Introduction: In Japan, aging shift of population has resulted in increase of elder cervical cord injury without bony injury in recent years. There is controversy whether to perform surgical treatment urgently for cervical spinal cord injury without bony injury. Methods: From April 2014 to December 2019, 17 cervical spinal cord injury patients without bony injury encountered at emergency department of our hospital, and underwent surgical treatment. The surgeon decided the indication for surgery by comprehensively assessing the symptoms and general condition. Average age was 65 years (44-88), and average follow-up period was 241 days (5-990). Five patients had urgent surgery within 48 hours and 12 patients had delayed surgery (>48h). We investigated hospitalization period, improvement of ASIA (ABCDE was converted as 1,2,3,4,5 as a score), and compared the outcomes between the urgent and delayed surgical treatment. Results: The average of ASIA classification before surgery was 2.6 in urgent surgery group and 3.3 in delayed surgery group. The average of ASIA improvement was 1.0 in urgent surgery group and 0.3 in delayed surgery group. (P=0.04 by ANOVA). The average hospital stay is 22.7 days in urgent group and 36.4days in delayed group. (P=0.12 by Mann-Whitney) Conclusion: The urgent surgery made better outcomes including ASIA improvement than delayed surgery.

Introduction: Fractures and dislocations of the lower cervical spine (C3 – C7) are potentially devastating injuries, with an important impact of morbidity and mortality. They mainly occur in young people due to high energy trauma, with neurological sequelae in up to 40% of patients. Methods: Retrospective study of 107 patients admitted with lower cervical spine fractures between 2015 and 2020. Evaluation of age, sex, mechanism of injury, level affected, treatment provided, presence of neurologic deficit, type of fracture, trauma and associated complications. Results: 77.6% of males with an average age of 44.77 years. Traffic accidents accounted for 55.1% of lesions. The segment C5-C7 was affected in 49.5% of cases. 40,2% of patients were submitted to surgical intervention and 25.2% presented neurological injuries requiring corticotherapy. These values are in agreement with the epidemiological study of Hege Linnerud Fredø et al. (2012). Fracture-dislocation was observed in 33.6% of cases and comminuted fractures in 28%. There were the following associated lesions: 52.3% head injury, 45.8% thoracic trauma, 12.1% abdominal trauma and 50% of limb fractures. 41.1% of patients had respiratory infection and 36.6% went into sepsis. 15 multiple trauma patients died. Conclusion: Lower cervical spine fractures are complex entities, with prognosis depending on the neurological injury, associated lesions and complications. Neurological injury and hemodynamic instability are the main factors of poor prognosis. The increase of high-energy trauma has led to a higher incidence of injuries to the lower cervical spine, emphasizing the importance of new studies in this area.

Background: To achieve fusion in spine the use of allograft has been well documented and the efficacy of it has been proven. We sought to describe our experience in using freeze dried allograft in paediatric spine to achieve fusion in scoliosis surgeries. Methods: In this study, the records of patients who underwent spinal fusion surgeries between 2015-2019 were evaluated and data was collected with regard to diagnosis, surgery performed, and number of levels fused, Cobb’s angle, and complications if any. Minimum follow up was 12 months and the loss of correction and patient satisfaction was tabulated. Results: Final Follow up 63 patients were included who underwent spinal fusion surgeries for scoliosis. The children were divided into two groups. Group 1 included children who underwent short segment fusion 14 patients were included in this group at the time of final follow up. The mean pre op Cobb’s angle was 54.240(24.390-95.410±16.810). The mean Post-operative Cobb’s angle was 26.010(30-49.220±14.680). The loss of correction was 1.960. Group 2 included 49 patients who underwent long segment fusion. The mean Pre-op Cobb’s angle was 55.540(23.960-84.160±13.510). The mean post-operative Cobb’s angle was 26.810(5.450-52.320±12.110). The loss of correction was 1.340. Conclusion: Allograft Bone appears to be an effective alternative to iliac auto graft in Scoliosis surgery. The use of allograft greatly reduces donor site morbidly and the requisite for another procedure to harvest the auto graft. The results of allograft and auto graft in fusion and rate of complications are same with the use of freeze dried product

Aims
To describe the clinical, radiological and functional outcome in isolated congenital thoracolumbar kyphosis patients treated with three-column osteotomy by posterior-only approach.
Methods
Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis operated at a single center were retrospectively analyzed. All patients underwent deformity correction which necessitated 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, T1 slope, pelvic incidence minus lumbar lordosis; PI-LL), functional scores and clinical details of complications were recorded.
Results
Mean age of the study population was 13.9 ± 6.4 .Apex of deformity was in thoracic, thoracolumbar and lumbar spine in 5, 14 and 8 cases respectively. The mean operative time was 178.4 ± 38.5 minutes and the mean operative blood loss was 701.8 ± 194.4 ml. KA (preoperative: 70.8 ± 21.6 v/s final follow-up: 24.7 ± 18.9; p- value<0.0001) and TK (preoperative: -1.48 ± 41.23 v/s final follow-up: 24.28 ± 17.29; p value = 0.005) underwent a significant change with surgery. Mean SRS-22r score improved after surgical correction (preoperative: 3.24 ± 0.37 v/s final follow-up: 4.28 ± 0.47; p<0.0001) with maximum improvement in self-image and mental health domains. The overall complication rate was 26% – including 2 neurological and 5 non-neurological complications. Permanent neurological deficit was noted in a single patient.
Conclusion
Deformity correction employing three-column osteotomies by a single-stage, posterior-only approach is safe and effective in isolated congenital thoracolumbar kyphosis.

