Introduction: Since the last decade, the frequency of anterior lumbar surgeries has dramatically increased for anterior interbody fusion and artificial disk arthroplasty. In this approach, the surgeons frequently encountered complicated neurovascular anatomy, which hindered the wide exposure of the intervertebral disk. Until the last decade, surgeons had preoperatively referred only to the basically described vascular anatomy in textbooks. Materials and methods: To help the surgeon in this clinical issue, the current authors conducted this computed tomography (CT) angiographic study. Results:

• In 7 patients (14.6%), the abdominal aortas were located in the right anterior one-third of the vertebra. In 26 patients (54.2%), they were in the left two-thirds of the anterior vertebral surface, and in 15 patients (31.3%), they were in the middle. In 5 patients, they were located in the extreme left margin of the body.
• In the running pattern of aorta, straight vertical aorta in 29 patients (60.4%), curved aorta in 17 patients (35.4%), kinked aorta in 1 (2.1%), and tortuous aorta in 1 (2.1%) were observed.
• Abdominal aorta bifurcated at L3 body level in 1 (2.1%), 9 (18.8%) at the L3–L4 disk level, 23 (45.8%) at the L4 body, 12 (25%) at L4–5 disk level, and 4 (8.3%) at L5 body level.
• The running pattern of the iliac artery was not constant; there were several types: symmetrical/asymmetrical spreading and straight/curved with widely or narrowly spread ones.

Conclusion: It was found that there is variant vascular anatomy, not described in the textbooks.

Objective: To look for the proper magnetic resonance (MR) imaging time after intravenous contrast medium administration to map the image of the abdominal vessels and lumbosacral spine together in a cut. Materials and methods: The utilized MR machines were Achieve 1.5T and 3.0T (Philips, the Netherlands) and cut thickness was 4.0 mm. Contrast medium was Iopamidol (Dongkuk Pharma, Seoul, South Korea). For the vessel image, scan was done at 30 seconds after intravenous Iopamidol administration, and then scans were repeated every 10 seconds to pick up the best imaging time in a cut until 150 seconds postcontrast medium administration. Results: Aorta and its bifurcation could be imaged at 30 seconds postcontrast medium injection. The best wanted image of all the large abdominal vessels and lumbosacral spine together in a cut was obtained at 70 seconds after contrast medium administration. The best peripheral venogram was obtained at 150 seconds. Summary: This MR imaging time sequence provided easy access to obtain the large abdominopelvic vessels together with the lumbosacral spine in a cut.

Introduction: Fracture of the odontoid and particularly type II, is the commonest injury in the upper cervical spine. In the past, it was presumed to cause by high velocity road traffic accidents. But now, with the increase in the number of two-wheeler vehicles and sub-standard conditions of indian roads, this type of injury is common. It is usually caused by hyper-extension of the neck but, can be caused by hyper-flexion. The surgical management has remained controversial. Material and methods: Data was collected from four centres in Maharashtra- India. In one centre, the treatment was posterior C1-C2 stabilization with screws and plate. In centre two, odontoid fracture line was fixed by anterior screws. In the third centre, Magerel technique was used. The fourth centre believed in direct anterior screw and plate fixation of the fracture line. Analysis: The number of patients operated upon, were too less in each centre to analyse and compare with each other. As a result, use of software analysis was not felt necessary which is in fact the need to assess the best technique which can be used to treat this fracture. Results: No definite conclusion could be arrived at by studying the pattern of treatment in these four centres. Conclusion: Way back in 2009, an attempt was made to do a multi-centre retrospective analysis. There was no definite conclusion and even in the present study, no definite conclusion is derived.

Craniovertebral instability is usually treated by posterior occipitocervical fixation using occipital plate and bilateral atlas lateral mass and axis pars/pedicle fixation with screw rod construct. A patient with unfavorable anatomy of the lateral masses of the atlas and superior facet of the axis due to previous surgical wound infection had developed craniocervical instability. A new technique using a customized plate rod construct fixed anteriorly to the midcervical vertebrae (by a standard midcervical exposure) with the rods contoured to reach posteriorly through the safe paraspinal corridor and connected with dominos to occipital plate rods fixed on either side of midline by additional posterior exposure avoiding the midline scar was planned and executed successfully. The technique seems to be safe and easy, but will need further evaluation.

