MDR-TB of the spine is a different disease and is here to stay. There is an urgent need to include culture and drug susceptibility testing in the protocol for the treatment of tuberculosis of the spine.

Purpose To report morphological patterns of osteoporotic vertebral compression fractures (OVCFs) presenting for surgery. To describe surgical options based on fracture pattern. To evaluate clinical and radiological outcome. Methods Forty consecutively operated OVCFs nonunion patients were retrospectively studied. We define four patterns of OVCFs that needed surgical intervention. Group 1 mini open vertebroplasty (N = 10) no neurologic deficits and kyphotic deformity, but with intravertebral instability and significant radiological spinal canal compromise. Group 2 with neurologic deficits (N = 24) (2A)-transpedicular decompression (TPD) with instrumentation (N = 14). Fracture morphology similar to (1) and localized kyphosis \30°(2B)-pedicle subtraction osteotomy (PSO) with instrumentation (N = 10). Fracture morphology similar to (1) and local kyphosis [30°. Group 3 posterolateral decompression with interbody reconstruction (N = 06) endplate(s) destroyed, with instability at discovertebral junction, with neurologic deficit. Average follow-up was 34 months. VAS, ODI and Cobb angle were recorded at 3, 6, 12 months and yearly. Results There was significant improvement in the clinical (VAS and ODI) scores and radiologic outcome in each group at last follow-up. 30 patients out of 40, had neurologic deficits (Frankel's grade C = 16, Frankel's grade D = 14). The motor power gradually improved to Frankel's grade E. Average duration of surgery was 97 min. Average blood loss was 610 ml. Conclusion Different surgical techniques were used to suit different fracture patterns, with good clinical and radiological results. This could be a step forward in devising an algorithm to surgical treatment of OVCF nonunions.

It is recommended to do routine biopsy, culture and drug sensitivity testing in all patients of tuberculosis spine to guide selection of appropriate second-line drugs when required. In cases of non availability of drug susceptibility testing despite repeated attempts, it is suggested to use data from large series such as this to plan best empirical chemotherapy protocol.

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Background:Interbody fusion surgery has been considered by many to be a treatment of choice for instability in lumbar degenerative disc disease. A posterior lumbar interbody fusion (PLIF) has the advantages of spinal canal decompression, anterior column reconstruction, and reduction of the sagittal slips from a single posterior approach. The PLIF using double cage was a standard practice till many studies reported comparable results and lesser complications with single cage. Iliac crest was considered as an appropriate source of bone graft until comparable spinal fusion rates using local bone graft and cage emerged. Till date, there has been no report of corticocancellous laminectomy bone chips alone being used for spinal fusion. In this paper, we present radiologic results of single level instrumented PLIF, where in only corticocancellous laminectomy bone chips were used as a fusion device.Materials and Methods:It is a retrospective cohort study of 35 consecutive patients, who underwent single level instrumented PLIF surgery, wherein only locally obtained bone chips was used for spinal fusion. The average follow-up was 26 months. The indications for the surgery were as follows: 19 patients had disc herniations, with back pain of instability type, normal disc height on radiology. Ten patients had grade 1 spondylolisthesis, with significant back pain and translational instability on radiography. Three patients were redo spine surgeries, and three patients had healed spondylodiscitis with significant back pain and instability. All patients were regularly followed up and decision of spinal fusion or no fusion was taken at 2 years using modified criteria of Lee.Results:Of total 35 patients, there were 24 males and 11 females, with a mean age of 41 years. There were 16 patients with definitive fusion, 15 patients with probable fusion, 04 patients with possible pseudoarthrosis, and no patient had definitive pseudoarthrosis. The mean time for fusion to occur was 18 months. The average loss of disc height, over 2 year follow up, was only 3 mm in 8 patients. Three patients had a localized kyphosis of more than 3° at the fusion level. The average blood loss was 356 ml and average operating time was 150 min.Conclusion:Corticocancellous laminectomy bone chips alone can be used as a means of spinal fusion in patients with single level instrumented PLIF. This has got a good fusion rate.

The presented complication is a catastrophe considering a routine surgical procedure. In cases of spondylodiscitis, spine surgeons should be careful about inflammation of major vessels with friable vessel walls anterior to the vertebrae. This mandates a cautious surgical technique.

We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies.

Purpose As Indian spine surgeons, we have to choose between 'foreign implants' and 'Indian implants'. An Indian four pedicle screw rod construct costs 330 US dollars (one-third that of a similar foreign construct). About 60% of patients cannot afford expensive foreign implants. There is little written data evaluating how these Indian implants fare. The purpose of our study was to evaluate implant failure rate with Indian implants and compare it to foreign implants. Methods We analysed results of 1,572 titanium pedicle screws used in 239 patients with a minimum 1-year followup. Patients were divided into Indian and foreign implant groups. Radiological failures were classified as (1) surgery and disease failure, (2) bone failure and (3) implant failure. The null hypothesis was that there is no difference between implant failure rate for Indian and foreign implants.