A 72 y-o female, presented to the emergency after a fall from her own height complaining of back pain and clinically neurologic exam was normal. Xrays were suggestive of a compression-type fracture of L1 (AO A1), which was confirmed by CT.Conservative treatment was decided.At 6 weeks she was again admitted with another fall;CT revealed the same degree of deformity but mild sclerosis of endplates and intrasomatic air.Due to pain persistency, percutaneous vertebroplasty was performed 11 weeks;during surgery, vertebral height recovery with intrasomatic gas was observed.Immediate pain relief after surgery was obtained after vertebroplasty.One week after, the patient sustained another fall;X ray and CT scan revealed vertebral compression fractures (VCF) of D12 and L2 (AO A1).Percutaneous vertebroplasty was performed within a week with symptomatic clinical improvement;subsequent outpatient clinic follow-up showed a good clinical and imaging results.
Vertebral fragility fractures are common;fortunately, most can heal without complications with conservative treatment, although some can benefit from delayed percutaneous cement augmentation for pain relief, in a subacute setting.In this situation, preoperative imaging studies are increasingly showing the presence of avascular necrosis of the vertebral body following VCF. Kümmell’s disease (KD) was first described in 1895, but is sparsely described in spine journals; incidence can reach up to 30%. Aging, steroids, radiotherapy and osteoporosis are risk factors that can eliminate healing potential in VCF, being common in both fragility fractures and KD, although these two have different clinical features. CT is the best imaging study. Cement augmentation techniques are increasingly being recommended with good results.

Introduction: Dynamic ASC is a novel method of surgical treatment of adult spinal deformities. Currently, spinal surgeons around the world are starting to actively utilize this approach and accumulate data regarding the effectiveness of this technique. Material and methods: A retrospective analysis of clinical and radiological data of 19 patients who underwent dynamic anterior scoliosis correction was carried out. The following patient groups were formed: Lenke 1 - 8, Lenke 3 - 4, Lenke 5 - 7, who were compared with each other in pairs. The patients were assessed for 12 months postop. Results: The number of dynamic fixation levels for all scoliosis types ranged from 6 to 12. The most proximal level of fixation was Th5, the most distal was L4.Comparison of the same indicators for groups with scoliosis of Lenke types III and V showed differences in the angles of deformity after the intervention and the number of fixation levels (p = 0.024 and p = 0.006). Since the differences between the preoperative deformity angles were statistically insignificant, we speculate that difference in effectiveness of the method in the treatment of scoliosis types 1 and 3 is possible. We can assume that type V is more “responsive” to ASC treatment than type III, and may have a significantly better prognosis. There were also no statistical differences between types I and V. Conclusion: ASC and dynamic fixation has promising short-term results. Further research and data accumulation will allow to evaluate the long-term effectiveness of the technique.

Background: Raised patient BMI is recognised as a relative contraindication to posterior lumbar interbody fusion (PLIF) due to the anaesthetic challenges, difficult positioning, and increased intra-operative and postoperative complications, with the relative risk rising in patients with a BMI >25kg/m2. The impact of obesity on Anterior Lumbar Interbody Fusion (ALIF) outcomes is not yet established. The purpose of this review was to evaluate if the presence of a raised BMI in patients undergoing ALIF procedures was an independent risk factor for intra- and post-operative complications. Methods: A systematic review of search databases PubMed; Google Scholar; and OVID Medline was made to identify studies related to complications in patients with increased BMI during anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Complication rates in raised BMI patient cohort was compared to normal BMI complication rates with meta-analysis where available. Results: 315 articles returned with search criteria applied. Six articles were included for review, with 2190 patients included for analysis. Vascular complications in obese vs. non-obese patients undergoing the anterior approach demonstrate no significant difference in complication rates (p=0.62; CI=-0.03-0.02). Obesity is found to result in an increased rate of overall complications (p=0.002; CI=0.04-0.16). Conclusion: Obesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs. Increased focus on patient positioning and reporting of outcomes in this patient cohort is warranted to further evaluate peri-operative complications.

Introduction– Several clinical scores and MRI parameters are used in lumbar spinal stenosis (LSS) patients. How these parameters correlate is not clear.
METHODS– 82 patients with clinico-radiological features suggestive of degenerative LSS completed 10 clinical questionnaires which included Oswestry disability index (ODI), Swiss spinal stenosis (SSS) questionnaire, Quebec pain disability scale (QPD), Visual analogue scale (VAS), modified Japanese orthopaedic association scale (mJOA), Pain disability index (PDI), Short form health survey (SF-36), Self-paced walking test (SPWT), Euro quality (EQ-VAS) and Neurogenic claudication outcome score (NCOS). Lumbosacral MRIs were performed and 8 quantitative parameters namely transverse & AP diameter of dural sac (TDD, APDD), anteroposterior diameter of spinal canal (APDS), ligamentous interfacet distance (LID), mid-sagittal diameter of thecal sac (MSDT), cross-sectional area dural sac (CSAD), lateral recess depth and angle (LRD, LRA) were measured at the maximum stenotic level at the level of the disc. Clinical and radiological parameters were then statistically analysed.
RESULTS– The mean age was 53.02 years . NCOS had a strong positive correlation with TDS (r=0.806, p=0.00) and a moderate positive correlation with CSAD, LID, APDS and APDD (0.7>r≥0.3, p<0.05). MSDT showed moderate negative correlation with SSS, VAS, ODI and QPD (0.7>r≥0.3, p<0.05). For most other comparisons, there was poor or no correlation.
CONCLUSIONS– Barring a few, most of the MRI parameters showed a poor or no correlation with most of the commonly used clinical scores. Hence, the MRI parameter may not always predict clinical outcomes and their role should be supplementary -overreliance on them should be avoided.

