Nandan Marathe

University Health Network | UHN · Toronto Western Hospital

Purpose: This study aimed to investigate the impact of vertebral column destruction and kyphotic deformity due to spinal tuberculosis on pulmonary functions in paediatric patients. Methods: A cross-sectional study was conducted, involving 30 patients diagnosed with healed spinal tuberculosis, aged 7–18 years. Detailed radiographic measurements, in...

Background Spinal synovial cysts are rare in the cervical spine where they may cause myeloradiculopathy. Contrast MR studies help differentiate these from other lesions. The optimal treatment is often surgical removal. Case Description A 47-year-old male presented with axial neck pain, numbness, and left-hand paresthesia. When the MR study showed...

Study design: Prospective randomized control trial. Objective: To analyze outcomes following the injection of cerebrolysin in surgically treated patients with degenerative cervical myelopathy (DCM). Summary of background data: Previous research has concluded that superior functional outcomes are achieved with the use of cerebrolysin in surgica...

Background Despite emerging techniques, sample inadequacy remains the most important factor that necessitates need for repeat biopsy. Transpedicular Biopsy has diagnostic accuracy ranging from 75 to 90% in both computed tomography guided or percutaneous C-arm guided biopsy. Presenting in this article is an add on technique as a modification to enha...

OBJECTIVE Since its initial description, the definition of Ehlers-Danlos syndrome (EDS) has notably changed. At present, it broadly refers to disorders of the connective tissue that are heritable and have similar features including joint hypermobility, dermal dysplasia, and vascular as well as internal organ fragility. There has been no comprehensi...

Background: Preoperative lumbar epidural steroid injections (LESI) are known to be a risk factor for intraoperative dural tears in traditional spine surgery. However, whether the same holds true after minimally invasive surgery is debatable. The authors decided to investigate the incidence of complications in patients undergoing minimally invasive...

Objective: Executions of indications/extended indications are associated with higher than normal rates of symptomatic recurrences and treatment failures, especially for novice surgeons incorporating Percutaneous Transforaminal endoscopic lumbar discectomy/decompression (PTELD) techniques. Causes of failures can be manifold and can occur because of...

Background Ossification of the posterior longitudinal ligament (OPLL) is a progressive disorder that mostly involves the cervical spine. It is more prevalent in East Asian countries. Patients typically present with the gradual onset of myelopathy, while about 5% show rapid progression. Case Description A 51-year-old diabetic and hypertensive male...

Study design: Prospective, observational. Objectives: The aim of our study was to assess the amount of reduction in lean muscle mass (LMM) of multifidus muscle (MFM) between conventional open Transforaminal lumbar interbody fusion (CO-TLIF) as compared to Minimally invasive spine Transforaminal lumbar interbody fusion (MIS-TLIF). Methods: This...

Background: Advances in case selection, operative methods, and postsurgical care have facilitated spine surgeons to manage complex spine cases with short operative times, decreased hospital stay and improved outcomes. Methods: This is an overview of recent updates and future directions in the field of spine surgery. All the articles were obtained t...

Advances in patient selection, surgical techniques, and postoperative care have facilitated spine surgeons to manage complex spine cases with shorter operative times, reduced hospital stay and improved outcomes. We focus this article on a few areas which have shown maximum developments in management of degenerative cervical myelopathy and also thro...

We performed a retrospective observational study to analyze the neurological recovery pattern in patients with a sub-laminar retro-thecal epidural abscess managed at our tertiary apex center from 2014 to 2020. We evaluated the Maximal Spinal Cord Compression (MSCC) ratio on Magnetic Resonance Imaging (MRI), the time interval between the appearance...

Background The scarcity of mortality data in our country led to systematic effort with aim of evaluating peri-operative parameters associated with mortality in hip arthroplasties to determine better fixation method and reducing avoidable variables. Materials & methods 252 consecutive patients (133 males and 119 females; Mean age 58.68 years) opera...

BACKGROUND Cerebrospinal fluid–venous fistulas (CVFs) may cause cerebrospinal fluid leaks resulting in spontaneous intracranial hypotension (SIH). Surgical treatment of CVFs aims to eliminate abnormal fistulous connections between the subarachnoid space and the epidural venous plexus at the level of the nerve root sleeve. The authors propose a perc...

Scoliosis has always presented a challenge to the clinicians both at the stage of decision-making and at the stage of correcting the same. Predicting curve progression is important as it helps in selecting the patients who may benefit from an earlier intervention. Patients can be treated either by brace application or by operative intervention depe...

