServiceUniversity of California, USA

Patient details

Ganga HospitalCoimbatore

Case 01

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neuromuscular scoliosis Patient is ambulatory, but has residual weakness of the

lower limbs due to polio. Operated in 2002 through an all posterior approach instrumentation Status - progressive deformity and implant failure

42 year old male patient with history of postpolio residual paralysis &

Left Neuromuscular scoliosis with broken implantDiagnosis

Spinal osteotomy, posterior corrective instrumentation & spinopelvic fixation

Procedure

3rd GANGA OPERATIVE SPINE COURSE 2013

Cobb angle: 80 degrees of scoliosis & 74 degrees of kyphosisPelvic obliquity: 20 degrees,

Notes

Surgeon: Dr Manabu ItoProfessor, Department of Advanced Medicine for Spine and Spinal Cord DisordersHokkaido University Graduate School of MedicineSapporo, Japan

Patient details


Case 02

48 years old male with complaints of difficulty in walking and loss of manual dexterity since 6 months Unstable gait& myelopathy hand signs positive Non dermatomal sensory deficit in bilateral hand Motor power is normal Exaggerated deep tendon reflexes

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C3-4 cervical spodylotic myelopathy NURICK grade IV.

Diagnosis

Muscle sparing laminoplastyProcedure


Notes

C3-4 spodylotic myelopathy

Surgeon: Dr Daniel RiewProfessor of Neurological SurgeryChief, Cervical Spine Surgery Director, Ortho & Rehab Institute for Cervical Spine SurgeryWashington University School of MedicineSt. Louis, USA

Patient details


Case 03

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C7 sensory blunting present Motor power is normal

31 years old female with neck pain and right C7 radiculopathy

C 6 -7 Disc Prolapse with right radiculopathy

Diagnosis

Cervical Disc ReplacementProcedure


Notes

C 6 -7 Disc Prolapse

Surgeon:

Ganga Spine team

Patient details


Case 04

Low back pain radiating to left lower limb – 6 weeksStraight leg raise test - 40 degrees in left side Neurology: Sensation - decreased in S1 dermatome, Power - Normal

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L5 S1 Disc Prolapse with left radiculopathy

Diagnosis

L5 S1 Microdiscectomy (ligamentum flavum flap technique)Procedure


Notes

L5 S1 Disc Prolapse

Patient details


Case 05

Low back pain radiating to the left lower limb for 1 monthSymptoms along the left L5 nerve root Normal power Decreased sensation in the left L5 dermatome

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L4-5 stenosis (left more than right)Diagnosis

L4-5 micro decompression and contralateral over the top decompression Procedure


Notes Surgeon: Ganga Spine teamGanga Hospital Coimbatore

L4-5 discogenic stenosis

Patient details


Case 06

Low back pain radiating to the right lower limb for 6 monthsSymptoms along the right L5 nerve root Normal power Decreased sensation in the right L5 dermatome No nerve root tension signs

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L4-5 discogenic stenosis

Diagnosis

L4-5 limited internal microdecompressionProcedure



L4-5 stenosis

Surgeon: Dr. Samir DalvieConsultant Spine SurgeonBombay Hospital Mumbai

Patient details


Case 07

43 years male with low back pain for 5years Radiating to both lower limb Claudication distance ~ 100mts Normal Neurology

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L4-L5 Degenerative Spondylolistheis Grade 1

Diagnosis

L4 L5 Fusion & decompressionProcedure

L4-L5 stenosis and listhesis


Notes

Surgeon:Dr Neel AnandDirector, Orthopaedic Spine Surgery, MinimallyInvasive Spine SurgerySpine Center, Cedars Sinai Medical CenterLos Angeles, USA

Patient details


Case 08

68 years old male with low back pain since 5 years. Instability type back pain Neurology is normal

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L4 – L5 Lytic Grade I Listhesis

Diagnosis

MIS TLIF L 4 - 5

Procedure


Notes

L4 – L5 Lytic Grade I Listhesis

Surgeon: Dr Yang HaiProfessor and chairman, orthopaedic surgery departmentBeijing Chaoyang Hospital,Capital Medical University of China

Case 09

40 years old female with progressive deformity of the back with mid back pain since 3 years History of conservatively treated traumatic L1 fracture 3 years ago Neurology is normal

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Pedicle Subtraction Osteotomy with posterior instrumented correction


Kyphosis: 77 degrees

Progressive post traumatic thoraco-lumbar kyphosis

Patient details


Diagnosis

Procedure

Notes

Patient details


Case 10

68 year old male with history of sustaining injury to back two months ago

Treated conservatively but now presents with instability back painNormal neurology

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T11 pseudoarthrosis

Diagnosis

Vertebroplasty

Procedure



T11 pseudoarthrosis

Patient details


Case 11

Patient diagnosed to have spinal tuberculosis 5 years ago for which she took anti-tuberculous treatment for 6 months

Presented to us with upper back pain and progressive spinal deformity for 2 years

T4 knuckle deformity, Tenderness +, no myelopathic features

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Post- Tubercular Kyphotic Deformity

Diagnosis

Posterior Closing Opening Wedge Osteotomy

Procedure


Kyphotic angle T2 – T4 - 60 degrees

Notes SurgeonDr. S. RajasekaranConsultant Orthopaedic and Spine SurgeonGANGA HOSPITALCOIMBATORE

Surgeon: Dr Yang HaiProfessor and chairman, orthopaedic surgery departmentBeijing Chaoyang Hospital,Capital Medical University of China

Patient details


Case 12

Known case of Arnold Chiari Malformation & operated for Foramen Magnum Decompression in 2012 Normal neurology

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23 years old male with progressive deformity of back since 5 years

Left Thoracolumbar rigid Kypho Scoliosis

Diagnosis

All Posterior Corrective Instrumentation with Ponte’s Osteotomies.

