Cervical facet joint effusion: A sign of instability in cervical degenerative spondylolisthesis.

Aims: The aim of this study was to trace the association between cervical facet joint effusion and cervical degenerative spondylolisthesis (CDS). CDS has not received as much attention as its lumbar counterpart. Identification of features of instability on magnetic resonance imaging (MRI) is crucial to avoid missing presence of CDS. Materials and Methods: The authors retrospectively reviewed cervical spine MRI scans and upright lateral flexion-extension radiographs of 17 consecutive patients at a single institution between January 2017 and June 2018 that revealed CDS. Presence of cervical facet joint effusion and CDS was recorded. Data were analyzed to deduce possibility of an association between cervical facet joint effusion and CDS. Results: Seventeen patients fulfilled the inclusion criteria of cervical spondylotic myelopathy associated with CDS. Out of these, 10 patients revealed facet joint effusion at C3-C4 (4 patients) and C4-C5 (6 patients) levels. The mean age of patients was 65.8 years (49-79) and M:F was 2.2:1. Amount of facet joint effusion varied and ranged from 1.6 mm to 4.7 mm on the axial images. Ten patients (58.82%) demonstrated facet joint effusion associated with mobile CDS. Seven patients (41.17%) with CDS and without facet effusion did not demonstrate mobility of more than 0.5 mm in flexion-extension radiographs. Conclusion: The current study acknowledges the association of "cervical facet effusion" and CDS. Clinically measurable facet joint effusion on MRI suggests the need for further attempts to diagnose CDS.

Surgical outcomes of posterior trans-facetal decompression and stabilisation in tuberculous spondylodiscitis with neuro-deficit.

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the functional, neurological and radiological outcomes of posterior trans-facetal decompression and stabilisation in tuberculous spondylodiscitis patients with neuro-deficit. OVERVIEW OF LITERATURE: Spinal tuberculosis mainly involves anterior column and for that anterior approach has been the most frequently used surgical technique in the past as it allows direct access to the infected tissue providing a good decompression. However, anterior surgery is associated with higher morbidity which can be reduced by posterior trans-facetal approach. MATERIALS AND METHODS: The study included 100 Tuberculous Spondylodiscitis patients with neuro-deficit who underwent posterior trans-facetal decompression and stabilisation from 2009 to 2014. Demographic data, clinical parameters (back pain score-VAS, ODI), neurological status (Frankel's grade), radiological parameters (Kyphosis angle) and complications were evaluated. RESULTS: Out of the total 100 patients there were 58 males and 42 females. 84 patients had thoracic and 16 had thoracolumbar region involvement. The mean age of the patients was 34.7 years. The extent of fixation was 2 segments in 52 patients and >2 segments in 48 patients. Postoperatively significant improvement in VAS (pre-op 6.5 ± 0.65 to post-op 1.73 ± 0.64) and ODI (pre-op 76.54 ± 6.96 to post-op 30.5 ± 6.56) were noted. The mean kyphosis angle was corrected from 22.33° ± 5.59° to 5.14° ± 1.32°. 86 patients showed at least 1 grade of improvement in neurology (Frankel's grading) and there was no deterioration in any patient. 3 patients developed superficial infection and 2 had an intra-operative dural tear. 94 patients showed bony fusion at 2 years follow-up. CONCLUSION: Posterior trans-facetal decompression and stabilisation is an effective procedure in the management of thoracic & thoracolumbar tuberculous spondylodiscitis patients with neuro-deficit. It offers circumferential decompression with stabilisation and also maintains kyphosis correction.

Management of spondylolisthesis using MIS techniques: Recent advances.

The authors discuss the recent advances in the understanding and management of spondylolisthesis. The two most common kinds of spondylolisthesis - Degenerative and Spondylolytic types have been elaborated in this paper, with the understanding that similar management principles can be applied to the other lesser common varieties. The impetus has been on application of minimally invasive techniques in the treatment as well as renewed interest in stand-alone decompression in degenerative spondylolisthesis.