Troublesome venous bleed is a significant challenge from epidural channels around facets in spine, more so at C1 and C2. Patience during surgery is the key factor to avoid and control such bleeding. Meticulous patient positioning, coagulation of venous plexus, and compression tamponade with hemostats are essential in preventing troublesome epidural bleeding.

Objective: Congenital spinal dermal sinus is a rare form of spinal dysraphism. It often presents in childhood with varied symptomatology. We analyzed our patients to study the symptomatology, operative findings, and patient outcomes. Materials and methods: We evaluated 10 patients with congenital dermal sinus (CDS) over spine who attended our outpatient clinic during the period 2006 to 2008. Results: The male: female ratio was 1:1 in our series. Two patients were of below 2 years of age. We noticed 1 cervical, 3 dorsal, 2 lumbar, and 4 lumbosacral sinuses. Reasons for attending the clinic were neurological deficits in 4 patients and cutaneous findings in 6 patients. Pain, restricted neck movements, and infection were found in one patient each. Patients in pediatric age group (57%) were more likely to have neurological deficit than adults (33%). Bifid spinous processes were noticed in all except one patient. Tethered cord was a common finding in all patients. Two intramedullary dermoid with abscess formation in one of them was found. Terminal lipoma, terminal syrinx, and neurenteric cyst were found in each one. Hydrocephalus, split cord malformation, and epidermoids were not encountered by us. Postoperatively, six remained neurologically intact, three were unchanged, and one partially improved. Neurological worsening was not noticed. Conclusion: Congenital spinal dermal sinus should be dealt surgically. Intradural exploration is the most important part of surgical excision. Early referral will prevent permanent sequel. Outcome is directly related to preoperative neurological status.

Introduction: To assess the chronological changes of the disease-related kyphosis after chemotherapy alone, and secondly to clarify the role of growth cartilage in the healed lesion on kyphosis change. Materials and methods: A total of 101 children with spinal tuberculosis in various stages of disease processes, aged 2 to 15 years, were the subject materials. They were treated with two different chemotherapy formulas; before 1975, 18 months of triple chemotherapy [isoniazid (INH), paraaminosalicylic acid (PAS), and Streptomycin], and from 1976, 12 months of triple chemotherapy (INH, rifampicin, ethambutol, or pyrazinamide). By utilizing the images, the effects of the remaining growth plate cartilage on chronological changes of kyphosis after the initiation of chemotherapy were analyzed. The first assessment at postchemotherapy was at 1 year and at the final discharge time from the follow-up. Results: Complete disk destruction at the initial examination was observed in 2 (5.0%) out of 40 cervical spine, 8 (26.7%) out of 30 dorsal spine, and 6 (19.4%) out of 31 lumbosacral spine. In those cases, kyphosis developed inevitably. In the remainders, the disks were partially preserved or remained intact. Among 101 children, initial kyphosis was maintained in 20 (19.8%), while kyphosis decreased in 14 (13.7%) children, and increased in 67 (66.3%) children with nonrecoverably damaged growth plate. Conclusion: It was possible to predict the fate of the kyphosis at the time of initial treatment, but its predictive accuracy was low. Therefore, finally, it is recommended to be done at the end of chemotherapy. In children, the kyphotic deformity assessment should be continued till the maturity

Introduction: Surgery for Pott's spine is a controversial issue with respect to the unpredictable outcome. In this, we made an attempt to evaluate the factors that determine a role in determining the neurological results of surgery. Materials and methods: Thirty patients who underwent any surgical procedure for Pott's spine were included in the study. Demographic, clinical, hematological, and radiological profiles were noted. Drainage of abscess/debridement/posterior decompression, and stabilization; radical debridement and bone grafting and radical debridement, bone grafting, and instrumentation were the surgical interventions done. All the patients were followed up for minimum 9 months. The outcome was noted as partial neurological recovery (PNR), near complete neurological recovery (NCNR), and complete neurological recovery (CNR). Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: At the last follow-up, majority had NCNR (53.3%), followed by PNR (33.3%) and CNR (13.3%). Illness duration. 3 months, presence of sphincter disturbance, and McCormick grade III/IV were significantly associated with PNR (p < 0.05). Conclusion: The findings of the study indicate that duration of illness and few clinical factors might be associated with poor outcome in patients of Pott's spine who underwent surgery.

Introduction: Surgery in properly selected lumbar disk prolapse provides better early results than conservative management. Lumbar microendoscopic discectomy (MED) has been found to be associated with good results. We are reporting our experience of 920 consecutive patients using MED technique. Materials and methods: Visual analog scale (VAS) scores for back pain and leg pain were recorded preoperatively and at 3, 6, and 12 months postoperatively. MacNab criteria were used to measure postoperative outcome. Indication for surgery was persistent leg pain despite 12 weeks of conservative management. The progressive neurologic deficit was also an indication for surgery. Disk prolapses associated with spinal instability and infections were excluded. Results: The mean VAS score for leg and back pain before surgery was 7.6 and 2.4 respectively, which improved to 1.5 and 0.6 three months after surgery. There was a significant improvement in VAS scores for backache and radicular pain in 819 patients (89%) compared with preoperative values. About 91% patients had good-to-excellent results according to MacNab criteria. The average operative time and blood loss were 70 minutes and 20 mL respectively. Unilateral or bilateral symptoms were observed in 673 and 247 patients respectively. There were 14 recurrent disk surgeries. Accidental intraoperative single-facet injury, minor dural injuries, postoperative discitis, and root injury occurred in 5, 12, 5, and 2 patients respectively. The mean follow-up was 38 months. Conclusion: Microendoscopic discectomy is an effective and safe alternate technique for lumbar disk disease.

