Background: Cervical radiculopathy is a common pathological entity encountered by spine surgeons. Many surgical options have been described including anterior cervical discectomy with or without fusion to arthroplasty and posterior cervical laminoforaminotomy. Being a motion-preserving procedure, posterior cervical laminoforaminotomy is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis. With the advent of minimally invasive techniques, this procedure has regained popularity. Objectives: Although there is enough evidence in the literature highlighting the benefits, safety, and efficacy of minimally invasive versus conventional techniques, a detailed technical report along with long-term surgical outcomes is lacking. Methods: The authors present their experience in minimally invasive cervical laminoforaminotomy (MIS-CLF) over a 7-year period (2013–2020) along with a technical note. Clinical evaluation was performed both before and after surgery, using the Visual Analog Scale (VAS) pain scores. Patient functional outcome was measured using the modified Odom's criteria. Results: There were no major perioperative complications. No patient required surgery for the same level during the follow-up period which ranged from 1 to 3 years. Statistically significant results were obtained in all cases, reflected by an improvement in VAS for neck/arm pain. Conclusion: MIS-CLF is an effective technique for treatment of radiculopathy due to cervical disc herniation in a carefully selected subgroup of patients with good medium- to long-term outcomes. A larger study would possibly highlight the effectiveness of this procedure.

“Brown tumors (BTs)” of the spine are benign rare lesions, seen in about 5%–13% of all patients with chronic hyperparathyroidism (HPT). They are not true neoplasms and are also known as osteitis fibrosa cystica or occasionally osteoclastoma. Radiological presentations are often misleading and may mimic other common lesions such as metastasis. A strong clinical suspicion is therefore necessary, especially in the background of chronic kidney disease with HPT and parathyroid adenoma. Surgical spinal fixation in case of instability due to pathological fracture may be required along with excision of the parathyroid adenoma being the treatment of choice, that maybe usually curative and carries a good prognosis. We would like to report one such rare case of BT involving the axis, or C2 vertebra, presenting with neck pain and weakness that was treated surgically. Only a few cases of spinal BTs have been reported so far in the literature. Involvement of cervical vertebrae and in particular C2 is rarer still with the one in this report only being the fourth such case.

Background: Interlaminar full endoscopic discectomy has been the least invasive and preferred route to treat disc herniations at L5-S1 and are being increasingly accepted and adopted in many centres. Compared to transforaminal approach, it offers the advantage of a familiar posterior approach with presumably easier transition for surgeons who have been doing another form of minimally invasive spine surgery. Objective: The article describes the surgical steps and early outcomes along the initial learning curve of Interlaminar Endoscopic discectomy for herniated disc at L5-S1 level. Material and Methods: This retrospective study included the first 20 patients who underwent Interlaminar Endoscopic Lumbar Discectomy (IELD) at our center. Patients with unilateral symptoms, failed conservative treatment, and good interlaminar window were selected for IELD. Visual Analog Scale (VAS) score s and McNab criteria were used to assess the outcome. Postoperative magnetic resonance imaging (MRI) was done in the majority of patients to assess and correlate the adequacy of root decompression and extent of discectomy. Results: The mean age of the 20 patients was 41 years (17 to 60 yr) with a male: female ratio of 3:2. The median surgical time was 80 min (40 to 150 min). The mean VAS scores for leg pain reduced from 8.2 preoperatively to 2.1 in the postoperative period. All patients had a minimum follow-up for 6 months. Postoperative MRI was done in 14 patients, which showed complete fragment removal with the good decompression of the nerve root in 12 patients. There was no early recurrence of radicular symptoms in any patient. According to Modified McNab criteria, 8 patients had excellent outcome, 9 patients had good outcome, and 3 patients did fairly well. Conclusion: IELD offers an excellent alternative to tubular surgeries for treating disc pathologies at L5-S1. This series represents the early reports from the first 20 cases at the author's center who have been performing tubular surgeries for more than a decade. With the learning curve been overcome, the technique could be used in a wider array of lumbar spine pathologies henceforth.

Hemostatic agents are commonly used in neurosurgical procedures with often exceptionally low complication rates. Rarely, they may cause neurological deficits secondary to pressure effect on neurologic structures, especially when applied within narrow bony cavities. We would like to report two cases of delayed unilateral C5 palsy following anterior cervical discectomy and arthroplasty for a C5–C6 cervical disc herniation. Clinical presentation was identical in both cases, with left deltoid and bicep weakness and left-arm pain without myelopathy symptoms, although with the unusual imaging findings of a new left C4–C5 foraminal lesion. An additional emergency posterior minimally invasive cervical laminoforaminotomy was carried out to decompress the nerve. The weakness improved fully within 2 months after the second surgery. This case report highlights the importance of strong clinical suspicion for a possible lesion as a cause of postoperative C5 palsy. In this case, it was due to an unusual phenomenon where flowable hemostatic agent used in the first surgery had migrated superiorly leading to nerve compression away from the primary level.