Bleeding and bleeding management both pose serious challenge to the surgeon and patients especially in complex surgeries, like spinal surgery. This paper evaluates clinical evidences published on use of topical absorbable hemostats in different bleeding scenarios in spinal surgery. Review of clinical evidence indicates clearly the need for further studies in this space.

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The present work emphasizes upon rare occurrence of giant osteoblastoma of lumbar spine (L4) in a 10-year old male child reporting to our spine clinic. He presented with back pain and visible swelling on flexion over back which disappeared on extension. He was evaluated clinically and radiologically. There was no neurological deficit. Tumor resection was done by posterior approach. The diagnosis was confirmed histopathologically. Postoperatively, pain disappeared completely. The purpose is to highlight such delayed presentations in developing countries and the importance of early diagnosis.

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Intramedullary spinal tuberculomas, though rare are an important cause of compressive myelopathy in developing countries. They are usually seen to occur in patients with pulmonary tuberculosis and may also occur in patients who are already on antitubercular treatment for central nervous system tuberculosis. Advancements in the imaging modalities have facilitated an early detection with prompt institution of early medical management and/or surgical intervention when deemed necessary. We report interesting three cases of intramedullary spinal tuberculomas who improved with medical management.

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Background: Leiomyomas originate from smooth muscle, with uterus being the most common site of origin. Intraosseous leiomyomas are very rare. Few cases of primary intraosseous leiomyomas have been reported in the mandible, appendicular skeleton and rib. To the best of our knowledge, there is no previous report of a primary intraosseous leiomyoma in the sacrum. Purpose: To report the clinical presentation, magnetic resonance imaging (MRI) findings, peroperative findings and histopathology of a case of a sacral intraosseous leiomyoma. Study design: Observational case report. Materials and methods: A 26 years old male presented with acute onset low backache, without any neurological deficit. magnetic resonance imaging LS Spine revealed an intraosseous mass in the sacrum, which was excised. Histopathological examinations proved the mass to be a leiomyoma. Patient became asymptomatic postoperatively. On follow-up, 2 years after surgery, patient is asymptomatic and neuroimaging revealed no recurrence. Result: Peroperatively, a lobulated, yellowish, sharply demarcated, soft to firm, expansile mass was encountered between the inner and the outer table of the lamina of the S1 vertebra, which was detected to have bundles of spindle shaped cells with oval nuclei arranged in a fibrous stroma on H and E stain. On immunohistochemistry (IHC), it showed positivity for smooth muscle actin (SMA) and vimentin and was negative for cytokeratin (CK), epithelial membrane antigen (EMA), neuron-specific enolase and desmin. Conclusion: To the best of our knowledge, this is the first case report, in English literature, of a primary intraosseous leiomyoma in the sacrum.

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In Indian health setup with short of précised expertize, the nonunion with C1-C2 instability of odontoid fractures usually results from delayed diagnosis and its inappropriate treatment. Our patient had kyphotic deformities at the C1-C2 joint complex secondary to neglected odontoid fractures. Patient was asymptomatic for a long period of time before appearance of symptoms, neck pain and instability, despite being obvious subluxation and kyphotic deformities at C1-C2 joint complex. The reactive new bone formation around the odontoid fracture plays a chief role in preventing further movement and development of myelopathy or instability. However, the treatment options available for neglected odontoid fractures remain controversial. Patient was operated by us without posterior C1 decompression, occipital-to-C2 fusion and spinal instrumentation with two lateral mass screws.

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Objectives: Minimally invasive spine surgery is gradually being preferred over conventional techniques due to several advantages. Our study was conducted to compare the persistent cervical symptoms and the surgical outcomes between open cervical laminoforaminotomy (O-CLF) and minimally invasive cervical laminoforaminotomy (MI-CLF). Materials and methods: Between June 2011 and 2013, 14 patients with radicular pain in the upper limb with magnetic resonance imaging (MRI) proven posterolateral cervical disk prolapse and failed conservative treatment were assigned to either O-CLF or MI-CLF. Neurological examination and visual analog scale (VAS) for upper limb and neck pain was done. Follow-up was done on day 1, 4 weeks and 6 months. Results: Out of the 14 patients, seven underwent O-CLF and seven underwent MI-CLF. Demographic characteristics and operating time were comparable between the two groups. The mean follow-up duration was 3 months. Mean blood loss was higher in O-CLF group (150 ml) as compared to MI-CLF (30 ml). Postoperative analgesic requirement was also significantly high in the O-CLF group. Length of hospital stay was more in the O-CLF (4.85 days) as against MI-CLF (1.28 days). Visual analog scale scores for radicular pain did not differ between the two groups. However, VAS scores for neck pain was significantly higher in O-CLF at 6 weeks follow-up as compared to the MI-CLF group. Patients who underwent MI-CLF returned to work faster (2.28 weeks) than their O-CLF counterparts (3.42 weeks). Conclusion: Minimally invasive cervical laminoforaminotomy results in reduction of postoperative analgesic requirements, hospital stay, blood loss, decreased incidence of postoperative axial neck pain and early return to work.

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Aim: To compare early clinical and surgical outcome of patients treated with open transforaminal lumbar interbody fusion (O-TLIF) vs minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Materials and methods: Sixty-two consecutive patients from 2011 to 2013 undergoing transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis and lumbar spinal stenosis were included in the study. For analysis, they were divided into two groups based on whether TLIF was done by a conventional open technique (O-TLIF, 31 cases) or minimally invasive tubular retractor-assisted technique (MIS-TLIF, 31 cases). The demographic profile, clinical and surgical outcome variables, including pre- and postoperative visual analog scale (VAS), Japanese orthopedic association (JOA) scores and JOA recovery rates were noted in both the groups. Results: The median duration of follow-up was 9 months in MIS-TLIF group and 14 months in O-TLIF group. Preoperative clinical variables were comparable in both the groups. MIS-TLIF group had lesser mean intraoperative blood loss, lesser analgesic requirement, shorter hospital stay and earlier return to work as compared to O-TLIF group. Improvements in postoperative VAS for leg pain were similar in both the groups. Immediate postoperative and follow-up VAS for back pain were lower while mean JOA score and mean JOA recovery rate were significantly higher in MIS-TLIF group as compared to O-TLIF group. Conclusion: Minimally invasive transforaminal lumbar interbody fusion resulted in lesser blood loss, lesser analgesic requirement, shorter hospital stay, earlier return to work and improved functional outcome in terms of higher JOA recovery rates as compared to O-TLIF.

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