Psychological, social and physiological factors can delay the patient's consent to surgery. Study aimed to determine the effectiveness of PreOp brace management of patients with IS surgical forms with incomplete growth. Materials and methods: 84 patients 15-17 y.o. with IS randomly applied in 2019-2021yy in two different institutions regarding the spinal deformity treatment and were enrolled in the prospective study, M:F=1:4.25. The PreOp Cobb was 44-87 degrees with preserved corrective mobility. Lenke I were in 38 patients, Lenke V - in 26, Lenke III - in 20. Risser was RIV-RV. The Sadof’eva test illustrated the X-ray vertebrae maturity, was SII-SIII, which indicated the spine growth potential. Because of patients' doubts about surgery Chenot-type bracing offered. The bracing period was from 1-2.5 years until the SIV-SV stage, which confirmed the spine growth completion. Results and discussion: By the end of brace management 12(15%) patients (group I) had the Cobb angle less than 40 degrees and refused surgery. 49(58)% patients (Group IIA) had the same deformity and allowed to do surgical correction with optimal parameters. In 23(27%) patients (group IIB), the deformity continued to progress. All patients of groups IIA and IIB underwent a planned corrective surgery with instrumentation and fusion.
After surgery, the deformity angle for IIA was 19.4(9.3-29.5), p<0.05 with a correction percentage of 73%(67%-79%), for IIB 33(21-45), p<0.05 and 63%(55%-72%), respectively.
Thus, for patients with IS surgical spine deformities and incomplete bone growth of the vertebrae, it is reasonable to perform brace treatment as a PreOp management.

Background : 2 cases of an An atypical case of a traumatic posterior C1-C2 dislocation with an odontoidis reported.
AIM: To describe treatment strategy for c1-c2 dislocation
Case presentation: 2 patients with atypical posterior atlantoaxial dislocation was presented and underwent reduction and posterior stabilization . A retrospective review of the occupational therapy reports, patient records, and radiographs was performed.
Conclusion: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release.
Keywords: Cervical spine dislocation, Posterior Atlantoaxial dislocation, sub-axial cervical spine

Introduction: Because previous studies have not focused on postoperative cervical collapse, the purpose of the present study was to introduce the overload vertebra body (OVB) phenomenon following multilevel anterior cervical discectomy and fusion (ACDF) as well as to investigate its effects on clinical and radiographic outcomes. Methods: We conducted a retrospective study involving patients who underwent ACDF. A total of 32 patients were included in the analysis, including 64 OVB and 64 non-OVB. The evaluated vertebral parameters included the vertebral cross-sectional area (CSA), wedge angle (WA), vertebral height (anterior [AH] and posterior [PH]) and anterior-posterior vertebral diameter (upper [UD] and lower [LD]). Results: The CSA and WA were significantly lower in the OVB group than in the non-OVB group at 3, 6, and 12 months after surgery as well as at the final follow-up (p<0.01). The AH of the OVB group was significantly lower at 3, 6, and 12 months after surgery as well as at the final follow-up compared to 1 week after surgery (p<0.01). Conclusion: OVB, a new phenomenon following multilevel ACDF, is defined as the cervical vertebra located in the middle of the surgical segments in multilevel anterior cervical spine surgery. Statistical analysis of vertebral parameters, including CSA, WA, AH, PH, UD, and LD, showed that OVB occurs mainly at the anterior edge of the vertebra and that its largest radiographic manifestation is the loss of height at the anterior edge of the vertebra in the early postoperative period.

