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Shi L, Ding T, Wang F, Wu C. Comparison of Anterior Cervical Decompression and Fusion and Posterior Laminoplasty for Four-Segment Cervical Spondylotic Myelopathy: Clinical and Radiographic Outcomes. J Neurol Surg A Cent Eur Neurosurg 2024; 85:331-339. [PMID: 36584878 DOI: 10.1055/a-2005-0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although anterior or posterior surgery for cervical spondylotic myelopathy (CSM) has been extensively studied, the choice of anterior or posterior approach in four-segment CSM remains poorly studied and controversial. We compared the clinical and radiographic outcomes of four-segment CSM by posterior laminoplasty (LAMP) and anterior cervical decompression fusion (ACDF) to further explore the merits and demerits of ACDF and LAMP for four-segment CSM in this study. METHODS Patients with four-segment CSM who underwent ACDF or LAMP between January 2016 and June 2019 were retrospectively analyzed. We compared the preoperative and postoperative cervical Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI), neck pain visual analog scale (VAS) score, sagittal vertical axis, cervical lordosis (CL), and range of motion. RESULTS There were 47 and 79 patients in the ACDF and LAMP groups, respectively. Patients in the ACDF group had a significantly longer surgical time and lower estimated blood loss and length of stay than those in the LAMP group. There was no significant difference in the JOA, NDI, or neck pain VAS scores between the two groups preoperatively, but the NDI and neck pain VAS scores in the ACDF group were significantly lower than those in the LAMP group at the final follow-up. The preoperative C2-C7 Cobb angle of the ACDF group was significantly lower than that of the LAMP group but there was no significant difference between the two groups postoperatively. The improvement of C2-C7 Cobb angle (∆C2-C7 Cobb angle) in the ACDF group was significantly higher than that in the LAMP group. This indicated that ACDF can improve CL better than LAMP. The linear regression analysis revealed the ∆C2-C7 Cobb angle was negatively correlated with the final follow-up neck pain VAS scores and NDI. This indicated that patients with better improvement of CL may have a better prognosis. CONCLUSIONS Although both ACDF and LAMP surgeries are effective for four-segment CSM, ACDF can better improve CL and neck pain. For patients with poor CL, we suggest ACDF when both approaches are feasible.
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Affiliation(s)
- Liang Shi
- Department of Orthopedics, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Tao Ding
- Department of Spine Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Fang Wang
- Department of Pathology, Qujing Second People's Hospital of Yunnan Province, Qujing, China
| | - Chengcong Wu
- Department of Spine Surgery, Qujing First People's Hospital: Kunming Medical University Affiliated Qujing Hospital, Qujing, Yunnan, China
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The Essence of Clinical Practice Guidelines for Cervical Spondylotic Myelopathy, 2020. Spine Surg Relat Res 2024; 8:119-132. [PMID: 38618212 PMCID: PMC11007242 DOI: 10.22603/ssrr.2022-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 04/16/2024] Open
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Wadhwa H, Sharma J, Varshneya K, Fatemi P, Nathan J, Medress ZA, Stienen MN, Ratliff JK, Veeravagu A. Anterior Cervical Discectomy and Fusion Versus Laminoplasty for Multilevel Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World Neurosurg 2021; 152:e738-e744. [PMID: 34153482 DOI: 10.1016/j.wneu.2021.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is effective for the treatment of single-level cervical spondylotic myelopathy (CSM). However, the data surrounding multilevel CSM have remained controversial. One alternative is laminoplasty, although evidence comparing these strategies has remained sparse. In the present report, we retrospectively reviewed the readmission and reoperation rates for patients who had undergone ACDF or laminoplasty for multilevel CSM from a national longitudinal administrative claims database. METHODS We queried the MarketScan Commercial Claims and Encounters database to identify patients who had undergone ACDF or laminoplasty for multilevel CSM from 2007 to 2016. The patients were stratified by operation type. Patients aged <18 years, patients with a history of tumor or trauma, and patients who had undergone anteroposterior approach were excluded from the present study. RESULTS A total of 5445 patients were included, of whom 1521 had undergone laminoplasty. A matched cohort who had undergone ACDF was identified. The overall 90-day postoperative complication rate was greater in the laminoplasty cohort (odds ratio, 1.48; 95% confidence interval, 1.18-1.86; P < 0.0001). The mean length of stay and 90-day readmission rates were greater in the laminoplasty cohort. The hospital and total payments of the index hospitalization were greater in the ACDF cohort, as were the total payments for ≤2 years after the index hospitalization. CONCLUSIONS In the present administrative claims database study, no difference was found in the reoperation rate between ACDF and laminoplasty. ACDF resulted in fewer complications and readmissions compared with laminoplasty but was associated with greater costs. Additional prospective research is required to investigate the factors driving the higher costs of ACDF in this population and the long-term clinical outcomes.
