Study Design Systematic review. Objectives Vertebral haemangioma has been classified into typical and aggressive vertebral haemangioma (AVH). Management options for AVH are many and the clinician has decision dilemma in choosing the right one. Metastases mimic AVH in clinical and radiological presentation. Differentiating pointers between them has not been clearly delineated in literature. Aim of our review is to identify treatment options; to formulate a management algorithm for AVH based on clinical presentation and to identify radiological differentiating pointers between them. Methods Systematic review was conducted according to PRISMA guidelines. We systematically reviewed all available literature from the year 2001 to 2020. Relevant articles were identified as per laid down criteria from the medical databases. After inclusion, first and second authors went through full text of each included article. Results Of 139 studies reviewed, eight met our criteria for review of management and three separate studies for radiological differentiating pointers. 99 patients with 88 AVH had undergone treatment. Back pain with myelopathy is the presenting symptom in majority of patients. Patients with backpain - myelopathic symptoms had improved following surgery; patients with back pain alone had improved with either percutaneous vertebroplasty or CT guided alcohol ablation. Dynamic contrast MRI, Diffusion weighted MRI and ratio of signal intensity between T1w and fat suppression T1w MR help the clinician in differentiating them. Conclusion Management of AVH can be based on the patient’s clinical presentation. Patients presenting with AVH and back pain can be managed with either Percutaneous vertebroplasty or CT guided alcohol ablation. Patients presenting with AVH and neurological symptoms could be managed with surgery. Dynamic contrast enhanced MR, Diffusion weighted MR, ratio of signal intensity between T1w and Fat suppression T1w MR imaging could help the clinician in differentiating the two before contemplating biopsy. Grade Practice Recommendation C

Introduction: Literature evidence of outcome of reduction, spinal fusion through single stage posterior approach in patients of high-grade spondylolisthesis is lacking. Aim of the study, is to study the surgical outcome of High-grade spondylolisthesis patients, managed through single stage posterior approach. Materials and Methods: We have retrospectively analysed high -grade spondylolisthesis adolescents and young adults of patients of age less than 30 years, who have undergone reduction and spinal fusion in our institute for the past 5 years with a follow-up of two years. 27 patients, who have undergone surgery in the time period between 2011 to 2016, were evaluated with preop standing lumbosacral radiograph for slip angle, L5 incidence angle, lumbar lordosis, slip percentage. Oswestry disability index [ODI] score for low back pain, neurological examination, sf-36 health survey questionnaire are the clinical parameters analysed. The patients who had undergone the surgery were followed up for 2 years and evaluated with standing radiographs for all the above radiological parameters, clinical parameters and assessment of spinal fusion by Bridwell criteria. Parameters were analysed statistically with SPSS software version 25.0. p less than 0.05 was considered statistically significant. Results: The aim of the surgery is to reduce the L5-S1slip angle to less than 30 degrees, and not about the complete restoration of displacement of L5 over S1. Mean slip angle, L5 incidence angle, Lumbar lordosis, slip percentage changed from 41.57 to12.10 [p<0.01], 78.57 to 47.50[p<0.05], 81.40 to 55.5 degrees, 4.93 to 1.77 percent respectively. Change in slip angle, L5 incidence angle were statistically significant. ODI score improved from 71.17to 17.72. SF-36 health survey questionnaire showed superior results at follow-up and all the patients showed excellent fusion [Bridwell grade 1], no significant neurological complications were encountered at 2 years follow-up. Conclusion: Surgical outcome of high-grade spondylolisthesis patients through single stage posterior approach produces superior results, at two years postoperatively, if intraoperatively slip angle is reduced to less than 30 degrees.

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Study Design Case control study Objective Micro-lumbar discectomy or Interbody fusion procedure are work-horse surgical procedures in management of lumbar disc disease. Spine surgeon in their early years of practice gets confused in choosing ideal surgical plan when dealing with a complex scenario. A clinical score is needed to guide spine surgeons in choosing an optimal surgical plan. Materials and methods Study was done with research grant approval from AO Spine. A predictive score was formulated as per hypothesis following a pilot study. Two fellowship trained spine surgeons-one using the score (Group A) and other not using score (Group B-control) treated 40 patients included in their respective group. All patients were analysed preoperatively, post-surgery at 12 months follow-up with Visual analog scale score for back pain, leg pain, Oswestry disability index score, SF-36 score. Change in parameters at 12 months follow-up were analysed statistically. P ≤ .05 was considered statistically significant. Success rate of individual surgeon who managed respective group of patients and Difficulty index of surgeon who managed without using score was evaluated at 12 months follow-up. Results Success rate of Group A-surgeon was higher than Group B-surgeon .15% of Group B patients had poor surgical outcome at follow-up. Statistically significant improvement in Group A patients were seen in all 3 evaluated parameters when compared to Group B patients at 12 months of follow-up ( P ≤ .05). Difficulty index of surgeon who didn’t use the score was 15%. Conclusion The proposed predictive score comprising all risk factors, can be used by spine surgeons when they are confronted with difficult scenario in decision-making. Accuracy, reliability and validity of the score needs to be evaluated in a larger scale. Level of evidence Ⅲ

Background: Studies reporting multilevel anterior cervical corpectomy (. 2 levels) and reconstruction in patients with long-segment anterior cervical compression are few and surgical outcomes are variable with increased surgical morbidity and a high incidence of graft-related complications. The aim of this study is to evaluate the effectiveness and safety of cervical corpectomy and anterior reconstruction of 3 or more levels in patients with long-segment anterior cervical compression.Methods: We retrospectively reviewed patients who had undergone 3 or more levels of anterior cervical corpectomy and reconstruction from 2014 to 2018. Clinical and radiological parameters such as Nurick grading, modified Japanese Orthopedic Association (mJOA) score, cervical segmental angle, cervical sagittal angle, graft subsidence, and fusion rate were evaluated preoperatively and at a 2-year follow-up. Patients were divided into 2 groups according to their anterior reconstruction, either with fibular strut autogenous graft or titanium mesh cage and rigid anterior cervical plating for subgroup analysis. Patients whose bone stock was found to be poor had undergone posterior instrumentation as a staged procedure.Results: There were 48 patients (mean age: 58.17 years) in the cohort: 42 had undergone 3-level and 6 had undergone 4-level cervical corpectomy with an ossified posterior longitudinal ligament and multilevel cervical spondylotic myelopathy being the main surgical indications. C5 to C7corpectomy was commonest. Of the cohort, 83.4% had standalone anterior reconstruction and only 8 patients (16.6%) had supplementation with posterior instrumentation. Our subgroup analysis showed statistically significant change in Nurick grading, mJOA score, cervical segmental angle, and sagittal angle in both groups at a 2-year follow-up (P , .05). Overall fusion rate was 89.5%. Decreased incidence of graft subsidence, statistically significant less graft subsidence (P ¼ .002) and a higher fusion rate (P ¼ .001) were noted in titanium mesh cage group at 2-year follow-up.Conclusions: Multilevel anterior cervical corpectomy and reconstruction is a safe and efficacious procedure. A titanium mesh cage filled with autogenous bone graft and a rigid anterior cervical plate gives best results. Posterior instrumentation should be considered along with a multilevel cervical corpectomy construct in patients with poor bone stock.