Prashanth Rao

• Doctor of Philosophy
• UNSW Sydney

Background: Cervical spine range of motion (ROM) assessment has long been carried out via use of the universal goniometer (UG) as an objective tool in the evaluation of patient rehabilitation pre- and post-operatively. The advent of novel ROM assessment technology, such as HALO digital goniometer (DG), presents an avenue for research and potential...

Background A bacterial cause of disc degeneration has evoked several controversies and, if true, would lead to a major shift in treatment paradigm. Earlier studies analyzing the relationship of bacterial disc infection within a degenerative cohort featured prolonged cultures susceptible to contamination. The DISC trial aims to investigate this theo...

Study Design Retrospective case control study. Objectives Adjacent-level ossification development (ALOD) is a distinct form of adjacent segmental degeneration that has been recognized to occur after anterior cervical discectomy and fusion (ACDF). It is unclear whether ACDF with plate versus standalone has an effect on rates of ALOD. This retrospec...

BACKGROUND CONTEXT Chronic infection of the intervertebral disc resulting in acute/chronic back pain/leg pain remains a controversial topic of ongoing spinal research, with questions surrounding commensal organisms, its role in the pathogenesis of acute and chronic back/leg pain, and the subsequent clinical implications, all pending.A systematic re...

BACKGROUND CONTEXT A bacterial cause of disc degeneration has evoked several controversies and if true may lead to a major shift in treatment paradigm. Earlier studies analyzing the relationship of bacterial disc infection within a degenerative cohort featured prolonged cultures, susceptible to contamination. Although more recent studies have demon...

Recent evidence into an infectious etiology of discogenic back pain/leg pain are ongoing with contradictory data in literature. We sought to validate the clinical relevance of histopathological evidence of inflammation through a previously proposed histological grading system. In this prospective cohort study, 124 consecutive patients undergoing an...

Idarucizumab is the first Food and Drugs Administration (FDA) approved reversal agent for anticoagulant dabigatran, a direct thrombin inhibitor. Emerging evidence suggests idarucizumab can improve clinical outcome following dabigatran-associated hemorrhage, however, its specific use in intracranial hemorrhage has been poorly described. The aim of t...

Background: Direct lateral interbody fusion (DLIF) mitigates many of the vascular complications and bony resections associated with other interbody fusion techniques. However, there are concerns regarding postoperative neural complications and that indirect decompression of the foramen has not been consistently demonstrated. This study prospective...

Study design: Literature review. Objective: To conduct a literature review of studies reporting the incidence of pars interarticularis defects in athletes of specific sports, in order to allow more targeted prevention and treatment strategies to be implemented for the groups at highest risk. Methods: Electronic searches were performed using Pu...

Objective To evaluate the initial outcomes of a composite cage with integral fixation using the Redmond titanium (Ti)/polyetheretherketone (PEEK) anterior cervical discectomy and fusion (ACDF) device. Methods Data from 50 consecutive patients were prospectively collected from a single senior surgeon cohort. All cages were between 5 and 8 mm in hei...

Background: The present work reports a historical case series of reaction bonded silicon nitride (Si3N4 or RBSN) implants for Anterior Lumbar Interbody Fusion (ALIF) for a patient population of 30 and surgery levels L3/4, L4/5, and/or L5/S1. Prior to the study, the only work on Si3N4 as a biomedical material was associated preliminary work, which...

Introduction There have been recent attempts to enhance interbody cage implants with the goal of early osseointegration through the use of composite-designs combining the materials titanium (Ti) and polyetheretherketone (PEEK). Design modifications include spray coating, and a variety of other methods to achieve a thin film of Titanium attached to...

Abstract Introduction Silicon Nitride (Si3N4) is a non-oxide ceramic with several important properties useful in orthopedic implants. The first ceramic implant used in humans was designed and developed in Australia, constructed of Silicon Nitride, and implanted for Anterior Lumbar Interbody Fusion (ALIF). With a renewed interest in this material,...

Study Design Prospective cohort study. Objectives To evaluate the role of magnetic resonance imaging (MRI) in evaluation of fusion status following anterior lumbar interbody fusion (ALIF) and compare agreement and confidence in assessing fusion or its absence on MRI to the current standard computed tomography (CT). Methods A prospective follow up...

Background: To analyse the relation between immediate intraoperative neurophysiological changes during decompression and clinical outcome in a series of patients with lumbar spinal stenosis (LSS) undergoing surgery. Methods: Twenty-four patients with neurogenic intermittent claudication (NIC) due to LSS undergoing decompressive surgery were pros...

