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Santifort KM, Carrera I, Platt S. Case report: Traumatic hemorrhagic cervical myelopathy in a dog. Front Vet Sci 2023; 10:1260719. [PMID: 37869493 PMCID: PMC10585029 DOI: 10.3389/fvets.2023.1260719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
A 1.5-year-old female entire French bulldog was referred for neurological evaluation, further diagnostic tests, and treatment 24 h after a road traffic accident. Initial emergency treatment, diagnostic tests, and stabilization had been performed by the referring veterinarian. Neurological examination revealed severe spastic non-ambulatory tetraparesis and was consistent with a C1-5 myelopathy. A magnetic resonance imaging (MRI) study revealed an irregular to elongated ovoid intramedullary lesion centered over the body of C2. The lesion showed marked signal heterogeneity with a central T2W and T2* hyperintense region, surrounded by a hypointense rim on both sequences. The lesion appeared heterogeneously T1W hypointense. The lesion was asymmetric (right-sided), affecting both white and gray matter. The C2-3 intervertebral disk appeared moderately degenerate with a Pfirrmann grade of 3. No evidence of vertebral fracture or luxation was found on radiographs or MRI of the vertebral column. Additional soft tissue abnormalities in the area of the right brachial plexus were suggestive of brachial plexus and muscle injury. A diagnosis of traumatic hemorrhagic myelopathy at the level of C2 and concurrent brachial plexus injury was formed. Conservative treatment was elected and consisted of physiotherapy, bladder care with an indwelling urinary catheter, repeated IV methadone based on pain scoring (0.2 mg/kg), oral meloxicam 0.1 mg/kg q24h, and oral gabapentin 10 mg/kg q8h. The dog was discharged after 4 days, with an indwelling urinary catheter and oral medication as described. The catheter was replaced two times by the referring veterinarian and finally removed after 10 days. Thereafter, voluntary urination was seen. During the 2 months after the road traffic accident, slow recovery of motor function was seen. The right thoracic limb recovery progressed more slowly than the left limb, also showing some lower motor neuron signs during follow-up. This was judged to be consistent with a right-sided brachial plexus injury. The dog was reported ambulatory with mild residual ataxia and residual monoparesis of the right thoracic limb at the last follow-up 3 months post-injury. This case report highlights the MRI-based diagnosis of traumatic hemorrhagic myelopathy in a dog. A fair short-term outcome was achieved with conservative treatment in this case.
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Affiliation(s)
- Koen M. Santifort
- IVC Evidensia Small Animal Referral Hospital Arnhem, Neurology, Arnhem, Netherlands
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
| | - Simon Platt
- Vet Oracle Teleradiology, Norfolk, United Kingdom
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Gautam S, Rijal B, Sharma LK. Traumatic Spinal Cord Injury among Patients Admitted to the Spine Unit in a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:765-768. [PMID: 38289780 PMCID: PMC10579767 DOI: 10.31729/jnma.8292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Spinal cord injury usually results in disabling conditions. The incidence of spinal trauma is region-specific due to unique geography and demography. The epidemiology of spinal trauma changes with economic and social factors even in different periods. The aim of this study was to find out the prevalence of traumatic spinal cord injury among patients admitted to the Spine Unit in a tertiary care centre. Methods A descriptive cross-sectional study was done in a tertiary care centre among patients admitted to the Spine Unit from 1 January 2022 to 31 December 2022 after receiving ethical approval from the Institutional Review Committee. Demographic details, mode of injury, level of injuries, neurological grading at the time of admission using American Spinal Injury Association grading, management methods, and complication if any were recorded. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Out of 465 patients, the prevalence of traumatic spinal cord injury was 316 (67.95%) (63.72-72.20, 95% Confidence Interval). A total of 243 (76.89%) cases were due to falls. The mean age of patients was 43.13±16.55 years. Conclusions The prevalence of traumatic spinal cord injury patients was lower than the other studies done in similar settings. Keywords falls; prevalence; spinal cord injuries.
