Despite good posterior decompression of thoracic myelopathy due to ossification of ligamentum flavum (OLF), recovery varies widely from 25 to 100%. Neurological status on presentation also varies widely in different patients. We, therefore retrospectively studied relation of various clinical and magnetic resonance imaging (MRI) parameters with preoperative neurological status and postoperative recovery in 25 patients who underwent decompressive laminectomy for thoracic myelopathy due to OLF. Patients were assessed using leg-trunk-bladder scores of JOA scale and recovery rate (RR) was calculated as RR = postoperative score -preoperative score/11 -preoperative score 9 100. With Pearson's correlation, postoperative recovery rate (RR) significantly correlated with preoperative duration of symptoms, JOA score, sensory JOA score, canal grade, dural canal-body ratio (DCBR), intramedullary signal size (ISS), and intramedullary signal type (IST) on MRI. On MRI, two types of signal changes were identified: normal in T1/hyperintense in T2 representing cord edema and hypointense in

Bradycardia and rarely cardiac arrest as a complication of cervical spine injury due to reduced sympathetic activity is well known, which usually settles down in 4-6 weeks of injury. There are few case reports in literature of high cervical spinal cord injury requiring permanent cardiac pacemaker due to this complication, but an injury as low as cervico-dorsal junction requiring permanent cardiac pacemaker has never been reported. A 47-year-old male suffered traumatic C7-D1 dislocation and continued to have severe bradycardia with multiple episodes of cardiac arrest till 2 months after injury, which finally warranted permanent cardiac pacemaker as a life saving measure. Following permanent cardiac pacemaker no cardiac arrest occurred and the patient was successfully rehabilitated. The case directs our attention to a rare complication of cardiac arrest occurring in an injury as low as cervico-dorsal junction when all other causes are ruled out and shows importance of using permanent cardiac pacemaker to ensure patient safety in community.

Background:Post-surgical lumbar instability is an established complication but there is limited evidence in the literature regarding the incidence of lumbar instability following fenestration and discectomy. We analyzed our results following fenestration discectomy with a special focus on instability.Materials and Methods:Eighty-three patients between the age of 17 and 52 years who had undergone fenestration discectomy for a single-level lumbar intervertebral disc prolapse were followed-up for a period of 1–5 years. The criteria for instability included “instability catch,”, “painful catch,” and “apprehension.” The working capacity of the patient and the outcome score of the surgery were assessed by means of the Oswestry disability score and the Prolo economic and functional outcome score. Flexion-extension lateral radiographs were taken and analyzed for abnormal tilt and translation.Results:Of the 83 patients included, 70 were men and 13 were women, with an average age of 37.35 years (17–52 years) at 5 years follow-up. Clinical instability was seen in 10 (12.04%) patients. Radiological instability was noted in 29 (34.9%) patients. Only six (60%) of the 10 patients who demonstrated clinical instability had radiological evidence of instability. Twenty (68.96%) patients with radiological instability were asymptomatic. Three (10.34%) patients with only radiological instability had unsatisfactory outcome. The Oswestry scoring showed an average score of 19.8%. Mild disability was noted in 59 (71.08%) patients and moderate disability was seen in 24 (28.91%) patients. None of the patients had severe disability. These outcomes were compared with the outcomes in other studies in the literature for microdiscectomy and the results were found to be comparable.Conclusion:The favorable outcome of this study is in good agreement with other studies on microdiscectomy. Clinical instability in 12.04% of the patients is in agreement with other studies. Radiological signs of instability are seen even in asymptomatic patients and so are not as reliable as clinical signs of instability. Standard fenestration discectomy does not destabilize the spine more than microdiscectomy.

Case: Two male patients aged 37 years and 39 years, diagnosed with sacral chordoma, underwent robotic-assisted preparatory adhesiolysis from the anterior aspect of the tumor, followed by posterior en-bloc partial sacrectomy. The average total operative time was 360 minutes (anterior docking + anterior console + posterior excision), and mean blood loss was 930 mL. Both patients were mobilized early, had no postoperative complications, and were free of local recurrence at 18 month of follow-up. Conclusions: Robotic-assisted surgery is a novel, valid, safe, and minimally invasive technique which drastically reduces the associated surgical complications of single-staged posterior sacrectomy, resulting in excellent functional and oncological outcome.

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