Procedure


Cobb’s angle: 87 degrees correcting to 69 degrees in the bending films, Kyphosis - 74 degrees

Notes

Surgeon: Dr. Saumyajit BasuConsultant Spine SurgeonPark Hospital, Kolkatta

Patient details


Case 13

Symptoms along the C6 dermatome Neurology – right C6 – 3/5, decreased sensation in right C6 dermatome No myelopathic features

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59 year old male, neck pain radiating to left arm – 1 month

C5-C6 Disc Prolapse with left RadiculopathyDiagnosis

ACDF C5-C6

Procedure


Notes

C5-C6 Disc Prolapse

Surgeon: Dr. G. BALAMURALI Consultant Neuro -Spine SurgeonGANGA HOSPITALCOIMBATORE

Patient details


Case 14

pain with numbness of hand Tenderness over paraspinal region Neurology – left C7- 3/5, C8/T1 – 4/5 , No myelopathic signs

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38year old male, neck pain for 2 months, left radicular

C6 – C7 Disc Prolapse with left radiculopathy

Diagnosis

C6-7 LaminoForaminotomy (MIS)Procedure


Notes

C6 – C7 Disc Prolapse

Surgeon: Dr. Abhay NeneConsultant spine surgeonMumbai

Patient details


Case 15

both hands since 18 months Stiffness of both legs and housebound for last 8 months Neck movements are restricted, myelopathic hands signs are positive exaggerated deep tendon reflexes and extensor planters

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46 years male with difficulty in walking, difficulty in using

Cervical myelopathy Nurick Grade IV secondary to C3 – 6 OPLL Diagnosis

Laminectomy and lateral mass screw fixationProcedure


Notes

Cervical myelopathy due to C3 – 6 OPLL

Surgeon: Dr. Shankar AcharyaConsultant Spine SurgeonSir Gangaram HospitalNew Delhi

Patient details


Case 16

of hands - 3 months Tandem gait not possible, broad based myelopathic gait Myelopathic hand signs present, Exaggerated reflexes

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46 year old male with difficulty in walking and clumsiness

Cervical Spondylotic Myelopathy Nurick Grade 4Diagnosis

Cervical Laminoplasty C3-6Procedure


Notes

Cervical Spondylotic Myelopathy

Surgeon: Dr Sajan HedgeConsultant Spine SurgeonApollo HospitalsChennai

Patient details


Case 17

Syndromic features with high arched palate, pes excavatum, ligament laxity Neurology normal except right L5 – 3/5

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12 year old girl with low back pain and bilateral leg pain

L5 S1 Dysplastic SpondylolisthesisDiagnosis

L5 S1 reduction and interbody FusionProcedure


Slip angle 66 degrees, pelvic incidence 35 degrees, pelvic tilt 21 degrees, sacral slope 14 degrees

Notes

Surgeon: Dr Daniel RiewChief, Cervical Spine Surgery Professor of Neurological SurgeryDirector, Ortho & Rehab Institute for Cervical Spine SurgeryWashington University School of MedicineSt. Louis, USA

Patient details


Case 18

both hand since 3 years Normal gait, Hoffman sign positive, positiveInverted radial reflex Brisk tendon reflexes Neurology is normal except for C 8, T1 – 4/5

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46 years male with bilateral hand numbness and difficulty in using

Os Odontoideum - instability with Nurick grade II Myelopathy

Diagnosis

Occipito Cervical fusionProcedure


Notes

Os Odontoideum

Surgeon: Dr German OchoaHead, Spine Unit and Pain Treatment, Orthopaedic and Traumatology, Education Committee Chairman, AOSpine International BoardColombia

Patient details


Case 19

History of fall from height 5 months back Neurology is normal Kyphotic deformity at thoracolumbar junction

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63 years old male with mid back pain since 5 months

5 months old L1 fracture with Post Traumatic Kyphosis

Posterior Corrective Instrumentation with StentoplastyProcedure


Notes

Diagnosis

Kyphotic angle – 49 degrees

Surgeon: Dr. Shekar BhojarajConsultant Spine SurgeonLilavati Hospital MUMBAI

Patient details


Case 20

Gradually increasing Right thoracic scoliosis, Right shoulder high, level pelvis,

No limb length discrepency Coronal imbalance and truncal shift to right side Neurology – normal , No cord anomalies