BACKGROUND–This study is aimed to investigate the correlation among various clinical scoring systems, in patients with degenerative lumbar spinal stenosis (LSS).
METHODS–Eighty two patients aged more than 45 years with clinico-radiological features suggestive of degenerative LSS were enrolled. They completed 9 clinical scoring questionnaires which included ODI, SSS, QPD, VAS, mJOA, PDI, SPWT, EQ-VAS and NCOS. A comparison was done among various scores and they were statistically analyzed and correlated.
RESULTS–The mean age was 59.35±9.1 years and included 51 females (62.2%) and 31(37.8%) males. The QPD and SSS had a significant strong positive correlation (r=.707,p=.000) with each other and moderate correlation(p<0.05,r > 0.3) with all other scores except NCOS. The VAS and SPWT had a moderate correlation with all clinical scores except NCOS(p<0.05,r > 0.3). EQ-VAS had moderate correlation with ODI, SSS, QPD, VAS and SPWT(p<0.05,r > 0.3). The ODI had moderate correlation with the SSS, QPD, VAS, EQ-VAS and SPWT(p<0.05,r > 0.3). The PDI had a moderate correlation with SSS, QPD, VAS, mJOA and SPWT(p<0.05,r > 0.3). The mJOA had a moderate correlation with SSS, QPD, VAS, PDI and SPWT(p<0.05,r > 0.3). The NCOS did not show any significant correlation with any of the other scales.
CONCLUSIONS-The VAS, QPD, SPWT and SSS had a strong to moderate correlation with all the clinical scores except NCOS. Other score like ODI, PDI, mJOA and EQ-VAS also correlated well with most of the other scores. The NCOS did not demonstrate a clinically significant correlation with any of the other scores.

Introduction: Spinal deformity is prevalent among osteogenesis imperfecta (OI) patients, but little is known about the impact of scoliosis and treatment on quality of life. Methods: OI patients were invited for quality of life assessment through validated questionnaires (SRS-22 and EQ-5D-5L), with scoliosis severity and treatment assessed. Patients without a confirmed diagnosis of OI or without radiographic assessment of spinal deformities were excluded. Results: 148 OI patients - 101 with scoliosis (M=60, F=41, mean age 16.5 years) and 47 without scoliosis were analysed. The scoliosis group had lower self-image (3.31 vs 3.70, p=0.003) and mobility (3.13 vs 3.66, p=0.015). The median Cobb angle for the primary curve was 34.5°, with elder patients having greater curves (σ=0.544, p<0.001). Curve magnitude was associated with pain (σ=-0.355, p<0.001) and anxiety (σ=-0.352 p<0.001), but inversely correlated with function (σ=-0.225, p=0.024), self-image (σ=-0.379, p<0.001), and total SRS score (σ=-0.283, p=0.004). 11.9% OI patients with scoliosis underwent scoliosis surgery, 13.9% underwent bracing (with 18.2% compliance of brace wear >20hours per day), and 41.6% underwent physiotherapy. Patients treated operatively reported higher treatment satisfaction scores (4.41 vs 3.43, p=0.002) than patients with scoliosis of Cobb angle over 50 without receiving treatment, despite similar curve magnitudes (p=0.354). Conclusion: OI patients with scoliosis reported lower self-image and mobility. Curve magnitude was associated with older age, pain and anxiety, and was inversely correlated with function, self-image, and total SRS score. Patients who received surgery reported higher treatment satisfaction than those managed nonoperatively.

Introduction: Interbody fusions can be performed through an anterior or posterior approach for unstable single-level degenerative spondylolisthesis (DS). The purpose of this study was to compare the total cost between the two approaches for this population. Methods: In this retrospective database study, patients with single-level DS who underwent anterior or posterior interbody fusion were queried through the PearlDiver Mariner Database, consisting of claims from 2010-Q2 2018. Primary outcome was 90-day costs. Results: Of 30,558 included patients 4,935 (16.1%) underwent anterior and 25,623 (83.9%) underwent posterior interbody fusion. At 90 days, patients who underwent anterior fusion had an average reimbursement of $73,139.91 +/- $50,484.25, while patients who underwent posterior fusion had an average reimbursement of $55,619.57 +/- $34,919.27. From 2010-2015 the average paid per claim in the following 90-day period was higher for patients undergoing anterior interbody fusion in every year aside from 2010. Conclusion: Single-level DS patients who undergo anterior interbody fusion accrue higher total costs at 90 days than patients who undergo posterior interbody fusion.

Introduction: Several studies report that worker’s compensation (WC) leads to worse outcomes, especially in spine surgery. However, this association is not fully understood, with most of the works published 1 or 2 decades ago and the majority of them in the United States.
The purpose of this work is to compare the results of lumbar discectomy in patients undergoing surgery in WC and in the national health system.

Materials and Methods: Retrospective analysis of patients undergoing lumbar microdiscectomy performed by the same surgeon between 2017 and 2020, in two different hospitals- one public university hospital and one private hospital which treats patients with WC. Oswestry Disability Index (ODI) and 36-Item Short Form Survey (SF-36) were used to evaluate the outcomes.

Results: 84 patients were included, 40 treated in the national health service hospital and 44 in WC ‘s hospital. We found a significant predominance of males in the WC group, but the mean age of patients is similar in the two groups. Patient’s in WC returned to work seven weeks earlier than the others.
ODI values were significantly different, 24.2 in the WC group and 17.6 in the public hospital group. However, the results of SF-36 were similar between both groups.

Conclusion: Contrary to what has been reported, in or study, WC status had small effect in the outcomes of patients submitted to lumbar microdiscectomy. We believe that the impact of the WC may be related to the health system, social security and labor market of each country