Introduction: More than 50% slippage is considered as High Grade listhesis (Meyerding). Surgical management is choice of treatment for such cases but some grey area still persists as far as indication & type of surgery is concerned. We present such a case where surgical decision & procedure to be done was a challenge. Case Report: A 55 year male patient came to us for chronic Low Back Pain – 9 months associated with Rt leg pain & radiculopathy but no claudication and no other co-morbidities. He had taken Conservative t/t for 9 months with minimal relief. On examination: Hyper lumbar lordosis, No other obvious deformity of spine. Mild Tenderness + at L4-5 level. SLRT – 40 degrees – B/L. Movements of Spine limited due to pain. Radiograph of L.S. spine – AP, Lateral (flexon, extension & oblique views – MEYERDING – Grade II (High Grade +). On MRI - No Dural Compression, No root compression. Decision making & treatment: Dilemma of Conservative trial to continue OR Surgical t/t. Pros / Cons of conservative / Surgical treatment discussed with Patient & relatives and finally Surgical Decision was taken. Reduction & Pedicular Screw fixation by using reduction screw with Decompression by wide laminectomy with Fusion posterolateral bone grafting (TLIF could not done due to some unavoidable circumstances). Follow-up (1 ½ years) Clinical results: Lumber lordosis – maintained, Movements of spine – OK, SLRT – B/L Free, No local tenderness, No gait abnormality. Patient is happy and doing all indoor / outdoor work

Background information:
Many patients experience gastrointestinal (GI) morbidity after spine surgery. Constipation tops the list of these gastrointestinal morbidities. In this study, we look into the likelihood of constipation and potential risk factors in patients having lumbar spine surgery.

Methods:
The case-control study was carried out at the department of orthopaedics at Fayoum General Hospital in Fayoum, Egypt. We looked through hospital databases and file records for patients who had spine surgery between 2019 and 2022. All patients who met our inclusion criteria were included. Patients were interviewed at the orthopaedic clinic and asked about any gastrointestinal morbidity symptoms, particularly constipation. Data from file records and patient interviews were combined and analysed to identify potential risk factors for GI morbidity. The findings were compared to a control group.

Results:
A total of 194 patients were assigned to the opioid (116) and control groups (78). Constipation affected 36 females and 17 males. Females had significantly more constipation than males (p-value = 0.028). Constipation, however, did not correlate with age, operative time, comorbidities, or the need for transfusion. In terms of constipation, there was no significant difference between the opioid and control groups (p-value = 0.157).

Conclusion:
Female patients were more likely than male patients to have constipation. Diabetes, hypertension, and neurology were not found to have a strong correlation with constipation. In addition, patients who received opioids were more likely to have constipation than those who did not.

Introduction: the most common complication after lumbar discectomy is reherniation.Many studies were conducted to detect the cause of recurrence.However, to our knowledge no intraoperative test was designed to detect the residual disc material that could represent a cause of later recurrence . A novel intraoperative induced cough reflex was used in our study to detect the unstable hidden disc material .

Aim: to evaluate the efficacy of the intraoperative induced cough reflex during lumbar microdiscectomy in reducing the incidence of residual and recurrent disc herniation .

Methods : a total of 50 Patients had undergone lumbar microdiscectomy in a period from November 2021 to January 2023 . 25 Were males and 25 Were females . Follow up MRI of the lumbosacral spine was done in all cases at least 6 months postoperatively.

Results : The test was positive in 20 Cases (40 % )where repeat microscopic examination showed a disc material that appeared after the test . The average time taken by the test is 8 min.The VAS was reduced from average 7 to 2 six months postoperatively. MRI detected recurrence in 9 patients in which 1 case needed further intervention .

Conclusion: the novel test of intraoperative induced cough reflex may be valuable in detection of the unstable residual disc material and thus in reducing the incidence of later recurrence .

The leading cause of death in the southern region of India, specifically in the coastal belt region, is a fall from a great height, which is most typically related with the profession of toddy tapping. This is due to the lack of appropriate protective gear. To demonstrate the correlations and effects of gender, age and the type and distribution of vertebral fractures, as well as the possibility of suffering neurological deficit or an associated injury.

