Study Design: Prospective randomized controlled trial. Objective: To study the effect of local steroids in the retropharyngeal space after anterior cervical discectomy and fusion (ACDF) in reducing prevertebral soft-tissue swelling (PSTS) and complications associated with it. Methods: A total of 50 consecutive patients operated with ACDF were double-blinded randomized into 2 groups: steroids (25) and control (25). Triamcinolone in collagen sponge was used in the steroid group and normal saline in gelatin sponge in the control group. Patients’ lateral radiographs were taken on the immediate postoperative day; days 2, 4, and 6; at 2 weeks; and 2 and 6 months postoperatively. The PSTS ratio at C3 to C7 and PSTS index were calculated. Patients were clinically evaluated using the Visual Analogue Scale (VAS) score for odynophagia and radiating pain, modified Japanese Orthopedic Association Score (mJOA), and Neck Disability Index (NDI). Results: PSTS showed a significant reduction in the steroid group as compared with the control group on the immediate postoperative day; days 2, 4, and 6; and at 2 weeks. However, at 2 and 6 months, PSTS remained the same. VAS score for odynophagia also showed a significant difference between the 2 groups on the immediate postoperative day; days 2, 4, and 6; and 2 weeks postoperatively, with no significant difference at the 2- and 6-month follow-up. mJOA and NDI showed no significant difference between the 2 groups at the 2- and 6-month follow-up. Conclusion: Use of retropharyngeal steroids helps in reducing the postoperative odynophagia on a short-term basis without any complication.

OBJECTIVE Since its initial description, the definition of Ehlers-Danlos syndrome (EDS) has notably changed. At present, it broadly refers to disorders of the connective tissue that are heritable and have similar features including joint hypermobility, dermal dysplasia, and vascular as well as internal organ fragility. There has been no comprehensive review of spinal manifestations of EDS in the recent literature. That has led to controversies in management protocols of this so-called orphan disease. METHODS The authors used the latest version of the EDS classification from 2017, in which 13 subtypes were recognized. EDS has 19 different causal genes, mainly associated with collagen synthesis. Of these, 5 subtypes have associated spinal manifestations. RESULTS Some of the spinal pathologies associated with EDS include Chiari malformation, craniocervical instability, kyphoscoliosis, segmental instability and kyphosis, spontaneous CSF leaks, Tarlov cyst syndrome, tethered cord, and problems associated with wound healing. Here, the authors briefly discuss the demographics, etiology, pathophysiology, clinical features, management strategies, and directions for further research for each of these manifestations. CONCLUSIONS EDS belongs to the group of orphan diseases, with the total patient population being below 200,000. Further research on spinal manifestations of EDS is the need of the hour to establish clinical practice guidelines and close the significant knowledge gaps that currently exist.

Background: Restoration of spinopelvic balance during spinal surgery is very important to ensure a good outcome. Many studies have been conducted to define the normal ranges, examining the correlation between these individual parameters and their relation with spinal parameters of thoracic kyphosis and lumbar lordosis. The ranges, specific to individual ethnicities, is very essential to restore the sagittal balance in patients suffering from spinal degenerative conditions. Hence this study aims to define the average ranges of relevant spinopelvic parameters in the adult population of Indian origin. Methods: A observational cross sectional study was conducted in 130 healthy volunteers in Mumbai without having any spine, hip or pelvis pathology. Spinopelvic parameters like Pelvic Incidence(PI), Sacral Slope(SS) and Pelvic Tilt(PT) were studied and compared between various other similar studies with patients of different ethnicities. The correlation of those parameters with each other was also evaluated. Results: The mean value of PI was 51.50(±6.85 ), that of SS was 39.17 (±6.26 ) and for PT it was 12.32 (±5.41 ). These values were statistically significant between both sexes for PI and PT. The strongest positive correlation among the parameters was between pelvic incidence and sacral slope, with a r-value of 0.668. Comparison of our study with similar studies within the country (Chennai, Delhi and Surat) showed statistically significant differences in PT and SS of all three studies while PI was not significant when compared with the Surat study. Conclusion: There appears to be considerable variation of the values of the spinopelvic parameters as determined by various studies due to ethnic variations. Further studies should be done with larger samples and directed towards early detection of individuals at risk of developing degenerative spinal disorders with sagittal imbalance, so that interventions can be made at an earlier stage.

Study Design Systematic review. Objective Ehlers-Danlos Syndrome (EDS) comprises a spectrum of connective tissue disorders, which may be associated with cranio-cervical instability (CCI). There is a lack of consensus on diagnostic imaging parameters, indications, and outcomes of surgical treatment. Methods This systematic review analyses the literature on diagnostic methods and/or criteria for CCI, screening the databases Ovid Medline, Embase, Cochrane Library, and PubMed. Articles were included based on the PRISMA guidelines and assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) and according to their evidence level. Results Sixteen articles, including 78 surgical patients, met the inclusion criteria. The main diagnostic measures for CCI were dynamic x-rays and CT imaging. Ten different radiographic parameters were reported, of which 4 were the most frequently applied for surgical decision-making: the clivo-axial angle (CXA), the Harris measurement, the Grabb–Mapstone–Oakes measurement, and the angular displacement of C1 to C2. The evidence level ranged between III and V and the article quality between 4 and 8 out of 9 stars on the NOS Scale. Conclusions There is a lack of high quality, prospective evidence regarding the evaluation of suspected CCI in patients with EDS. Based on our systematic review, we recommend that the CXA, Harris measurement, Grabb–Mapstone–Oakes measurement, and the angular displacement of C1 to C2 be used to evaluate suspected CCI in EDS patients. Surgical fixation of suspected CCI should only be performed in cases with clear radiographic presence of instability and concordant symptoms/signs. Consensus-based guidelines and care pathways are required.

Acromio-clavicular joint ganglion cysts are a rare manifestation secondary to either degenerative acromio-clavicular joint arthritis or a rotator cuff tear arthropathy. We report a case of 76 year old female with acromio-clavicular joint cyst associated with cuff tear arthropathy and advanced acromio-clavicular joint arthritis with normal shoulder functions. She had superficial pain over the cyst with no complaints of cuff tear and provocative tests were negative. The shoulder arthrogram revealed the "geyser sign". The cyst was excised en bloc along with distal clavicular resection. The check valve was identified and the defect in the acromio-clavicular joint capsule was treated with capsulorraphy. Patient at one year follow up showed no signs of recurrence. Excision of cyst along with distal clavicular resection and capsulorraphy is a good procedure in patients with acromio-clavicular joint cysts.