Introduction: This study aimed to evaluate the safety and curative effect of endoscopic full see technique for the treatment of lumbar spinal spinal stenosis. Methods:From August 2018 to August 2019,this retrospective study recruited 21 patients with lumbar spinal stenosis who underwent Endoscopic full see technique via surgical approach of posterolateral intervertebral foramen, used the outer endoscopic reamer, endoscopic bone chisel and rongeur for foraminotomy and lateral recess stenosis decompression. The postoperation neurological function and pain status were evaluated by the VAS score of pain and ODI. The data, including preoperative comorbidities, operation time, the quantity of bleeding, bed rest time, and intraoperative and postoperative complications, were recorded.Results: The mean operation time was 100 minutes, the mean quantity of bleeding was 30 mL. All patients were followed-up for 4 months to 1 years. The mean preoperative VAS score was 7.3 ± 1.3, while postoperative 1 months, 3 months, and final follow-up VAS scores were 1.8 ± 0.7, 1.1 ± 0.6, and 0.8 ± 0.6, respectively (P < 0.001). The mean preoperative ODI score was 72.4 ± 1.2, while postoperative 1 months, 3 months, and final follow-up ODI scores were 28.5 ± 3.9, 22.6 ± 4.1, and 12.5 ± 3.3, respectively (P < 0.001).Conclusion: Endoscopic full see technique for the treatment of spinal stenosis is an safe, and effective minimally invasive surgery for patients with lumbar spinal stenosis .But this technique has a “long and steep” learning curve.

One reason for coccydynia is sacrococcygeal joint degeneration. Congenital/acquired deformity of the joint may lead to eccentric forces on it and secondary degenerative change. Deformities of the joint in the sagittal plane are recognised; we find no description of deformity in the coronal plane. A tall, slim, physically fit 42-year-old male reported spontaneous onset of natal cleft pain, worse on sitting and standing; “intolerable” by presentation. The only sign was tenderness palpating the coccyx. MRI scan revealed degeneration of the sacrococcygeal joint and marked coronal plane angulation; Cobb angle 30°. Manipulation of the sacrococcygeal junction per rectum under general anaesthetic plus accurate injection of a long-acting anti-inflammatory agent onto the coccyx was performed. The sacrococcygeal joint was stiff but stable; coronal plane angulation, crepitus and osteophytes were palpable. Excellent symptomatic relief was reported. Sagittal plane-imaged abnormalities of the coccyx and sacrococcygeal joint are described including multiple segmentation, deformity of individual ossicles, bone spicules and instability. We describe a coronal plane deformity and associated painful degeneration of the sacrococcygeal junction. We speculate this deformity resulted from fused hemivertebrae of either or both caudal sacral/cranial coccygeal vertebra(e) to create such an abnormal joint angle or a forgotten childhood accident with eccentric growth arrest; sacral hemivertebra - extremely rare - has been described but only at the lumbosacral junction. We speculate degenerative change of the sacrococcygeal joint evolved secondary to eccentric forces on it. We anticipate need for coccygectomy, but conservative management is currently adequate.

The term lumbar spinal stenosis (LSS) refers to the anatomical narrowing of the lumbar spinal canal and is associated with symptoms of low back pain, radiculopathy or claudication.The annual incidence of LSS is reported to be five cases per 100,000 individuals. It is a common finding in ageing or degenerative spine.The Lumbar L4-5 spinal discs are most frequently affected by Lumbar Spinal Stenosis.Primary stenosis is caused by congenital narrowing of the spinal canal, whereas secondary stenosis can result from a wide range of conditions, most often chronic degeneration, which leads to a destabilized vertebral body.The characteristic symptom is neurogenic claudication.Lumbar spinal stenosis has become the most common indication for lumbar spine surgery, in part because of the increasing quality and radiological imaging. The need for efficient therapy is reflected by the substantial economic burden of low back pain, with lost productivity at work representing the majority of the overall costs.All the surgical procedures used aim to decompress the entrapped neural elements without disrupting the stability of the segment.Many techniques have been described for LCS decompression including microhemilaminotomy, interlaminar microdecompression, intersegmental microdecompression, recapturing microlaminoplasty, and segmental microsublaminoplasty.A classic laminectomy is the most common surgical approach FOR decompression. It permits maximal operative decompression of the neural canal and/or bilateral foramina, but there is damage to the posterior spine stabilisers.The microsurgical method is ideal for sufficient bilateral decompression of the spinal canal or foramen, with minimal paraspinal muscle separation and preserving posterior stabilisers of spine.

