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Neurologico Spinale Medico Chirurgico
Published by Universitas Udayana
ISSN : -     EISSN : 26212064     DOI : https://doi.org/10.36444/nsmc
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience
Neurologico Spinale Medico Chirurgico (NSMC) is an open-access, single-blind peer-reviewed journal, published by Indonesian Neurospine Society (INSS) under the flag of Indonesian Neurosurgery Society (INS) and Faculty of Medicine, Udayana University. NSMC publishes articles which encompass all aspects of basic research/clinical studies. The journal facilitates, bridge and integrate the intellectual, methodological, and substantive diversity of medical knowledge, especially in the field of surgery, neurology, neurosurgery, spine, neuroanesthesia, medicine, and health. The journal appreciates any contributions which promote the exchange of ideas between practising educators and medical researchers all over the world.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 134 Documents
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Back Pain and Sciatica are not the Signs of HNP (Nerve Compression) Ali Shahab Shahab
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

We used to think that back pain and sciatica were the signs of HNP. In fact, each of them has distinct clinical manifestations. In the majority of nerve compression cases, back pain and sciatica are not found. Meanwhile, most of back pain and sciatica are facet syndromes. Thus, the treatment of nerve compression and facet syndrome is different. To treat nerve compression that was progressing to paralyze, about a hundred years ago, Joel Goldthwait performed decompression through laminectomy from L1 to S3. On the other hand, in 1971, Rees, who was the first surgeon to do the procedure, performed facet denervation to cure facet syndrome on 1000 patients by using scalpel and the result was satisfying. Recently, the treatment of back pain and sciatica (facet syndrome) switches over from open surgery to facet denervation by radiofrequency. In patients with back pain whose MRI show signs of HNP but do not experience motor deficit, the choice of management is also facet denervation. Moreover, according to my experience about the treatment of back pain and sciatica, the best results so far are also by facet denervation.
Our Surgical Strategy for Adult Spine Deformity with Osteoporosis Yasuhiro Nakajima
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Osteoporosis is a major social problem in Japan, which is becoming a super-ageing society. Spinal deformity in the elderly causes various symptoms such as neurological deficits, pain, gastroesophageal reflux disease, etc., which impair QOL of the patients. Osteoporosis is one of major etiologies for elderly spinal deformity. At the same time, osteoporosis often causes serious problems in surgical treatment for elderly spinal deformity including instrumentation failure, proximal and distal junctional kyphosis, etc. This presentation will summarize our surgical strategy for prevention of instrument failure, including our original surgical techniques and osteoporosis treatments.
Surgical Treatment for Scoliosis Tjokorda Gde Bagus Mahadewa
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Recently, patients with spinal deformities, particularly scoliosis, could be handled well through surgical pathways. Generally, surgery is indicated in patients with scoliosis curve exceeding 45 degrees (COBB angle > 45). The ultimate goal is to reduce the curve as optimally as possible without disturbing spinal cord. Whether the result is straight or not, it also depends on the patient's spine flexibility before surgery. Surgical indications are for improving appearance, preventing increasing degrees of the curve, preventing interference to other organs such as the lungs, and preventing neurological deficits. Correction of Cobb angle below 25 degrees had already makes the patient feel more comfortable. The amount of screw and instrumentation length depends on the number of spines involved. After surgery treatment, 2-4 weeks of rest are required before returning to daily activity. Fusion principle states that the spine will be slightly stiff in order to be corrected but it is believed that patient's activity could still be done with the remaining flexibility. Surgical treatment of scoliosis that does meet the indications is imperative and relatively safe with advances in medical technology today.
Analysis of Clinical Results of Three Different Routes of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for Lumbar Herniated Disk Farid Yudoyono; Rully Hanafi Dalan
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Objective: Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) can be performed by using foraminal, intervertebral, and suprapedicular routes. The aim of this study was to assess clinical results of three different routes of PETLD. Methods: One hundred and eleven patients who underwent PETLD between January 2016 and October 2016 were included in this study. PETLD was performed using the foraminal (group A), intervertebral (group B), and suprapedicular (group C) routes in 32, 46, and 33 patients, respectively. Outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and MacNab criteria. Results: Seventy-one men and 40 were women (mean age 53.33 ± 14.12 years). The mean follow-up period was 6.44 ± 3.26 months. The preoperative VAS score decreased significantly (P < 0.01) in all 3 groups, but the postoperative VAS score was higher for the foraminal route than the intervertebral (P<0.001) and suprapedicular routes (P < 0.001). Excellent outcome grade according to MacNab criteria was less in foraminal route (18.7%) than in intervertebral (52.2%) and suprapedicular (56.7%) routes. ODI improved significantly (P < 0.01) in all 3 groups. Conclusion: All 3 routes of PETLD resulted in good to excellent clinical results. Nevertheless, the postoperative VAS score was higher for the foraminal route than the intervertebral and suprapedicular routes, probably because of the neurologic characteristics of the disk location. The surgeon should consider this problem to alleviate pain postoperatively and to better counsel the patient before surgery.
PEID (Percutaneous Endoscopic Interlaminar Discectomy): Cautionary Points Based on the Evidence Jun Ho Lee
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Background: Percutaneous endoscopic lumbar discectomy (PELD) is one of the most sophisticated operative procedures for the treatment of lumbar disc herniation (LDH). Endoscopic techniques are now becoming standard in many areas due to expanded technical possibilities of fullendoscopic transforaminal or interlaminar resection of herniated lumbar discs as well as stenosis. However conventional percutaneous endoscopic interlaminar discectomy (PEID) disc operations may sometimes result in subsequent untoward complications due to unnoticed iatrogenic trauma to neural structures, which is mostly related to an anatomical limitation during endoscope insertion. Methods: An appropriate operative indication of the PEID without bone removal or laminectomy can be used to treat LDH cases with an enough interlaminar space (at least ≥ 20 mm by bi-facetal distance) from the reported evidences. Otherwise, there might be several indications for requirement of bone removal; a narrow interlaminar space, disappearance of the concave shape of the upper vertebral laminae, high-grade migration of LDH, recurrent LDH, obesity, or an immobile nerve root. Conclusion: The significance of PEID lies also in its minimal damage to surrounding structures such as muscle, bone, and ligaments. A discrete radiographic evaluation from the patient preoperatively is mandatory before choosing a proper endoscopic surgical modality for the sake of optimal clinical outcome after PEID.
The Feasibility of Optimal Surgical Result Prediction according to the Centre of Rotation Shift after Multilevel Cervical Total Disc Replacement Jun Ho Lee
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Objective: This study investigates the relation between shifted locations of centre of rotation (COR) at each cervical level and subsequent surgical outcomes after multilevel cervical total disc replacement (MCTDR) and identifies radiological parameter that corresponded to change of COR after MCTDR. Methods: The study included a consecutive series of 24 patients who were treated with MCTDR following diagnosis of multilevel cervical disc herniation or stenosis. Numeric rating scale (NRS), range of motion (ROM) at both C2-7 segment and TDR implanted levels, and the location of COR at TDR implanted level were evaluated at pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief. Results: The inherent CORs relatively at ventro-cranial coordinates have demonstrated significant migrations to dorso-caudal locations at each cervical levels, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2-7 ROM and reduced angular improvement at C2-7 as well as MCTDR level after surgery in comparison with the successful group. Postoperative C2-7 ROM was related to postoperative COR along the X-axis. Conclusions: The crucial determinants for clinical success after MCTDR, other than mere preservation of the ROM both at C2-7 and TDR implanted levels, was the restoration of COR from ventro-cranial location at degenerated cervical motion segment close to normal coordinates by posterior and inferior shifts after MCTDR. The position of COR along the X-axis after MCTDR was an important factor to determine maintenance of C2-7 RO.
Acute Traumatic Cervical Facet Fractures Shankar Gopinath
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Acute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization.
Abstract For Thoracolumbar Trauma Shankar Gopinath
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

