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.

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.

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.

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.

Pai SB, Raghuram G, Srihari BG. Posterior Cervical Microdiscectomy. J Spinal Surg 2015;2(2):33-36.

Retrospective cohort study.

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.

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.

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.

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.

Patients with the factors, like increased BMI, two or more level surgery and implants placed may benefit from surgical drain placement after ACD surgeries.

Patil SR, Kishan A, Gabbita A, Varadharaju DN, Jagannath PM. Anterior Cervical Surgery: Drain Needed or Not? J Spinal Surg 2015;2(2):37-41.

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.

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.

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.

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.

Gopal VV, Mahadevan K. Importance of Hyaline Material in Herniated Lumbar Disk Pathology: Predicting the Presence of Hyaline from Preoperative Magnetic Resonance Imaging and its Clinical Significance. J Spinal Surg 2015;2(2):42-47.

Sivasubramanian S, Cherian M, Mehta P, Parthiban JKBC. Imaging of Spinal Cord Compression: Magnetic Resonance Imaging and Beyond. J Spinal Surg 2015;2(2):48-51.

Aneurysmal bone cyst of the cervical spine is very rare. It requires thorough neural decompression and 360° fusion for better stability and outcome.

Naveen MA, Naik V, Keshav GC, Kumar SAS, Pai SB. Aneurysmal Bone Cyst of C2, C3 Cervical Spine: A Rare Case Report and Review of Literature. J Spinal Surg 2015;2(2):52-54.

Vora TK, Ravi RR. Split Cord Malformation Type 2 Complicated by Presence of Tuberculous Arachnoiditis. J Spinal Surg 2015;2(2):55-57.

Desai AA, Trivedi A, Chandrakar Bl, Thakkar R. Isolated Giant Cell Tumor of the Lumbar Spine. J Spinal Surg 2015;2(2):58-60.