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Background: Pelvic incidence (PI) and pelvic parameters (PP) regulate the sagittal alignment of the spine and the pelvis in normal populations. Correlation of PI even more so than PP with lumbar spondylolisthesis (LS) would be useful for surgical planning. Methods: This study included 45 patients randomly selected with LS. They were divided into two groups; Group S had LS and Group C had low back pain due to other causes. All patients received lateral standing radiographs of the spine and pelvis. Based on these films, we measured the sacral slope, pelvic tilt, PI, and lumbar lordosis (LL). Results: There were significant correlations between the PI and the sacral slope, pelvic tilt, and LL in Group S (P < 0.05). The majority of patients with LS presented with middle (60%) followed by high PIs (26.67%). Low PI was observed among just 13.33% patients with LS. Conclusion: Changes in spinopelvic parameters reflecting pelvic compensatory mechanisms differ depending on the extent of PI in patients with LS. In short, higher PI values correlated with more significant degrees of degenerative LS in Group S population.

Background The purpose of this study was to evaluate the efficacy of intrathecal morphine (ITM) in combination with bupivacaine as pre-emptive analgesia in patients undergoing posterior lumbar fusion surgery. This is in comparison with traditional opioid analgesics such as intravenous (IV) morphine. Methods Two groups were identified retrospectively. The first (ITM group) included patients who had general anaesthesia (GA) with low-dose spinal anaesthesia prior to induction using 1–4 mls of 0.25% bupivacaine and 0.2 mg ITM. 1 ml of 0.25% bupivacaine was administered per hour of predicted surgery time, up to a maximum of 4 ml. The insertion level for the spinal anaesthetic corresponded to the spinal level of the iliac crest line and the level at which the spinal cord terminated. The control group had GA without any spinal anaesthesia. Patients were instead administered opioid analgesia in the form of IV morphine or diamorphine. The primary outcome was the consumption of opioids administered intraoperatively and in recovery, and over the first 48 h following discharge from the post-anaesthesia care unit (PACU). Total opioid dose was measured, and a morphine equivalent dose was calculated. Secondary outcomes included visual analogue scale (VAS) pain scores in recovery and at day two postoperatively, and the length of stay in hospital. Results For the ITM group, the median total amount of IV morphine equivalent administered intraoperatively and in recovery, was 0 mg versus 17 mg. The median total amount morphine equivalent, administered over the first 48 h following discharge from PACU was 20 mg versus 80 mg. Both are in comparison with the control group. The median length of stay was over 1 day less and the median VAS for pain in recovery was 6 points lower. No evidence was found for a difference in the worst VAS for pain at day two postoperatively. Conclusion ITM in combination with bupivacaine results in a significantly decreased use of perioperative opioids. In addition, length of hospital stay is reduced and so too is patient perceived pain intensity. Trial registration The study was approved by the ethics committee at The Robert Jones and Agnes Hunt Orthopaedic Hospital as a service improvement project (Approval no. 1617_004).

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoimmune disorder of childhood and adolescence which often manifests as recurring episodes of inflammatory bone pains. Spinal involvement is rare; however, recent studies advocate full body magnetic resonance imaging in all suspected cases to pick up asymptomatic lesions early to prevent complications. Spinal involvement may manifest as fractures, scoliosis, or kyphotic deformity. Case Report: We present a case of a 12-year-old boy who had three-level involvement of thoracic spine, T6-T8, and was worked up and managed for pathological fracture of spine. He underwent biopsy for the same and was later diagnosed as CRMO. Here, we discuss the diagnostic challenges involved in CRMO, need for biopsy, and the management options available. Conclusions: Identifying CRMO is challenging and remains a diagnosis of exclusion. Nonsteroidal anti-inflammatory drugs often constitute the first line of treatment and other drugs such as bisphosphonates and biologics such as TNF-alpha antagonists are reserved for more severe cases. Although CRMO is considered a benign disease, recent data suggest up to 50% rate of residual impairments despite optimal management. Keywords: Chronic recurrent multifocal osteomyelitis, spine, contiguous, child.

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