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Affiliation(s)
- Harsh Wadhwa
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jigyasa Sharma
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Kunal Varshneya
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Parastou Fatemi
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jay Nathan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Zachary A Medress
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
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Elbhrawy S, Abdou A, ElSaghir H, Ashram YA, Mekky J. Pattern and Rate of Functional Recovery After Surgery for Cervical Spondylotic Myelopathy: Egyptian Prospective Study. World Neurosurg 2021; 150:e279-e286. [PMID: 33689851 DOI: 10.1016/j.wneu.2021.02.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study pattern and rate of neurological functional recovery after surgery for cervical spondylotic myelopathy (CSM). METHODS This prospective study comprised 25 patients with CSM who underwent surgical decompression at our institution. Upper limb, lower limb, and sphincter functions were assessed using the modified Japanese Orthopaedic Association score (mJOA). Assessment was done before the operation and at 1 month, 3 months, and 1 year after surgery. RESULTS The mJOA score did not significantly increase at 1 month after surgery (P = 0.051); however, increase in mJOA score was statistically significant at 3 and 1 year after surgery (P < 0.001 and P < 0.001, respectively). Upper limb motor dysfunction improved in 65% of patients, lower limb motor dysfunction improved in 52% of patients, upper limb sensory dysfunction improved in 48% of patients, and sphincter dysfunction improved in 14.2% of patients. There was a significant positive correlation between preoperative and postoperative mJOA score at 1 month, 3 months, and 1 year after surgery. CONCLUSIONS Minimal improvement occurred in the first month after CSM surgery to reach a peak at 3 months after surgery and steady improvement up to 1 year after surgery. Upper limbs recovered better and earlier than lower limbs and sphincter function. Preoperative severity of CSM is one of the main predictors of postoperative neurological outcome.
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Affiliation(s)
- Sonia Elbhrawy
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Ashraf Abdou
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hesham ElSaghir
- Spine Unit, Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasmine A Ashram
- Department of Physiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jaidaa Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Yoshii T, Egawa S, Chikuda H, Wakao N, Furuya T, Kanchiku T, Nagoshi N, Fujiwara Y, Yoshida M, Taguchi T, Watanabe M. A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical spondylotic myelopathy. J Orthop Sci 2021; 26:116-122. [PMID: 32205020 DOI: 10.1016/j.jos.2020.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/23/2019] [Accepted: 02/09/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial because there are few comprehensive studies that have investigated the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and to compare the surgical outcomes between anterior decompression with fusion (ADF) and laminoplasty, which are representative procedures for CSM. METHODS An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and laminoplasty for CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies of CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and treatments with posterior instrumented fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, cervical alignment, surgical complications and reoperation rates. Then, a meta-analysis was performed on these surgical outcomes. RESULTS Nine studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the preoperative JOA score was similar between the ADF and laminoplasty groups. The postoperative JOA scores and neurological recovery rates were not different between the ADF and laminoplasty groups. ADF exhibited more favorable results than laminoplasty in terms of postoperative cervical alignment. In contrast, overall complications were more frequently observed in the ADF group than in the laminoplasty group, leading to higher rates of reoperation. However, postoperative neck pain was more frequently observed in the laminoplasty group than in the ADF group. CONCLUSIONS This systematic review and meta-analysis showed both the merits and shortcomings of ADF and laminoplasty. ADF and laminoplasty showed similar results in terms of neurological recovery. Postoperative cervical lordosis was better preserved with ADF than with laminoplasty. However, ADF was associated with a higher incidence of surgical complications than laminoplasty.
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Affiliation(s)
- Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan.