In both adult and pediatric populations, thoracolumbar trauma accounts for a large portion of traumatic injuries. There is a wide spectrum of injury types, including compression fractures, burst fractures, fracturedislocations, and more. The traditional treatment for many of these has been instrumented stabilization by an “open” approach. However, as minimally invasive techniques have been developed for degenerative disorders, there has been considerable interest in bringing the same benefits of decreased blood loss, improved wound exposure, and potentially decreased operative time to the trauma population. Further, “minimally invasive” is a broad category, encompassing percutaneous pedicle screw fixation, endoscopic/thoracoscopic approaches, and anterior column reconstruction. A few authors have put forward some algorithms of selecting appropriate patients for MIS techniques. However, the majority of published data has been limited to small case series with very heterogeneous pathologies. Further studies are needed to assess minimally invasive surgery for thoracolumbar spine trauma, with respect to short- and long-term clinical outcome, fusion rates/radiographic outcome, and cost-effectiveness.
Endoscopic Access to the Ventral Thoracic spine: PETD vs. Thoracoscopy Jun Ho Lee
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Symptomatic thoracic disc herniation (TDH) is estimated to afflict between 1 in 1,000 and 1 in 1,000,000 people; affecting men more frequently than women, with the highest incidence seen at 40-50 years of age. TDH occurs at all levels of the thoracic spine but 75% of cases occur below T8, with T11-T12 being the most common site due to spinal mobility and weakness of the posterior longitudinal ligament. Manipulation of the thoracic spinal cord through the conventional posterior approach has been associated with poor outcomes. A conventional posterior approach consisting of laminectomy, cord retraction, and disc removal was historically done to treat TDH but this causes spinal cord injury and irreversible paraplegia due to cord manipulation on the relatively rigid spinal cord.The anterior approach to the spine is also intimidating to the spine surgeon due to the unique anatomy of the thoracic spine. Conventional open approaches to the thoracic spine involve a thoracotomy, rib resection, and corpectomy to view the spinal cord anteriorly. This has been associated with perioperative morbidity due to surgical site pain, difficult/painful breathing, shoulder girdle dysfunction, and wound healing problems. In order to spare the patients suffering from these postoperative iatrogenic sequelae, the author presents two different minimally invasive approach techniques; percutaneous endoscopic thoracic discectomy (PETD) vs. thoracoscopy, each applied to a different indication or thoracic pathology, to gain an enough but safe access to the ventral thoracic spinal canal through minimized surgical damages without yielding a postsurgical morbidity.
Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now? Chiung Chyi Shen
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%. The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively. "Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. Image

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