Introduction: This study to explore the clinical effects and safety of Platelet-rich plasma (PRP) in treating Chronic Discogenic Low Back Pain. Methods: The clinical data of 21 patients (22 disc) from June 2018 to December 2019 were diagnosed with discogenic low back pain by clinical means, imaging. Patients underwent treatment of intradiscal and epidural injection of PRP at one or multiple levels.Outcome measures included the use of a visual analog scale (VAS) and Oswestry Disability Index (ODI) score.Patients were followed up at intervals of preoperative, postoperative1 months, 3 months, last follow-up. Results: Data were analyzed from 21 patients (11 men and 10 women; mean age, 37.8 years). Following treatment, no patient experienced adverse events or significant narrowing of disc height. The mean preoperative low back pain VAS scores decreased from 6.81±0.83 to 1.44±0.58 at 1 months after surgery, 1.38±0.51 at 3 months after surgery,1.02±0.58 at final follow-up after surgery. The mean preoperative ODI scores decreased from 75.2±13.3 to 33.4±10.8 at 1 months after surgery,25.2±3.2 at 3 months after surgery, 20.2±1.2 at final follow-up after surgery (p <0.01).Conclusion: This study demonstrated that intradiscal and epidural injection of autologous PRP in patients with low back pain was safe, with no adverse events observed during follow-up.Intradiscal and epidural PRP injection is a safe and a possibly effective treatment for discogenic low back pain. Randomized placebo controlled trials are needed to further evaluate the efficacy of this treatment.

Congenital kyphoscoliosis results from formation and/or segmentation failure of the vertebrae.Segmented or semi-segmented variants of the hemivertebrae may lead to abnormal and unbalanced growth of the spinal cord,leading to pain and functional disability.
In progressive cases conservative treatment is not effective and surgical treatment should be chosen.
Case Report of a 13-year-old male adolescent with a prematury history.He had a poorly flexible kyphoscoliosis on the Adams test. Radiographically a rigid congenital kyphoscoliosis was evident by T7 hemivertebra. Scoliosis was 43° Cobb angle and the dorsal kyphosis angle averaged 82° Cobb angle.Patient had Risser 2.
The surgery was performed at a single time later,with the patient under neurological monitoring.
The hemivertebra and adjacent intervertebral discs were resected,the deformity corrected with the aid of segmental pedicular instrumentation and posterior arthrodesis with autologous graft.No complications were reported.
Three years after surgery,the patient was asymptomatic and radiologically without loss of correction.Correction of Cobb angles in the coronal plane to 6° and sagittal to 54°.
The classic surgical treatment of kyphoscoliosis by hemivertebra involves the use of a combined approach,which implies long operative times,with consequent increase in morbidity and complication rates.
In the last decades,techniques of resection and posterior instrumentation in one time were introduced.Despite the high technical complexity and higher neurological risks,these pathways provide good results.
Comparative studies between the two techniques have shown comparable clinical, radiological and quality-of-life results.
This case is an example that corroborates the utility of single posterior pathways in the treatment of kyphoscoliosis by hemivertebra.

Introduction: The Rib Based Growing System (RBGS) have been presented as an alternative to improve clinical status, spinal deformity & pulmonary function in patients with Early Onset Scoliosis (EOS). The aim of this study was to evaluate respiratory & post-operative long-term outcomes in EOS patients who undergo a RBGS. Methods: Thirty-six consecutive EOS patients (44.4% female) were treated with a RBGS, with a mean age of 7.2+2.9 years. An average follow-up of 6.6+3.4 years, and 6.0+3.0 subsequent lengthening procedures at six-month intervals was found. Demographic, primary coronal-sagittal Cobb angles and pulmonary function test were performed from preoperative to last follow-up. Post-op complications were analyzed until last available examination. Results: The average preoperative coronal Cobb angle was 60.0+15.0 with immediate postoperative angle of 33.0+14.4, & 60.0+23.5 angle at last follow-up. Mean preoperative sagittal Cobb angle showed 36.0+20.6 with immediate post-op angle of 27.9+13.2, & 36.0+20.2 angle at last follow-up. Twenty-one out of 36 patients were able to complete pulmonary function test. Mean force vital capacity percentage changed from 77.3+41.0% initially to 46.8+14.5% at last expansion. The average of force expiratory volume-1 changed from 74.3+37.7% initially to 47.8+14.9% at last expansion. Among 38 complications, the most common were infection & wound dehiscence followed by device migration. Conclusion: This fifteen-year follow-up study of EOS patients undergoing RBGS shows a concerning decrease in PFT and spinal correction with a high post-op complication rate at last follow up visit.

