Shanmuganathan Rajasekaran

• M.S(Ortho), DNB, FRCS, FACS, MCh, Ph.D
• Ganga Medical Centre & Hospitals Pvt. Ltd.

Background Pierre Roussouly et al. classified four distinct types of sagittal profiles in normal individuals based on their sacral slope (SS). It was modified by Laouissat et al., (theoretical) including a fifth type. Study Design The study design was a cross-sectional study. Objective The objective of this study was to identify and classify the...

Background Cervical sagittal alignment maintains horizontal gaze, supports the axial load of the skull, and has a reciprocal relationship to the cervicothoracic sagittal alignment. Studies are being conducted on different ethnicities, but little literature exists about cervical sagittal alignment and correlation chains in the Indian population. The...

Study design Prospective, randomized control study. Objective To assess the safety and efficacy of fluoroscopy-guided vs ultrasound-guided Erector Spinae Plane Block (ESPB) for perioperative analgesia in lumbar fusion surgery. Materials and Methods 66 patients requiring single-level lumbar fusion were randomized into 2 groups. One group had fluor...

Introduction Symptomatic Adjacent segment disease presents in myriad ways with varying clinic-radiological presentation but the optimal management and the factors that predict need for revision surgery are unclear. Methodology Consecutive patients (n = 132) who experienced significant back or leg pain after an asymptomatic period (minimum 1 year)...

Case A 52-year-old male fell from his bike and sustained fractures of the right proximal humerus and the left distal radius, both of which were fixed in a single sitting a day after the injury. On postoperative day four, the patient developed features suggestive of acute pulmonary embolism. Conclusion Reports of acute pulmonary embolism developing...

The spine research within India has seen significant advancement, yet detailed examinations of its impact and evolution still need to be made sparse. To conduct a comprehensive scientometric review of the most frequently cited papers in Indian spine research from 1995 to 2024, aiming to map the field’s evolution and its global impact. Utilizing the...

Purpose Acute Paraspinal compartment syndrome (PCS) is a very rare clinical condition resulting from high pressures within the erector spinae muscle compartment due to intense edema of the erector spinae muscles and can be associated with rhabdomyolysis and renal injury. Though several causes have been identified, PCS caused by power yoga has not b...

Case We report three male patients, ages 20, 22, and 54 years, who sustained open calcaneus fractures following a road traffic accident with a major composite bone and soft tissue loss salvaged successfully, with a minimum follow-up of 2 years. Wound debridement and an ankle-spanning external fixator were initially applied, followed by a free micro...

In cases of closed tibia fractures with acute compartment syndrome (ACS), there is no established agreement on whether performing internal fixation at the time of closure or after healing of the fasciotomy wounds would affect the likelihood of non-union or infection risk. The study aims to compare fracture union rates, incidence of infection, and o...

Purpose Recently, there has been significant focus on extracellular matrix proteolysis due to its importance in the pathological progression of intervertebral disc degeneration (IVDD). The present study investigates the circulating levels of extracellular matrix proteins in the plasma of IVDD and determines their potential relevance as biomarkers i...

Gap non-union of long bones are challenging problems in orthopaedic patients. Non-vascularized fibular grafting is a simple, cost effective, single stage procedure and is an accepted method of reconstruction for gap non unions in children. However, there is a risk of non-union when a long avascular strut of fibula is used. The periosteum, by itself...

Background Traumatic spinal injuries (TSIs) due to falls from heights are characterized by unique injury mechanisms, morphological features, and severity. In this study, we conducted an analysis of the epidemiological, clinical, and radiological data of TSI patients caused by falls from heights. We compared these findings with those of patients inj...

Introduction Unplanned readmissions after spine surgery are undesired, and cause significant functional, and financial distress to the patients and healthcare system. Though critical, knowledge about readmissions after surgery for traumatic spinal injuries (TSI) is scarce and under-evaluated. Methods Consecutive patients surgically treated for TSI...

Case An 18-year-old right-handed male student presented after a road-traffic-accident; he had type-II Monteggia fracture dislocation associated with ipsilateral type-I capitellum fracture and comminuted lateral condyle avulsion fracture. He underwent open reduction and fixation of ulna with 3.5 DCP with autologous olecranon bone grafting and fixati...

Background context: Gut microbiome alterations resulting in inflammatory responses have been implicated in many distant effects on different organs. However, its influence on disc health is still not fully investigated. Purpose: Our objective was to document the gut biome in healthy volunteers and patients with disc degeneration and to understan...

With the increase in the aging population globally, there has been a proportional increase in total knee arthroplasty (TKA) procedures. Estimates show that by 2030, the number of TKA procedures will grow by more than 650%. Furthermore, the demand for revision TKA following failed primary TKA is expected to grow by nearly 600% in the next five years...

