Study Design A Retrospective Study Objective To determine the prevalence and characteristics of DISH using whole spine CT scans and to evaluate the association of DISH with co-morbidities and other ossified lesions. Method A retrospective study of whole-spine CT scans of polytrauma patients from 2018-2021 above the age of 20 years. The screening was done using modified Resnick criteria. Overall and age-specific prevalence, characteristics, and associations with obesity, diabetes mellitus (DM), ischemic heart disease (IHD), aortic calcification (AC), ossified posterior longitudinal ligament (OPLL), and ossified ligamentum flavum (OLF) were evaluated. Results Out of 1815 patients, 347 had DISH, with a prevalence rate of 19.1% and a mean age of 61.7 years. The highest prevalence of DISH was seen in individuals over 80 years of age (45.5%). The prevalence among males (20.2%) was higher than for females (14.9%). The most commonly involved level was T8-T9 (95.4%), followed by T9-T10 (91.9%), and the most common vertebra involved was T9 (96%). All the cases involving T9 had ossification on the right anterior aspect of the vertebral body. The presence of DM, high BMI, and IHD was found to be significantly higher in patients with DISH (P value < .001). The incidence of aortic calcification was 22.5%, OPLL was 13.3%, and OLF was 4.9% in patients with DISH. Conclusion This study reports a prevalence rate of 19.1% for DISH, with the highest prevalence among individuals above 80 years of age (45.5%). DISH has a higher propensity to affect the right anterior aspect of the vertebral body in the thoracic spine and is strongly associated with obesity, DM, IHD, and AC.

Study Design: Retrospective study.Purpose: To investigate the radiological phenotype, patient and surgery-related risk factors influencing postoperative clinical outcome for cervical myelopathy caused by ossification of the posterior longitudinal ligament involving C2 following posterior instrumented laminectomy and fusion.Overview of Literature: Ossified posterior longitudinal ligament (OPLL) is caused by ectopic ossification of the posterior longitudinal ligament. It can cause neurological impairment and severe disability. For multilevel cervical OPLL, studies have shown good neurological recovery following cord decompression via either an anterior or posterior approach. There is, however, a lacunae in the literature regarding the outcomes of patients with OPLL extending to C2 and above (C2 [+]).Methods: We retrospectively studied 61 patients with C2 (+) OPLL who had posterior instrumented laminectomy and fusion at Ganga Hospital, Coimbatore between July 2011 and January 2021, with a minimum follow-up of 2 years. Data on demographics, clinical outcomes, radiology, and post-surgical outcomes were gathered.Results: Among 61 patients, 56 were males and five were females. The OPLL pattern was mixed in 32 cases (52.5%), continuous in 26 cases (42.6%), segmental in two cases (3.3%), and circumscribed in one patient (1.6%). All of our patients showed signs of neurological improvement after a 24-month follow-up. The mean preoperative modified Japanese Orthopaedic Association (mJOA) score was 10.6 (range, 5–11) and the postoperative mJOA score was 15.8 (range, 12–18). The recovery rate was >75% in 27 patients (44.6%), >50% in 32 patients (52.5%), and >25% in two patients (3.3%). The average recovery rate was 71% (range, 33%–100%). The independent risk factor for predicting recovery rate is the preoperative mJOA score.Conclusions: In C2 (+) OPLL, posterior instrumented decompression and fusion provide a relatively safe approach and satisfactory results.

Case: A 46-year-old man with left leg radiculopathy due to a left L4-5 disc extrusion had a lumbar microdiscectomy that was complicated by the pituitary rongeur tip breaking in the L4-5 disc space. The rongeur tip was successfully retrieved by widening the entry access without damaging the adjoining facet and utilizing a blunt nerve hook and probe dissector. Conclusion:Breakage of the pituitary rongeur tip is an unforeseen complication of lumbar microdiscectomy. Surgeons should be aware of this potential complication, ideally confirm the rongeur is intact prior to wound coverage, and understand the risks versus benefits of attempting to retrieve a broken rongeur tip. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C16).

Background: This prospective clinical study was performed to compare the clinical outcomes between patients with cruciate-retaining (CR) and cruciate-substituting (CS) total knee arthroplasty (TKA). Methods: from July 2018 to June 2019, 52 patients (32 females and 20 males) with a total of 70 knees with a mean age of 61.11 years (range, 46 to 78 years) were enrolled in this study. Patients were randomly divided into two groups including group A (Cruciate-Retaining Total Knee Arthroplasty (CR-TKA) underwent 35 CR TKA, and group B (Cruciate-Substituting Total Knee Arthroplasty (CS-TKA) underwent 35 CS total knee Arthroplasty. The evaluation parameters included knee scores, pain score, functional scores, radiographs of the knees and ROM (Range of motion). Regular follow up done at 4 weeks, 12weeks and then every 6 months. All data were collected and analyzed with the help of suitable statistical parameters. Results: Both designs give equal and good results. We preferred CR Knees in relatively young patients and patients with smaller knees as its bone conserving implant and CS knees in patients with Inflammatory arthritis, patient with severe Varus or flexion deformity, when tibia cut is more than 10 mm and when intra-operatively findings suggestive of non-functional posterior Cruciate ligament. However, in our short term randomized interventional study Posterior Cruciate substitution Total Knee Arthroplasty had a marginally better outcome than the posterior Cruciate retaining in terms of range of motion but it needs a long-term analysis. Key words: Cruciate substitution Total Knee Arthroplasty, Cruciate-Retaining Total Knee Arthroplasty, Knee scores, Pain score

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