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Affiliation(s)
- Samaj Gautam
- Department of Orthopaedics, National Trauma Center, Mahankal, Kathmandu, Nepal
| | - Badri Rijal
- Department of Orthopaedics, National Trauma Center, Mahankal, Kathmandu, Nepal
| | - Laxmi Kanta Sharma
- Department of Orthopaedics, National Trauma Center, Mahankal, Kathmandu, Nepal
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Gan L, Du J, Sun SG, Ye ZX, Li P, Wang H, Luo ZJ, Li M. Comparison of the Clinical Efficacy of Two Reduction Methods for the Treatment of Irreducible Unilateral Subaxial Cervical Facet Joint Dislocation. World Neurosurg 2023; 169:e51-e58. [PMID: 36252906 DOI: 10.1016/j.wneu.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the clinical efficacy of the minimally invasive technique and the open method in the treatment of irreducible unilateral subaxial cervical facet joint dislocation (SCFD). METHODS From March 2015 to September 2018, 62 patients with unilateral SCFD were studied. The cases were divided into 2 groups based on different surgery strategies. Thirty-one patients were enrolled in the minimally invasive surgery (MIS) group, and 31 patients were enrolled in the open surgery group. The duration of prone position operation, blood loss, and total hospitalization costs were recorded. The clinical effects were evaluated using visual analogue scale scores, the Oswestry Disability Index, and Japanese Orthopedic Association scores at each follow-up. In addition, the segmental Cobb angle and intervertebral height were recorded and compared. RESULTS The amount of intraoperative blood loss, prone position operation duration, and total hospital costs in the MIS group were significantly lower than in the open surgery group. The visual analogue scale, Oswestry Disability Index, and Japanese Orthopedic Association scores of the 2 groups significantly improved after the operation. A satisfactory fusion rate was obtained in both groups, and the segmental Cobb angle and intervertebral height scores in both groups improved significantly. CONCLUSIONS Minimally invasive reduction had equal clinical efficacy to posterior open surgery. However, MIS was less invasive and had lower costs. Therefore, it is a potential option in the treatment of SCFD.
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Affiliation(s)
- Lu Gan
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Junjie Du
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Si-Guo Sun
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Zheng-Xu Ye
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China
| | - Pan Li
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China
| | - Han Wang
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Zhuo-Jing Luo
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China.
| | - Mo Li
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China
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Time to Surgery in Spinal Trauma: A Meta-Analysis of the World's Literature Comparing High-Income Countries to Low-Middle Income Countries. World Neurosurg 2022; 167:e268-e282. [PMID: 35948226 DOI: 10.1016/j.wneu.2022.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to: 1) compare time from traumatic spinal injury (TSI) to operating room (OR) in high-income countries (HICs) versus low-middle-income countries (LMICs), and 2) evaluate hospital length of stay (LOS) in HICs versus LMICs. METHODS A systematic literature search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines involving articles of all languages. INCLUSION CRITERIA published between 1991 and 2021, spine trauma population, single country/region, and recorded time from injury to OR. The primary outcome was time from injury to OR, and the secondary outcome was LOS. Means and standard deviations were estimated in a random effects model by DerSimonian and Laird methods. RESULTS Of 2367 articles, 163 met the inclusion criteria for systematic review. Regarding time from injury to OR, 23 articles were eligible for meta-analysis; 16 studies were conducted in HICs and 7 in LMICs, comprising 3819 patients with TSI. A significantly shorter mean time from injury to OR was found in HICs (1.92 days, 95% confidence interval 1.44-2.41) compared with LMICs (3.27 days, 95% confidence interval 2.27-4.27) (P = 0.020). Regarding length of stay, 14 articles were eligible for meta-analysis, 10 studies were conducted in HICs and 4 in LMICs, comprising 11,003 patients. There was no difference in LOS between HICs and LMICs (25.76 days vs. 20.48 days, P = 0.140). CONCLUSIONS Patients with traumatic spinal injuries in HICs were more likely to undergo earlier surgery compared to patients in LMICs. No difference was found in total LOS between HICs and LMICs. While multiple factors can influence time to surgery, these findings draw attention to the global disparity in spinal trauma care.
