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Study Design: This was a retrospective study. Objective: The objective of this study was to evaluate the clinico-radiological outcome in single-level lumbar pyogenic discitis treated with single-stage combined percutaneous posterior stabilization with mini-open anterior debridement and fusion under single anesthesia. Materials and Methods: We retrospectively reviewed 27 patients with single-level lumbar pyogenic discitis who presented to our institute from January 2010 to August 2015. All the patients underwent preoperative evaluation with blood parameters including complete blood count, erythrocyte sedimentation rate, C-reactive protein, blood and urine cultures, and imaging studies. They underwent single-stage combined posterior percutaneous stabilization with mini-open anterior debridement and fusion with tricortical iliac crest graft under the same anesthesia. They were followed up at regular intervals with clinical and radiological assessment with minimum follow-up of 24 months. Preoperative and postoperative final follow-up assessments of neurological status, pain, and disability were conducted using the Frankel Grade scoring, visual analog scale (VAS) score, and Oswestry Disability Index (ODI), respectively. Results: This study included 10 women and 17 men (n = 27) with average age of 57 years (range: 45–73 years). The mean operative time was 194min (range: 150–230min). The mean intraoperative blood loss was 212mL (range: 100–350mL). The mean VAS score (0.56) at final follow-up was significantly lower than the mean preoperative VAS score (7.30) with P < 0.001. The ODI scores at final follow-up (mean, 13.48) were significantly lower than preoperative ODI scores (mean, 83.70) with P < 0.001. Conclusion: Single-stage combined posterior percutaneous stabilization with mini-open anterior debridement and fusion under one anesthesia is an effective alternative to conventional open technique as it allows thorough debridement and rigid fixation, and results in minimal blood loss and lesser postoperative complications.

Introduction Langerhans cell histiocytosis (LCH) in spine is a benign disorder that mainly affects children and is rare in adults. The treatment of LCH in adults is still controversial. The literature is drought with reports regarding management of LCH in adults with pathological fracture. We report a case of LCH at L5 vertebra in an adult patient treated with posterior stabilization, decompression, and anterior corpectomy and reconstruction. Case presentation A 30-year-old manual laborer working in Middle East, presented to us with severe pain in the lower back (VAS-8) with the right lower limb radiculopathy for 6 months. Radiological investigations revealed to have a solitary osteolytic lesion with pathological fracture at L5 vertebral body. MRI showed hyperintense lesion in T2 sagittal images and hypointense in T1 sagittal images in L5 vertebral body. PET scan showed metabolically active lesion involving L5 vertebra body and right ischium. CT-guided biopsy from L5 vertebral body was performed, but was inconclusive. The patient underwent surgical management in the form of posterior stabilization L4-S1 and transpedicular biopsy. The sample was sent for frozen section and confirmed the presence of neoplasia but did not provide sufficient information about the nature of pathology. Intraoperatively, the decision was made to do anterior excision biopsy, corpectomy, and reconstruction with titanium mesh cage filled with cement. The precise diagnosis of LCH was established on histopathological examination and confirmed with immunohistochemistry positivity for CD1a and S100. The patient had immediate relief of his back pain and radicular pain. He was able to resume his daily activities at 1 month after the surgery. At 2-year follow-up patient was asymptomatic and no local recurrence was noticed. Conclusion Surgical excisionfor LCH in adults should be considered in patients with refractory low back pain with pathological fracture, neurological deficits, or spinal instability.

Study Design: This was a retrospective study. Purpose: To evaluate the short term outcomes of a novel self-developed technique of performing uninstrumented open-door cervical laminoplasty (ODCL) in patients with cervical myelopathy secondary to ossified posterior longitudinal ligament (OPLL). Review of Literature: Published literature on cervical laminoplasties largely focuses on the outcomes of instrumented variants. Materials and Methods: Retrospective data were collected from 54 patients who underwent uninstrumented ODCL for cervical OPLL at a single institution from January 2010 to February 2017. The preoperative and postoperative modified Japanese Orthopaedic Association score (mJOA) and Nurick grading were documented. Cervical lordotic angle at C2–C7 and range of motion (ROM) were obtained from the preoperative and postoperative lateral cervical radiographs in neutral and flexion extension views, respectively. Descriptive and analytical statistics were generated by SAS 9.4 University Edition (SAS Institute, Cary. North Carolina, USA). Results: The average age was 58.6 ± 7.8 years. The average time of presentation from the onset of symptoms was 7.6 ± 3 months. Of the 54 patients who were included in the study, majority (48.14%) had segmental type of OPLL while C3–C6 was the most commonly operated level (66.67%). The mean operating time was 115 ± 31 min with a mean blood loss of 165.9 ± 75 ml. There was a significant improvement in the mJOA scores (9.2 ± 1.1–13.7 ± 0.9, P < 0.0001) and Nurick grading (3.4 ± 0.8–1.6 ± 0.5, P < 0.0001) at 24-month followup. Preoperative C2–C7 angle had an average decrease of 4.5° at 24-month followup (19.3 ± 7.2–14.8 ± 8.8, P < 0.0001). There was a mean reduction of 4.3° ± 3.78° noted in the C2–C7 ROM between the preoperative and final followup. Conclusion: Uninstrumented ODCL is an easily reproducible and economical alternative to the standard instrumented laminoplasty with equivalent short term outcomes. This technique is a valuable option in the treatment of cervical OPLL, especially in regions with scarce resources.