Adult idiopathic lumbar scoliosis: Analysis of surgical treatment in 14 patients by "only fixation".

Objective: The authors report their experience with 14 cases having adult idiopathic lumbar scoliosis (AIDLS) and presenting with the predominant symptoms of claudication pain in the low back and legs. The patients were treated by only multisegmental stabilization, and the surgical procedure aimed for arthrodesis without any form of bone or soft-tissue decompression. The clinical outcome of this novel form of surgical treatment is presented.

Atlantoaxial Instability as a Cause of Craniovertebral and Cervical Spinal Alterations and Dorsal Kyphoscoliosis.

Background: Musculoskeletal and neural alterations secondary to chronic atlantoaxial instability are evaluated.

Case Description: An 11-year-old girl presented with major symptoms of progressively worsening dorsal kyphoscoliosis (spinal kyphoscoliosis [SKS]). In addition to dorsal SKS, investigations revealed multiple craniovertebral and cervical spinal musculoskeletal abnormalities, Chiari formation, and syringomyelia.

"Interdural" Surgical Strategy for Lower Cranial Nerve Neurinomas-A Report of 14 Cases.

Objective: We describe the dural relationships and its surgical implications for large lower cranial nerve (CN) neurinomas. The study is based on surgical experience with 14 cases.

Methods: During the period January 2014 to December 2019, 14 consecutive cases with large lower CN neurinomas were surgically treated with the aim of radical tumor resection.

Supracerebellar Approach for Clival Chordomas: Technical Note.

Background: The conventional retrosigmoid and lateral supracerebellar approach was used for surgery in 5 select cases of large chordomas.

Methods: Patients were treated during 2011 and 2019. Location of the tumor in the depth from surface, wide tumor extensions, and intimate relationships with critical neural and vascular lesions made the approach selection a formidable challenge.

Mobilization of the high-riding vertebral artery for C2 screw insertion.

The basic surgical steps in the Goel technique of atlantoaxial fixation involve exposure of the atlantoaxial articulation, denuding of the articular cartilage, stuffing of bone graft pieces within the articular cavity, and subsequent instrumentation. "High-riding" vertebral artery in relationship to the pedicle-facet of C2 has been widely recognized to be a factor that makes insertion of the C2 pedicle-facet screw difficult or impossible. In this video, a technique of exposure and mobilization of the high-riding vertebral artery to permit safe C2 screw insertion is shown.

Chiari 1 Formation Redefined-Clinical and Radiographic Observations in 388 Surgically Treated Patients.

Objective: The subject of Chiari formation is revisited and redefined. Results of surgical treatment of patients with Chiari formation by atlantoaxial fixation are presented.

Methods: Results were analyzed of 388 patients with Chiari formation surgically treated during 2010 to June 2019.

Is C2-3 fusion an evidence of atlantoaxial instability? An analysis based on surgical treatment of seven patients.

Objective: The authors analyze the rationale of atlantoaxial fixation in patients presenting with symptoms related to cervical myelopathy and wherein the radiological images depicted C2-3 fusion and presence of single or multiple level neural compression of the subaxial cervical spinal cord attributed to "degenerative" spine.

Materials And Methods: Seven adult males were analyzed who presented with long-standing symptoms of progressive cervical myelopathy and where imaging showed presence of C2-3 fusion, no cord compression related to odontoid process, and evidence of single or multiple level lower cervical cord compression conventionally attributed to spinal degeneration. There was no other bone or soft tissue abnormality at the craniovertebral junction.

Ossified Anterior Foramen Magnum Meningioma: Report of Long-Term Surgical Outcome.

Background: Technical surgery-related issues for large ossified/calcified meningioma that encased one or both vertebral arteries located anterior to brainstem in the region of foramen magnum are discussed. Relatively long-term outcome of successful surgery is reported.

Case Description: Three women were operated on for symptoms of progressive quadriparesis.

Tethered cord and Chiari formation: Analysis of treatment in a relatively rare clinical situation.

A 32-year-old male patient was operated for tethered cord associated with spinal lipoma. Further investigations showed the presence of basilar invagination, Chiari formation, and extensive syringomyelia. His neurological symptoms continued to worsen after the surgery, and over a 3-year period, he developed spastic quadriparesis and urinary retention and constipation.

