Background and Objectives: To analyze the functional outcome of open doorlaminoplasty (ODL) for the treatment of Cervical Ossified Posterior Longitudinal Ligament(OPLL). Study Design: Case series study. Setting: Civil Hospital Karachi. Period: 05 years,2013 to 2017. Material & Methods: 18 patients (15 Male, 3 Female) underwent ODL for cervicalOPLL, over a period of 5 years. Pre-operative & post- operative degree of myelopathy wasassessed using Nurick grading score. Patients with Nurick grade > 2 were included in study.MRI compatible titanium micro plates & screws were used. Instability was assessed by X-rayCervical Spine obtained 6 weeks post-operatively. Results: Mean age of presentation was 52years. 2 to 3 levels were involved in most cases. Mean operative time was 2 hours 30 minutes.Following Nurick grading 94.4% (n=17) improved by grade 1 or more, while in only 5.6%(n=1) it remained same. No instability or kyphotic deformity was seen on follow up X-rays.Conclusion: ODL is a safe & effective procedure for the treatment of multiple level OPLL. Itcan avoid complications related to the anterior approach (like unintentional durotomy & spinalcord injury) and diminished the possibility of instability & kyphotic deformity associated withlaminectomy alone.

Background Penetrating trauma to the brain is a rare mode of self-harm in individuals with depressive psychosis. It may have variable presentations ranging from intact neurological status to non-survivable damage and the subjects may be surprisingly apathetic to pain. It is even unusual for such an injury to have an excellent prognosis despite coming late to clinical attention. Case presentations We report two cases of patients with psychotic depression who attempted suicide by hammering nails into their heads. On imaging, deep penetration within the brain parenchyma was noted; however, neither case had any neurological deficit or symptoms attributable to brain trauma. Conclusions Self-inflicted penetrating brain injuries with peculiar objects such as nails are rarely encountered in practice. They need prompt management for their removal and addressing the underlying mental health illnesses.

… Background and Objectives: To analyze the functional outcome of open door laminoplasty (ODL) for the treatment of Cervical Ossified Posterior Longitudinal Ligament (OPLL). Study Design: Case series study. Setting: Civil Hospital Karachi. Period: 05 years, 2013 to 2017. Material & Methods: 18 patients (15 Male, 3 Female) underwent ODL for cervical OPLL, over a period of 5 years. Pre-operative & post-operative degree of myelopathy was assessed using Nurick grading score. Patients with Nurick grade > 2 were included in study. MRI compatible titanium micro plates & screws were used. Instability was assessed by X-ray Cervical Spine obtained 6 weeks post-operatively. Results: Mean age of presentation was 52 years. 2 to 3 levels were involved in most cases. Mean operative time was 2 hours 30 minutes. Following Nurick grading 94.4% (n=17) improved by grade 1 or more, while in only 5.6% (n=1) it remained same. No instability or kyphotic deformity was seen on follow up X-rays. Conclusion: ODL is a safe & effective procedure for the treatment of multiple level OPLL. It can avoid complications related to the anterior approach (like unintentional durotomy & spinal cord injury) and diminished the possibility of instability & kyphotic deformity associated with laminectomy alone.