Study design Prospective, randomized controlled study. Objective To assess the safety and efficacy of an ultrasound-guided ISP block for postoperative analgesia in posterior cervical laminectomy. Methods 88 patients requiring posterior cervical laminectomy were randomized into two groups, those who underwent ISP block with multimodal analgesia (I...

Pulmonary dysfunction in thoracic kyphoscoliosis has been correlated with chest wall distortion, uneven trunk growth and restrictive pattern. The study aims to analyse the variation in thoracic inlet measurements on pulmonary dysfunction with varying curve magnitude and thoracic cage parameters. In a non-randomised, prospective case–control study,...

Case A 52-year-old man presented with cauda equina syndrome after a motorcycle accident. Magnetic resonance imaging revealed traumatic disc herniation, at L2-L3 and L5-S1 levels without bony injury. He was managed successfully by wide laminectomy and microdiscectomy at both levels with complete neurological recovery at 2-month follow-up. Conclusio...

Purpose With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly. Methods A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomize...

Purpose: Improper utilization of surgical antimicrobial prophylaxis frequently leads to increased risks of morbidity and mortality. This study aims to understand the common causative organism of postoperative orthopedic infection and document the surgical antimicrobial prophylaxis protocol across various institutions in to order to strengthen surgi...

Coronal shear fractures of the distal humerus involving the capitellum and trochlea are rare injuries. Internal fixation with headless compression screws provides a stable construct facilitating early mobilisation. Our study aimed to identify the key determinants of both radiological and functional outcomes of patients with distal humerus coronal s...

Study design: A retrospective cohort study. Purpose: To determine outcomes following all-posterior surgery using computed tomography navigation, hybrid stabilization, and multiple anchor point techniques in patients with neurofibromatosis type 1 (NF-1) and dystrophic scoliosis. Overview of literature: Previous studies favored antero-posterior...

Study design: A retrospective cohort study. Purpose: This study aimed to understand the role of magnetic resonance imaging (MRI) in predicting neurological deficits in traumatic lower lumbar fractures (LLFs; L3-L5). Overview of literature: Despite studies on the radiological risk factors for neurological deficits in thoracolumbar fractures, ve...

Study Design: Global cross-sectional survey. Objective: The objective of this study was to validate the hierarchical nature of the AO Spine Sacral Classification System and develop an injury scoring system. Summary of Background Data: Although substantial interobserver and intraobserver reliability of the AO Spine Sacral Classification System has b...

Purpose To evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting. Methods Patients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center...

Proximal femur has a variable anatomy and anatomical reconstruction during total hip replacement is always a challenge. With good preoperative planning and meticulous intraoperative techniques, it is possible to achieve a stable long-lasting fixation with restoration of length offset and version with a standard femoral prosthesis. But modularity mi...

Study Design A prospective study. Objective to evaluate the impact of vertebral body comminution and Posterior Ligamentous Complex (PLC) integrity on the treatment recommendations of thoracolumbar fractures among an expert panel of 22 spine surgeons. Methods A review of 183 prospectively collected thoracolumbar burst fracture computed tomography...

Study Design Prospective Observational Study. Objective To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making. Methods 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts. These experienced clinicia...

Study Design Retrospective analysis of prospectively collected data. Objectives Our goal was to assess radiographic characteristics associated with agreement and disagreement in treatment recommendation in thoracolumbar (TL) burst fractures. Methods A panel of 22 AO Spine Knowledge Forum Trauma experts reviewed 183 cases and were asked to: (1) cl...

Study Design This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue. Objectives Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoraco...

Study Design Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations. Objectives To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifie...

Study Design Retrospective analysis of prospectively collected data. Objectives To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making. Methods This study is a sub-analysis of a prospective...

Study design Predictive algorithm via decision tree Objectives Artificial intelligence (AI) remain an emerging field and have not previously been used to guide therapeutic decision making in thoracolumbar burst fractures. Building such models may reduce the variability in treatment recommendations. The goal of this study was to build a mathematica...

Purpose: At the molecular level, disc degeneration (DD) has been associated with dissociation of matrix assembly, leading to the loss of structural integrity. As a result of matrix dissociation, tissue ECM proteins are expected to leak into the newly developed blood vessels that circulate in the peripheral blood, indicating diseased states. Experim...

The role of prophylactic pinning of the contralateral hip in unilateral SCFE is well established in patients with risk factors for developing contralateral slip. The effect of prophylactic pinning on the growth and morphology of the hip is not well documented in the literature. We aimed to study the effect of prophylactic pinning on the residual gr...

Introduction: Primary hyperparathyroidism (PHPT) is an intrinsic abnormality of the parathyroid glands in which there is an inappropriate secretion of parathormone (PTH), resulting in skeletal resorption and bone loss. The characteristic bony changes of fibrotic cystic lesions are called Brown’s tumors. Clinical dilemmas exist due to the varied cli...