Lumbar radiculopathy: Outcome analysis following treatment by only fixation - A report of an early experience of 44 cases.

Objective: An alternative novel form of surgical treatment for patients having prolapsed or bulging intervertebral disc, with or without associated osteophyte, related lumbar radiculopathy by "only fixation" or internal orthosis and aiming for segmental arthrodesis is presented.

Materials And Methods: During the period July 2014-October 2018, 44 patients presenting with symptoms of lumbar radiculopathy and diagnosed to have bulging, prolapsed or herniated lumbar intervertebral disc with or without associated osteophytes were treated by only spinal stabilization without resorting to any kind of bone, ligaments, osteophyte, or disc resection.

Results: All patients had "immediate" postoperative relief from radicular symptoms.

Brainstem Anatomy: A Study on the Basis of the Pattern of Fiber Organization.

Objective: A focused dissection of the brainstem was performed to study the various fiber bundles and gray matter nuclei of the brainstem and to decipher the intricate anatomy.

Methods: Ten formalin-fixed cadaveric human brains were procured. The fiber dissection techniques described by Klingler were then adopted to study the anatomy.

Os Odontoideum: Analysis of 190 Surgically Treated Cases.

Objective: The aim of this study was to report an experience with 190 cases of os odontoideum over 20 years. The management outcome following atlantoaxial fixation was analyzed.

Methods: From January 2000 to September 2018, 190 patients with os odontoideum were surgically treated.

Computed Tomography-based Analysis of Tibial Tuberosity-Trochlear Groove Distance in Indian Population.

Aim To study the tibial tuberosity-trochlear groove distance (TT-TG) in normal Indian population and the variation of the same in relation to tibial size using computed tomography (CT) of knee. Methods CT of 100 knees (62 males and 38 females) were assessed. TT-TG distance and maximal medio-lateral (MML) distance of tibia was measured on axial CT scans.

Atlantoaxial fixation for craniovertebral anomaly associated with absent posterior elements of the axial vertebra: report of 3 cases.

This is a report of 3 relatively rare clinical cases in which the absence of posterior elements of the axis was associated with basilar invagination and multiple other craniovertebral junction musculoskeletal and neural abnormalities. Atlantoaxial fixation resulted in remarkable clinical recovery in all 3 cases. C2-3 fixation was not done, and bone decompression was not done.

A Review of a New Clinical Entity of 'Central Atlantoaxial Instability': Expanding Horizons of Craniovertebral Junction Surgery.

The author discusses the novel form of central or axial atlantoaxial instability and analyses its clinical significance. High degree of clinical and radiological understanding of the region is mandatory to diagnose and then treat such atlantoaxial instability. Evaluation of alignment of facets of atlas and axis and observations on direct manipulation of facets of atlas and axis forms the basis of diagnosis.

Atlantoaxial Fixation as Treatment of Trigeminal Neuralgia in a Patient Having Basilar Invagination.

Background: Trigeminal neuralgia can rarely be identified in association with basilar invagination. The presented case report observes that the treatment of basilar invagination by atlantoaxial fixation can result in lasting relief from trigeminal neuralgia.

Case Description: We report a case of a 36-year-old male patient who presented with the primary symptom of trigeminal neuralgia for a period of 2 years.

Lumbar canal stenosis: analyzing the role of stabilization and the futility of decompression as treatment.

OBJECTIVEThe authors report their current experience with their previously published novel form of treatment in 70 cases of lumbar canal stenosis. The treatment consisted of only fixation of the spinal segments by the transarticular screw fixation technique. No bone, ligament, osteophyte, or disc resection was done for spinal canal and neural foraminal decompression.

Recovery of Transcranial Motor Evoked Potentials After Atlantoaxial Stabilization for Chiari Formation: Report of 20 Cases.

Background: The outcome of neurophysiologic motor evoked potential (MEP) monitoring during surgery for Chiari formation by atlantoaxial fixation and without any bone or dural foramen magnum decompression is analyzed.

Methods: During the period August 2017 to October 2018, 20 patients having Chiari formation with or without syringomyelia were surgically treated by atlantoaxial fixation. Apart from other forms of monitoring, MEP monitoring formed the basis of study.