Sacral chordomas are locally aggressive tumors that grow slowly and often involve the sacral nerve roots leading to bladder disturbances. The treatment of these tumors involves utmost care as it can lead to tumor recurrence and neurological morbidity. We present our experience of 6 patients with sacral chordomas out of 17 patients with sacral lesions, where we have treated them with partial sacrectomies. In all of our cases, we have preserved at least one S2 root and postsurgery 83.33% of patients had intact bowel and bladder function. The lumbopelvic fixation was done in none of the cases as we have preserved the stability of the sacroiliac (SI) joint, as all osteotomy was done below S1. None of the patients had recurrence with an average follow-up of 4.1 years. This study aims at describing the surgical steps in managing a sacral chordoma.

Introduction: Intramedullary spinal tuberculoma (IMT) combined with abscess is rare. Because of such rarity, there is no standardized treatment protocol for this condition. We present a case of intramedullary tuberculoma combined with abscess in a female child who was successfully treated with surgery and antituberculosis medicine. Case report: We present a case of spinal intramedullary tuberculoma in a 2-year-old female child who was receiving antituberculous treatment for tuberculous meningitis presented with weakness in both lower limbs. Magnetic resonance imaging (MRI) lumbar spine showed heterogeneously enhancing intramedullary lesion in the lumbosacral region which was hypointense on T1-weighted images and hyperintense on T2-weighted imaging. Lesion was explored in view of neurological deficit. Pus containing solid lesion was removed. Histopathology confirmed intramedullary tuberculoma with abscess. Conclusion: Intramedullary tuberculoma with abscess is a rare cause of paraparesis. In spite of antituberculous treatment, patients are susceptible for development of intramedullary tuberculoma with abscess. One has to keep this pathology in mind when patients present with intramedullary space occupying lesions with tuberculous lesions elsewhere.

Introduction: The quantitative understanding of cervical pedicle morphology minimizes the injury to the neurovascular structure and improves the surgical outcome. The aim of this study was to investigate the morphometry of the cervical pedicle using computed tomography (CT) scans. Materials and methods: The CT scan was performed in eleven cervical spine injury patients and the axial and sagittal images were used to calculate the four linear parameters—outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle axis length (PAL), and the pedicle transverse angle (PTA). Results: A total of 110 pedicles were measured and studied. The mean OPW, IPW, and PH showed gradual increase of the value from C3 to C7. The PTA showed maximum value at C4 vertebra and minimum value at C7 vertebra. Conclusion: The study demonstrated that pedicle dimensions were small in comparison to European and other Asian populations. To enhance the safety of cervical pedicle screw insertion, the pedicle dimensions and trajectories should be determined individually. The screw diameter should also be optimal to avoid pedicle violations because of narrow OPW in our study population.

Chordomas are rare locally aggressive midline tumors usually seen involving clivus and craniovertebral junction. Safe maximal resection is the mainstay of treatment. We report a case of a young girl with chordoma where a transoral approach was used with limited resection of hard palate and vomer for optimal exposure and maximal safe resection. Good exposure for radical decompression and reduced postoperative morbidity can be achieved using individualized modifications in transoral approach for chordomas involving craniovertebral junction.

Introduction: Cervical spine injury is the most feared spinal injury for physicians, patients, and their families. All patients with unstable subaxial cervical spine injury must be managed by cervical traction and stabilization. Lateral cervical X-ray remains standard diagnostic tools to evaluate the stability of cervical spine structure and has a high diagnosis value in evaluating the success of the cervical traction. The success of the cervical traction could be predicted by observing the alignment of the cervical based on series lateral cervical spine X-ray. Materials and methods: This retrospective study involves 30 patients with subaxial cervical spine injury admitted to the Emergency Unit of Dr. Hasan Sadikin Hospital, Bandung, Indonesia, from 2012 to 2016. This study uses the logistic regression analysis with p < 0.05 considered to be significant and the confidence interval (CI) of 95%. Results: The results of this study showed that the failure of cervical traction (closed reduction) was mainly determined by interval admission time and facet lock (FL). The interval admission time (p = 0.015; two-sided tail, Pearson's chi-square) and distribution of FL showed significant results (p = 0.001; two-sided tail Fisher's exact test). Odds ratio (OR) whether FL is present or absent is 3.8; 95% CI 0.5 to 27.1, with p = 0.001. Conclusion: It is concluded that informed consent regarding cervical traction failure is needed in subaxial cervical injury > 24 hours, where in patients with FL cervical traction trail is not needed, instead immediate definitive management (opened reduction) with stabilization is recommended.