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopedic Surgery, Gunma University School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8513, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Norimitsu Wakao
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Moriokacho7-430, Obu City, Aichi, 474-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda City, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami2-1-1, Asakitaku, Hiroshima City, 731-0293, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiro Yoshida
- Department of Surgery, International University of Health and Welfare Ichikawa Hospital, Konodai 6-1-14, Ichikawashi, Chiba, 272-0827, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda City, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
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Does the Neurological Examination Correlate with Patient-Perceived Outcomes in Degenerative Cervical Myelopathy? World Neurosurg 2019; 132:e885-e890. [PMID: 31382071 DOI: 10.1016/j.wneu.2019.07.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In patients with neurological disorders, a divergence can exist between patients' perceptions regarding the outcomes and the objective neurological findings. Degenerative cervical myelopathy (DCM), a prevalent condition characterized by progressive compression of the cervical spinal cord, can produce debilitating symptoms and profound neurological findings. The purpose of the present study was to determine whether the physician-derived neurological examination findings, as recorded by American Spine Injury Association (ASIA) summary score, correlated with the patient-derived outcome measures for DCM. METHODS A total of 78 patients underwent surgical management of DCM with completion of preoperative and 6-month follow-up assessments. Surgical management consisted of either anterior or posterior cervical decompression. All patients underwent a neurological evaluation, including an ASIA assessment before surgery and 6 months after surgery, and completed the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and Short-Form 36-item (SF-36) scales pre- and postoperatively to measure both disease-specific and general perceived outcomes. RESULTS The objective physician-derived neurological testing (ASIA) did not correlate with the patient-derived scales (mJOA, NDI, and SF-36) pre- or postoperatively. Patients reported significant improvements (P < 0.001) at 6 months postoperatively in extremity functioning (mJOA), neck pain (NDI), overall physical health (SF-36), and objective strength and sensory functioning (ASIA). All patient-perceived outcome measures correlated with each other pre- and postoperatively (P < 0.01). CONCLUSIONS Objective scoring of postoperative neurological function did not correlate with patient-perceived outcomes before and after surgery for DCM. Traditional testing of motor and sensory function as part of the neurological assessment may not be sensitive enough to assess the scope of neurological changes experienced by patients with DCM.
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Montano N, Ricciardi L, Olivi A. Comparison of Anterior Cervical Decompression and Fusion versus Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis of Clinical and Radiological Outcomes. World Neurosurg 2019; 130:530-536.e2. [PMID: 31254693 DOI: 10.1016/j.wneu.2019.06.144] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Spondylotic cervical myelopathy is a severe condition commonly affecting aging people. Although many investigations have been conducted, a consensus on the best surgical management is still missing. The aim of our study was to systematically review the pertinent literature and carry out a meta-analysis to compare the clinical and radiological outcome of the anterior cervical decompression and fusion (ACDF) and the posterior laminoplasty. METHODS This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines statement. Different medical database (PubMed, Embase, Scopus) were screened for eligible scientific reports. The key words "cervical," "spondylosis," "myelopathy," "laminoplasty," "ACDF" (MeSH) have been used in any possible combination. As outcome variables, the Japanese Orthopedic Association score, operation time, blood loss, cervical lordosis, range of motion and, complications were evaluated. RESULTS A total of 626 articles were screened and 5 finally included in the meta-analysis. Comparing the anterior cervical decompression and fusion (ACDF) and laminoplasty groups, no differences were found in Japanese Orthopedic Association score, operation time, and complication rate. The ACDF was associated with lower intraoperative blood loss and better cervical lordosis preservation, whereas the laminoplasty was associated with a wider cervical range of motion. CONCLUSIONS The results of this meta-analysis seem to suggest that ACDF should be preferred to the laminoplasty for the treatment of multilevel cervical myelopathy, although proper designed randomized controlled clinical trials are needed to further investigate this relevant ongoing issue.
