Publications by authors named "N A Marathe"

117 Publications

Extramedullary myeloid sarcoma mimicking tuberculosis of spine: A case report and literature review.

Surg Neurol Int 2021 19;12:178. Epub 2021 Apr 19.

Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.

Background: A definitive diagnosis of spinal tuberculosis (TB) remains challenging. The "gold standard" is to obtain histopathological confirmation of the lesion. This analysis highlights how to avoid missing the diagnosis of an extramedullary myeloid sarcoma (EMS) versus TB.

Case Description: A 25-year-old male presented with paraparesis. Although this was first attributed to TB spondylodiscitis, a PET-CT and reevaluation of the biopsy specimen both confirmed the diagnosis of an EMS.

Conclusion: Nontubercular spinal disease should be suspected when a patient deteriorates despite the institution of antitubercular therapy for a reasonable duration. Further, microbiological and/or pathological confirmation is warranted to direct appropriate treatment and differentiate spinal TB from other entities as, in this case, an EMS.
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http://dx.doi.org/10.25259/SNI_855_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8168697PMC
April 2021

Mid Thoracic intra-spinal facet cyst with lumbar canal stenosis: A rare "double crush".

Int J Neurosci 2021 Jun 1:1-6. Epub 2021 Jun 1.

Department of Spine Services, Indian Spinal Injuries Centre, Vasant kunj, Sector C, 110070 New Delhi.

Introduction: Intraspinal synovial cysts occurrence causing spinal canal occlusion are mostly seen in mobile segments of the spine (lumbar and cervical). An appearance of the cyst in thoracic spine is a relatively rare occurrence. We present an interesting case of "double crush" caused by Lumbar canal stenosis with a mid-dorsal Facet cyst.

Case Presentation: A 67-year-old woman presented with complaints of back pain with neurogenic claudication with significant loss of touch sensation and motor power of MRC grade 3/5 in lower extremities bilaterally. However, patient was hyperreflexic with Babinski sign positive. She was unable to perform tandem walking test and complained of instability. MRI of lumbar spine revealed lumbar canal stenosis. However, in view of the UMN signs, an MRI of the dorsal spine was done. It revealed an extradural, well-delineated lesion along the dorsal aspect of spine at T6-7 level. Thus the patient had a "double crush" due to the FC along with lumbar canal stenosis.Clinical findings correlated with the imaging. Two teams simultaneously operated the 2 pathologies and T6-7 laminectomy along with left sided TLIF at L4-5 level was performed. Presently she is asymptomatic for back pain, claudication distance has improved to 800m.

Conclusion: Our case reiterates the importance of thorough clinical examination to avoid missing a diagnosis. Our case is the first in literature to report a "double crush" due to a proximal dorsal FC and distal LCS. Both the pathologies were tackled in a single setting by two operating teams with a good functional outcome.
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http://dx.doi.org/10.1080/00207454.2021.1938034DOI Listing
June 2021

Management of AO-type C thoracolumbar fractures during COVID-19 pandemic using distractor device: a novel technique.

Br J Neurosurg 2021 May 31:1-8. Epub 2021 May 31.

Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.

Study Design: Prospective cohort study.

Introduction: Management of the severe thoracolumbar (TL) spine fracture-dislocation injuries have been further complicated by the COVID-19 pandemic. The need to optimize resources and minimize the personnel in the operating room (OR) led us to develop a novel technique to reduce TL fracture-dislocations (AO type-C) using an orthopedic distractor device (ODD).

Methods: This prospective study was conducted at a tertiary care spine center with a study duration from March 2020 to May 2020 coinciding with the nationwide lockdown and travel restrictions imposed in view of the COVID-19 crisis. Only patients with AO type C fracture-dislocation managed using the ODD operated by a single surgeon were included in the study.