Although intramedullary spinal cord tumors are predominantly primary tumors like ependymomas and astrocytomas, the intramedullary spinal cord metastatic tumors account for 4 to 9% of all such tumors. With the advent of magnetic resonance imaging (MRI) and improvement in the survival of cancer patients due to effective therapeutic options, the number of patients harboring intramedullary spinal cord metastasis (IMSCM) is increasing. Review of large series of IMSCM has revealed rarity of intramedullary metastasis to conus medullaris (IMCM). We present a short series of two cases of IMCM managed in our hospital and review of literature to describe how it is different from IMSCM at other regions of spinal cord. We also describe various management options available in the light of 25 cases of conus metastasis described in the literature till date.

Rhombencephalosynapsis is a rare congenital intracranial malformation. Partial rhombencephalosynapsis is a variation of this anomaly with few reported cases. We report a unique case of a patient with partial rhombencephalosynapsis associated with Chiari II, and various spinal malformations, which is very rare, and only few such cases have been reported in literature. These findings suggest that rhombencephalosynapsis can be associated with spinal malformations and, furthermore, that cases with the common features of rhombencephalosynapsis and Chiari II malformation can exist. Such an association likely represents a new anomaly of the hind brain with spine.

Intramedullary abscess of the spinal cord (IASC) is a rare condition caused by purulent infection of the central nervous system (CNS). There have been relatively few cases recorded in literature, with the condition first identified in 1830. We are reporting an interesting case of cervical cord intramedullary abscess in a young male patient caused by Streptococcus intermedius. The presentation was atypical, without constitutional symptoms, but progressive neurology over a short period of time.

Aim: The aim of this article is to report a case of ossification of the posterior longitudinal ligament (OPLL) in a patient who showed a de novo ossification focus compressing the spinal cord at the pseudarthrosis site several years after anterior decompression and fusion treatment for OPLL using the floating method. Background: Segmental motion of the ossification foci has been reported to promote OPLL development. The OPLL can grow longitudinally and thicken after laminoplasty, which allows segmental motion of the OPLL. Case report: A 66-year-old man, who has a history of OPLL anterior surgery with floating method 11 year prior, showed a gradual increase in gait disturbance. Imaging analyses revealed a de novo ossification focus at the C6 to 7 pseudarthrosis level compressing the spinal cord anteriorly. Discussion: The present case showed that there is a possibility of de novo OPLL development after pseudarthrosis of anterior decompression and fusion surgery, even after complete floating of the ossification foci. Conclusion: The OPLL can develop under certain conditions even after anterior decompression and fusion surgery using a floating method. Thus, rigorous observation is essential for pseudarthrosis even though the initial neurological recovery may be good. Clinical significance: The present case showed a close relationship between OPLL genesis and segmental motion.

Aim: Spinal hydatid disease is a rare entity, and a primary extradural, extraosseous hydatid lesion in spine is rarer, with only a few reported cases in literature. Our aim was to present one such case. Background: Spinal hydatid disease being a very rare entity, high suspicion should be kept in compressive cystic spinal lesion, especially in endemic countries. Surgery is the treatment of choice with long-term antihelminthic therapy. Case report: Herein we report a case of a 26-year-old male patient who presented to us with low back pain, progressive paraparesis for last 4 months with urinary retention. Magnetic resonance imaging (MRI) showed multiple intraspinal extradural cystic lesions at L1–2, L3–4 and L5–S1 level. Patient underwent laminectomy and complete excision of the cyst. He is under our regular follow-up for last 1 year without any recurrence. Conclusion: A high level of suspicion is required for proper identification of a rare hydatid lesion in spine in extradural and extraosseous location and surgery is the treatment of choice. Clinical significance: Hydatid cyst is to be kept as a differential diagnosis in any cystic spinal lesion, especially in an endemic area.