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Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique.

This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology.

The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure.

Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.

Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.

The standard treatment for a fixed coronal malalignment of the craniovertebral junction is an anterior and/or posterior column osteotomy (PCO) plus instrumentation. However, the procedure is very challenging, carrying an inherently high risk of complications even in experienced hands. This case series demonstrates the usefulness of an alternative treatment that adds a unilateral spacer distraction (USD) to the subaxial cervical facet joint to promote coronal realignment and fusion.

A single-center retrospective study of the patients with fixed coronal malalignment of the craniovertebral junction caused by different etiologies treated with USD in the concavity side with PCO in the convexity side of the subaxial cervical spine. Demographic characteristics and radiological parameters were collected with special emphasis on clinical and radiological measurements of coronal alignment of the cervical spine.

From 2012 to 2019, four patients were treated with USD of the subaxial cervical spine complementing an asymmetrical PCO at the same level. The causes of coronal imbalance were congenital, tuberculosis, posttraumatic, and ankylosing spondylitis. The level of USD was C2-C3 in three patients and C3-C4 in one patient. A substantial coronal realignment was achieved in all four. One patient had an iatrogenic vertebral artery injury during the dissection and facet distraction and developed Wallenberg's syndrome with partial recovery.

USD of the concave side with unilateral PCO of the convexity side in the subaxial cervical spine is a promising alternative treatment for fixed coronal malalignment of the craniovertebral junction from different causes.

USD of the concave side with unilateral PCO of the convexity side in the subaxial cervical spine is a promising alternative treatment for fixed coronal malalignment of the craniovertebral junction from different causes.

The C1-C2 fixation technique revolutionized the management of complex craniovertebral junction (CVJ) anomalies. Presently used polyaxial screw and rod systems have inadvertent technical difficulties in rod fitting and reduction of atlantoaxial dislocations (AAD) requiring forceful joint handling. The purpose of this study is to analyze the use of a specially designed "reduction screw" in C1 lateral mass in C1-C2 fixation for treating AAD with or without basilar invagination (BI).

This is a retrospective cohort study in which long lateral mass reduction screws were used for C1-C2 fixation.

Eighteen patients diagnosed with congenital AAD with or without BI treated with C1-C2 fixations using C1 reduction lateral mass were included in the study. selleck The outcome was measured clinically by the modified Japanese Orthopedic Association score and radiologically by conventional craniometric indices.

Among all cases included in the study, 72% (13/18) are males and 18% (5/18) are females with average age at presentation of 33.5 years. Among 18 cases of AAD, 84% (15/18) of patients have BI, 22% (4/18) have Chiari Type 1 malformation, and one patient has Klipple-Feil syndrome. Symptomatic improvement is noted in all patients following surgery. Adequate reduction of AAD with normalization of radiological indices was also achieved in all 18 (100%) patients.

C1 lateral mass reduction screw in C1-C2 fixation helps in reduction of AAD and BI (Type A) even in difficult cases of CVJ anomalies with intraoperative technical ease, reduced operative time, no need for special instruments or complex maneuvers, and avoiding potential neurological injury.

C1 lateral mass reduction screw in C1-C2 fixation helps in reduction of AAD and BI (Type A) even in difficult cases of CVJ anomalies with intraoperative technical ease, reduced operative time, no need for special instruments or complex maneuvers, and avoiding potential neurological injury.Aspergillus spinal epidural abscess (ASEA) is a rare entity that may mimic Pott's paraplegia as it commonly affects immunocompromised patients. We present one institutional case of ASEA with concomitant review of the literature. A 58-year-old female presented with intermittent low back pain for 10 years recently aggravated and with concurrent spastic paraparesis, fever, and weight loss. Emergent magnetic resonance imaging (MRI) showed T11-T12 epidural abscess with discitis and osteomyelitis. After empirical treatment with antibiotics, computed tomography-guided, percutaneous biopsy with drainage was performed, showing granulomatous tubercular-like collection. Antitubercular therapy was initiated, but after 1 month, the patient's condition deteriorated. Repeat MRI showed growth of the spinal epidural abscess with significant cord compression and vertebral osteomyelitis. T11-T12 laminectomy and tissue removal were performed with a posterior midline approach. Tissue histopathology showed necrotic debris colonies of Aspergillus spp. Antifungal therapy was started, and the patient rapidly improved. ASEA may mimic Pott's disease at imaging, leading to immediate start of antitubercular treatment without prior biopsy, leading to severe worsening of patients' clinical status. Cases of ASEA should be considered at pretreatment planning, opting for biopsy confirmation before treatment initiation so to prevent the occurrence of fatal infection-related complications.

