The study aims to compare the outcomes of micro-lumbar discectomy (MLD) with tubular micro-endoscopic discectomy (MED). Methods: A retrospective analysis of 414 patients who underwent single-level lumbar discectomy either by tubular MED or MLD between 2008-2016 was performed. Demographics, surgical duration, intraoperative blood loss, total hospital stay, visual analogue scale (VAS) pain score, Oswestry disability index (ODI) score before and after the surgery and complications were evaluated between the groups. Results: Out of the 414 patients, 217 patients were treated with MLD and 197 by tubular MED. The mean age in MLD and tubular MED group was 44.7 and 42.4 years. There was a significant improvement in VAS and ODI scores at 2 weeks in both the groups, without any significant difference. Average surgical time was shorter and the average blood loss was higher in MLD as compared to the MED group. Average hospital stay in MED (1.03 days) was significantly less than MLD group (1.91 days). There were similar incidences of dural tear in both the groups, however, more patients had wound infection in the MLD group. Conclusion: Lumbar discectomy either by tubular MED or MLD are very safe and effective means of treating disc herniation related sciatic pain. Patients who underwent minimally invasive tubular micro-endoscopic discectomy were found to have similar outcomes as those of who underwent micro-lumbar discectomy. However, given the learning curve associated with minimally invasive approaches to clinical practice, these modest clinical benefits probably do not warrant the transition from a standard microsurgical approach to a minimally invasive approach.

Study Design: This study was a radiographic observational study for C1–C2 anthropometry. Purpose: The purpose of the study was to understand the anatomic relationship of C1–C2 in view of transarticular screw (TAS) fixation, to overcome the difficulties related with TAS placement, and to minimize the technique-related complications. Materials and Methods: It was an anthropometric observational study with retrospectively obtained anatomical data of randomly selected 116 patients from a single center. The anatomical measurements such as pars width, pars height, screw trajectory, and length were evaluated on the axial, sagittal, and three-dimensional reconstructed cervical CT scan using the radiant DICOM viewer software by the two fellowship trained spine surgeons which were blind to the study group details. The intra- and interobserver reliability with regard to the measured parameters was statistically analyzed. Results: The mean age of male and female was 28 and 29 years. The average BMI was calculated to be 23.5 and 25 for males and females, respectively. The mean right pars width in males was 5.78 ± 0.93 (range: 3.1–6.5 mm), while in female, it was 5.84 ± 0.95 (range: 3.1–6.5). The mean left pars width in males was 5.95 ± 1.13 (range: 3.8–8.1 mm), while in females, it was 5.70 ± 1.18 (range: 3.7–8.1 mm). Right side mean pars height in males was 5.90 ± 1.2 (range: 3.7–9.4 mm), and in females, it was 6.11 ± 1.04 (range: 3.8–9.3 mm). Left-sided mean pars height in males was 6.0 ± 1.1 (range: 3.2–9.4 mm) as compared to females, in which it was 5.77 ± 1.23 (range: 4.1–9.3 mm). The mean lateral angulation angle in males was 9.99° ± 1.70° (8.1°–15°), while in females, it was 10.15° ± 1.73° (8.1°–15°). The mean sagittal angulation in males was 26.33° ± 3.32° (21.0°–32.80°), while in females, it was 27.18 ± 3.05 (21.0°–32.10°). The average screw length in males was 41.74 ± 5.63 (34–54.8 mm), whereas in females, it was 41.35 ± 4.77 (34–54.8 mm). Conclusion: This study provides a morphometric database which is characteristic of the C1–C2 vertebrae in the normal Indian population with regard to the anatomic feasibility of the TAS fixation for various C1–C2 pathologies. The C2 pars width and height measured in the current study can guide the selection of TAS screws in the Indian population. This study could serve in providing the baseline anatomic parameters assessed in the healthy individuals to design and develop customized screws and related implant assembly which might provide wider clinical applicability.

