Objective To study the indications, technical nuances, learning curve, and outcomes associated with minimally invasive tubular discectomy of spine (MITDS) and minimally invasive tubular decompression (MITD) using the tubular retractor system and compare the outcomes with open microdiscectomy and open decompression. Materials and Methods All patients who underwent MITDS and MITD received a trial of conservative management for 6 weeks prior to surgery. Patients who had undergone open microdiscectomy and open decompression during the same period were used as controls. Operating time, intraoperative blood loss, preop and postop visual analogue scale (VAS) scores, preop and postop Oswestry disability index (ODI) scores, duration of hospital stay, complications, and need for redo surgery were analyzed. Results Thirty-two patients who underwent MITDS and 8 patients who underwent MITD were compared with an equal number of patients who underwent open microdiscectomy and open decompression, respectively. MITDS and MITD were associated with shorter hospital stay. Short-term pain outcome was better in MITDS and MITD group, although it was not statistically significant in MITD group. Functional outcome measured in terms of ODI at 6 months was not statistically significant between minimally invasive and open procedures. Conclusion Both MITDS and MITD have a significant learning curve and have a distinct advantage of shorter hospital stay. MITDS has the distinct advantage of better short-term pain relief compared with open procedures. For MITD, comparison of short-term pain relief requires a larger sample size. To establish long-term advantages of MITDS and MITD, larger sample size and long-term follow-up are needed.

The authors describe four cases of basilar invagination (BI) with irreducible atlantoaxial dislocation (AAD) by distraction and compression technique. The article describes the technique in detail and the principles of the reduction achieved in all the planes by C1C2 screw placement, the cage insertion in the C1C2 joint, and manipulation of the joint. They described in the literature well-discussed various modifications and their application for treatment of BI with irreducible AAD.

We report a case of a right anterior clinoid process (ACP) neurenteric cyst which presented with gradual impairment of vision in the right eye. Imaging suggested an infective cystic lesion. In view of rapid visual loss urgent surgery was conducted. Erosion of the ACP was found from where white mucus like material was aspirated. The cyst wall was completely excised. Immunohistochemistry indicated an endodermal origin of the cyst.

Cervical myelopathy consequent on ossification of posterior longitudinal ligament (OPLL) is very rare in Caucasians. A 65-year-old Anglo-Saxon woman developed progressive gait disturbance, paresthesia in both legs and urinary urge incontinence. Radiological examination showed OPLL from fifth to seventh cervical vertebral level; the dense OPLL was graphically displayed by three-dimensional computerized tomography. Medial corpectomy, C5 to C7, and removal of OPLL, with subsequent fusion C4 to Tl using a free fibula graft resulted in clinical improvement. Three dimensional computerized tomographic imaging is a valuable diagnostic procedure in OPLL. RESUME: Myelopathic cervicale secondaire a une ossification du ligament vertebral commun posterieur chez une caucasienne. La myelopathic cervicale derivant d'une ossification du ligament vertebral commun postdieur (OLVP) est tres rare chez les Caucasiens. La malade d'origine anglosaxonne agee de 65 ans, develope des troubles progressifs de la marche avec paresthesies des deux membres inferieurs et incontinence urinaire. L'examen radiologique montre l'ossification du 5 dmc ou l imc niveau cervical vertebral. Cette dense ossification est demontre graphiquement par la tomodensimetrie tri-dimensionnelle. L'amelioration clinique est evidente apres une vertebrectomie anterieure de C5* a C7 avec extirpation du ligament ossifie et greffe osseuse. La tomodensimetrie tri-dimensionnelle est une d-marche diagnostique inportante dans l'O.L.V.P.Can. J. Neurol. Sci. 1993; 20: 329-332 Ossification of the posterior longitudinal ligament (OPLL) is a common cause of cervical myelopathy in Japan but is very rare in Caucasians. 1 " 3 CASE REPORTThe patient is a 65-year-old housewife, of Anglo-Saxon descent who had lived and worked on a farm. In 1981 she developed low back pain and numbness in the gluteal region and thighs. A year later, paresthesia were experienced in the legs, including the dorsum of feet (L > R), together with weakness in the left leg. There was progressive weakness of the left leg over the next eight years. In 1990 pins and needles sensation were noted in the left hand; as well as urgency of micturition.Family history is non-contributory. Abnormality on clinical examination was confined to the central nervous system; speech, and cranial nerve functions were normal. Neck movements were unimpaired and pain free. On admission, she needed a cane to walk; gait was spastic. Relatively mild paresis of the left upper and lower limb muscles was detected. Hyperreflexia was clearly more marked in the left upper and lower limbs (compared with the right). She could not climb stairs without support. Upgoing left plantar response, left ankle clonus was elicited. Hypalgesia and dysesthesiae were noted below the level of the groin, and in the ulnar distribution of the left hand.Laboratory investigations were normal, including urinary excretion of calcium and phosphate. Radiological FindingsLateral views of the cervical spine showed an irregular longitudinal retrovertebral opa...

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