Study design: Prospective observational study. Purpose: This study was aimed to understand the risk factors of spine injuries, in the region of Northwest India. Overview of literature: There had not been many studies on epidemiology of spine injury in this part of world. Western studies have documented their own risk factors which are becoming beneficial for them to reduce the incidence of this problem. Materials and methods: Spinal injury patients were analyzed with focus on patient-related data including age, gender, regional distribution, injury mechanism, vehicle in Road traffic accident, vertebral level involved, concurrent cord injury, other bodily injury and socioeconomic status of the patient. Results: Total 5,726 trauma patients were included in the study, in which 355 (6.19%) patients were found to be having spine injuries. Male:female ratio was 4.5:1. Mean age was 38.14. Most injuries occurred in the rural population (69.3%), and fall from height > 2 m (43.4%) constituted the most common mode of injury. Mode of injury showed no correlation with any particular spinal level involved; neither had it showed any correlation with age. Cervical was the most common level (45%). The study did not show predilection for any gender to have cord injury in a spinal injury patient (p = 0.006). Head injury was the most common associated injury (43.3%). All injuries were more common in low socioeconomic status group. Conclusion: Impetus should be toward rural areas and low socioeconomic group for prevention and better management of spine injuries in Northwest India.

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Caudal regression syndrome (CRS) is a rare congenital disorder characterized by agenesis of the vertebral bodies of the lumbosacral spine associated with other malformations of the pelvis and inferiors limbs. We present a case of a 18 months boy referred to Central Military Hospital (Bogotá, Colombia) with sacrococcygeal fistula and a permanent hip abduction brace. On physical examination, there was an abnormal palpation of the sacral hiatus and coccyx. His hips were flexed and abducted, but did not have contractures. Neurological examination and psychomotor development were normal. In lumbar MRI, there were found hypoplasia of the sacrum and agenesis of the coccyx with a large subcutaneous and spinal lipoma, tethered spinal cord, and two dermal tracts at the level of L4 and S3 vertebrae. Somatosensory evoked potentials with latency and amplitude within normal ranges. Because of this, operation was not considered.

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Introduction: Primary central nervous system (CNS) melanoma is a rare condition that accounts for only 1% of all melanomas. Primary spinal cord melanoma is even rarer. The first case of spinal cord melanoma was reported by Hirschberg in 1906 and since then only 62 cases have been reported. Intramedullary spinal cord melanoma, as one described here, is extremely rare and cervical location is still rarer in occurrence. Case report: A 27-year-old male presented with history of neck pain. On examination, he had sensory impairment on the nape of neck with no other deficits. Investigation: Spinal magnetic resonance imaging (MRI) shows intramedullary tumor C1-C2 region which is hyperintense on T1 and T2 with moderate enhancement. Treatment: C1-C2 was done. Tumor was completely excised and diagnosed as melanoma. Results: No metastatic lesion was found elsewhere. On 1 year follow-up after surgery, patient is doing well with no evidence of recurrence. Conclusion: We present the details of a rare case of primary intramedullary spinal cord melanoma in cervical location which was completely resected.

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Various imaginary signs are presented in literature to make easy for the practitioners to interpret radiological images in many neurological disorders. Uterus sign is one among that kind. Distortion of uterus sign in the magnetic resonance imaging (MRI) axial cut of lumbar spine indicates a compressive element which needs to be correlated with clinical status.

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Salmonella spondylitis is a rare illness and may present as pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis and epidural abscess. The diagnosis depends on clinical, radiological, blood and tissue cultures and histopathological findings. We describe a rare case of 63-year-old male, with diagnosis of pyogenic salmonella vertebral osteomyelitis of thoracic spine. Timely surgical intervention and appropriate antibiotic treatment resulted in complete cure.

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Introduction: Hirayama disease is a rare form of dynamic cervical flexion myelopathy. The incidence is more in Asian countries, like Japan, India, etc. Early diagnosis and treatment is the mainstay for the prognosis for this disease. Materials and methods: Our aim is to assess the outcome of anterior cervical stabilization in this disease. We had six patients who was diagnosed to have Hirayama disease in our center and underwent anterior cervical stabilization. Results: All six patients had fair to good outcome according to Odom's criteria. Conclusion: Early diagnosis and prompt treatment is the mainstay for better outcome. Mode of treatment depends on surgeons preference.

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Introduction: Osteoporotic vertebral fracture most common located at thoracolumbar junction, whereas most spondylolisthesis at L4-5 is six to 10 times more frequent involved than adjacent level. Concomitant compressed fracture with lumbar spondylolisthesis is rarely reported. Aim: To report an unusual case concomitant osteoporotic compressed thoracic fracture with lumbar spondylolisthesis and severe comorbidity. Case: A 68 years old female complaining 3 months severe low back pain and right thigh pain after falling on the floor. On physical examination, she had bilateral foot drop, there was no sensory loss and neither any bowel and bladder involvement with cardiovascular problem 70% left artery coronary obstruction on cardiac angiography. Investigation: Magnetic resonance imaging (MRI) D12 compression fracture with spinal cord and thecal sac compression and spondylolisthesis L5-S1. Management: L5 laminectomy, L4/5 and S1 posterior stabilization, D-12 laminectomy and transpedicular vertebroplasty and posterior stabilization of D11-L1. Result: The pain was significantly reduced after the surgery. Conclusion: Open surgery among osteoporotic compression fracture in thoracic spine and degenerative spondylolisthesis in lumbar spine needs further evaluation regarding comorbid disease which often present in advancing age.

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Postoperative visual loss (POVL) after spine surgery is a rare but devastating complication. A recent population-based, retrospective study conducted through NIS in united states, reported an overall incidence of visual disturbance after spine is 0.094%. We describe a 62-year-old patient operated for cervical and lumbar canal stenosis in prone position, unfortunately developed blindness in his left eye due to central retinal artery occlusion.

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Aim: To study the C1-2 facets in patients with congenital atlantoaxial dislocation and their bearing on the presentation and management. Materials and methods: Thirty-six patients of congenital AAD were studied in the last 2 years. Twenty-four patients had irreducible AAD (not reducing on traction) and remaining 12 had reducible AAD. Computed tomography (CT) scans were obtained and the C1-2 joints were studied in axial, sagittal and coronal planes. The obliquity of (C1-2) joints was measured using the novel inferior C1 coronal and sagittal angles. The relationship of obliquity of joints, age and reducibility was studied and these were compared with normal subjects. The amount of facet to be drilled was decided by these angles. Direct posterior reduction was attempted by drilling the facets flat in all. Anomalous vertebral arteries (VA) were detected with preoperative CT angiograms and addressed appropriately intraoperatively. Results: The inferior C1 sagittal and coronal angles were significantly acute in patients with IrAAD as compared to those with RAAD and normal spine. An inferior sagittal angle more than 150° predicted reducibility. More acute the angle, younger was the age of presentation. Relatively acute coronal angles were noticed in patients with telescoping (central or vertical dislocation). Intraoperative reduction could be achieved after drilling the facets nearly flat. Anomalous VA were found in over 70% of the patients with CAAD and were appropriately addressed. The fusion rates were over 90%. Conclusion: The congenital AAD appears to be a dynamic process, progressing with time. The acuteness of the inferior C1 sagittal facet angles possibly determines the age at presentation and reducibility. Coronal angle determines the telescoping of C2 within C1. Intraoperative reduction through a direct posterior approach can be achieved in patients with IrAAD by drilling the wedge of C1-2 facets to make the joints relatively flat. Comprehensive facetal drilling also increases the fusion rates.

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