DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

Management of Delayed Cervical Spine Fracture–Dislocation with Severe Myelopathy in an Ankylosed Spine Using Navigation-Assisted Long-Segment Fixation
Cervical spine fracture–dislocation with delayed presentation and advanced myelopathy remains one of the most challenging scenarios in spine trauma. Neurological compromise, instability, and distorted anatomy significantly increase surgical risk.
A 56-year-old male presented 10 days after a slip and fall with severe neck pain and rapidly progressive weakness of all four limbs. He was unable to stand or walk. Neurological examination showed marked quadriparesis with hyperreflexia and features of cervical myelopathy (modified Nurick grade 5). Bowel and bladder functions were preserved.
Radiological evaluation revealed a C6–C7 fracture dislocation with critical spinal canal compromise and cord compression. Given the delayed presentation, poor neurology, and cervico-thoracic instability, surgical goals were clear:
• Adequate neural decompression
• Restoration of alignment
• Rigid and durable stabilization
A posterior decompression and long-segment stabilization from C4 to T2 was planned. The cervico-thoracic junction, altered anatomy, and need for precise screw placement made accuracy critical.
To enhance safety and precision, intraoperative navigation with O-arm imaging was employed. Navigation assisted:
• Accurate pedicle and lateral mass screw placement
• Real-time verification of trajectory and depth
• Intraoperative CT confirmation of decompression and construct integrity
Post-fixation imaging confirmed satisfactory alignment, optimal hardware positioning, and effective decompression. The procedure was completed without intraoperative complications.
This case highlights the importance of:
• Early surgical intervention even in delayed presentations
• Long-segment stabilization in unstable cervical injuries
• Navigation-assisted techniques to improve accuracy and confidence in complex spine trauma
Advanced intraoperative imaging has become a valuable ally in managing high-risk cervical spine injuries, enabling safer execution of demanding procedures and improving overall surgical reliability
#SpineSurgery #CervicalSpine #SpineTrauma #Myelopathy #OArmNavigation #ComplexSpine #PatientCare #PrecisionSurgery #medtronics

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17 hours ago | [YT] | 9

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

‪@Sanchetispinepune‬
My article in #sakal about growing #spine problems in #females
#treatment #prevention

4 days ago | [YT] | 12

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

#spine #patient #happy #gratitude #healing #cure #compassion #empathy #blessed

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1 week ago | [YT] | 10

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

2 weeks ago | [YT] | 22

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

Excessive cell phones or laptop use with incorrect posture can lead to serious cervical spine (neck) issues

My article in Sakal news paper

‪@Sanchetispinepune‬

#cellphone #laptop #computer #neckpainrelief #spine

1 month ago | [YT] | 4

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

Hi everyone, welcome to my new YouTube Community. Now you can post on my channel too. To get started, tell me in a post what you'd like to see next on my channel.
Visit my Community: youtube.com/@Sanchetispinepune/community

1 month ago | [YT] | 3

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

Endoscopic spine surgery is an ultra–minimally invasive technique that uses a working cannula and endoscope through a small (usually <1 cm) incision to address spinal pathologies such as disc herniation and stenosis while minimizing muscle and bony disruption. It aims to achieve adequate neural decompression with less blood loss, reduced postoperative pain, shorter hospital stay, and faster return to function compared with conventional open procedures.[1][2][3]

## Concept and Principles
- Endoscopic spine surgery uses a high-definition endoscope with continuous irrigation and specialized micro‑instruments to reach the target via natural tissue corridors, often under fluoroscopic guidance.[2][5]
- Core **principles** are complete neural decompression and, where indicated, stabilization while preserving normal anatomy as much as possible.[3][1]

## Indications
- Common indications include lumbar disc herniation, foraminal or lateral recess stenosis, and selected cases of central stenosis or recurrent disc herniation.[5][3]
- Cervical and thoracic applications, including foraminal decompressions and soft disc herniations, are expanding as optics, instruments, and surgeon expertise advance.[3]

