We present a rare case of split cord malformation (SCM) type II complicated by presence of tuberculous arachnoiditis without any history of systemic tuberculosis or vertebral body lesions. Diagnosis was made based on intraoperative findings and was confirmed by histopathology. Surgical decompression along with a combination of steroid and antitubercular therapy resulted in a good outcome. Clinical features, magnetic resonance imaging (MRI), intraoperative findings, pathology and the relevant literature are herein discussed.

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Aneurysmal bone cysts (ABCs) are benign lesions occurring predominantly in metaphysis of long bones. Lesions involving the cervical spine comprise 1% of all spinal ABCs. We report a rare case of C2, C3 ABC in a 39-year-old male patient, who presented with progressive weakness of all four limbs since 8 months. Magnetic resonance imaging (MRI) of spine showed an expansile osteolytic mixed intensity lesion with fluid level involving the body of axis and left pedicle causing significant compression on thecal sac posteriorly suggestive of ABC. Decompression of the cyst along with occipitocervical stabilization with iliac crest bone grafting by combined anterior and posterior approach was done. Histopathological examination revealed trabeculated, dilated vascular beds consistent with the diagnosis of ABC. The patient's neurological status improved immediately after surgery and he continues to do well 6 months postoperatively. Conclusion: Aneurysmal bone cyst of the cervical spine is very rare. It requires thorough neural decompression and 360° fusion for better stability and outcome.

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Aim: To conduct a prospective study to assess whether we can predict the presence of hyaline material in the extruded disk from preoperative magnetic resonance imaging (MRI) in patients with lumbar disk herniations and its clinical significance. Materials and methods: Hundred patients posted for microlumbar discectomy were included in the study. They were assessed preoperatively for severity of symptoms using visual analog scale (VAS). Detailed radiological assessment was done using MRI. Following surgery, extruded disk specimens were sent for histopathological examination. The presence of hyaline material in biopsy was correlated with specific MRI findings and postoperative outcome assessed based on the VAS score. Results: Out of the 100 patients, there were 58 males and 42 females between the age of 18 and 55 years. Histopathology of herniated disk material showed annulus fibrosis in 15% of patients, nucleus pulposus in 78% and a combination of both in 7%. Hyaline cartilage was found in 24% of patients. Extend of Modic changes more than 50% of vertebral end plate in MRI was indicative of the presence of hyaline in biopsy (p < 0.001). Preoperative MRI finding of vertebral end plate defect (VEPD) was associated with the presence of hyaline in 92.8% of cases. Presence of hyaline was correlated with the improvement in mean VAS score postoperatively. Conclusion: In this study, the importance of hyaline in the extruded disk with its clinical significance is emphasized. We conclude that the presence of hyaline, as predicted from MRI findings like VEPD and extend of Modic changes, is a predictor of good postoperative outcome.

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Giant cell tumors (GCTs) are benign tumors of the bone that most commonly occur at the ends of the long bones; they are rarely found in the spine above the sacrum. The management of patients with GCTs of the spine represents a challenge, and the clinical approach to this problem continues to evolve with improvements in surgical and adjunctive therapies. Giant cell tumor is a rare bone tumor seen in 3 to 5% of primary bone neoplasm. Approximately, 7% of GCTs are found in the vertebral column. Giant cell tumors of the spine are found in only 5 to 7% of cases and can occur in any region of the spine but are believed to be predominantly in the sacrum. Despite its benign nature, expansion in a confined space makes early detection of spinal GCTs important to prevent occurrence of compressive myelopathy/radiculopathy. Although complete en bloc surgical resection is difficult in the spine, treatment with adjuvant radiotherapy has been considered controversial because of a small risk of malignant transformation. We are reporting a cases of GCTs in the lumbar vertebrae that were treated successfully with surgical excision, decompression and as well as follow-up.

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Background: Posterior cervical foraminotomy was first described by Spurling and Scoville. With the incorporation of the operating microscope and microsurgical techniques, there has been renewed interest in this approach for laterally placed cervical disk prolapse. Materials and methods: Twenty-nine patients (20 males and 9 females) with ages varying from 31 to 55 years underwent posterior cervical microdiscectomy for laterally placed cervical disk prolapse at 30 levels. Surgical procedure employed by us for the posterior cervical microdiscectomy is described in the article. Results: All the patients had relief from radiculopathy following the surgery. No major complication was noted in our series. One patient developed transient nerve root deficit which improved, over 6 weeks. No fusion was required in any case. Hence, all the complications of anterior approach and fusion could be avoided. Conclusion: Posterior cervical microdiscectomy is a safe and effective approach for the treatment of laterally placed cervical disk prolapse. In selected cases, this approach provides excellent results with minimal complications.

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Study design: Retrospective cohort study. Objective: To recognize the factors that influence drain output and based on the results to formulate certain guidelines which help in deciding drain placement in patients who have undergone anterior cervical discectomy (ACD) surgeries. Summary of background data: The common worry of operating surgeon after anterior cervical discectomy and fusion (ACDF) surgery is postoperative neck hematoma. To avoid this, there has been a traditional practice to keep the drain postoperatively. Drain placement has got inherent complications, like infection risk, postoperative pain, increased analgesic use and increased length of hospital stay. Materials and methods: All patients who underwent elective ACD surgeries with surgical drain placement in our institution between from Jan 2011 and July 2014 were identified using operation theater (OT) records. Patient information was abstracted from the medical records section. Patients were categorized on the basis of normal or increased total drain output, with increased drain output defined as total drain output 50th percentile (20 ml) or more. A multivariate logistic regression was used to determine which factors were independently associated with increased drain output. Results: A total of 161 patients with ACDF met inclusion criteria. Total drain output was in the range from 0 to 300 ml. Among all patients in the study, 67 patients had increased drain output (drain output ≥ 50th percentile or 20 ml). Multivariate analysis identified three independent predictors of increased drain output: BMI, number of levels (≥ 2 levels) and implants. Conclusion: Patients with the factors, like increased BMI, two or more level surgery and implants placed may benefit from surgical drain placement after ACD surgeries.

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Imaging plays a crucial role in spinal cord compression. Routine magnetic resonance imaging (MRI) sequences often detect pathological changes occurring in the cord only in the late stages of the disease process. Diffusion tensor imaging (DTI) is a novel imaging technique which has the potential to identify the course of nerve fiber tracts and detect early microstructural changes occurring in the cord ahead of the other techniques. Cord changes occur in the form of altered DTI values, such as fractional anisotropy, mean diffusivity, which add functional information to the imaging report.

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