Objective: The role of bacterial infection in the causation of disc degeneration and its consequences is controversial. The current evidence is limited to underpowered studies, with the majority of such studies having only an internal contaminant arm, and only one study having a control arm with a non-degenerate disc population. The Degenerate-dis...

Low back pain is the principal cause of long-term disability worldwide. We intend to address one of its main causes, degenerative disk disease, a spinal condition involving degradation of an intervertebral disk. Following unsuccessful conservative treatment, patients may be recommended for surgery. The two main surgical treatments for lumbar degene...

In recent decades cervical arthroplasty, or cervical disc replacement, has been steadily increasing in popularity as a procedure for the treatment of degenerative pathologies of the cervical spine. This is based on an evolving body of literature that documents superior outcomes in cervical disc replacement over fusion, for both single and double le...

Background: The complications associated with obesity have been well described for posterior lumbar spinal surgery. However, the influence of obesity on anterior lumbar interbody fusion (ALIF) is not well established. We aimed to compare complication risks, functional outcomes and subsidence rates in normal, overweight and obese patients who under...

Background: Anterior lumbar interbody fusion (ALIF) is a widely used surgical technique for disorders of the lumbar spine. One potential complication is the subsidence of disc height in the post-operative period. Few studies have reported the rate of subsidence in ALIF surgery prospectively. We prospectively evaluated the rate of subsidence in adu...

This study aims to review the literature and identify key molecular markers affecting the prognosis of Gliomatosis cerebri (2) to evaluate the level of evidence and identify outstanding markers requiring further study. A literature search was conducted across 5 major databases using the key terms: “Molecular markers” AND “Gliomatosis cerebri” OR “d...

Background: Anterior Lumbar Interbody Fusion (ALIF) is a surgical technique used to treat patients with a variety of lumbar pathologies. Identification of risk factors leading to complication following ALIF surgery may allow surgeons to better judge candidacy and optimize care for high-risk patients. Methods: A retrospective analysis was conduct...

Background: Anterior lumbar-interbody fusion (ALIF) is a common performed procedure for degenerative spinal disorders with reasonable clinical and safety outcomes, although there is limited evidence regarding the impact of ALIF in patients receiving worker's compensation (WC) compared to those without. The aim of our study is to identify whether W...

Study Design Systematic review and meta-analysis. Objective Current surgical management of degenerative spondylolisthesis (DS) involves decompression of the spinal canal followed by fusion with or without interbody. The additional functional and operative benefits derived from interbody inclusion has yet to be thoroughly established with a number...

The use of WEARABLE technologies in spine surgery patients.

Vertebral artery (VA) aneurysms in the paediatric population are a rare but a serious condition. However, the epidemiology of paediatric VA aneurysms is poorly understood and there is little consensus on what constitutes the appropriate treatment. Although multiple treatment options are available, including surgery, endovascular approaches, coil em...

Purpose: The traditional surgical approach to treat multi-level cervical disc disease (mCDD) has been anterior cervical discectomy and fusion (ACDF). There has been recent development of other surgical approaches to further improve clinical outcomes. Collectively, when elements of these different approaches are combined in surgery, it is known as...

Wegener’s granulomatosis (WG) causing spinal cord compression is very rare with only few cases reported in literature. We present a case report with review of literature. A 55-year-old lady with known WG presented with acute on chronic spinal cord compression. MRI scan revealed spinal cord compression anteriorly and posteriorly at T2–T5 level. Pati...

Objective: Facet joint cysts (FJC) of the lumbar spine are an increasingly reported cause of radiculopathy, lower back pain and neurological deficits. Currently, there is a lack of conclusive evidence outlining when a particular treatment should be undertaken, nor what patient indications suit a particular approach. The present systematic review a...

Study design: A systematic review and meta-analysis OBJECTIVE.: To investigate the outcomes of anterior lumber interbody fusion (ALIF) with and without an "access surgeon". Summary of background data: Anterior approaches for spine operations have become increasingly popular but may often involve unfamiliar anatomy and territory for spine surgeon...

Background: Surfers myelopathy can be a rapidly devastating disease and little is known surrounding the pathophysiology of the condition. Although the classical pattern of illness has been well reported, it has never been observed in a non-surfing setting. Methods: A 51-year-old demolition worker presented with acute non-traumatic myelopathy. Clini...

