V2 segment – entry of VA higher than C6 or through the C7 foramen transversarium – loops (medial or lateral) – medial loops (at disc or vertebral body level)
V3 segment (divided into three parts)
V31 – High riding vertebra artery – too high, too posterior or too medial V32 – VA branches below the C1 arch (extracranial origin of PICA VA coursing below the C1 arch (persistent first intersegmental artery), or a fenestrated VA V33 – Ponticulus ponticus, abnormal courses associated with occipitalised atlas
Sharing the slides of my talk on cervical spondylotic myelopathy that I give each year at the Basic Spine Course (Bombay Orthopaedic Society). Many delegates/residents have asked me for these slides. So here you go!
If you have any questions or suggestions please put them in the comment box below. Thank you!
Treatment of spinal tuberculosis – presented at the Postgraduate teaching course held at KEM Hospital, Mumbai in March 2016.
The talk highlights steps in diagnostic workup and treatment algorithm for management of spinal tuberculosis.
Please see notes attached to clinical slides. They contain details about clinical presentation and treatment approach chosen for the cases presented.
The focus of this article is on nonoperative treatment of spinal tuberculosis with details about diagnostic protocols and antibiotic therapy.
Following is the abstract:
“Musculoskeletal tuberculosis, especially spinal tuberculosis is a challenging scenario. The disease presentation varies and profile of the organism is changing rapidly with the rise of antibiotic resistance. The management protocols need to be revisited in light of new information and current review is aimed at achieving this goal. This review article is a summary of the symposium conducted by Bombay Orthopaedic Society at KEM Hospital in November 2016. The focus of this discussion was primarily on nonoperative management of spinal tuberculosis including a focus on diagnostic protocol and medical management controversies. Surgical aspect of the disease is also covered with recent advances in the spine surgical protocols mentioned in brief.”
As a spine surgeon, I am frequently asked about the benefits of stem cell therapy by patients (and their loved ones) who suffer from spinal cord injury. India is part of a vast network of countries where “website clinics” offer stem cell therapy for such injuries. These websites publish glowing patient testimonials, and many assure patients of cure. The desperate patients and their families who are searching for hope do not know that these treatments are experimental and potentially harmful. Also, the recipient of such therapy is disqualified from participating in legitimate clinical trials in the future.
The Association of Spine Surgeons of India has published a position statement condemning such practice. They state that it is unethical to offer this experimental therapy and charge an exorbitant price for it. The ICMR in its published national guideline on Stem cell research warns that such treatment provided outside the ambit of an approved clinical trial shall be considered as malpractice.
For more information on this subject, please listen to the following panel discussion on the perils of stem cell tourism conducted at the Harvard Stem Cell Institute.
Read the brief summary of the panel discussion here.