Study DesignThis was a double-blinded cross-sectional study, which obtained no financial support for the research.PurposeTo obtain a detailed morphometry of the lateral mass of the subaxial cervical spine.Overview of LiteratureThe literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine.MethodsWe assessed axial, sagittal, and coronal computed tomography (CT) cuts and anteroposterior and lateral X-rays of the lateral mass of the subaxial cervical spine of 104 patients (2,080 lateral masses) who presented to a tertiary care public hospital (King Edward Memorial Hospital, Mumbai) in a metropolitan city in India.ResultsFor a majority of the parameters, males and females significantly differed at all levels (p<0.05). Females consistently required higher (p<0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5

<p class="abstract"><strong>Background:</strong> Ideal management of intertrochanteric fractures in elderly individuals has been debated for several years. Due to difficulty in obtaining anatomical reduction, management of the complex intertrochanteric fractures in elderly patients is challenging and controversial<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> In the present study prospective comparative evaluation has been done between dynamic hip screws<strong> (</strong>DHS), proximal femoral nail (PFN) and bipolar hemiarthroplasty for overall clinical outcome of patients with unstable intertrochanteric fractures. The total numbers of patients were 90 with each group consisted of 30 patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Complication rate and requirement of revision surgery was more in DHS group but this was not found to be statistically significant. Harris Hip Score &amp; hence the functional outcome was found to be more in PFN group as compared to DHS which was statistically significant. Bipolar hemiarthroplasty provides early full wieght bearing leading to better HHS at 6 weeks evaluation but almost similar score to PFN in long term<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> PFN is better choice of fixation if good bone quality present while extremely osteoporotic patients or extreme comminution at fracture site favours bipolar hemiarthroplasty in elderly patients<span lang="EN-IN">.</span></p>

Study Design: A retrospective radiographic analysis.Purpose: The aim of the current study is to assess endplate changes after the use of polyetheretherketone (PEEK) cages in posterior lumbar interbody fusion (PLIF).Overview of Literature: A few recent reports had revealed endplate abnormalities due to PEEK cages, which may lead to nonunions.Methods: A retrospective computed tomography (CT)-based analysis of the endplate cavities and fusion status following PLIFs with PEEK cages was conducted by two independent observers. The term “cavity” was used to describe the endplate changes. The vertebral endplate cavities were assessed according to the size, multiplicity, location, and presence or absence of sclerosis.Results: There were 86 fixed levels in 65 consecutive patients, with a mean age of 35.44±19.60 years. The mean follow-up was 16.5±10.1 months (range, 6–57 months). Definite fusion was seen in 56 levels (65.12%) by observer 1 versus 44 levels (51.16) by observer 2. The strength of agreement was moderate. Endplate cavities were observed in 42 levels (48.84%) by observer 1 versus 47 levels (54.65%) by observer 2, with fair agreement. The strengths of agreement for the locations, multiplicity, and size were moderate, fair, and poor, respectively. Neither age, sex, etiology, levels, nor follow-up period was significantly associated with the presence of cavities. With regard to fusions, the nonunions detected by observer 1 were significantly associated with the presence of cavities (p<0.0001). However, those detected by observer 2 were nearly significant (p=0.05).Conclusions: There was a high rate of unfavorable radiographic findings in the form of endplate cavities in PLIF cases with PEEK cages. A more comprehensive classification for the assessment of fusions and endplate cavities should be formulated. We strongly recommend further CT-based studies with larger sample size and longer follow-up periods.

Objective: The objective was to compare Cobb angle measurements performed using an Oxford Cobbmeter and digital computer software (Surgimap) in a series of 83 adolescent idiopathic scoliosis (AIS) patients. Methods: Two independent observers measured the Cobb angles for 123 curves on 83 consecutive long radiographs of patients with AIS using both Oxford Cobbmeter and digital computer software (Surgimap). The measurements were repeated a week. Curves were classified according to the severity into mild, moderate, and severe. The results were statistically analyzed for intraobserver and interobserver reliability Results: The mean Cobb angle was 48.12°± 19.75° (range, 10.54°-110.76°). Globally the results of curve measurements were comparable between and within both observers using both methods, with small mean differences. According to intraclass correlation coefficient, there was high inter-and intraobserver high agreement for both methods. All readings were > 0.9. There was a good interobserver (κ = 0.745, 0.693) and a very good interobserver agreement (κ = 0.810, 0.804) for both methods for curve classification. However, poor agreement was observed as regards to the measurement time, being less with Oxford Cobbometer. Conclusion: The results of this study indicate that the Surgimap digital computer software measurement is an equivalent measuring tool to the Oxford Cobbmeter in Cobb angle measurement. Both have high intra and interobserver agreement for measurement and for curve classification, with small measurement differences. Oxford Cobbmeter is advantageous in being quicker, and therefore it is the method of choice for manual measurement, where PACS (patient archiving and communication system) or digital system is not available.

Retrospective radiographic study. Purpose: We hypothesized that the pedicle is almost perpendicular to the interlaminar line in the sagittal plane of the lumbar vertebrae. The current study aimed to define the lumbar lamina-pedicle inclination to verify the right-angle concept and to estimate the safety zones of sagittal inclination during pedicle screw insertion. To the best of our knowledge there are no previous similar studies. Overview of Literature: Based on our observations in different spinal disorders including deformities, we noted that following a sagittal (cranial-caudal) trajectory perpendicular to the interlaminar line joining the two adjacent vertebrae would work well in most of the vertebral levels. Methods: This was a retrospective study on normal lumbar spine lateral radiographs of patients who presented with low back pain and were reviewed by two observers. Different inclination angles were constructed to estimate the safety zones of the pedicle screws' sagittal inclination. Results: Radiographs of 30 consecutive patients, 25 females and five males, with a mean age of 39.43±11.18 years, were studied. The mean angle of the interlaminar line and the pedicle axis was almost orthogonal at all the levels, with a range of 89.16°-94.63°, which was not affected by the lumbar sagittal profile. The safety zones of the pedicle screws were measured, and they revealed a safe sagittal range of 19.73°-24.40° if the screw was inserted from the pedicle axis, 21.03°-22.59° if inserted from the most cephalic part, and 13.31°-17.03° if inserted from the most caudal part. Conclusions: Our results confirmed the perpendicularity of the interlaminar line with the pedicle axis in the lumbar spine at all the levels. The interlaminar line is a useful guide for pedicle screw sagittal inclination.