Introduction: Lumbar and thoracic fractures represent 90% of all vertebral fractures and can have devastating consequences. Neurologic damage is present in up to 20%. Reverse cortical sign corresponds to a posterior vertebral wall fragment that has flipped 180°, with the cancellous surface facing posteriorly into the canal and the cortical surface facing anteriorly. Its identification is crucial due to incompetence of the posterior longitudinal ligament and risk of damaging the thecal sac while using indirect decompression by ligamentotaxis. Care must be taken to differentiate from pseudo-reverse cortical sign, recently described as depression of the posterior superior or inferior endplate. Case Presentation: A 65-year-old female presented to the emergency room following a fall from the same height with direct lumbar trauma. Physical examination revealed pain over the spinous process of L2, with evidence of acute neurologic damage. Imaging revealed a L2 A4 complete burst (AO classification) with a clear true reverse cortical sign. Percutaneous transpedicular fixation of T12 to L4 was performed. Postoperative imaging showed clearance of the spinal canal. The patient returned to normal daily life, without pain or limitations. No residual neurologic deficit was reported. Conclusion: Although a well-recognized sign among spine surgeons and in textbooks, few published articles reference or describe this sign and its implication in treatment choices. Early recognition and evaluation are essential. Indirect decompression methods are contraindicated, due to the risk of worsening posterior retropulsion into the spinal canal with further neurologic damage. If indicated, direct reduction methods should be addressed.

Introduction: The purpose of this presentation is to discuss the role of the rib construct (RC) with severe pediatric deformity relative to pulmonary issues, need for halogravity traction(HGT), safety, management of hyperkyphosis, and need for osteotomies. HGT is now recommended for curves >90°, and staged procedures for patients with osteoporosis, defined as greater than -2.5 T score. Methods: The RC consists of a “claw” construct on the proximal 2nd to 5th ribs, so midline spinal structures remain intact. We report results of 24 cases between 2007-2013; 11 neuromuscular, 10 syndromic, 3 congenital. Results: The population was medically fragile, 8 died between 33-74 months postop of unrelated causes. Hyperkyphotic patients had substantial increases in lung volume (1.4L-2.7L), scoliotic did not(2.2L-2.4L). 11 patients had osteoporosis greater than -2.5T score and >90° sagittal or coronal curve, sagittal improved 114°-61°, coronal 114°-76° with no HGT. Despite severe deformity, 0/24 patients had neuromonitoring changes or PJK, documenting safety. The RC can serve as a “bridge” procedure as an alternative to early fusion, saving the increase in spinal growth during puberty and severe deformity can be managed without transfusions with fusionless surgery. Only 3 patients, all with failed prior fusion, had posterior column osteotomies, no VCR. A Jehovah’s witness CP patient with 118° scoliosis and 110° hyperlordosis was corrected without transfusion. Conclusion: The RC improves lung volume in hyperkyphotic patients, has remarkable safety, provides a much less stressful alternative to HGT, and reduces the need for osteotomies; thus with less blood loss.

