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).

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.

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.

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.

Subramanian N, Srikantha U, Sitabkhan M, Jagannatha AT, Khanapure K, Varma RG, Hegde AS. Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion: Early Outcome Observations. J Spinal Surg 2014;2(1):1-7.

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).

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.

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).

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.

Subramanian N, Srikantha U, Jagannatha AT, Khanapure K, Varma RG, Hegde AS. Posterior Cervical Laminoforaminotomy: A Comparative Study between Open vs Minimally Invasive Approach. J Spinal Surg 2014;2(1):8-12.

Sewlikar S, Pillai R, Mahajan N, Desai A. Bleeding Scenarios in Spine Surgeries: Role for Topical Hemostatic Agents. J Spinal Surg 2015;2(1):13-16.

Yadav S, Goswami A, Vijayraghavan G, Jayaswal A. An Uncommon Giant Osteoblastoma in a Young Child: Our Experience and Literature Review. J Spinal Surg 2015; 2(1):17-19.

Joshi D, Sinha P, Yadav RS, singh A, gupta G, Mishra VN, Chaurasia RN. Intramedullary Spinal Tuberculomas: A Report of Three Cases. J Spinal Surg 2015; 2(1):20-23.

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.

To report the clinical presentation, magnetic resonance imaging (MRI) findings, peroperative findings and histopathology of a case of a sacral intraosseous leiomyoma.

Observational case report.

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.

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.

To the best of our knowledge, this is the first case report, in English literature, of a primary intraosseous leiomyoma in the sacrum.

Sengupta SK, Negi RS, Rathi KR. Intraosseous Leiomyoma in the Sacrum. J Spinal Surg 2015;2(1):24-26.

Desai AA, Trivedi A, Chandrakar BL, Soni R. Old and Neglected Odontoid Fracture with C1-C2 Dislocation: An Approach. J Spinal Surg 2015;2(1):27-29.