Introduction: Cauda equina syndrome (CES) is a spinal emergency requiring timely diagnosis and intervention to prevent permanent neurological dysfunction. The Society of British Neurological Surgeons state that an MRI scan for suspected CES should be requested by the examining clinician. Arranging an orthopaedic review and then obtaining an MRI scan leads to major delay in diagnosing CES. Objective: This study evaluates the time interval from patient arrival in the emergency department (ED) to diagnosis or exclusion of CES. Methodology: A prospective study of patients referred to orthopaedics from ED with suspected CES who had an MRI scan during their hospital visit were included. Pre intervention (1st October -31st October 2021) 16 patients and post intervention (1st January – 28th February 2022) 30 patients were identified. Intervention: Timely request of an MRI scan by the ED clinician assessing the patient was highlighted in an educational lecture to all ED, orthopaedic and radiology clinicians. Results: Pre-intervention, the mean time from patient arrival to MRI request was 332 minutes and post- intervention, it was 274 (decreased by 58 minutes). The mean time from patient arrival to MRI report pre-intervention was 1032 minutes and post-intervention was 809 (decreased by 223 minutes). Conclusion: An MRI scan requested by ED clinicians at time of assessment improved the time interval from patient arrival to diagnosis of CES. This improves overall morbidity, reduces patient anxiety and frustration whilst they await their diagnosis. Timely exclusion of CES can lead to early patient discharge, which is also more cost-effective.

Introduction: Thoracolumbar burst fractures are a frequent cause of the neurological deficit. The management strategy and surgical technique of choice is still a debate for thoracolumbar spine injuries. There are very few studies done to show the extent of the decompression following posterior wall subsidence of the vertebral body to achieve spinal canal clearance. Hence, we studied the efficacy of posterior wall subsidence in achieving decompression, spinal canal clearance as well as deformity correction in acute thoracolumbar burst fractures. Methodology: Twenty-five patients with acute thoracolumbar burst fractures with neurological injury (ASIA A-D) were prospectively included in this study. The enrolled patients underwent surgical decompression by subsidence of retropulsed posterior wall and posterior instrumentation. Spinal canal diameter and Kyphotic deformity were measured preoperatively, within a week post-surgery, and at final follow-up using Computed Tomography scans. Neurological status was assessed according to the ASIA scale. Results: 25 patients were included in this study. The mean spinal canal decompression achieved at the final follow-up was 6.44 ± 1.64 mm and the mean improvement in kyphosis was 12.53 ± 7.06°. The decompression achieved and the sustenance of these measurements between the immediate post-operative period and the final follow-up of six months was statistically significant (P <0.001). However, no statistical significance could be established between neurological improvement and the extent of spinal canal encroachment or decompression achieved. Conclusion: Subsidence of retropulsed fractured posterior wall is an effective surgical method to achieve adequate spinal canal decompression and deformity correction in acute thoracolumbar burst fractures.

We reported one patient with multiple spinal fractures and COVID-19 infection developing rapid healing of spinal fractures than expected. Male patient, 45 years old, falling from height, ±7 meters, with pain all over the back, GCS 15/15, and neurologically intact. Radiological investigations revealed compression fracture of C6, spinous process fracture of T7-to-T11, fracture of Rt and Lt transverse processes of L1-to-L3, and Fracture Rt. 6th, 7th, and 8th Ribs. Lumbo-dorsal and neck support applied then admitted for further evaluation and definitive management in asymptomatic status regarding COVID-19. On the second day he had cough, fever, shortening of breath and decrease O2 Saturation confirmed COVID-19 infection by PCR test, kept in isolation for 12 days with suitable medications. During regular follow up we noticed that back and neck pain decreased in noticeable degree day after day and patient removed the support most of the time. After 14 days became Symptoms free and negative test, reevaluation revealed clear union of the transverse process fractures with visible callus too much than usual seen, Stable C6 with signs of healing, dramatic improvement in neck and back pain. The patient was moving and doing his usual activities freely without pain only little pain in chest. The patient was satisfied and asked to be discharged. We advised him to keep neck collar till union completed. Two weeks later visible callus inT7-T11 spinous processes and C6 complete union. Rapid unexpected healing process may be a result of COVID-19, needs more recorded cases and studies to be improved.

Background: The proximity of neurovascular structures may lead to complications from pedicle violation. Characterizing the morphology of the pedicles can assist the surgeon in making informed decisions whenever transpedicular screw fixation is being considered. Objective:The objective was to perform morphometry of the subaxial cervical spine in a Filipino population. Measurements of the linear dimensions and angular projections of each pedicle were acquired, then analyzed.Methods: We retrospectively review the cervical CT scans showing normal cervical vertebrae of Filipino at at least 18y/o. These were measured; linear parameters: outer pedicle width (OPW), inner pedicle width (IPW), outer pedicle height (OPH), inner pedicle height (IPH), pedicle length (PL), pedicle axis length (PAL); angular projections: pedicle transverse angle (PTA), and pedicle sagittal angle (PSA). The mean and standard deviations for each parameter were calculated. The t test was used to determine if there were any significant differences in the pedicle morphologic parameters according to side and sex. Results: Total of 1,470 pedicles were measured from 735 subaxial cervical vertebrae in 147 subjects. For all the linear parameters measured, a gradual increase was noted from C3 to C7; for the angular projections, the PTA variations from C3 to C7 were wider in the upper subaxial cervical spine, C3 to C5, and narrower in the C6 and C7.Conclusion: Our data demonstrated that pedicle morphology is, and therefore screw placement and orientation,significantly different at each subaxial cervical spinal level and between men and women. It is therefore necessary to account for these differences during surgical planning.

