Ossification of ligamentum flavum (OLF) is well known but rare entity causing slow progressive thoracic myelopathy. It affects especially lower thoracic spine and is relatively common in the East Asian population particularly in Japan. Posterior decompression in the form of extensive laminectomy with or without instrumented fusion is the treatment of choice. Decompression itself can be very challenging since the flavum is fused with the laminae above and below and it becomes very difficult for the surgeon to insert Kerrison roungers in inter-laminar space. Seven cases of recurrence of OLF at same intervertebral level reported till now but no case of adjacent level OLF in thoracic spine reported yet. We report the case of a 37-year-old male with D6-7-8 ossified ligamentum flavum with coexisting asymptomatic L1-2 disc prolapse and previously operated for D8-9 OLF. Pre-operative counseling of patients should be done regarding possibility of reoperation due to new adjacent segment or same level OLF. Keywords: Ossified ligamentum flavum, Thoracic myelopathy, Posterior decompression.

Management of sacral fractures with neurological deficits has been a topic of debate. Literature is divided between conservative and operative management. We report a case of a 32-year-old male with post-traumatic unstable complex transverse sacrum fracture and associated stable pelvic ring fractures with loss of bowel and bladder control. He had a fall from the second floor over the buttocks. Plain lateral radiography showed a transverse sacral fracture located between S2 and S3 with kyphosis at the fracture site. MRI showed a compromised canal due to a large retro pulsed fragment pressing over the anterior aspect of sacral roots. Thorough decompression of cauda equina and sacral roots was performed, and sacral ala fracture was fixed with two percutaneous 6.5 mm cannulated cancellous Ilio-sacral screws and two 3.5 mm recon locking plates were applied for the sacrum. The patient regained his bladder control 3 months after the surgery and bowel control 4 months after the surgery. At the end of 1 year, the patient has persistent saddle anaesthesia but good bowel and bladder control. Early decompression and stabilization of unstable complex sacrum fractures with neurological compromise can facilitate optimum neurological improvement and favourable clinical outcomes in terms of early mobilization and pain relief. Keywords: Fracture, Sacrum, Decompression surgery