No single event so far has stumped the world more significantly than the present COVID-19 pandemic. However, every adversity brings with it an opportunity and as medical community, we must evolve in order to survive this unique challenge. This essay throws light on the various opportunities we can seize or have done so in the pandemic. We explore t...

Aims: The aim of the study was to retrospectively evaluate the neurological outcome in operated patients of ossified posterior longitudinal ligament (OPLL) of cervical and/or dorsal spine using modified Japanese orthopedic association (mJOA) score and find out the factors affecting the outcome. Settings and design: The study design was a retrosp...

Study Design Systematic review. Objective Ehlers-Danlos Syndrome (EDS) comprises a spectrum of connective tissue disorders, which may be associated with cranio-cervical instability (CCI). There is a lack of consensus on diagnostic imaging parameters, indications, and outcomes of surgical treatment. Methods This systematic review analyses the lite...

ABSTRACT: Background: Prospective evaluation of the effect of physical parameters like height, weight and abdominal girth on different skin entry points in Transforaminal Endoscopic Lumbar Discectomy (TELD) in lower lumbar discs. Methods: This prospective study involved 174 patients with unilateral radicular pain or discogenic back pain, central,...

Background: T2 scans have been studied widely in the prognostication of the cervical myelopathy patients. However, whether T1 changes also have a similar effect is scarcely studied. In this study, we try to determine whether T1 changes in addition to T2 changes have a prognostic importance. Methodology: A retrospective analysis of prospectively col...

ABSTRACT Background: Kambin’s triangle is a safe corridor for transforaminal endoscopic approach as it is devoid of any neurovascular structure. We came across an interesting case where we encountered a large conjoined lumbosacral nerve root (CNR) in Kambin’s triangle during transforaminal endoscopic spine surgery. Patient had intraoperative symp...

Abstract: Introduction: Segmental defect reconstruction after en bloc resection of vertebra is a controversial topic and remains a matter of debate in spine surgery literature. Here we present a case in which anterior column reconstruction was done using vertebral bodies grafted from a cadaver. Case report: A 77 year old male patient had verte...

PurposeWe investigated whether a high Body Mass Index (BMI) affects the outcomes following Minimally Invasive TLIF (MI-TLIF) for degenerative lumbar pathologies.MethodsA retrospective study was undertaken to include patients operated between January 2016 and January 2020 with at least one-year follow-up. Various preoperative and demographic paramet...

Osteoporotic Vertebral compression fracture occurs in approximately 20% of individuals over 70 years of age. A significant majority of fractures approx 60% to 75% occur around the thoracolumbar region. The fractures can result in persistent pain, inability to perform daily activities, and a marked decrease in the quality of life. Reduction of pain...

Study design: Retrospective study. Purpose: To study the outcome of 2L-ACDF versus H-TDR for cervical myeloradiculopathy Overview of Literature: For bilevel disc issues of cervical spine 2L-ACDF has been a historical tool with numerous implants used at different timeframe. Recent development in total disc replacement at mobile level with fusion at...

Study design: Retrospective study. Purpose: To study the outcomes of two-level anterior cervical discectomy and fusion (2L-ACDF) versus hybrid total disc replacement (H-TDR) for cervical myeloradiculopathy. Overview of literature: For bilevel disc issues of the cervical spine, 2L-ACDF has been a historical tool with numerous implants used at d...

Study design: A prospective comparative study. Purpose: To compare the incidence of unintended durotomy and return to work after open surgery versus minimally invasive spine surgery (MIS) for degenerative lumbar pathologies. Overview of literature: The incidence of accidental durotomy varies between 0.3% and 35%. Most of these are from open su...

Spinal infection (SI) is an infection of vertebral bodies, intervening disc, and/or adjoining para-spinal tissue. It represents less than 10 % of all skeletal infections. There are numerous factors that predispose to developing a SI. Due to the low specificity of signs, delayed diagnosis is common. Hence, SI may be associated with poor outcomes. Di...

Study Design: Prospective comparative Purpose: To compare the incidence of unintended durotomy and return to work in open surgery vs MIS for degenerative lumbar pathology Overview of Literature: Incidence of accidental durotomy varies between 0.3% to 35% in literature. Most of these are from open surgeries and only a handful studies involve the MIS...

Background: Preoperative lumbar epidural steroid injections (LESI) are known to be a risk factor for intraoperative dural tears in traditional spine surgery. However, whether the same holds true after minimally invasive surgery is debatable. The authors decided to investigate the incidence of complications in patients undergoing minimally invasive...