Background: Intraarticular distal femur fractures are severe injuries posses many challenges in management and associated large number of complications like infection, knee stiffness, delayed union, nonunion, instability, and post-traumatic arthritis. The advent of distal femur locking plate has improved the operative outcome of these fractures. Aim and Objectives: This retrospective study aimed to determine the functional, clinical and radiological outcome of AO type C distal femur fractures treated with distal femur locking plate. Level and type of study: Level 4, A retrospective study. Methods: We retrospectively reviewed 52 patients with AO type C distal femur fracture in our hospital between January 2010 to December 2017. Patients were selected according to strict inclusions criteria and operated distal femur locking plate through medial parapatellar or modified swashbuckler approach. The functional and radiological outcome were studied using NEER knee score. Results: Total 52 patients in which 38 males and 14 females with a mean age of 41.77 years, a mean follow up of 14.56 months were included in our study. According to AO classification, 12 patients of type C1 fracture, 14 of C2 fracture and 26 of type C3 fracture were included. Average time of union was 18.4 weeks and average NEER score at final follow up was 77.68 with 18 patients had excellent, 22 patients had satisfactory results, 7 were had fair results and 5 had poor results. The average range of flexion was 95.86. Conclusion: Distal femur locking plate is better to provide angular stability, multiple options to secure fracture fragments both metaphyseal and articular to restore limb length, joint congruity, and varusvalgus alignment. Along with the anatomical reduction of joint surface and rigid fixation, early mobilization and proper physiotherapy are mandatory to get the optimum outcome.

This study aimed to evaluate the effectiveness of a novel checklist that was designed specifically for the "spine-surgerysubspecialty" to reduce the incidence of some common preventable human errors and major perioperative complications in spine surgery. Overview of Literature: We proposed a unique spine surgery-specific checklist that recognizes the risk factors, anticipates the possible human errors, and thus helps in preventing these errors. This checklist is associated with increased patient safety awareness, improved communication (keeps everyone updated regarding their responsibilities), reduction in the surgical claims, and reduction in the number of postoperative complications, including mortality. Methods: This retrospective pilot study was performed at single center on 858 spine surgery patients. The patients were divided into the following two groups: the study group (after implementation of the checklist [2016][2017]) and the control group (before the implementation of the checklist [2015][2016]). The incidence of common preventable human errors and major perioperative complications in spine surgeries were recorded and compared between the two groups. Results: The prevalence of wrong-level surgeries was 0%, and the overall prevalence of the preventable errors was 1.22% (5/410). The rate of adverse, near-miss, and no-harm events was 0%, 0.73% (3/410), and 0.48% (2/410), respectively. The preoperative, intraoperative, and postoperative errors were 0.48% (2/410), 0.24% (1/410), and 0.48% (2/410), respectively. The reoperation rate related to preventable errors reduced after the checklist was used. There were significant differences in the total preventable errors related to complications, such as infections, prolonged hospital stays, and unplanned hospital readmission/revision surgeries (p=0.001). Conclusions:The authors proposed the first-of-its kind spine surgery-specific checklist that is comprehensive and involves perioperative parameters. The checklist is easy to use, safe, and effective for reducing the unforgiving errors and perioperative complications. However, its broader implementation would require validation in large, multi-center, randomized control studies.

Objective: To evaluate the learning curve associated with minimally invasive surgery (MIS) in posterior C1-C2 trans-articular (TAS) screw fixation based on surgical and clinical parameters. Also, to report the challenges faced and measures to overcome them. Methods: 84 patients who underwent C1-C2 MIS-TAS between 2009-2014 were included in the study and were divided into four quartiles (q) (21 patients each) based on the date of their surgery with each consecutive group serving as a control for prior. Pre-and post-operative clinical and perioperative parameters, technical issues and complications were evaluated. Results: The mean age of the patients was 36.26±5.78 years (20-78 years) with male to female ratio of 48:36. A statistically significant difference was observed between the mean operative time and mean blood loss between second and third quartile. Inadvertent vertebral artery injury occurred in 3 cases without any post-operative sequelae. There were 6 instances of guide wire migration (q1=4, q2=2). At 2 instances (q1=2) there was guide wire breakage. Total 9 times (q1=5, q2=2, q3=1, q4=1) dorsal burst into C2 pars occurred. VAS, ODI and mJOA scores showed a significant improvement from their pre-operative values in the entire study population without any significant difference between the quartiles. Conclusion: C1-C2 MIS-TAS is a very safe and effective means of treating reducible atlanto-axial instability. Pre-operative planning, detailed radiological evaluation, practice on cadavers/bone-saw models and by following the mentioned recommendations the learning curve of C1-C2 MIS-TAS can be reduced.