Novel Grading System for the Classification of Lumbar Facet Joint Cysts: A single-centre retrospective cohort study

Background: Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid arteries and the cavernous sinus. CCFs often present with double vision, reduced visual acuity, and conjunctivitis. Deteriorating ocular symptoms caused by abnormal fistula drainage can cause permanent blindness, and so urgent interventional treatment is nec...

Study design: Prospective cohort study. Objective: To evaluate if degenerative disc related back or neck pain and/or radicular symptoms is caused by infection with low virulent bacterial organisms. Summary of background data: The potential relationship between disc infection and disc degeneration-related symptoms remain controversial, with con...

Endovascular coil embolization is a widely accepted and useful treatment modality for intracranial aneurysms. However, the principal limitation of this technique is the high aneurysm recurrence. The adjunct use of stents for coil embolization procedures has revolutionized the field of endovascular aneurysm management, however its safety and efficac...

External ventricular drains (EVD) are crucial for the emergency management of hydrocephalus and raised intracranial pressure. Infection is the most morbid and costly cause of EVD malfunction and can cost up to $50,000 US to treat per case. In 2007, Canberra Hospital changed EVD management protocols requiring set-up of EVD transducer systems in thea...

Background: The spinal cord intramedullary cavernoma (SCIC) is a rare form of hemangioma that typically behaves as a space-occupying lesion resulting in neurological symptoms, including bladder and bowel dysfunction. To date, there have been few reports characterizing the clinical presentations and surgical outcomes of cavernomas at the C2 spinal...

Ti/PEEK cage for Anterior Lumbar Interbody Fusion

(Degenerate Disc Infection Study with Contaminant Control) DISC Trial: The Pitfalls of Not Sending Contaminant Control. Prashanth J. Rao, Rajesh Reddy, Jacob Fairhall, Marc Coughlan, Peter Mews, Martin Scholsem, Saeed Kohan, Mark Davies, Jerry Day, Kevin Phan, Ganesh Thayaparan, Daniel Scherman, Peter Taylor, Christine Chau, Elizabeth Salisbury, N...

Introduction Subsidence after interbody fusion is accepted as universal but with current interbody devices and graft materials subsidence prevalence and extent is not well known following ALIF. The aim of this study was to measure the prevalence of subsidence, extent of loss of disk height correction and a temporal relation of this loss. Methods Th...

Introduction: With recent interest in low grade infection as being a cause of degeneration of intervertebral disc a histopathological analysis maybe a good adjunct to diagnosis. Currently there are no criteria and this study was proposed to create a new scoring system. Material and Methods: A prospective collection of disc material obtained at sur...

Introduction: Recent studies have implicated disc infection in the majority of patients with axial back/neck pain or leg/arm pain. The majority of these studies are underpowered and lack a contaminant arm, the current study is aimed to fulfil these basic criteria. Material and Methods: A prospective case–control multicentric study (HREC 13/218) inc...

One of the primary strategies for the management of acute ischemic stroke is intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA). Over the past decade, endovascular therapies such as the use of stent retrievers to perform mechanical thrombectomy have been found to improve functional outcomes compared to t-PA alone. We aimed to re...

Microvascular decompression (MVD) has been demonstrated to be an excellent surgical treatment approach in younger patients with trigeminal neuralgia (TN). However, it is not clear whether there are additional morbidity and mortality risks for MVD in the elderly population. We performed a systematic literature review using six electronic databases f...

Background: Interspinous spacers are used in selected patients for the treatment of lumbar spinal stenosis. The uses of interspinous devices are still debated, with reports of significantly higher reoperation rates and unfavourable cost-effectiveness compared to traditional decompression techniques. Methods: Six electronic databases were searched f...

Lumbar disc herniation arises when the annulus fibrosus of the vertebral disc fails thus allowing displacement of the nucleus pulposus and other tissue. The term far lateral is used variably in the literature and usually refers to an extraforaminal displacement in the peridiscal zone peripheral to the sagittal plane of the most lateral part of the...

Background: Immobilization of the cervical spine is a cornerstone of spinal injury management. In the context of suspected cervical spine injury, patients are immobilized in a 'neutral position' based on the head and trunk resting on a flat surface. It is hypothesized that the increased thoracic kyphosis and loss of cervical lordosis seen in elder...

Background: Interspinous spacers are used in selected patients for the treatment of lumbar spinal stenosis. The uses of interspinous devices are still debated, with reports of significantly higher reoperation rates and unfavourable cost-effectiveness compared to traditional decompression techniques. Methods: Six electronic databases were searche...