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Deformity in back noticed 2 yrs back

Neglected Adolescent Idiopathic Right thoracic Scoliosis

Diagnosis

Anterior soft tissue release

Procedure


Notes

Cobb angle: 84 degrees correcting to 59 degrees in right bending films

Surgeon: Dr Munish GuptaProfessor &Co-Director of Spine CenterChief of Orthopaedic Spinal Disorders ServiceUniversity of California, USA

Patient details


Case 21

Known case of Ankylosing Spondylitis Rounded kyphotic deformity with forward stoop(sagittal imbalance)

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46 years old male with deformity of the back since 6 years

Ankylosing Spondylitis with sagittal imbalance

Diagnosis

Pedicle Subtraction Osteotomy

Procedure


T1-12 Thoracic Kyphosis:79 Degrees. Lumbar kyphosis: – 5 Degrees.

Notes

Patient details


Case 22

Neurology – Normal MRI – No spinal cord anomalies

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22 year old male,deformity of the back since 6years

Neglected Right Thoraco Lumbar Scoliosis

Diagnosis

Anterior soft tissue releaseProcedure


Cobb angle 82 degrees correcting to 50 degrees

Surgeon: Dr. Aravind JayswalConsultant Spine SurgeonAIIMS, NEW DELHI

Notes

Surgeon: Dr Neel AnandDirector, Orthopaedic Spine Surgery, MinimallyInvasive Spine SurgerySpine Canter, Cedars Sinai Medical CanterLos Angeles, USA

Patient details


Case 23

Operated for left knee arthrodesis 13 years ago Neurology is normal

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73 years old female with Low Back Pain with right radiculopathy

L 3 – 4 instability

Diagnosis

DLIF L 3 - 4Procedure


Notes

Degenerative scoliosis with right L4 radiculopathy

Surgeon: Dr Daniel RiewProfessor of Neurological SurgeryChief, Cervical Spine Surgery Director, Ortho & Rehab Institute for Cervical Spine SurgeryWashington University School of MedicineSt. Louis, USA

Patient details


Case 24

numbness in both hand since 3 months Myelopathic hand signs are positive, planter reflex is extensor

and exaggerated deep tendon reflexes.

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48 years old male with imbalance while walking and

Cervical Myelopathy secondary to C 3-4, C 4-5 disc prolapse

Diagnosis

Cervical Corpectomy C4 and C3-5 fusionProcedure


Notes

Surgeon: Dr Manabu ItoProfessor, Department of Advanced Medicine for Spine and Spinal Cord DisordersHokkaido University Graduate School of MedicineSapporo, Japan

Patient details


Case 25

Progressively increasing deformity Neurology is normal, no sagittal or coronal imbalance Risser’s sign – 4

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15 years old female with Deformity of back noticed since 2 years

Right thoracic Adolescent Idiopathic scoliosis

Diagnosis

Posterior instrumented correction with Double Rod Rotation Manoeuvre

Procedure


Notes

Cobb’s angle: T4 - T11 – 74 degrees corrected to 54 in bending film T12 - L4 - 42 degrees corrected to 32 in bending film

Surgeon: Dr Norbert PassutiProfessor of Spine SurgeryNantes, France

Patient details


Case 26

2 years and low back pain since 2 months. Walks with forward stoop Neurology is normal

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75 years old female with Deformity of back since

Right Lumbar degenerative scoliosis with sagittal imbalance

Diagnosis

Posterior Corrective Instrumentation with PSO & iliac fixationProcedure


Notes

Lumbar degenerative scoliosis

Patient details


Case 27

Decreased sensation over both lower limbs Difficulty in micturition; constipation (+) Sensation decreased below T12 Power Grade 3 to 4 below L2 with brisk reflexes and clonus

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36 year old female with history of difficulty in walking for 2 months

T10 tuberculosis with local kyphosis and neurological deficit

Diagnosis

Posterior decompression and stabilisation with posterior column shortening

Procedure



T10 tuberculosis with local kyphosis

Surgeon: Dr. Ajoy Prasad ShettyConsultant Spine SurgeonGANGA HOSPITALCOIMBATORE

Patient details


Case 28

History of weight loss,loss of appetite Tenderness over mid dorsal region, para spinal muscle spasm present Normal power, Myelopathic with gait disturbances

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18 year old female with mid back pain – 5 months

Diagnosis –Spinal tuberculosis from T4-T9 with early myelopathy

Diagnosis

Posterior Instrumented Stabilisation and decompressionProcedure


Notes

Thoracic Spinal tuberculosis

Surgeon: Dr. G. BALAMURALI Consultant Neuro-Spine SurgeonGANGA HOSPITALCOIMBATORE

Patient details


Case 29

Numbness in the left hand Neurology normal No myelopathic features

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46 year old female with neck pain radiating to left upper limb – 6 months

C1 C2 IntraduralExtramedullary tumour

Diagnosis

C1 - C2 IDEM Tumour excisionProcedure


Notes

C1- C2 Intradural Extramedullary tumour

case new srvertebroplasty procedure 3rd ganga operative spine course 2013 notes surgeon: ganga spine...

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