Aim – Spinal Cord Injuries (SCI) are debilitating injuries associated with significant morbidity and financial burden, with an incidence of 12-16 per million population in the UK. There is currently no cure for SCI, with majority of interventions focusing on primary prevention of SCI or of further damage once SCI is sustained. We present an overview of the role of closed reduction, timing of surgery and role of steroids, and provide an algorithm for management of SCI. Method: A search was carried out on PubMed, looking at notable reviews, consensus statements and trends in management of spinal cord injuries. This was cross-referenced with the NICE and BOAST guidelines for SCI. Results: The efficacy of closed reduction in cervical fractures and necessity of pre-reduction MRI is still equivocal and remains a source of major debate amongst spinal surgeons. The timing of surgery remains controversial as studies have not consistently shown improved outcomes with early, aggressive surgery but there have been trends noted in the newer studies with some benefit of early surgery. The use of steroids in acute SCI has fallen out of favour with most guidelines not recommending them due to their equivocal benefit and unequivocal side-effect profile. Conclusion: Prevention and pre-hospital management are crucial in the management of SCI, along with early spinal alignment restoration, decompression and stabilisation augmented by good long-term rehabilitation measures. There is a need for new randomised controlled trials assessing the role of closed reduction, need for pre-reduction MRI and timing of surgery in SCI.

Introduction:Early onset scoliosis(EOS) is frequently associated with severe cardiopulmonary disease and poor nutritional status due to increased energy expenditure overtaking calorie intake. For this reason, weight gain has been used in previous studies as an indicator for overall clinical improvement. Our aim was to evaluate the change in nutritional status of EOS patients after treatment with magnetically controlled growing rod instrumentation (MCGR).We analysed changes in weight-for-age Z-scores (WFA-Z) of EOS patients treated with MCGR to ascertain whether there was any significant improvement after a minimum 2-year follow up period. Methods: A retrospective review of patients treated with MCGR for EOS was performed from a single centre. Exclusion criteria were <2 years' follow-up and incomplete WFA-Z data for comparison. Pre-and postoperative radiographic and nutritional data were analysed. Results: 72 patients (16 congenital; 25 neuromuscular; 12 syndromic; and 19 idiopathic) met the inclusion criteria. Mean age at surgery was 8.2 years, with a mean follow-up of 3.8 years. Mean pre-operative and most recent WFA-Zs were -1.50 and -1.13 (P=0.005) respectively. Mean pre-operative and most recent scoliosis cobb and thoracic kyphosis angles were 75.5 and 45.3 degrees (P<0.001) and 43.5 and 32.5 degrees (P=0.001) respectively. Mean pre-operative and most recent space-available-for-lung ratios were 86.5% and 94.8% (P<0.001) respectively. Nineteen patients (26.4%) required additional unplanned surgery.Conclusion: Treatment of EOS patients with MCGR resulted in a significant improvement in weight-for-age Z-scores, Scoliosis Cobb Angles, and space available for lung ratios.

Study design: Prospective cohort study
Objectives : Lumbar disc herniation with radiculopathy has a favourable natural history and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of a selective nerve root block in the management of lumbar disc herniation with radiculopathy since there is limited evidence regarding this issue in the published literature. .
Methods:A prospective study of 50 patients who underwent a selective nerve root block and followed for three months with Numerical rating scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and DASS -21 score were included. At the final follow up at three months, the number of patients who underwent surgery was ascertained.
Results: 42/50 [84%] patients avoided the surgery with a reduction in mean pre-injection NRS for back and leg pain from 7.5[SD 1.33] and 7.7 [SD 1.35] to 3.1[SD 1.69] and 2.3 [SD 1.14]{p<0.001} respectively within the 30 minutes after injection and the pain relief was sustained until the last follow-up. ODI score also reduced from a pre-injection level of 59.4 [SD 14.69] to 26.3 [SD 9.43]{p<0.001} at 3 months. The mean pre-injection depression score was higher in patients who had recurrence of pain and eventually underwent surgery.
Conclusion: Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients.

Introduction: Transforaminal endoscopic surgery and tubular minimally invasive lumbar discectomy are both minimally invasive. Which procedure has better clinical outcomes remains controversial.

Aim: Compare the clinical outcomes between transforaminal endoscopic lumbar discectomy versus tubular minimally lumbar microdiscectomy for symptomatic lumbar disc herniation treatment.

Materials and Methods:We retrospectively analyzed 49 patients who underwent discectomy for lumbar disk herniation between November 2015 and March 2020 (group A: transforaminal endoscopic surgery, 23 cases; group B: tubular minimally invasive discectomy, 26 cases). All patients had a minimum follow up of 12 months.

Results:64 patients, 49.3 ±15 years (range: 19–75) and mean follow up time was 26.9 ±14.3 (range 12–60) months (p=0.72).
The mean improvement of VAS for leg was 7.8 ±2.4 for group A and 8.4 ± 1.1 for group B (p= 0.284). The mean improvement of VAS for back pain was 6.5 ± 2.3 for group A and 6.7 ± 2.2 for group B (p=0.851). The mean improvement of ODI scores was 37.3 ± 8.7 for group A and 39.6 ± 7 for group B (p=0.262). The mean improvement of EQ-5D score was 6.5 ± 2.4 for group A and 7.1 ± 1.1 for group B (p=0.271).
Hospital stay was shorter in group A (1.1 ± 1.1 vs 3.7 ± 2.1 days, p<0.05) and patients returned to work earlier in group A (90 ± 67.8 vs 162.1 ± 80.1 days, p<0.05).


Conclusion
Patients submitted to transforaminal endoscopic surgery had a shorter hospital stay and return earlier to work.