Background Disrupted anterior pelvic ring injury most often requires plate fixation to achieve stability of the injury pelvic ring. However, there is relatively high incidence of hardware failure either in the early or late follow-up. Many of them require revision surgery if they become symptomatic in the early phase. Most commonly preferred fixati...

Study Design Prospective Study. Objectives There are numerous techniques for performing lumbar discectomy, each with its own rationale and stated benefits. The authors set out to evaluate and compare the perioperative variables, results, and complications of each treatment in a group of patients provided by ten hospitals and operated on by experie...

Rubber band or Dhaga syndrome is a rare condition commonly present in infants or toddlers of specific communities who wear bracelets or sacred thread for religious or decorative purposes. It was first described by Hogeboom and Stephens in 1961. We report a case of a 2-year-old girl who came to our institution with swelling, inflammation, and pain i...

Background: The use of intraoperative CT navigation to manage osteoid osteoma is not common. We report our experience managing osteoid osteoma in the appendicular skeleton using an intraoperative AIRO CT navigation system. Materials & Methods: Between May 2013 and December 2022, 59 patients underwent Navigation-assisted excision of osteoid osteoma...

Needle abscission in balsam fir has been linked to both cold acclimation and changes in lipid composition. The overall objective of this research is to uncover lipid changes in balsam fir during cold acclimation and link those changes with postharvest abscission. Branches were collected monthly from September to December and were assessed for cold...

Diabetic foot ulcers are becoming more prevalent, and microsurgical free flaps are gaining popularity in salvaging the foot after postdebridement. The perivascular fibrosis around the recipient vessels often makes the dissection of vessels difficult. In this article, we describe a technique of dissection in such situations where fibrosis and dissec...

Introduction The purpose is to report on the fourth set of recommendations developed by SPINE20 to advocate for evidence-based spine care globally under the theme of “One Earth, One Family, One Future WITHOUT Spine DISABILITY”. Research question Not applicable. Material and methods Recommendations were developed and refined through two modified D...

Needle abscission in balsam fir has been linked to both cold acclimation and changes in lipid composition. The overall objective of this research is to uncover lipid changes in balsam fir during cold acclimation and link those changes with postharvest abscission. Branches were collected monthly from September to December and assessed for cold toler...

Study Design Prospective, randomized controlled double-blinded study. Objective To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia. Methods 81 patients requiring single-level lumbar fusion surgery were rand...

Background context: The disc, endplate (EP), and bone marrow region of the spine form a single anatomical and functional interdependent unit; isolated degeneration of any one structure is rare. Modic changes (MC), however, are restricted to the subchondral bone alone and based on only T1 and T2 sequences of MRI. This results in poor reliability in...

Infantile cortical hyperostosis also named as Caffey’s disease is a rare self-limiting inflammatory disease that usually affects children during infancy. It is characterized by subperiosteal new bone formation usually involving the diaphysis of long bone as well as the ribs, mandible, scapula, and ribs. It is crucial to diagnose the disease at an e...

PurposeThe aim of our study was to determine the surgical outcomes of patients who underwent lateral femoral sliding osteotomy (LFSO) with total knee arthroplasty (TKA) for Ranawat’s type 2 fixed valgus deformity.Methods The consecutive patients who underwent primary TKA with posterior-stabilized implant and LFSO for fixed valgus deformity were rev...

Case: A 47-year-old male patient presented with progressively worsening gait instability caused by a giant anomalous, free-floating C5 spinous process resulting in dynamic cord compression and myelopathy. The patient was successfully managed with a C5 laminectomy and total excision of the anomalous spinous process with a good functional outcome at...

Case: Intrawound vancomycin in spine surgery is a common clinical practice. We report a case of a 14-year-old adolescent girl undergoing surgery for scoliosis correction who developed features of vancomycin flushing syndrome after the use of vancomycin-impregnated bone graft. After resuscitation, she was extubated and had an uneventful postoperati...

Objective: Disc degeneration following trauma has been the focus of several investigations, while vertebral endplate changes have received comparatively less attention. The main aim of the study is to radiologically evaluate the prevalence of degree of degeneration of the adjacent discs and endplates following AO type A thoracolumbar fractures. M...

Background Meniscal extrusion is a phenomenon in which a degenerative posterior horn tear, radial tear, or root tear results in displacement of the body of the meniscus medial to the tibial rim. The paramount function of the meniscus is to provide load distribution across the knee joint. Meniscal extrusion will prevent the meniscus from properly fu...

Purpose To determine various radiological parameters predicting spinal cord injury (SCI) in patients with cervicothoracic translational injury. Materials and Methods Forty-four patients operated for cervicothoracic (C7-T1) translational injury between January 2009 and 2019 were reviewed to obtain demographic details, mechanism of injury (based on...