Purpose: This study was done to analyze the neurological and functional recovery and factors influencing the outcome in patients with traumatic spinal cord injury (SCI) who underwent delayed surgery. Materials and methods: Retrospective analysis of 33 patients with thoracolumbar SCI who underwent delayed surgery (≥72hrs post trauma) with a minimum...

Introduction: Castleman’s disease is a rare lymphoproliferative disease of unknown origin, rarely affects the spine. We present a case of Castleman disease that manifested as a paraspinal mass extending into spinal canal in upper subaxial spine and mimicking a metastatic secondaries or lymphoma. Case report: A 52/M presented with complaints of prog...

Degenerative cervical myelopathy (DCM) is a recently coined term encompassing a variety of age-related and genetically associated pathologies, including cervical spondylotic myelopathy, degenerative disc disease, and ligamentous aberrations such as ossification of the posterior longitudinal ligament. All of these pathologies produce chronic compres...

Background: The anterior atlantodental interval (AADI) and posterior atlantodental interval (PADI) on X-ray and CT studies can both be used to gauge the risk and/or presence of neurological compression. Methods: This retrospective observational study was conducted at a tertiary care centre in 116 patients with head injuries additionally warranting...

Purpose In developing part of the world, it is common to see complete destruction of vertebral bodies in tuberculosis. Our study aims to assess the effect of spinal tuberculosis with vertebral shortening on pulmonary function. Methods 50-cases of spinal TB(14 males, 36 females) managed both operatively and non-operatively, who presented to tertiary...

Many spine surgeons are not optimally acquainted with anatomy anterior to sacrum. Screw malposition injuring these structures can lead to unwanted lethal consequences. We report unusual cases of acute radiculopathy due to misplaced bicortical sacral screw causing L5 nerve root impingement on anterior sacrum. A 39/M patient complained of severe rest...

Case: A 36-year-old man presented with a subacute onset left upper limb weakness. Further investigation revealed a myoepithelial carcinoma arising from the C3-C5 vertebrae. He underwent 2-stage surgery with tumor excision and postoperative radiotherapy. An improvement in power was noted, and no recurrence was observed at the 1-year follow-up. Con...

Purpose: Cervical pedicle screws (CPSs), though associated with complications and steep learning curve, have significantly increased strength and stability as compared to any other posterior instrumentation methods. Using anatomical referral techniques, pedicle screws can be inserted safely with a high accuracy rate obviating the need for anterior...

Study Design Prospective observational study. Objectives Studying the effect of degenerative cervical spondylosis(CS) on blood flow velocity of vertebral artery (VA) during cervical spine rotation in different head positions and its association with vertigo. Introduction Vertigo is one of the most common complaints seen in an out-patient clinic....

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 pre...

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 t...

ABSTRACT: Study Design: Prospective Randomized Control Trial Objective : Analyze role of cerebrolysin in patients of degenerative cervical myelopathy (DCM) managed by surgical modalities. Summary of Background Data: Cerebrolysin has been extensively researched with variable success in neurodegenerative pathologies. There has been only one stud...

Introduction: Thoracolumbar kyphosis is common cause of sagittal spinal malalignment. Neglected tuberculous infection in childhood often presents as kyphotic deformity in adulthood, especially in India, where tuberculosis is endemic. Complete clinical and radiological evaluation is necessary to decide need for surgical intervention. We came across...

Study Design: Retrospective study Purpose: To retrospectively evaluate the long-term outcome of only anterior stabilization in three- column injury of sub-axial cervical spine. Overview of literature: Literature shows varied results regarding approach to be chosen.Most studies prefer combined approach over isolated anterior or posterior,as it biome...

ABSTRACT Background: Definitive clinico-radiological diagnosis of tuberculosis (TB) of spine remains challenging despite availability of various investigative tools. Histopathology with culture remains the gold standard. Case description: We report a rare case of a 25-year-old male patient who presented with clinic-radiological features suggestive...

We hereby present a rare case of pharyngocutaneous fistula associated with locking screw loosening causing internal cricopharynx perforation and Horner's syndrome following anterior cervical plating. A 27-year-old male patient had undergone anterior cervical plating at C5-C7 level due to gunshot injury to the neck, and 1 month postsurgery, he devel...

Introduction: Sphingomonas paucimobilis is an opportunistic pathogen and a rare cause of human infection. This case report shows bacteremia with pyogenic spondylodiscitis in lumbosacral spine caused by Sphingomonas and discusses its clinical diagnosis, treatment, and literature reviews. Case report: Patient presented with severe low back pain, i...

Context: Cervical radiculopathy and myelopathy is one of the most frequent ailments encountered by spine surgeon. Motion-preserving surgeries in cervical spine is a standard of care due to its certain advantages such as biomechanical anatomical conformity, reduced chances of adjacent segment degeneration, and revision surgeries. While there is abu...

