Study Design A Retrospective observational study. Objectives To determine the influence of hyperglycemia on severity of lumbar degenerative disc disease (LDDD). Methods We retrospectively included 199 patients with low back pain (LBP) who visited our tertiary care hospital from June 2016 to December 2018. All patients divided into three groups as per inclusion and exclusion criteria. Group-A had patients without DM ( n = 75). Group B had well-controlled DM patients ( n = 72) and Group-C had uncontrolled DM patients ( n = 52). Group B and C subdivided according to dutation of DM. Group-B1 DM duration was ≤ 10 years ( n = 38), Group-B2 DM duration was >10 years ( n = 34), Group-C1 DM duration ≤10 years ( n = 28), Group-C2 DM duration >10 years ( n = 24). Sex, age, BMI, occupation, smoking history, alcohol use and duration of type-II DM were recorded. The severity of LDDD was evaluated using the five-level Pfirrmann grading system. Operated patient's disc material sent for histological examination. Results Patients with DM showed more severe disc degeneration compared to patients without DM. The average Pfirrmann scores between Groups A and B1 had no difference; Groups B2, C1, and C2 showed higher average Pfirrmann-scores than Group-A ( p > 0.05). Group-B2 and Group-C2 showed higher average Pfirrmann-scores than Group-B1 and Group-C1 ( p > 0.05). Group-C1 and Group-C2 showed higher average Pfirrmann-scores than Group-B1 and B2 ( p > 0.05). The severity of LDDD was significantly related to DM duration both in groups B & C ( p > 0.05). DM groups showed increased disc apoptosis and matrix aggrecan fragmentation, Disc glycosaminoglycan content and histological significantly different, the results are similar to Pfirrmann-score results. Conclusions There is a positive relationship between diabetes and LDDD. A longer the duration and poor control of hyperglycemia could aggravate disc degeneration.

Study Design: A retrospective study. Objectives: To determine the association between type-2 diabetes mellitus (T2DM) and the severity of lumbar disc degeneration disease (LDDD). Methods: We included 199 patients with low back pain (LBP) who visited our hospital from 2016 to 2018. All patients were divided into 3 groups as per inclusion criteria. Group A, patients without DM (n = 75); group B, patients with controlled DM (n = 72); and group C, patients with uncontrolled DM (n = 52). The patients were further subdivided into group B1, DM duration ≤10 years (n = 38); group B2, DM duration >10 years (n = 34); group C1 DM duration ≤10 years (n = 28); and group C2, DM duration >10 years (n = 24). Sex, age, body mass index, occupation, smoking history, alcohol use, and duration of T2DM were recorded. The severity of LDDD was evaluated using the 5-level Pfirrmann grading system. Operated patients’ disc materials were sent for histological examination. Results: Demographic data showed no difference among groups ( P > 0.5), except age. Patients with DM showed more severe disc degeneration compared with patients without DM. The average Pfirrmann scores between groups A and B1 had no difference; groups B2, C1, and C2 showed higher average Pfirrmann scores than group A ( P < 0.05). Groups B2 and C2 showed higher average Pfirrmann scores than groups B1 and C1 ( P < 0.05). Groups C1 and C2 showed higher average Pfirrmann scores than groups B1 and B2 ( P < 0.05). The severity of LDDD was significantly related to DM duration in both groups B and C ( P < 0.05). DM groups showed increased disc apoptosis and matrix aggrecan fragmentation, disc glycosaminoglycan content and histological analysis were significantly different; the results are similar to Pfirrmann score results. Conclusions: DM duration >10 years and uncontrolled DM were risk factors for LDDD.

Case: The authors present a case of retro-odontoid pseudotumor (ROP) with congenital C1 assimilation and C2-C3 block vertebra without radiological instability who presented with cervical myelopathy with spastic quadriparesis. The patient was managed with occipitocervical fusion and C1 laminectomy. She had rapid neurological recovery in 3 months postoperatively and at 2 years had complete resolution of the retro-odontoid mass. Conclusion: C1 assimilation without apparent radiographic instability as a cause of ROP is underappreciated. This case report and review of literature highlight that C1 assimilation and C2-C3 fusion can lead to ROP even in the absence of apparent radiographic instability with posterior atlantoaxial fusion alone providing good results.

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Case: The authors present a case of syringobulbia in a setting of elbow arthropathy due to syringomyelia. The patient had painless elbow instability with subtle neurological findings such as ulnar neuropathy, palatal palsy, and dysphonia. As she denied surgery, she was managed with physiotherapy and orthosis. At 24 months of follow-up, she had good clinical outcome without neurological or functional worsening. Conclusion: Many patients with neuropathic joints due to syringomyelia present to an orthopaedician before a neurologist. A high index of suspicion and thorough neurological examination is essential. Conservative management of such a joint provided good results in this patient.