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Affiliation(s)
- Nicola Montano
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.
| | - Luca Ricciardi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review. Arch Orthop Trauma Surg 2019; 139:735-742. [PMID: 30739192 DOI: 10.1007/s00402-018-03102-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The goal of this meta-analysis is to explore the overall efficacy as well as the safety of anterior versus posterior approach for the therapy of patients with multilevel cervical spondylotic myelopathy based on qualified studies. METHODS Three electronic databases, PubMed, Cochrane, Embase were searched updated to January 2018 to identify all relevant and qualified studies using the index words. The qualified studies were including prospective or retrospective comparative studies. Relative risk (RR) and mean difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. RESULTS In this meta-analysis, there were a total of 24 studies with 959 patients in the anterior approach group and 1072 patients in the posterior approach group. The final results showed, in comparison of the posterior approach group, the anterior approach group significantly increased the JOA score (SMD: 0.36, 95% CI 0.10-0.62), the operation time (WMD: 49.87, 95% CI 17.67-82.08), and the neurological recovery rate (WMD: 10.55, 95% CI 3.99-17.11) with higher complication rate (RR: 1.53, 95% CI 1.24-1.89). Besides, there was no significant difference of the blood loss (SMD: - 0.40, 95% CI - 1.12 to 0.32) and ROM (SMD: - 0.28, 95% CI - 0.78 to - 0.22) between posterior approach group and anterior approach group. CONCLUSIONS Studies found a significant increase of JOA score as well as neurological recovery rate by the anterior approach treatment when compared with posterior approach treatment. However, increased operation time and complications could also occur through the anterior approach treatment. More high-quality randomized controlled trials with larger sample size, multi-centric and longer follow-ups are needed to support our current conclusions.
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Pandita N, Gupta S, Raina P, Srivastava A, Hakak AY, Singh O, Darokhan MAUD, Butt MF. Neurological Recovery Pattern in Cervical Spondylotic Myelopathy after Anterior Surgery: A Prospective Study with Literature Review. Asian Spine J 2019; 13:423-431. [PMID: 30685954 PMCID: PMC6547403 DOI: 10.31616/asj.2018.0139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/02/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective clinical study. Purpose The present study aimed to examine the neurological recovery pattern in cervical spondylotic myelopathy (CSM) after anterior cervical decompression and compare it with the existing reports in the literature. Overview of Literature Neurological recovery and regression of myelopathy symptoms is an important factor that determines the outcomes of surgical decompression. The present findings contribute to the literature on the pattern of neurological recovery and patient prognosis with respect to the resolution of myelopathy symptoms after surgery. Methods This prospective study was conducted in Government Medical College in Jammu, North India between November 2012 and October 2014, a total of 30 consecutive patients with CSM were included and treated with anterior decompression and stabilization. They were prospectively followed up for 1 year and were evaluated for their neurological recovery pattern. The postoperative outcome was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. The recovery rate was calculated using Hirabayashi’s method. The JOA score was assessed before the operation and postoperatively at 1 week, 2 weeks, 1 month, 3 months, 4 months, 6 months, and 1 year. Results The postoperative mJOA score was 0 in the 1st month, 12.90±3.57 in the 3rd month, 13.50±3.55 in the 4th month, 14.63±3.62 in the 6th month, and 14.9±3.24 at the final follow-up of 1 year. The average recovery rate during the 1st month follow-up was 0%, and that during the 3rd month follow-up was 12.91% with a range of 0%–50%. The average recovery rate during the 4th month was 32.5%, with a range of 0%–60%, while that during the 6th month was 72.83%, with a range of 0%–100%. The average recovery rate during the final follow-up of 1 year was 54.3%. Conclusions Neurological recovery after surgical decompression starts from the 3rd postoperative month and progresses until the 6th postoperative month; thereafter, it gradually plateaus over the subsequent 6 months until it steadies. Symptom duration is an important factor that requires consideration while determining postoperative neurological recovery.
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Affiliation(s)
- Naveen Pandita
- Department of Spine Services, Primus Super Speciality Hospital, New Delhi, India
| | - Sanjeev Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Jammu, India
| | - Prince Raina
- Department of Orthopaedics, Government Medical College and Hospital, Jammu, India
| | - Abhishek Srivastava
- Department of Spine Services, Primus Super Speciality Hospital, New Delhi, India
| | - Aamir Yaqoob Hakak
- Department of Orthopaedics, Government Medical College and Hospital, Jammu, India
| | - Omeshwar Singh
- Department of Orthopaedics, Government Medical College and Hospital, Jammu, India
| | | | - Mohd Farooq Butt
- Department of Orthopaedics, Government Medical College and Hospital, Jammu, India
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