## Technique Overview
- A guidewire and dilator are positioned to the target disc or foramen under imaging, followed by insertion of a working cannula and endoscope through a keyhole incision.[2][5]
- Herniated disc fragments, hypertrophic ligament, or osteophytes are removed using punches, burrs, RF, or laser to decompress the nerve root while continuously visualizing neural structures.[5][2]

## Advantages
- Potential benefits include smaller incision, less muscle trauma, reduced blood loss, shorter hospital stay (often day-care or overnight), and quicker mobilization.[1][5]
- Reduced soft‑tissue disruption may translate into lower postoperative pain, decreased infection risk, and fewer long-term biomechanical changes compared with open surgery.

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1 month ago | [YT] | 17

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

Minimally Invasive Spine Surgery in Degenerative Scoliosis — A Case Insight
As a Spine Surgeon, I continue to focus on safer, evidence-based solutions for elderly patients with complex spinal pathology.
Recently, I managed an 84-year-old patient with degenerative lumbar scoliosis and severe L4–L5 stenosis, where traditional long-segment stabilization would have required a high-risk surgery due to multiple comorbidities.

To avoid the morbidity of an extensive fusion, we opted for a Navigation-Guided Unilateral Biportal Endoscopic (UBE) Decompression assisted by O-arm 3D navigation. This approach enabled:
✅ Precise localization despite scoliotic distortion
✅ Targeted bilateral decompression through two small portals
✅ Preservation of stabilizing structures—preventing the need for long-segment instrumentation
✅ Minimal blood loss and reduced surgical stress

The results were encouraging:
• Significant pain reduction immediately after surgery
• The patient was discharged on Post-Operative Day 2
• Functional recovery began early, with preserved spinal alignment on follow-up

This case highlights an important takeaway:

For carefully selected high-risk patients, minimally invasive, navigation-assisted endoscopic decompression can provide effective relief while avoiding the risks of long-segment fusion surgery.
I remain committed to advancing patient-centric, minimally invasive spine care and contributing to ongoing progress in UBE techniques.

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2 months ago | [YT] | 6

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

Honoured to visit the prestigious IIM Ahmedabad—an institution that continues to shape some of the finest leaders and innovators of our nation.

I had the privilege of being part of an enriching 2-day workshop on entrepreneurship, leadership, hospital management, and the transformative role of AI in modern healthcare.
The discussions were deeply insightful, especially around how technology and innovation can be seamlessly integrated into our day-to-day practice to help patients recover faster and enhance overall clinical outcomes.

Interacting with dynamic thinkers, exchanging perspectives on building sustainable systems, and exploring new-age leadership in healthcare reaffirmed a timeless truth: true leadership is rooted in learning, evolving, and empowering others.

Grateful for the meaningful conversations, the warm hospitality, and the opportunity to engage with an ecosystem where ideas flourish and future leaders are shaped.

Here’s to continuous growth, innovation, and creating impact—one step at a time.


#IIMA #Leadership #Entrepreneurship #Innovation #HospitalManagement #AIinHealthcare #AjayKothari #ContinuousLearning #GrowthMindset

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3 months ago | [YT] | 6

DR AJAY KOTHARI SPINE SPECIALIST PUNE INDIA

Attended the ASSI Operative Course 2025 in Mumbai as faculty — a great opportunity to share our work on navigated spinal complex and kyphoscoliosis deformity surgeries, advanced techniques, and treatment protocols.
Also presented our approach to complex dorsal fracture management, which sparked insightful discussions during the session.
It was a well-attended event with national and international delegates contributing immensely to the academic exchange.
Grateful to Dr. Sameer Dalvi, Dr. Dheeraj Sonavne, and Dr. Tushar Rathore for the kind invite and for curating such a valuable learning platform. 🙏
#ASSI2025 #SpineSurgery #Navigation #Kyphoscoliosis #AcademicExchange #OperativeCourse #SpineDeformity #SpineFaculty #sanchetihospital

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4 months ago | [YT] | 9