Recurrent disc herniation is a common condition that often results in months of disabling symptoms and additional costs.

The objective of this study was to investigate the incidence of recurrent disc herniation in patients treated surgically.

Clinical trials and prospective studies involving patients treated with different techniques, such as open, percutaneous, or microendoscopic discectomy, were included. The incidence of recurrence as well as the level and the time until the recurrent disc herniation was collected.

Thirteen studies were included. Recurrence of disc herniation ranged from 0% to 14% of patients. Most recurrences occurred at the same level of herniation and on the same side. The time to recurrence of disc herniation ranged from 1 to 5 years.

This study answers the question of how much, when, and where in lumbar recurrent disc herniation.

This study answers the question of how much, when, and where in lumbar recurrent disc herniation.

The purpose is to investigate if a correlation existed between the frequency of cervical degenerative disc disease occurrence and cranial incidence (CI) angle.

A retrospective analysis of case series. Sagittal parameters of the case series were compared with the sagittal parameters of the same number of consecutive patients with neck pain only but no cervical degenerative disc disease (CDDD). Moreover, CI angle values were noted to be significantly different among groups on variable-based examination. Furthermore, the cervical lordosis (CL) values of men were observed to be significantly different. Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis.

No intergroup differences were noted regarding gender and age distribution (

= 0.565;

= 0,498). A significant intergroup difference was observed regarding CS values and the mean vector of CI angle and CL values for men and women (

= 0.002). CI angle values were noted to be significantly different among groups upon variable-based examination (

< 0.001). The CL values of men were observed to be significantly different, but not the CL values of women (

= 0.850). Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis.

A reverse correlation between CI angle and CDDD development is demonstrated. This correlation is valid between CL and CDDD development. Therefore, cervical sagittal profile and the CI angle and CL measurements should be performed to follow-up patients with cervical pain.

A reverse correlation between CI angle and CDDD development is demonstrated. This correlation is valid between CL and CDDD development. Therefore, cervical sagittal profile and the CI angle and CL measurements should be performed to follow-up patients with cervical pain.Giant cell tumor (GCT) is an intermediate malignant bone tumor which mostly involves long extremity bones, less commonly involving the spine with sacral predominance. Cervical spine involvement is rare. According to literature, the selective approach for the treatment of GCT is en bloc resection with spinal reconstruction. For unusual sites, such as cervical region, which is a mobile spinal segment and critically proximate to the cervical spinal cord, great vessels, and vital organs, it is almost impossible to perform the selective approach for treatment. Alternative approaches in such situations are under investigations. We present a case of C2 vertebral body GCT, who was treated with polymethylmethacrylate intravertebral injection and was followed by adjuvant therapy with denosumab. A 16-year-old boy without any past medical history presented with progressive suboccipital and axial neck pain since 3 months earlier, which had not responded to conservative treatments. There was no neurologic deficit, and pain was significantly controlled. In the 1-year follow-up, no complication and tumor recurrence was seen. Vertebroplasty with bone cement for lytic spinal GCT lesions, followed by adjuvant therapy with denosumab, not only is a less invasive treatment but also has good results in spinal stability, patient recovery, and 12-month recurrence.