ABSTRACT Background: Often, the cause of bony torticollis is difficult to determine, especially in cases of multiple craniovertebral junction anomalies. Case Description: We report a rare case of a dysplastic C1 vertebra (assimilation to the right occiput and C2, a nonseparated left odontoid, and discontinuity in both anterior and posterior arches...

Study design: Retrospective observational Objectives: This study aimed to document the safety and efficacy of lumbar corpectomy with reconstruction of anterior column through posterior-only approach in complete burst fractures. Methods: In this retrospective study, we analyzed complete lumbar burst fractures treated with corpectomy through posteri...

ABSTRACT Background Tuberculosis/ tuberculous spondylodiscitis (TB) of the spine causing paraplegia in the second trimester of pregnancy is rare and poses significant management dilemmas. Pregnancy, a relatively immunocompromised state with high hormonal levels, may prompt rapid TB destruction of a vertebral body resulting in an acute/ profound ne...

Radiographic analysis of sagittal alignment of spine and pelvis in asymptomatic Indian population. Study Design: descriptive observational study Objectives: The objective of this study was to analyze and document the sagittal alignment of the spine and pelvis in normal Indian adult volunteers and compare these parameters with other races and ethnic...

Study designRetrospective study.Objective Congenital craniovertebral (CV) anomalies include a wide variety of conditions involving basilar invagination (BI), atlantoaxial dislocation (AAD), bony congenital anomalies and Chiari malformation. The management of these disorders is more surgeon dependent rather than based on clear guidelines. This study...

Introduction: Lumbar disc herniation (LDH) is common manifestation of a degenerative disease involving tensile failure of the annulus to contain the gel like nuclear portion of the disc. Lumbar herniated discs can often cause muscle weakness, reduced motor function, and change in walking capacity and gait pattern. Case presentation: We present t...

Purpose: The aim is to study the recovery of neurological deficit in paediatric spinal tuberculosis cases presenting to us more than 6 months after onset of motor weakness in lower limbs. Methods: This is a retrospective analysis of 13 consecutive patients of paediatric spinal tuberculosis presenting to us at least 6 months after the onset of neuro...

Purpose: Corrective manouvres in an angular kyphotic deformity has its own problems including early complications such as neurological deficit and late complications such as PJK and PJF. This article discusses the probable mechanisms leading to PJK in pediatric severe angular kyphotic deformities and preventive strategies for the same. We will also...

Background Airway management with cervical spine immobilization poses a particular challenge for intubation in the absence of neck extension and risks neurological damage in cases of unstable cervical spine injuries. Here, with manual inline stabilization (MILS) in patients with cervical spine injuries, we compared the safety/efficacy of intubation...

Non penetrating trauma to vertebral artery is a known complication in craniovertebral trauma. They are mainly reported with facet dislocations or injuries involving the foramen transversarium. Such a type of injury is rarely seen with flexion injuries. We report such a case leading to cerebellar stroke in a young male presenting to us with hemipare...

Abstract: Introduction: Lumbar disc herniation is common manifestation of a degenerative disease involving tensile failure of the annulus to contain the gel like nuclear portion of the disc. Lumbar herniated discs can often cause muscle weakness, reduced motor function and change in walking capacity and gait pattern. Case presentation: We presen...

Abstract Introduction : Distal tibia fractures or Pilon fractures are usually the result of combined compressive and shearing forces, which may lead to instability of the metaphysis. Poor vascularity, lack of muscle cover and frequent intra-articular extension often make these fractures very challenging to manage. There are plenty of options avail...

Abstract: Introduction: Osteoid osteoma is a rare benign tumor of the spine that involves the posterior elements with 75% tumours involving the neural arch. The common presenting symptoms include back pain, deformity like scoliosis, and rarely radiculopathy. Methods: From 2011- 2017, we evaluated cases of osteoid osteoma managed by posterior surgi...

ABSTRACT: Background: Pyogenic Spondylo-discitis (PS) is a rare infection involving the intervertebral disc space, adjacent vertebral endplates, and vertebral bodies. PS occurs in elderly and immunocompromised patients, and is an uncommon cause of initial and/or postoperative PS. There are only 7 cases involving this organism reported in literature...

Introduction: Introduction of posterior spacer for atlantoaxial joint distraction followed by posterior stabilization is a commonly performed procedure for I-AAD. However, here we present a unique case where posterior distraction was associated with increased risk of injury to VA due to its anomalous course and hence a novel anterior distraction te...