Jaypal Reddy Sangala

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (8)12.99 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The management of spinal vascular malformations (SVM) has improved over the last four decades with the evolution of imaging, anesthesia, microsurgery, and endovascular techniques. Commonly used high-resolution imaging techniques include CT angiography, magnetic resonance angiography, and digital subtraction angiography. We review the advances that have been made in these imaging modalities and discuss their present role for imaging SVM, with the goal of assisting neurosurgeons in making judicious use of current imaging techniques to develop the most effective management strategies for these complex lesions.
    Journal of Clinical Neuroscience 10/2012; · 1.25 Impact Factor
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    ABSTRACT: surgical correction of symptomatic cervical or cervicothoracic kyphosis involves the potential for significant neurological complications. Intraoperative monitoring has been shown to reduce the risk of neurological injury in scoliosis surgery, but it has not been well evaluated during surgery for cervical or cervicothoracic kyphosis. In this article, the authors review a cohort of patients who underwent kyphosis correction with multimodal intraoperative monitoring (MIOM). twenty-nine patients were included in the study. Preoperative and postoperative Cobb angles were measured to determine the extent of correction. Multimodal intraoperative monitoring consisted of somatosensory evoked potentials, transcranial motor evoked potentials (tMEPs), and electromyography activity. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were assessed for each monitoring modality. the mean patient age was 58.0 years, and 20 patients were female. The mean pre- and postoperative sagittal Cobb angles were 41.3° and 7.3°, respectively. A total of 8 intraoperative monitoring alerts were observed. Transcranial MEPs yielded a sensitivity of 75%, specificity of 84%, PPV of 43%, and NPV of 95%. Somatosensory evoked potentials had a sensitivity of 25%, specificity of 96%, PPV of 50%, and NPV of 88%. Electromyography resulted in a sensitivity of 0%, specificity of 93%, PPV of 0%, and NPV of 96%. Changes in tMEPs led to successful intervention in 2 cases. There was 1 case in which a C-8 palsy occurred without any changes in MIOM. in contrast to sensitivity and PPV, specificity and NPV were generally high in all 3 monitoring modalities. Both false-positive and false-negative results occurred. Transcranial MEP monitoring was the most useful modality and appeared to allow successful intervention in certain cases. Larger, prospective comparative studies are necessary to determine whether MIOM truly decreases the rate of neurological complications and is therefore worth the added economic cost and intraoperative time.
    Journal of neurosurgery. Spine 01/2011; 14(1):99-105. · 1.61 Impact Factor
  • Jaypal Reddy Sangala, Paul Park, Mila Blaivas, Frank Lamarca
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    ABSTRACT: Ossifying fibromyxoid tumors (OFT), first described in 1989 by Enzinger et al., are rare lesions; malignant OFT (MOFT) are even rarer. We report a large recurrent paraspinal MOFT invading the spine and causing epidural compression in a 70-year-old male, despite prior debulking and radiotherapy. Paraspinal involvement of these tumors has been reported only twice before. We describe its imaging, pathology, and also review the pertinent literature.
    Journal of Clinical Neuroscience 12/2010; 17(12):1592-4. · 1.25 Impact Factor
  • Jaypal Reddy Sangala, Tann Nichols, Thomas B Freeman
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    ABSTRACT: Paraspinal muscle atrophy (PMA) after posterior cervical fusion is a known complication that causes considerable morbidity. It has been shown in the lumbar spine that preservation of the posterior ramus of the spinal nerve is important in minimizing paraspinal muscle atrophy. During posterior cervical spine fusions, we modified the exposure of the dorsal cervical spine by exposing only the medial two-thirds of the lateral mass utilizing a low electrocautery setting. In a retrospective analysis, we compared the incidence of paraspinal muscle atrophy using this modified technique with historical cohorts who underwent posterior cervical fusion using the standard technique of exposure of the entire lateral mass. All patients who underwent posterior cervical fusion and internal fixation between 1999 and 2007 were included. Patients operated from 1999 to 2003 who underwent the standard exposure of the lateral mass formed Group 1 (n=31). Group 2 (n=32) included patients whose lateral masses were exposed using the modified technique of limiting the exposure only to the medial two-thirds of the lateral mass with the cautery on a low setting. All patients were assessed for PMA at six months after surgery. Atrophy was graded as no atrophy, mild atrophy (minimal midline atrophy), moderate atrophy (muscle lost without palpable hardware) and severe atrophy (hardware palpable). Before initiating the study, no atrophy and mild atrophy were grouped together as a non-significant atrophy and moderate atrophy and severe atrophy were grouped together as significant atrophy. We found a statistically lower incidence of paraspinal atrophy using this modified exposure of the lateral mass (p<0.03). This modified technique of cervical spine exposure is associated with lower paraspinal muscle atrophy secondary to the preservation of the innervation of the paraspinal musculature.
    Clinical neurology and neurosurgery 10/2010; 113(1):48-51. · 1.30 Impact Factor