With the potential of bias from subjective evaluation scores in spine surgery, there is a need for practical and accurate quantitative methods of analysing patient recovery. In recent years, technologies such as accelerometers and global positioning systems have been introduced as potential objective measures for pain and symptoms following spine s...

Granular cell tumors (GCTs) are rare tumors that most commonly occur in the tongue, other areas of the head and neck, and the skin of the upper limbs and trunk. GCTs of the nervous system arise from peripheral nerves and the central nervous system (CNS), however only 11 cases have been reported in the spine (1-10). We here present the case of a 13-...

Background: Surgical approaches are usually required in cases of severe cervical disc disease. The traditional method of anterior cervical disc fusion (ACDF) has been associated with reduced local mobility and increased occurrence of adjacent segment disease. The newer method of anterior cervical disc arthroplasty (ACDA) relies upon artificial dis...

Background: One of the proposed advantages of anterior lumbar interbody fusion (ALIF) is restoration of disc height and hence an indirect foraminal height restoration. While this proposed advantage is often quoted in the literature, there are few robust studies demonstrating restoration of foraminal volume. Thus, this study aimed to review the lit...

Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective...

Ventriculoperitoneal shunt (VPS) surgery is the most commonly used method for the treatment of hydrocephalus. Traditionally, distal catheters in the VPS surgery have been placed either through a standard small open laparotomy or via a laparoscopic technique. Although there are many studies demonstrating the benefits of a minimally invasive approach...

Study Design Prospective observational study. Objective Patient-based subjective ratings of symptoms and function have traditionally been used to gauge the success and extent of recovery following spine surgery. The main drawback of this type of assessment is the inherent subjectivity involved in patient scoring. We aimed to objectively measure fun...

Background: The main aims of managing thoracolumbar fractures involve stabilisation of traumatised regions, to promote vertebral healing or segmental fusion. Recently, percutaneous pedicle screw fixation has evolved as an alternative approach for the treatment of thoracolumbar fractures, aiming to minimize soft tissue injury and perioperative morbi...

Background: Surgical approaches are usually required in cases of severe cervical disc disease. The traditional method of anterior cervical disc fusion (ACDF) has been associated with reduced local mobility and increased occurrence of adjacent segment disease. The newer method of anterior cervical disc arthroplasty (ACDA) relies upon artificial disc...

Unilateral hemilaminectomy (UHIL), an alternative surgical approach to intradural lesions, involves a unilateral approach to meningeal opening that provides an adequate window for tumor extraction while leaving most of the vertebral structures intact. The techniques and results of a modified hemilaminectomy technique with spinal endoscopy is discus...

We conducted a systematic review to assess the safety and clinical and radiological outcomes of the recently introduced, direct or extreme lateral lumbar interbody fusion (XLIF) approach for degenerative spinal deformity disorders. Open fusion and instrumentation has traditionally been the mainstay treatment. However, in recent years, there has bee...

Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the lite...

We sought to evaluate the clinical and radiologic efficacy of stand-alone anterior lumbar interbody fusion (ALIF) for low grade degenerative spondylolisthesis, the favoured surgical management approach at our institution. The optimal approach for surgical management of spondylolisthesis remains contentious. We performed a prospective analysis of al...

Study Design Retrospective analysis of prospectively collected observational data. Objective To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a salvage option for lumbar pseudarthrosis following failed posterior lumbar fusion surgery. Methods From 2009 to 2013, patient outcome data was collected prospectively over 5 y...

Systematic review and meta-analysis. To review and assess the current evidence from the literature on the potential association between disc infection with the development of symptomatic degenerative disc disease. The potential relationship between disc infection- and disc degeneration-related symptoms remains controversial, with contradictory evid...

Introduction A controversial study implicated bacterial factors in chronic back pain and reported a potential treatment option with long-term antibiotics. Currently, a multicentric case–control study is being conducted looking at bacterial in surgical disc specimens: Is growth a true infection or a contaminant? A histopathological arm has been adde...

Introduction Debate continues over the optimal approach for fusion of isthmic and degenerative spondylolisthesis. We favor anterior lumbar interbody fusion (ALIF) as it permits liberal discectomy and placement of a large, lordotic device which restores disc height and sagittal balance, reduces listhesis, and indirectly decompresses exiting nerve ro...

