Introduction: Microtubular decompression (MTD) being a short-duration surgery, with many advantages, has gained popularity and can be done either in general anaesthesia (GA) or awake techniques like spinal anaesthesia (SA). The authors ventured to assess perioperative parameters, quantify peri-operative complications as the primary aim and determine patient satisfaction as the secondary aim of the study. Materials and Methods: It was a retrospective study performed over a period of ten years (2009–2019) and included 625 patients. The patients included were aged greater than 18 years, American Society of Anaesthesiologists (ASA) score 1, 2, or 3. Patients with ASA 4 or 5, spinal instability, infection, or revision surgeries were excluded. Results: There is no significant difference in the complication rates. The clinical outcome in the form of VAS and ODI scores showed significant differences both in SA and GA groups at the final follow-up. The total anaesthetic, surgical times, mean arterial pressure (MAP), and heart rate (HR) perioperatively were longer in the GA group (P < 0.05). The perioperative blood pressures are lower in the SA group. The dissatisfaction rate is about 3.5%, of which the patients and a total of 88.5% of patients would like to opt for SA for future surgeries. Conclusion: This study represents the ten-year experience with MTD operated either with SA or GA. Awake spinal surgery is promising and has the glaring benefits of better peri-operative hemodynamic stability, and faster recovery with reduced surgical and anaesthetic duration. Dissatisfaction rates can be decreased by better explanation and the patient’s decision. Keywords: Awake spine surgery, Microtubular decompression, Hemodynamic parameters, Complications, Patient satisfaction.

Background: Spinal Tuberculosis (TB) is one of the significant health dangers that affect the general wellbeing of an individual. It is one of the most common form of extra pulmonary tuberculosis that affects the general population. Diagnosis of tuberculosis is done using an array of techniques. The present study has compared the efficacy of these tests used for detecting the spinal TB in biopsy samples. Material and Methods: The study was conducted on patients who suffered from spondylodiscitis and with biopsy proven spinal TB by one of the following tests and were treated in the study center. The study included a total of 150 patients with spinal TB who visited the department for further treatment. The biopsy samples of these patients were then processed for Line probe assay (LPA), Gene Xpert, liquid culture (bactec MGIT) followed by gram staining and fungal staining, and histopathological examination. Result: In this study total of 150 patients were included who had ages ranging from 16-77 years with 93male and 57 female patients. When the study results were compared Gene Experts showed a 100% sensitivity and 80% of specificity. When we compared the histopathology results with gene expert, we get a sensitivity of 16.7% and specificity of 50%. Gram stain with the sensitive gene expert, the sensitivity is 45.5% and specificity is 25%. Similar analysis was done with sensitive gene and now with the resistant gene to identify their sensitivity was 0% and the specificity was at 42.9%. Gram stain when correlated with gene, the sensitivity came out to be 9.1% and specificity at 25%. Fungal stain with resistant gene, when correlated, sensitivity comes to 9.1% and specificity is at 0%. Conclusion: This study showed that for detection of tuberculosis rather than relying on only single technique it should be done with a combination of techniques. Keywords: Gene Xpert, LPA, Histopathological examination, Tuberculosis, Gram staining

Retrospective analysis of prospectively collected data. To assess func Study Design: Objective: tional outcome of patients irrespective of timing of surgical intervention in cases with cauda equina syndrome. Cauda equina syndrome Background: (CES) is a spinal emergency requiring immediate surgical intervention. CES presents with constellation of symptoms like saddle anaesthesia, bladder or bowel dysfunction, sexual dysfunction, lower limb motor power loss having deep socioeconomic consequences on part of patients and medicolegal consequences on part of clinicians. 40 patients data were collected and compiled retrospectivel Methodology: y. Demographic data, Surgical data, Functional data in the form of bladder, bowel, sexual and motor power recovery were collected at 3 weeks, 6 months , 12 months follow-up and analysed based on Urinary symptom prole score, Neurogenic bowel dysfunction score, Arizona sexual experience scale, Medical Research Council grading respectively. Results: Though early presentation by the patient and emergent surgical intervention by clinician does play a decisive role in full and faster recovery of symptoms but our study suggests that even when patients presented with delay at our outpatient department and surgery was done on emergency basis, desired outcome was achieved in maximum number of cases presenting with incomplete CES.

To study the incidence, risk factors, surgical outcomes of accidental durotomies (ADT) in patients of microendoscopic lumbar decompression surgeries (MLDS) and the postoperative patient mobilization protocol. Methods: A total of 550 patients who underwent MLDS from January 2012 to march 2020 under single surgeon and single institute were included in the study and incidence of ADT risk factors like age, BMI, smoking status, diabetes mellitus, surgeon's experience were studied for the same and early mobilization protocol for all the patients was followed. Results: Age > 60 years (p = 0.0062), bilateral decompression with unilateral approach, surgeons experience in the first 3 years over next 5 years (p = 0.037) were the statistically significant risk factors for increased incidence of ADT. Most of the ADT were small which did not require primary repair and managed with sealants like gelfoam and fibrin glue. Postoperative recovery in JOA and ODI scores in both ADT and non ADT cohorts were same. Conclusion: MISS has low incidence of ADT and age > 60 years and surgical technique of bilateral decompression with unilateral approach and surgeons expertise are the significant risk factors. MISS also has less risk of CSF leak symptoms and pseudomeningocele formation because of limited dead space formation in the soft tissue which helps in early postoperative mobilization and reduces the duration of hospital stay.

Background: To undertake a study which outlines the clinical and radiological features of ossification of yellow ligament (OYL) causing thoracic myelopathy (TM) in Indian subcontinent, to assess the outcomes of surgical resection of yellow ligament and compare different preoperative factors that contribute to be a risk factor in the overall post-surgical recovery rates (RR). Methods: A retrospective analysis of prospectively collected data from a cohort of 45 patients who visited our spine OPD from January 2012 to December 2019 who underwent surgical decompression for TM due to OYL was studied. The surgical outcomes and RR were calculated, compared and pre operative risk factors which could possibly be involved in giving poorer RR were analysed. Results: Our study included 45 patients who underwent surgical resection of OYL for TM. On comparison of post operative improvement in myelopathic symptoms, pre-operative mJOA score of 4.56 had increased significantly to 7.83 at 2 years follow up. While the majority (80%) of patients had an excellent and good recovery rate while 16% of patients had a fair recovery rate and 4% had no change at all in comparison to pre-operative mJOA scores. Preoperative risk factors for poor outcomes were also analysed. Conclusions: Early and timely before the onset or progression of any neurologic involvement. The pre operative risk factors which could give guarded prognosis and lower RR are, the presence of intramedullary signal changes (myelomalacia), >6-10 months of progressive pre operative symptoms and an mJOA<5.