Purpose
To describe clinico-radiological and functional outcomes of patients with post-tubercular healed kyphosis operated by posterior-only three-column osteotomy.
Methods
47 patients from a single center, operated for healed, post-tubercular kyphosis were retrospectively analyzed. Deformity correction in all was done utilizing a three-column osteotomy by a single-stage, posterior-only approach. Radiological parameters (local kyphosis angle; KA, thoracic kyphosis; TK, lumbar lordosis; LL, pelvic tilt; PT, sacral slope; SS, C7 sagittal vertical axis; C7 SVA, pelvic incidence minus lumbar lordosis; PI-LL), functional scores and clinical details of complications were recorded.
Results
Median age of the study population was 16 years(6-45). Apex of deformity was in thoracic, thoracolumbar and lumbar spine in 22, 19 and 6 cases respectively. The mean operative time was 197.2 ± 30.5 minutes and the mean operative blood loss was 809 ± 312 ml. KA (preoperative: 68.2° ± 26.9° v/s postoperative: 29.6°± 20.3°; p- value<0.0001), C7 SVA (preoperative 20.9 ± 37.9mm v/s postoperative: 5.5 ± 16.3mm; p value = 0.005) and TK (preoperative 47.7° ± 33.2° v/s postoperative: 37.8° ± 19.8°; p value = 0.0024) underwent a significant change with surgery. Mean SRS-22r score improved after surgical correction (preoperative: 2.74 ± 0.24 v/s final follow-up: 3.99 ±0.21; p<0.0001) with the maximum improvement occurring in self-image domain. The overall complication rate was 29.7% – including 4 neurological and 10 non-neurological complications. Permanent neurological deterioration was seen in one patient.
Conclusion
Three-column osteotomies through posterior-only approach are safe and effective and offer good clinic-radiological and function outcome in post-tubercular kyphotic deformity correction.

Posterior pedicle screw fixation is a vastly recognized treatment option for cervical instabilities. However, the use of cervical pedicle screw fixation has been limited by its demand for technical skill and the risks posed to the complex neurovascular structures. Hence, the accuracy of screw placement plays a vital factor in the procedure's success. In the recent decade, attention has been given to 3D printing to create drill guide templates in cervical stabilization. While various literature has described the accuracy of using patient-specific drill guide in the subaxial cervical spine, limited studies have explored its role in the atlantoaxial spine. This cadaveric study aimed to assess the accuracy of atlantoaxial cervical pedicle screw insertion using patient-specific drill guide template molded from stereolithographic modeling. Seventeen atlantoaxial cervical vertebrae specimens were collected. Out of 17, two C1 and two C2 vertebrae were excluded. 3D reconstruction of cervical models was done. These images (.stl) were used to produce cervical plastic models. Using acrylic cement, drill guide templates were molded. Pedicle screw insertion was done on cadaveric specimens using the templates. The accuracy of pedicle screw placement was evaluated by an independent evaluator. Sixty pedicles (C1 and C2) from 15 axial cervical vertebrae were evaluated. Pedicle screw insertion in the antlantoaxial cervical vertebrae had a total accuracy of 93.33%. One-hundred percent accuracy was achieved in the C1 vertebrae compared to 86% in the C2 vertebrae. Patient-specific drill guide template using stereolithographic modelling is accurate in the pedicle screw insertion of cadaveric atlantoaxial specimens.

Objectives: To determine the correlation between the severity of lumbar canal stenosis (LCS) and type-II Diabetes mellitus(DM). Methods: A Retrospective study.We included LCS patients who received treatment from our institute between 2016 to 2018. Patients were divided into three groups as per DM status. Group-A without DM (n=150). Group-B well-controlled DM patients and Group-C uncontrolled DM. Subdivided into Group-B: DM duration was ≤ 10 years (n=76), Group-B2: DM duration was >10 years (n=68), Group-C1 DM duration ≤10 years (n=54), Group-C2 DM duration >10 years (n=48). The severity of LCS was evaluated using the SSSS and MODS. For patients who required surgery their disc material was sent for histological staining and quantitative immunofluorescence. All data were recorded and analysed. Results: There was no difference in demographic data among groups except age. The mean SSSS and MODS between Group-A and B1 had no difference; Groups-B2, C1, and C2 showed higher mean SSSS and MODS than Group-A (P<0.05). Groups B2 and C2 showed higher both scores than Group-B1 and C1. Groups-C1 and C2 showed higher scores than groups-B1 and B2 (P<0.05). The severity of LCS was significantly related to DM duration in Group B and C (P<0.05). Uncontrolled DM had significant elastin fibers loss and also a significantly higher rate of disc apoptosis, matrix aggrecan fragmentation, and disc glycosaminoglycan content on histopathologic examination. Conclusions: DM duration >10 years & uncontrolled DM were risk factors for LCS. Longer DM duration was associated with more severe disc degeneration.