Several techniques have been described for high cervical spine surgery. The classical anterior retropharyngeal approach described by Robinson and modified by McAfee is technically challenging and presents a substantial risk for complications. De Bonis proposed a 4-step simplified retropharyngeal approach that minimizes risks while being much easier to perform.
We present an 80-year-old woman with an unstable atypical C2-C3 traumatic spondylolisthesis (Josten 3/Al-Mahfoudh type 2b) without neurological impairment. Due to suspected anterior longitudinal ligament lesion and concomitant several facial fractures, rendering a posterior approach as non-desirable, we performed a C2-C3 anterior discectomy and fusion with a locking plate and autologous bone graft using an anterior submandibular approach following the 4-step simplified technique proposed by De Bonis. The procedure was uneventful and the patient was discharged presenting no symptoms of dysphagia, dysphonia or neurological lesion. At 6 months post-operatively, CT scan demonstrated complete fusion and patient was clinically well, having returned to normal daily activities completely autonomous.
This simplified approach of the upper cervical spine avoids critical steps of the classical approach, particularly submandibular gland dissection, facial artery and vein ligation and resection, digastric bellies dissection, hypoglossal nerve retraction and superior laryngeal nerve dissection – preventing the majority of possible complications.
This approach seems effective, safe, decreases surgical exposure time and requires a simple learning curve. Nevertheless, more studies are needed to validate this approach as gold-standard to high cervical spine surgery.

Introduction: Postoperative bacterial meningitis after cervical spinal fusion is a rare event. There is a paucity of literature describing the incidence and risk factors for such infection. We aimed to identify patients who are at risk of developing bacterial meningitis after cervical fusion. Methods: The U.S.A. Nationwide Inpatient Sample (NIS) database was used to identify patients who had cervical fusion from 2002 to 2014. Inpatient outcomes included the incidence and risk factors for developing meningitis. Secondary outcomes included average length of stay (LOS) and mortality rates. Statistical analyses were conducted with multivariate regression models using SPSS software. Results: 325,241 patients who underwent elective cervical fusion were identified. 91.3%(296,894/325,241) underwent fusion using the anterior approach; 8.7% (28,347/325,241) underwent fusion using the posterior approach. Of these patients, 0.004% (12/325,241) were found to have postoperative meningitis. Developing a postoperative cerebrospinal fluid (CSF) leak was associated with an increased risk of developing meningitis (0.4% (6/1,390) vs. 0.002% (6/323,851); p<0.05). Subgroup analysis based on CSF leak status found that independent risk factors for postoperative meningitis in patients with CSF leak included: posterior approach (Odds Ratio = 8.4; 95% Confidence Interval, 1.44-48.6; p =0.018) compared to anterior approach. Bacterial meningitis was associated with increased LOS days (19.0±9.87 vs. 1.91±2.42; p <0.0001), increased cost ($202,739.6±177,448.7 vs. $48,176.8±412,44.4; p <0.0001) and increased mortality (16.7% vs. 0.1%; P<0.05). Discussion/Conclusion: Surgeons should maintain a high degree of suspicion and take prophylactic measures against postoperative bacterial meningitis in patients who develop a CSF leak after cervical fusion using the posterior approach.

Between 2015 and 2018, adolescent patients with congenital kyphoscoliosis were treated by posterior wedge closing vertebral column resection. The base of the wedge started posteriorly at the convex side with the apex extending to the anterior column at the concave side aiming for correction of both kyphosis and scoliosis with closing of the wedge. This study included 12 patients (8 females and 4 males) with mean age of 15.7 years. The average follow-up was 2.9 years. The Cobb angle was 53.2° and corrected to a mean of 7.6° postoperative. Average preoperative local kyphotic angle was 76° corrected to a mean of 20.25o postoperative. The mean operative time was 158 minutes with an average estimated blood loss of 917 mL. There were no neurological complications. No major intraoperative or postoperative complications were reported. Radiological proximal junctional kyphosis was observed in 2 patients with no clinical symptoms. Posterior wedge VCR is an effective and relatively safe method for Correction of adolescent thoracolumbar congenital kyphoscoliosis. The advantages of this technique over the classic PVCR are shorter operative time and less blood loss because the osteotomy was done from one side with no need for resection of the other side. Controlled Shortening of the spine during closure of the wedge allows correction of both coronal and sagittal plane deformity smoothly without distracting the neural tissue with less incidence of neurological complications. Furthermore, keeping the anterior column and the concave side in continuity without resection provide further stability, prevent translation and allow faster bone healing.