Introduction:Back Pain is one of the most common cause of morbidity.Formetric spine-based on videorastergraphy-analyses the topography of back and gives the details of vertebral column.Earlier it is used for Idiopathic Scoliosis,but nowadays gives important information about chronic low back pain.Methods:In pain OPD 560 pt with chronic low back pain with or without acute exarbation were evaluated by Diers 4D motion lab(FCE scan) The evaluation was done in both static and dynamic phase for following parameters-*Imbalance-Coronal and Sagittal *angle-coronal, kyphotic and lordotic*Vertebral rotation and apical deviation*Pelvic torsion, rotation and inclination. The parameters were noted and compared by normal value given by Dr HC Harzmann. Analysis: It was found that abnormal parameters correlate with chronicity and severity of back pain. Few patient with normal parameters has back pain due to extra spinal pathology, which was confirmed by clinical examination and motion analysis. Conclusion: Although this is just observational study but it helps in creation of an algorithm to predict the functional disability based on above variables and may provide platform for INDIAN BACK PAIN SCORE. This study also gives details of relative motion of different vertebrae which may provide some insight on pathogenesis and Evolution of back pain .Because abnormal relative movement between lumbar vertebral segment due to core muscle imbalance may cause rapid degeneration of disc.

Small epidural hematoma (SEH) almost always occurs following spinal procedures such as laminectomy, which are usually asymptomatic. The incidence of symptomatic postoperative SEH leading to cauda equine syndrome, is extremely rare [0.1%-0.2%]. In this report, we present a 60-year-old male patient diagnosed with lumbar canal stenosis at L4-L5 and L5-S1 level and underwent decompression with laminectomy. No bleeding was noticed during the operation and drain was placed which was later removed after 48hours with less than 10ml collection. He was discharged on second post-operative day (POD) in stable neurological condition. On tenth POD, he presented with sudden onset of weakness in both lower limbs along with sensory involvement. On POD 10, he strained to pass stools. On evaluation, both foot ,dorsiflexion strength and plantar flexion strength was 0/5, sensory deficits in L4, L5, S1 dermatomes and urinary incontinence. Magnetic resonance imaging (MRI) confirmed SEH at the surgical site. Duration between onset of new symptoms to re-exploration surgery was less than 24 hours. Hematoma evacuation with drain insertion was done. On POD 2 neurological examination showed both foot dorsiflexion and Plantar flexion strength 3/5 and patient was on indwelling urinary catheter. Subsequent follow up showed full recovery by 3 to 4 weeks. Conclusion: The incidence of SEH is an uncommon but a very serious complication. Early diagnosis of post-operative SEH and surgical intervention is required to prevent morbid prognosis and achieve better outcome. Post spinal surgery avoid increased abdominal pressure and constipation symptoms. monitor INR values (<2).

