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Spinal metastasis of neuro-endocrine tumours (NETs) usually arise from a primary in the lung. We encountered such a patient with NET metastasis to T6 vertebra causing severe cord compression. Considering the neurological status, immediate decompression surgery along with T3-T8 posterior stabilization was done. Early recurrence of the tumour causing near total obliteration of the spinal canal leading to significant neurological compromise was noted within one month of surgery. A second surgery at this stage was avoided due to the risk involved and concurrent chemo-radiotherapy was initiated. The tumour was sensitive to chemo-radiotherapy and rapid resolution was noted on subsequent follow-up visits. With appropriate rehabilitation, patient regained full power to become ambulant with support. This case report highlights a rare, early and aggressive recurrence of metastatic vertebral NET following index surgery which was effectively managed with chemo-radiotherapy.

Ossification of the posterior longitudinal ligament (OPLL) most commonly occurs in the cervical spine, usually involving two to three segments; however, the disease has the potential to occur anywhere in the spine. We encountered a fifty-one year old male with progressive unsteadiness and bilateral lower limb weakness for a period of six months which eventually became worse resulting in inability to walk without assistance. Neurological examination revealed normal upper limb function; however, the lower limbs demonstrated motor dysfunction. Signs of myelopathy were elicited and the patient was subjected to detailed radiological evaluation. CT and MRI scans revealed an extensive cervico-thoracic continuous OPLL from C3 to T3 causing significant cord compression. In view of the deteriorating neurological status, extensive C3-T3 laminectomy with instrumented posterolateral fusion was done and the patient recovered without any immediate or delayed C5 palsy. This case highlights a rare occurrence or extensive OPLL involving eight segments at the cervico-thoracic region. This report also discusses surgical strategies for managing such extensive presentations and our technique to prevent C5 palsy.

The introduction of endoscopic spine surgery has led to a paradigm shift in the treatment of spinal disorders. In particular, biportal endoscopic surgery has gained traction for its wider visual field and improved the maneuverability of instruments, familiar anatomy, and cost-effectiveness. In this study, we describe our en bloc removal of the ligamentum flavum using a "butterfly" technique. This approach had several advantages: (1) The flavum serves as a protective barrier for the dura during drilling. (2) There is less epidural bleeding, which provides (3) better visualization. (4) In an inadvertent durotomy, this usually occurs later in the procedure, which is more manageable than the early stages of decompression. Biportal decompression for spinal stenosis can be performed using an en bloc ligamentum flavum removal technique that is safe, reproducible, and efficient. A systematic approach will help early adopters overcome the steep learning curve. [ABSTRACT FROM AUTHOR]

Intracranial haemorrhage (ICH) is a rare but devastating complication post spinal surgery. We present three cases of post spine surgery ICH that were associated with high drain outputs postoperatively. The first patient underwent C1–C6 instrumented fusion and C4–C6 decompression. 950 mls hemoserous fluid was drained via suction drain immediately postoperatively. He suffered cerebral hemorrhage with tonsillar herniation and was brain dead on the same night. The second patient underwent C1–T1 instrumented fusion with C3–C4 decompression. 400 mls hemoserous fluid was drained via suction drain shortly after skin closure. He suffered subdural hemorrhage, subarachnoid hemorrhage and intraventricular hemorrhage, with persistent neurologic deficits and required long-term institutionalised care. The third patient underwent L2–L4 decompression and instrumented fusion. 480 mls hemoserous fluid was drained via suction drain 2 hours postoperatively. He suffered subdural haemorrhage but eventually recovered fully. An excessive drain output, especially within first few minutes to hours postoperatively, may signify a CSFleak. Suction drains should be used with caution in these cases as negative suction in the presence of a dura tear increases risk of post spine surgery ICH. In these cases, the use of non-suction drains should be considered. [ABSTRACT FROM AUTHOR]

Surgery for ossification of the ligamentum flavum (OLF) comes with a relatively high risk of dural tear. We report a 50-year-old woman, who presented with symptomatic spinal stenosis from OLF at T11–T12 and lower lumbar spondylosis for which a single stage posterior decompression and instrumented fusion of both sites was done. Removal of the OLF resulted in a small dural tear with intact arachanoid which was covered using a fibrin sealant. In the first post-operative day, the patient's neurology started deteriorating. An MR scan was done to look for hematoma. It showed the spinal cord herniating out of the thecal sac at the operated level. Emergency re-operation was done to reduce the herniation and the dural defect was repaired. The patient gradually recovered to her best functional status. Based on this experience, we advise primary repair of inadvertent durotomies. [ABSTRACT FROM AUTHOR]