Results: Of 12 cases, the most commonly affected level was D12-L1. Nine patients were American Spinal Injury Association Impairment Scale (AIS) A at presentation, two patients were AIS B, and one AIS C. The mean operative time was 125 min and mean blood loss was 454 ml. Eight patients remained AIS A, one patient improved from AIS B to C. Two patients became independent walkers, one remained AIS B. The post-operative VAS score improved to a mean value of 2.33. The improvement in kyphosis was 26.24° immediate postoperatively and maintained at 25.9°, percentage height loss reduced to 2.75% immediate postoperatively and maintained at 3.16% at 3 months follow-up.

Conclusions: Management of TL fracture-dislocations in COVID times of health care resource scarcity can be challenging. Single surgeon with ODD is a useful technique for achieving good results in these injuries.
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http://dx.doi.org/10.1080/02688697.2021.1929836DOI Listing
May 2021

Radiographic Analysis of the Sagittal Alignment of Spine and Pelvis in Asymptomatic Indian Population.

Asian Spine J 2021 May 10. Epub 2021 May 10.

Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India.

Study Design: This is a descriptive observational study.

Purpose: The objective of this study is to analyze and document the sagittal alignment of the spine and pelvis in normal Indian adult volunteers and compare these parameters with the study population of other races and ethnicities.

Overview Of Literature: Given the importance of the spinopelvic parameters, there is a need to describe the parameters differentially in relation to the ethnicity of the studied individual. Very few reports have defined the normal physiological value. Ethnic differences are a significant factor not only when describing the anthropometric data but also when applying the findings to a different ethnic group. We have compared these values with other races and ethnicities so that we can know whether the principles of spinal fixation can be applied globally.

Methods: In total, 100 participants were studied by using their anteroposterior and lateral radiographic images of whole of pelvic and spinal area. Additionally, various spinal and pelvic parameters were also measured. Subsequently, the outcomes were analyzed with respect to age, sex, and body mass index (BMI). The correlation between different parameters and differences in these parameters between Indians and other races/ethnicities along with population groups were also analyzed.

Results: There was a significant increase in thoracic kyphosis (TK) from T1-T12 and T4-T12 with increasing age. Lumbar lordosis (LL), sacral translation (sagittal vertical axis), and pelvic tilt were significantly higher among females. Additionally, sacral slope (SS), pelvic incidence, C7 sagittal offset, and T9 sagittal offset were also higher in females. TK (T4-T12 and T1-T12), LL, SS, and pelvic incidence showed a significant correlation with BMI. As compared to European population, TK, segmental LL, and sacral translation were found to be significantly lesser in Indian population.

Conclusions: There is a statistically significant difference between Indians and other races/ethnicities and population groups with respect to TK, LL, and sacral translation. The values obtained can be considered as the physiological normal values for Indian population. Importantly, these values can serve as the reference values for future studies.
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http://dx.doi.org/10.31616/asj.2020.0301DOI Listing
May 2021

Hydatid Cyst of the Spine: A Rare Case Report and Review of Literature.

J Orthop Case Rep 2020 May-Jun;10(3):57-59

Department of Spine Services, Indian Spinal Injuries Centre, Delhi, India.

Introduction: Hydatid disease is caused by the parasite Echinococcus granulosus which is also known as the dog tapeworm. This disease is a relatively uncommon cause of spinal cord and dural compression.

Case Report: We came across a peculiar case in a 41-year-old male patient who presented to us with pus discharge from a surgical wound over lower back for 10 days. The patient was a diagnosed as a case of lumbar canal stenosis with recurrent hydatid cyst. The patient had neurological involvement in the form of left-sided foot drop. The patient gave a history of lumbar canal stenosis secondary to hydatid cyst, for which decompression and cyst excision were done 3 years prior. The patient was re-operated in the form of wound debridement with removal of hydatid cyst.

Conclusion: Meticulous surgery avoiding spillage of cyst material, appropriate medication as advised by the infectious disease specialist, will avoid recurrence of the disease.
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http://dx.doi.org/10.13107/jocr.2020.v10.i03.1748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051559PMC
May 2021