The literature has described different indications for pelvic fixation in neuromuscular scoliosis. We retrospectively evaluated changes in pelvic obliquity for a minimum of two years among three groups: group I (initial pelvic obliquity >15°; with pelvic fixation), group II (initial pelvic obliquity >15°; without pelvic fixation), and group III (initial pelvic obliquity <15°; without pelvic fixation). We used iliac screws for pelvic fixation in group I. There was significant postoperative improvement (p<0.0001) in Cobb's angle and pelvic obliquity. There was no significant loss of correction in Cobb's angle, thoracic kyphosis, and lumbar lordosis among all three groups; however, group II showed significant correction loss in pelvic obliquity compared to groups I and III at final follow-up (p<0.0001). Our results indicate that patients who have pelvic obliquity >15°require pelvic fixation to maintain the correction and balance over time while obliquity <15°does not require pelvic fixation.

Measurement of ST on radiographs is a simple and reliable method to track changes in pelvic tilt in different body positions. There is significant intersubject and intrasubject variation of ST and MAT with postural changes and it may explain causes of impingement or instability following THA, which could not be previously explained.

Low back pain is very disabling and dispiriting because of the physical impediment it causes and its psychological effects. Innumerable factors have been implicated in its etiology. In spite of improvements in diagnostic modalities, a considerable number of such cases fall in the ambiguous zone of unknown etiology or 'idiopathic.'Early diagnosis of low back pain will allow effective prevention and treatment to be offered. This study was conducted to assess the contribution of vitamin D levels and other biochemical factors to chronic low back pain in such cases. All patients attending the orthopedics OPD for low back pain in whom a precise anatomical cause could not be localized, were prospectively enrolled in this study. We measured serum levels of glucose, calcium, phosphorus, uric acid, rheumatoid factor, C reactive protein, alkaline phosphatase, total protein, albumin and 25 (OH) D concentrations in 200 cases and 200 control samples. The patients showed significantly lower vitamin D levels compared to controls with p value \ 0.0001. The maximum number of low back pain patients were in the age group of 31-50 years (42 %).The average BMI was 23.27 ± 5.17 kg/sq m, 73 % of total patient population were females and 27 % were known case of type 2 diabetes mellitus. Calcium, alkaline phosphatase, was positively correlated with vitamin D and glucose showed a negative correlation with vitamin D in the patient population. The problem of low back pain provides a challenge to health care providers. The problem in developing countries is compounded by ignorance to report for early treatment and occupational compulsions in rural areas and sedentary lifestyle in urban youth. The authors strongly recommend early frequent screening for vitamin D along with glucose, protein, albumin, calcium, phosphorus, CRP as part of general health checkup for non-specific body pain, especially low back pain.

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Prolonged hypervitaminosis D can result in calcium deposition in the soft tissues (especially the kidneys and heart), changes in the central nervous system & in severe cases, death. Patients and clinicians considering supplementation above currently recommended levels should be made aware of the possible toxicities of treatment with vitamin D, and baseline calcium and parathyroid hormone and vitamin D levels should be ascertained. We report here 8 such cases, all presenting with nausea, vomiting, polyuria, polydipsia, weakness and the common history of administration of vitamin D for backache, osteoarthritis, osteoporosis, leg cramps or generalized weakness. Laboratory tests revealed hypercalcemia and hypervitaminosis D in all cases. Vitamin D intoxication from increase in vitamin D intake may have become frequent in recent years due to an understanding of the role of 25-hydroxy vitamin D in the pathogenesis of several diseases. The importance of this case series as a warning against overtreatment and unnecessary treatment with high dose vitamin D cannot be overemphasized, especially as a public health measure in a country where vitamin D deficiency in children manifesting with rickets is a risk.