Osteoblastoma is a benign bone tumor that accounts for 10% of all spinal tumors and mostly arises from the posterior spinal elements. Isolated vertebral body osteoblastoma is relatively rare and generally requires extensive surgery. We report a rare case of L4 vertebral body osteoblastoma, which was managed successfully by computer navigation-guide...

Neurofibromatosis type 1 (NF-1) with extensive intraspinal involvement seldom presents with isolated radiculopathy. We report the case of a young male with NF-1 having dumbbell tumors along the entire extent of the spine presenting with isolated lower limb radiculopathy. The surgical goals for such tumors primarily involve symptom control, rather t...

Background Although microtrauma, gene polymorphisms, or subclinical infection could initiate lumbar disc herniation (LDH), the final pathway culminating in herniation can involve two possible trajectories—degeneration of nucleus pulposus or vertebral end plate (EP) damage. We performed a retrospective case–control study to understand the relative r...

Introduction: Foot pressure changes and morbidity after Flexor hallucis longus(FHL) transfer in chronic retracted Tendoachilles(TA) tears have not been documented. The primary aim of our study is to analyze the peak pressure changes in various zones of the foot at each successive follow-up in the affected foot versus normal foot. The secondary aim...

Background Spinal tuberculosis (TB) is the most common extrapulmonary form of tuberculosis. In both developing and developed countries, TB has been on the rising trend due to factors such as increasing HIV coinfection, multidrug resistance of the organism, and global migration. Spinal TB, which most often affects the lower thoracic and thoracolumba...

Purpose: The main purpose of the study is to perform a propensity-matched functional outcome analysis following microdiscectomy (MD) versus interlaminar endoscopic lumbar discectomy (IELD) for L5-S1 disc herniation. Although many studies have compared endoscopic lumbar discectomy and microdiscectomy, few have compared the outcomes of microdiscecto...

Spinal tuberculosis typically affects the vertebral bodies, resulting in various degrees of kyphosis. Children [Formula: see text]10 years, thoraco-lumbar spine affliction, late presentation, vertebral loss [Formula: see text]1.5 bodies and presence of spine at risk signs reasonably predict patients who are prone for worsening kyphosis during both...

The osseous structure of the talocalcaneal joint and the intricate arrangements of numerous ligaments at the medial and lateral parts of the ankle joint, the sinus tarsi, and the talocalcanonavicular joint complex, respectively, provide the stability of the subtalar joint. There is still a significant lack of understanding about the relationship be...

Case: Two patients who sustained multiple injuries after a road traffic accident developed cutaneous mucormycosis after a superficial abrasion. In the first case, the patient was diabetic with poorly controlled glycemic status. In the second case, the patient was young and immunocompetent with no known risk factors. Conclusion: Although there ar...

Background context: Computed tomography-based vertebral attenuation values (CT-based HU) have been shown to correlate with T-scores on DEXA scan; and have been acknowledged as an independent factor for predicting fragility fractures. Most patients undergoing lumbar surgeries require CT as part of their pre-operative evaluation. Purpose: The curr...

Incidental dural tears being a familiar complication in spine surgery could result in dreaded postoperative outcomes. Though the literature pertaining to their incidence and management is vast, it is limited by the retrospective study designs and smaller case series. Hence, we performed a prospective study in our institute to determine the incidenc...

Background: The majority of literature on bacterial flora in the disc stands disadvantaged in utilizing traditional culture methods and targeting a single bacterium, Cutibacterium acnes. Objective: Our objective was to document the diversity in the bacterial flora between normal and degenerated discs for shortlisting potential pathogens using ne...

Ralstonia mannitolilytica is a low-virulence, gram-negative bacillus which causes opportunistic infections in immunosuppressed patients. Postoperative spondylodiscitis by R. mannitolilytica has not been reported so far. We report the management of two cases of postoperative spondylodiscitis caused by Ralstonia mannitolilytica presenting to our cent...

Background content: The goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative...

Study design: Retrospective study. Purpose: To investigate the radiological phenotype, patient and surgery-related risk factors influencing postoperative clinical outcome for cervical myelopathy caused by ossification of the posterior longitudinal ligament involving C2 following posterior instrumented laminectomy and fusion. Overview of literat...

Introduction: Fracture of the base of the ulnar styloid has shown to have higher incidence of TFCC tears and DRUJ instability leading to nonunion and impaired function. Poorer functional outcomes of the distal radius fracture have been attributed to the untreated associated ulnar styloid fractures while some studies have shown no difference. Thus,...

Objective: Though magnetic resonance imaging (MRI) is the primary modality of investigation for determining the extent of PLC injuries in lower lumbar fractures (L3-L5), the reliability of computed tomography (CT) has not been well defined. The main objective of this study is to analyze the diagnostic accuracy of combined CT findings for detecting...

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). M...