Introduction: We designed PTES technique under local anesthesia and OLIF combined with anterior screw fixation for the treatment of single level lumbar spine spondylolisthesis. The purpose of study is to evaluate the feasibility, efficacy and safety of this method.
Materials and Methods: Fifteen cases of L4 spondylolisthesis with nerve root symptoms were included in this study. PTES was performed under local anesthesia in a prone position, and then the patients underwent OLIF for L4/5 in a right lateral position under general anesthesia. During the procedure of OLIF, the fixation of pedicle screws and rod was used in the same approach after insertion of cage into L4/5. Back and leg pain were preoperatively and postoperatively evaluated using VAS. And the clinical outcomes were evaluated with ODI at the 2-year follow-up. The fusion status was assessed according to the Bridwell’s posterior fusion grades.
Results: There was a mean blood loss of 30 mL (20–45 mL). The mean stay at the hospital was 4 days (3–5 days). The average follow-up duration was 26 (24-38) months. For the clinical evaluation, the VAS pain index and the ODI showed excellent outcomes. Fusion grades at 2-year follow-up were grade I in 11 segments, grade II in 4 segments.
Conclusion: PTES and OLIF combined with anterior screw fixation is a good choice of minimally invasive surgery for lumbar spine spondylolisthesis, which can get direct neurological decompression, rigid fixation and solid fusion, and hardly destroy the paraspinal muscles and bone structures.

Introduction: Anterior cervical plate has protruding profile, which usually leads to the sensation of swallowing foreign body, and self-locked cage has no profile. The purpose of study is to evaluate the feasibility, efficacy and safety of ACDF with self-locked cages for the treatment of 4-level cervical disc herniation.
Materials and Methods: Sixteen cases of C3/4, 4/5, 5/6, 6/7 disc herniation with myelopathy or radiculopathy were included in this study. ACDF using self-locked cages (LDR) filled with allograft was performed for C3-7 under general anesthesia. Arm pain was preoperatively and postoperatively evaluated using VAS and the severity of the neurologic deficit was assessed using the ASIA impairment scale.
Results: Sixteen patients were included in the present study. The mean length of the incision was 2.2±0.4 cm. There was a mean blood loss of 35 (15–180) mL. The stay at hospital was 4 (3-5) day. The average follow-up duration was 26 (24-36) months. There were no perioperative complications such as swallowing foreign body sensation. The VAS score and ODI showed excellent outcomes. CROM in 6 directions was close to normal, which had not affected daily life. Fusion grades based on the Bridwell grading system at 2-year follow-up were grade I in 57 segments (89.1%, 57/64), grade II in 7 segments (10.9%, 7/64).
Conclusion: ACDF with self-locked cages is a good choice of minimally invasive surgery for 4-level cervical disc herniation, which can get good clinical outcomes, rigid fixation, solid fusion and no swallowing foreign body sensation.

Post-traumatic kyphosis (PTK) is a challenging complication following thoraco-lumbar spinal trauma. It usually develops consequent to missed or conservatively managed AO type B2 injuries , injuries to the inter-vertebral discs or vertebral end-plates, severe osteoporosis, pseudoarthrosis, or iatrogenic causes including implant failure or loosening. Progressive kyphosis can lead to recalcitrant symptoms including pain, progressive deformity and neurological deterioration. The aim of the current study was to retrospectively analyze the long-term radiological and clinical outcomes of patients who underwent surgical correction of PTK. A retrospective analysis of the clinical and radiological data of 28 PTK patients who presented to our Out-Patient clinics or Emergency Department between January 2016 and August 2018 was performed. For deformity correction we performed pontes osteotomy,pedicle subtraction osteotomy(PSO), bone disc bone osteotomy(BDBO) and closing opening wedge osteotomy. Radiological evaluation of kyphosis was performed using cobbs angle.The functional outcome at the final follow-up was assessed using Oswestry Disability Index (ODI), visual analogue scale (VAS), and SF-12 score. The mean pre-operative cobbs angle was 33.3°. Post-operatively, the mean correction, which was achieved, was 23.85° . The mean surgical time was 275±40 minutes, and the mean intra-operative blood loss was 445±71 ml. The mean VAS score for back pain improved from 7.2 to 2, and ODI score decreased from 58.1 to 24.1 at the last follow-up. We can safely conclude that surgical deformity correction is a safe and effective method for correction of kyphosis and improving functional outcome in patients of PTK.
Key words: PTK(Post-traumatic kyphosis),kyphosis,osteotomy