This is a case report of a 3 year old with congenital scoliosis of lumbosacral vertebra operated by sacral osteotomy with 2 year followup. 3 year old girl born of a non-consanguinous marriage. Full term, normal delivery with normal developmental milestones and age appropriate IQ, came with deformity of the back. On evaluation she had C7D1 Block vertebra, Right D5 hemivertebra, Right L3 Hemivertebra and L5S1S2 block vertebra. The D5 hemivertebra was causing scoliosis with convexity to right (Cobb’s angle - 16°). The L3 hemivertebra was causing scoliosis with convexity to right ( Cobb’s angle - 33°) and the L5S1S2 block vertbra was causing scoliosis with convexity to the left ( Cobb’s angle - 40°). She was operated by L3 Hemivertebra excision and Right L2-L4 stabilisation along with Lt sacral osteotomy and Left L5-sacrum stabilisation. Post operatively the scoliosis at L3 level was completely corrected and the left sided scoliosis curve was reduced to 16° Cobb’s. Clinically coronal balance was achieved and in two year followup, there was no loss of correction.

Ankylosing Spondylitis is an inflammatory disease, progressively altering the spinal structure and biomechanics, making these patients more prone to fractures. The vulnerability and comorbidities of these patients increase the peri-operative risks and the percutaneous technique is a seducing alternative offering less peri-operative complications.
We studied 6 men and 2 women with ankylosing spondylitis, who presented with thoracolumbar fractures without neurological deficit. All patients had a pre-operative CT-scan to evaluate the type and location of the fracture and they have all been managed surgically with a long-segment percutaneous pedicle screw fixation. Post-operative follow-up allowed a functional evaluation, assessment of pain and post-operative complications. All patients underwent a CT-scan to assess screw placement, an eventual implant failure and fracture union.
The mean patient age was 55 years with a mean follow-up of 24 months. The VAS score for back pain significantly improved over the follow-up period (from 9 to 3.5). Bone union was observed in all patients. The overall complication rate was 25%, while no patient underwent reoperation. At the last follow-up, we did not observe any implant failure or kyphotic deformity.
Percutaneous technique is an interesting solution for the management of non-deficit thoracolumbar fractures of the ankylosed spine. It offers similar functional and radiological results as the classical technique, with less peri-operative morbi-mortality. The learning curve of this technique remains a limiting factor.

Background: Cervical trauma causing neurological injury and/or should be treated expeditiously. Though optimum timing of early surgical treatment (within 24 h or 72 h after injury) is still controversial. Early surgery may increase chance of neurological recovery and avoids ominous sequelae. Sometimes, immediate surgical decompression may not be possible due to several reasons.
Aims and objectives: In this study, a retrospective analysis of spinal injury patients is done to assess whether late surgical decompression and stabilisation is at all beneficial for the patients or not.
Materials and methods: Eleven patients (n=11) are taken in this study who had cervical spine injury with. Surgical treatment was done on these patients after five days of injury. M:F ratio was 8:3. Average age was 32.6 years. Two had serious chest injury, three had multiple long fractures, one had head injury and one had serious medical co-morbidity. Rest four patients arrived late.
Results: Nine out of 11 patients had neurological improvement of at least one grade in American Spinal Injury Association ( ASIA) scale. Two patients have mild disability in Neck Disability Index (NDI). Others have no disability.
Conclusion: Most of the literatures say, timing of surgery did not affect neurological recovery. Result of this study shows encouraging outcomes even after doing late surgical decompression and stabilisation of cervical spine injury after five days.

Introduction: Kyphosis is one of the most common complications of spinal tuberculosis. Patients are never satisfied with the residual kyphosis even if the disease is cured or arrested. Patients with hunchback live secluded lives both mentally & socially. To achieve correction & prevention- surgery is desirable. Nonetheless, satisfactory surgical correction is very difficult & dangerous as well. Materials & methods: This prospective case series was conducted in a tertiary level hospital & in a private hospital from January 2003 to December 2021. Most of the patients operated posteriorly to achieve correction. Correction of the deformity was easier in wet TB than the dry TB. Long segment posterior construct along with cylinder cage was applied. Results: This study comprises 57 cases (M=20, F=37), with an average age of 17 years. The mean kyphosis angle was 85±9 o preoperatively which came down to 13±7o finally. There was no major complication. None of the patients develop or worsened neurologically after surgery. Finally patient achieved a satisfactory cosmetic appearance. Conclusion: Prevention of deformity should be the primary aim. Long-standing severe kyphosis produces painful costopelvic impingement, reduced vital capacity, lumbar canal stenosis & late-onset paraplegia. With improved surgical technique & rigid spinal instrumentation involving three-column - the posterior is the only approach for prevention & correction of kyphosis