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Analysis of the Curative Effect and Prognostic Factors of Anterior Cervical Surgery for Spinal Cord Injury without Radiographic Abnormalities. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6836966. [PMID: 35979000 PMCID: PMC9377897 DOI: 10.1155/2022/6836966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 12/02/2022]
Abstract
Objective The study aimed to investigate the effect of anterior cervical surgery in the treatment of spinal cord injury without radiographic abnormalities (SCIWORAs) and analyze the related factors affecting the prognosis of patients. Methods A total of 86 patients with SCIWORA who were admitted to our hospital from June 2018 to March 2021 were selected as the research subjects. According to the different treatment methods selected by the patients, they were divided into the control group (n = 38) and the observation group (n = 48). The control group was treated with conservative therapy, and the observation group was treated with anterior cervical total laminectomy decompression, internal fixation, and bone graft fusion. The efficacy of the treatment was assessed preoperatively and 6 months after surgery using the Japanese Orthopedics Association (JOA) functional evaluation criteria for cervical spinal cord injury. The improvement rate of the JOA score at the last follow-up visit was calculated according to the Hirabayashi formula to evaluate the prognosis of patients. Results The JOA score of the observation group six months after surgery was (14.98 ± 2.75) that was higher than that of the control group (12.16 ± 2.54) (P < 0.05). After surgery, the improvement rate of the JOA score in the observation group was higher than that in the control group (P < 0.05). After surgery, the scores of health condition, physiological function, and role physical in the observation group were (23.18 ± 1.09), (22.75 ± 1.54), and (22.64 ± 1.46), which were higher than those in the control groups (20.94 ± 1.65), (20.26 ± 1.78), and (19.56 ± 1.82) (P < 0.05). The results of univariate analysis showed that the ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, lumbar disc herniation, and the time from injury to treatment were all related to the prognosis of the patients (P < 0.05). Multivariate analysis showed that the ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, and the time from injury to treatment were the independent factors affecting the prognosis of patients (P < 0.05). Conclusion For patients with SCIWORA, anterior total lamina decompression and internal fixation with bone grafting and fusion can effectively promote the recovery of cervical spinal cord function and improve the prognosis and quality of life of patients. The ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, and the time from injury to treatment were the independent prognostic factors for patients.
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Qi C, Cao J, Xia H, Miao D, Liu Y, Guo J, Li Z, Hou Z. Does cervical curvature affect neurological outcome after incomplete spinal cord injury without radiographic abnormality (SCIWORA): 1-year follow-up. J Orthop Surg Res 2022; 17:361. [PMID: 35883148 PMCID: PMC9327310 DOI: 10.1186/s13018-022-03254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background At present, surgery is the primary clinical treatment for SCIWORA patients, but conservative treatment still plays an important role in patients with incomplete spinal cord injury. As an important index of cervical spine degeneration, cervical curvature has an impact on the prognosis of spinal cord injury patients. This paper studied the prognosis of conservatively treated patients with SCIWORA and the correlation between cervical curvature and neurological prognosis. Methods A retrospective study was conducted in all the patients with SCI admitted to the Third Affiliated Hospital of Hebei Medical University between January 2017 and June 2020. Data were recorded in 106 eligible patients, including sex, age, injury factors, Cobb angle, CCI, CSA, and ASIA motor and sensory scores. The Wilcoxon sign rank sum test was used to analyze the data postinjury and at the 1-year follow-up. Pearson correlation analysis was performed for the Cobb angle, CCI and CSA. Simple linear regression analysis and multiple linear regression analysis were performed for each group of variables. Results The Wilcoxon signed rank sum test confirmed that the Cobb angle, the CCI and the CSA of the patients were not significantly different at the 1-year follow-up when compared with the postinjury values, and the ASIA motor and sensory scores were significantly improved. The Pearson correlation analysis showed correlations among the Cobb angle, the CCI and the CSA. Simple linear regression analysis and multiple linear regression analysis showed that the nerve recovery rate was negatively correlated with age and was positively correlated with the Cobb angle. Conclusion Conservative treatment of incomplete SCIWORA can achieve a good prognosis.
There is a clear correlation between the Cobb angle, CCI and CSA, and the Cobb angle, as an important influencing factor, needs to be considered. For SCIWORA patients undergoing nonsurgical treatment, improving cervical curvature is beneficial to the prognosis of patients. Age negatively affects the neurological prognosis.