Introduction Studies that implicate disc infection in the majority of patients with axial back/neck pain or leg/arm pain is potentially scandalous and irresponsible. The majority of these studies are underpowered and lack a contaminant arm, the current study is aimed to fulfil these basic criteria. Material and Methods A prospective case–control m...

Objective: The present retrospective study was performed to assess the anatomical features of the pedicle in isthmic spondylolisthesis and to correlate this with degree of slip. Methods: Twenty-six patients with isthmic spondylolytic spondylolisthesis were studied. Relevant patient variables, length, width, height of the L5 pedicle, and the product...

DISC : Degenerate disc Infection � Study with Contaminant control

Introduction Despite the relatively high prevalence of pseudoarthrosis following failed posterior lumbar fusion surgery, there is a lack of robust clinical evidence on salvage options for lumbar pseudoarthrosis. Whilst the literature demonstrates that anterior lumbar interbody fusion (ALIF) has been used to correct previously failed fusions, the ov...

Purpose: While open TLIF (O-TLIF) remains the mainstay approach, minimally invasive TLIF (MI-TLIF) may offer potential advantages of reduced trauma to paraspinal muscles, minimized perioperative blood loss, quicker recovery and reduced risk of infection at surgical sites. This meta-analysis was conducted to provide an updated assessment of the rela...

Background Surgical clipping and endovascular coiling yield similar functional outcomes for the treatment of saccular aneurysms of the anterior communicating (ACOM) artery. However, surgical treatment may be associated with greater rates of cognitive impairment due to injury of adjacent structures. We aimed to quantify the rates of injury (infarcti...

Background Surgical clipping and endovascular coiling yield similar functional outcomes for the treatment of saccular aneurysms of the anterior communicating (ACOM) artery. However, surgical treatment may be associated with greater rates of cognitive impairment due to injury of adjacent structures. We aimed to quantify the rates of injury (infarcti...

Background: One of the proposed advantages of anterior lumbar interbody fusion (ALIF) is restoration of disc height and hence an indirect foraminal height restoration. While this proposed advantage is often quoted in the literature, there are few robust studies demonstrating restoration of foraminal volume. Thus, this study aimed to review the lite...

Despite advances in our knowledge of glioblastoma multiforme (GBM), there have been limited improvements in achieving median survival over the past decades. There is a need to explore new approaches to diagnosis and management of malignant glioma, particularly based on the increasing knowledge regarding the molecular and immune microenvironment of...

Background context: A frequently quoted advantage of anterior lumbar interbody fusion (ALIF) is indirect foraminal decompression, although there are few studies substantiating this statement. Also, there are no clinical studies using a standardized method to measure the foraminal area (FA) and the correlation with disc height (DH) parameters. This...

Object: Despite limited availability and the morbidity associated with autologous iliac crest bone graft (ICBG), its use in anterior lumbar interbody fusion (ALIF) procedures remains the gold standard to achieve arthrodesis. The search for alternative grafts yielding comparable or superior fusion outcomes with fewer complications continues. In par...

Background: There is limited information on clinical outcomes after anterior lumbar interbody fusion (ALIF) based on the indications for surgery. Objective: To compare the clinical and radiological outcomes of ALIF for each surgical indication. Methods: This prospective clinical study included 125 patients who underwent ALIF over a 2-year peri...

Objective Surgical treatment of spinal metastasis is generally a palliative procedure. Although minimally invasive surgical (MIS) techniques are supposedly less morbid than open techniques, there is a lack of stratification of MIS techniques based on anticipated longevity. A simple stratification into three percutaneous surgical techniques based on...

Object The development of minimally invasive surgical techniques is driven by the quest for better patient outcomes. There is some evidence for the use of minimally invasive surgery for degenerative lumbar spine stenosis (LSS), but there are currently no studies comparing outcomes with matched controls. The object of this study was to compare outco...

The clinical outcome of lumbar spinal fusion is correlated with achievement of bony fusion. Improving interbody implant bone on-growth and in-growth may enhance fusion, limiting pseudoarthrosis, stress shielding, subsidence and implant failure. Polyetheretherketone (PEEK) and titanium (Ti) are commonly selected for interbody spacer construction. Al...

The effects of the nature of admission and a non-refusal policy on acute spinal cord injury care

Outcomes of Anterior Lumbar interbody fusion(ALIF) based on indication: a prospective study

Indirect foraminal decompression following anterior lumbar interbody fusion (ALIF): a prospective study using a new Pedicle to pedicle (P-P) technique