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    ABSTRACT: Retrospective chart review, technical note, cohort study. To describe the clinical outcome of a modified method of obtaining cancellous autograft from the manubrium of the sternum for use in interbody cages during anterior cervical fusions. Harvest of structural grafts from the anterior iliac crest (AIC) for anterior cervical fusion has well-established morbidities. In an effort to minimize morbidity and maximize fusion, we utilized interbody cages filled with autologous cancellous bone. In cases needing corpectomy, local bone graft from the corpectomy is used to fill the cage. In cases needing discectomy alone, no local bone is resected and therefore alternative donor sources must be used if autograft is to be used and the complications of AIC harvest are to be avoided. This technique is especially useful in countries where allograft is either not available or available in limited quantity. We have developed a modified technique for the harvest of autologous cancellous graft from the sternum which can be used as a fusion substrate with cervical interbody cages. This technique incorporates either a small incision just above the sternal notch or subcutaneous tunneling from the discectomy incision and use of a bone graft harvester. We retrospectively analyze the clinical outcome and fusion rates. Using the described technique, one-hundred sternal graft harvests (n=100) have resulted in three minor complications: one wound hematoma which resolved with observation, and two superficial wound infections which required treatment with oral antibiotics. All the patients were satisfied by the cosmetic appearance of the incision. Spinal fusion was achieved in all patients at the end of 12 months. We describe a modified technique of harvesting the sternal graft and also for the first time describe the long-term clinical outcome of using sternal autograft for ACDF. The sternal manubrium provides a viable alternative to AIC grafting. It confers the advantages of autograft fusion without the complications associated with AIC graft harvesting.
    Clinical neurology and neurosurgery 04/2010; 112(6):470-3. · 1.30 Impact Factor
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    ABSTRACT: Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom's criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara's index at 1 year. Group 1 had a mean age 46.2 years (range 35-60 years). Group 2 had a mean age 50.1 years (range 35-70 years).The operative time was significantly lower (P < 0.001) and blood loss significantly higher (P < 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P > 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P > 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.
    European Spine Journal 02/2009; 18(5):654-62. · 2.47 Impact Factor
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    ABSTRACT: Arachnoid cysts are rare lesions of the spine and can present with myelopathy, radiculopathy, local pain or a combination of these symptoms. Nerve root prolapse into an arachnoid cyst causing radiculopathy has not been reported before. We report a nerve root prolapse into a spinal arachnoid cyst presenting clinically as radiculopathy. An 18-year-old female patient presented with mid-back pain, right anterior thigh pain and hip flexor weakness. Magnetic resonance imaging (MRI) and computerized tomography (CT) myelography revealed an arachnoid cyst at T12-L1 level on the right side. At surgery, a nerve root was seen prolapsing into an extradural arachnoid cyst. The nerve root was replaced back into dural sac and the dural defect closed. At 20 months of follow-up, the patient continues to be asymptomatic with no evidence of recurrence on imaging. Replacing the prolapsed nerve root into the dural sac with meticulous closure of the dural defect could lead to good clinical outcome. We propose a modification to the popular classification of these lesions to better rationalize their surgical management. Classification of extradural arachnoid spinal cysts (Nabors's type 1) should be based on the presence or absence of dural communication. Sacral meningoceles (Nabors' type 1B) should be excluded from the classification as they have free communication with the thecal sac and are not true spinal cysts.
    Clinical neurology and neurosurgery 02/2009; 111(5):460-4. · 1.30 Impact Factor
  • Jaypal Reddy Sangala, Elias Dakwar, Juan Uribe, Fernando Vale
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    ABSTRACT: The aim of this study was to review the current evidence-based nonsurgical management strategies of ankylosing spondylitis (AS) for spine surgeons. Whereas surgical management is indicated in a highly selected group, nonsurgical management is itself a useful measure for nearly all patients with AS. The authors conducted a literature review of PubMed using relevant search words. All the articles published in English in the last 15 years were reviewed and the level of evidence provided by them was noted. Nonpharmacological treatments in the form of physical therapy and patient education have Level Ib evidence in maintaining function in AS. There is Level Ib evidence supporting the use of nonsteroidal antiinflammatory drugs (NSAIDs) and coxibs for treatment in patients with symptoms. There is not enough evidence to support the use of conventional disease-modifying antirheumatoid arthritis drugs. Tumor necrosis factor (TNF)alpha inhibitors (infliximab, etanercept, and adalimumab) are associated with Level Ib evidence in improving spinal pain, function, inflammatory biomarkers, and spinal inflammation detected by magnetic resonance imaging in patients in whom symptom duration has exceeded 3 months. Physical therapy and patient education are useful for all patients diagnosed with AS. If symptomatic, patients are started with either a course of nonselective NSAIDs or a selective cyclooxygenase-2 inhibitor. The role of NSAIDs as a disease-modifying therapy in the treatment of AS is increasingly being understood. The central role of TNF in the pathogenesis of AS is now known, and the advent of biological treatment in the form of anti-TNFalpha factors has revolutionized the medical management of AS and is used in patients with axial disease whose symptoms persist despite an adequate dose of NSAIDs.
    Neurosurgical FOCUS 02/2008; 24(1):E5. · 2.49 Impact Factor

Publication Stats

37 Citations
12.99 Total Impact Points

Institutions

  • 2010
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2009–2010
    • University of Michigan
      • Department of Neurosurgery
      Ann Arbor, MI, United States
  • 2008–2010
    • University of South Florida
      • Department of Neurosurgery and Brain Repair
      Tampa, FL, United States