Cervical Schwannoma camouflaged by cervical intervertebral disc prolapse-A case report.

INTRODUCTION: Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies. CASE REPORT: We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging. CONCLUSION: Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.

Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study.

STUDY DESIGN: Retrospective single-center study. PURPOSE: This study aims to evaluate perioperative and intermediate-term clinical outcomes of patients undergoing different lumbar fusion techniques. OVERVIEW OF LITERATURE: Various open and minimally invasive techniques for lumbar fusion are available, but previous studies comparing lumbar fusion techniques have heterogeneous data, making interpretation challenging. METHODS: Between 2011 and 2018, data from 447 consecutive patients undergoing one/two-level lumbar fusion were analyzed. Posterior lumbar interbody fusion (PLIF) with bilateral muscle strip or Wiltse approach, open transforaminal lumbar interbody fusion (TLIF) and minimally invasive TLIF, and posterolateral fusion only were among the surgical techniques used. Core outcomes measure index (COMI) questionnaires were distributed before surgery and at 3 months, 1 year, and 2 years postoperatively to establish patient selfreported outcome measures. Demographic data (age, gender, and body mass index [BMI]) for each patient were also collected in addition to surgical indication, previous operative history, perioperative outcomes, and complications, and whether later revision surgery was required. Pearson's chi-square test, Kruskal-Wallis test, repeated measure mixed-effects models, and ordinal logistic regression were used for statistical analysis. RESULTS: Postoperative COMI scores improved across all procedures compared with pre-surgery (p<0.001). There was no significant difference between different postoperative COMI scores. Significant predictors of higher postoperative COMI score included higher pretreatment COMI score (p≤0.001), previous surgery (p≤0.04), younger age (p≤0.05), higher BMI (p≤0.005), and the indications of lytic spondylolisthesis (p=0.02) and degenerative disc disease (p<0.001). Patients undergoing minimally invasive TLIF had a significantly shorter post-surgery stay than patients undergoing open PLIF (Kruskal-Wallis test, p=0.03). CONCLUSIONS: At 2 years postoperatively, there was no significant difference in clinical outcomes between open and minimally invasive techniques. These findings suggest that the main determinant of surgical approach should be surgeon preference and training.

Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating.

The emphasis of surgical correction in adolescent idiopathic scoliosis (AIS) has been given to coronal plane correction of deformity without addressing the sagittal plane thoracic hypokyphosis. Thoracic hypokyphosis has been implicated in cervical malalignment, increased incidence of proximal and distal junctional kyphosis, spinopelvic incongruence, and increased incidence of low back pain. The surgeon, variability in surgical technique, and difference in rod contouring have been implicated as factors resulting in less-than-adequate restoration of thoracic kyphosis. We hypothesised that predictable correction of hypokyphosis could be achieved by using a reproducible surgical technique with patient-specific rod templating. We describe a technique of correction of AIS with dual differential rod contouring (DDC) using patient-specific rod templating to guide intraoperative rod contouring. The pre- and post-operative radiographs of 61 patients treated using this technique were reviewed to compare correction of hypokyphosis achieved with that predicted. Analysis revealed that we achieved a kyphosis within +/- 5.5 of the predicted value. The majority of patients had a post-operative kyphosis within the optimal range of 20-40 degrees. We concluded that patient-specific rod templating in DDC helps surgeons to consistently achieve sagittal correction in AIS close to a predicted value while achieving a very good coronal plane correction.

Adolescent idiopathic scoliosis : a review of aetiological theories of a multifactorial disease.

Adolescent idiopathic scoliosis (AIS), defined by an age at presentation of 11 to 18 years, has a prevalence of 0.47% and accounts for approximately 90% of all cases of idiopathic scoliosis. Despite decades of research, the exact aetiology of AIS remains unknown. It is becoming evident that it is the result of a complex interplay of genetic, internal, and environmental factors. It has been hypothesized that genetic variants act as the initial trigger that allow epigenetic factors to propagate AIS, which could also explain the wide phenotypic variation in the presentation of the disorder. A better understanding of the underlying aetiological mechanisms could help to establish the diagnosis earlier and allow a more accurate prediction of deformity progression. This, in turn, would prompt imaging and therapeutic intervention at the appropriate time, thereby achieving the best clinical outcome for this group of patients. Cite this article: Bone Joint J 2022;104-B(8):915-921.