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Study Design: Four patients had C2-3 vertebral fusion and radiologically demonstrated cord compression at C3-4 level related to disc bulge with or without association of osteophytes and C1-2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed. Purpose: The article evaluates the significance of atlantoaxial facetal instability in cases having C2-3 vertebral fusion and cord compression at the level of C3-4 disc. Overview of Literature: C2-3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2-3 vertebral fusion. Methods: Between June 2013 and November 2014 four patients having C2-3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3-4 disc space. Further investigations revealed C1-2 posterior facetal dislocation. Results: All patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms. Conclusions: Identification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2-3 fusion and high cervical (C3-4) disc related cord compression. © 2016 by Korean Society of Spine Surgery.

Redhu R.,Kem Hospital And Seth Gs Medical College | Nadkarni T.D.,Kem Hospital And Seth Gs Medical College
Journal of Clinical Neuroscience | Year: 2011

A 26-year-old male presented with a rare cerebellar pilocytic astrocytoma with multicompartmental subarachnoid metastases. Cerebrospinal fluid dissemination of low grade astrocytoma at presentation is rare in adults. In the present patient, clinical and neuroradiological follow-up at 4 years, without adjuvant treatment, revealed non progression of tumors. The occurrence of benign dormancy, low grade tumor histology and multifocal involvement of the neuraxis is rare. Close clinical observation is the best approach for management of such a patient. The relevant literature is discussed. © 2011 Elsevier Masson SAS. All rights reserved.

Khuroo S.,Kem Hospital And Seth Gs Medical College | Rashid A.,Lok Nayak Hospital and Maulana Azad Medical College | Bali R.S.,Lok Nayak Hospital and Maulana Azad Medical College | Mushtaque M.,Lok Nayak Hospital and Maulana Azad Medical College | Khuroo F.,Sopore Nursing Home
Australasian Medical Journal | Year: 2014

Carcinoid tumours of the extrahepatic biliary ducts represent an extremely rare cause of bile duct obstruction. We report a case of obstructive jaundice secondary to carcinoid tumour arising at the hilar confluence. Resection of the primary tumour was done and the patient is doing well on follow-up. This case demonstrated that surgery offers the only potential cure for biliary carcinoid and aggressive surgical therapy should be the preferred treatment in cases of potentially resectable biliary tumours.

Goel A.,Kem Hospital And Seth Gs Medical College | Goel A.,Lilavati Hospital and Research Center | Nadkarni T.,Kem Hospital And Seth Gs Medical College | Shah A.,Kem Hospital And Seth Gs Medical College | And 3 more authors.
World Neurosurgery | Year: 2015

Background and Objective Surgical treatment of ossified posterior longitudinal ligament (OPLL) continues to be wrought with confusion, debate, and arguments. We report our experience with an alternative form of treatment that involves only fixation of the involved spinal segments. We report and put on record our remarkably gratifying clinical experience in 13 of 14 patients having OPLL after surgery that involved only facetal fixation and aimed at arthrodesis of involved spinal segments. No direct bone, ligament, or disc resection was done for decompression of the spinal dural tube or root canal. The OPLL was not directly handled during the surgical procedure. The rationale of the proposed treatment is discussed. Methods During the period June 2012 to August 2014, 14 patients having OPLL were treated by facetal transarticular screw fixation technique. The Japanese Orthopaedic Association score, visual analogue scale, and Odom's criteria were used as indices to monitor the clinical status. Results The procedure resulted in firm stabilization and fixation of the spinal segments and provided a ground for arthrodesis. During an average follow-up period of 17 months, there was immediate postoperative and progressive recovery in symptoms in 13 patients. There were no surgery or implant-related mechanical or infective complications. Conclusions Instability could be the defining phenomenon in pathogenesis of clinical symptoms related to OPLL. The clinical outcome in our patients suggests that only fixation of the spinal segments can be a simple, safe, and rationale form of treatment for the complex pathology of OPLL. © 2015 Elsevier Inc.

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