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Affiliation(s)
- Can Qi
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Junming Cao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hehuan Xia
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Dechao Miao
- Department of Spinal Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yaming Liu
- Department of Spinal Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zequn Li
- The Department of Radiology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. .,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei Province, China.
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Liang J, Wang L, Hao X, Wang G, Wu X. Risk factors and prognosis of spinal cord injury without radiological abnormality in children in China. BMC Musculoskelet Disord 2022; 23:428. [PMID: 35524245 PMCID: PMC9074214 DOI: 10.1186/s12891-022-05393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Compared to adults, spinal cord injury without radiographic abnormality (SCIWORA) is more common in children due to the congenital spinal soft tissue elasticity and immature vertebral bodies. In this study, we aimed to investigate the risk factors and prognosis associated with SCIWORA in China. Method We retrospectively examined patient records at the First Hospital of Jilin University from January 2007 to December 2020. Patients diagnosed with SCIWORA were included in the study group (n=16). The age, gender, history of trauma, symptoms, injury level of the spinal cord, the American Spinal Injury Association (ASIA) impairment score according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), as well as laboratory and imaging findings were analyzed. Result The study group included 16 patients with SCIWORA with a mean age of 6.69±2.51 y. The ISNCSCI impairment scale was significantly different between the pre-school age patients (≤7 years old) and school age patients (>7 years old) before (P=0.044) and after therapy (P=0.002). Similarly, magnetic resonance imaging demonstrated a significant difference in the spinal injury level between pre-school age and school age patients (P=0.041). Further, the study group was subdivided into three subgroups according to the cause of trauma: Dance, Taekwondo, or Falls. Magnetic resonance imaging revealed significant differences among the three subgroups (P=0.041). Conclusion Compared to school-age patients, pre-school-age patients were more vulnerable to SCIWORA with more severe ISNCSCI scores. Dance and Taekwondo are among the risk factors associated with SCIWORA in Chinese children.
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Affiliation(s)
- Jianmin Liang
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China.,Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Linyun Wang
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China
| | - Xiaosheng Hao
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China
| | - Guangliang Wang
- Department of Cardiology, Jiren Hospital of Far Eastern Horizon, Anda, P. R. China
| | - Xuemei Wu
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China. .,Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China.
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Goel A. Spinal cord injuries - Instability is the issue-stabilization is the treatment. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:1-3. [PMID: 35386251 PMCID: PMC8978847 DOI: 10.4103/jcvjs.jcvjs_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
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Goel A, Lunawat A, Shah A, Dandpat S, Hawaldar A, Darji H, Trivedi N. Clinical outcome following multisegmental cervical spinal fixation in patients who recovered partially following injury. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:216-222. [PMID: 34728986 PMCID: PMC8501811 DOI: 10.4103/jcvjs.jcvjs_110_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023] Open
Abstract
Objective The clinical outcome following multilevel stabilization in patients who suffered cervical spinal injury and developed severe neurological deficits and then gradually partially recovered is evaluated. The basis of the surgical concept was that cervical spinal degeneration is a result of single or multilevel spinal instability and that spinal trauma exaggerates the instability. Materials and Methods During the period 2015-2020, 14 patients who suffered severe cervical spinal injury and could be included in the classification of spinal cord injury without computed tomography evidence of trauma were surgically treated. There were 11 males and 3 females. The ages ranged from 45 to 67 years, average being 53 years. Cervical canal stenoses related to degenerative spinal changes were observed in all patients. All patients suffered severe neurological deficits and within few days or weeks had shown significant but incomplete neurological recovery. The identification of the levels of unstable spinal segments was done on the basis of radiological and clinical parameters and direct observation of spinal instability in adjoining spinal segments. Transarticular fixation was done by Camille's transarticular fixation technique. Using ASIA score, modified JOA score, and Goel Clinical Grading Scale, the clinical course of the patients was monitored. Results All patients showed recovery in the neurological status. Recovery started in the immediate postoperative period and the improvement progressed during the period of follow-up. Conclusions Surgery for spinal stabilization can be indicated even in cases that improve in the neurological function.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Aditya Lunawat
- Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Abhidha Shah
- Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Saswat Dandpat
- Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Akshay Hawaldar
- Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Hardik Darji
- Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Nishit Trivedi
- Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
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