We report a case of a progressive bilateral C5 palsy (C5P) following multilevel posterior cervical decompression and fusion surgery that was successfully treated with conservative management. A 58-year-old female patient with ossification of the posterior longitudinal ligament and resulting spinal canal stenosis underwent surgery in August 2015. Weakness in her both deltoid and biceps muscles was immediately detected after surgery and gradually deteriorated to severe paresis in the following 2 days. Postoperative magnetic resonance imaging showed sufficient decompression of the spinal cord with posterior shifting. However, residual neuroforaminal bilateral stenosis at levels C4/5 and C5/6 was found on postoperative computed tomography. After discussion of the therapeutic options, we decided to start conservative management including physical therapy and to follow the patient closely including clinical and neurophysiological examinations for the next 12 months. After 3 months, improvement of bilateral paresis was already evident. Muscle strength in the right biceps and the right deltoid muscles recovered completely within a year, but Grade 4 muscle weakness remained in the left deltoid and biceps muscles. Repetitive electromyography also showed continuous improvement of the interference patterns of the deltoid and biceps muscles. Although a standard management protocol for the treatment of postoperative C5P has not yet been established, a conservative therapy may be warranted even for severe and bilateral C5P.

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Background and Objective: Spinal cord injury (SCI) is a medically complex and life-disrupting condition that carries a high risk of morbidity and mortality. Dry mouth from xerostomia-causing medications, barriers to dental care access, dependence on others for oral hygiene significantly increase the risk of oral health problems. Hence, this study is contemplated to assess the association between oral health status and oral health-related quality of life (OHRQoL) among SCI patients. Materials and Methods: This cross-sectional study was conducted among 55 SCI patients. Data pertaining to the demographic details and socioeconomic status were also recorded through the Modified Kuppuswamy scale, 2016. The oral health status was recorded using the World Health Organization Proforma, 2013, and OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14) questionnaire. Descriptive statistics included computation of percentages, means, and standard deviations. Wilcoxon-signed ranks test was used to compare the association between mean OHIP and oral health status. Results: Forty-five of them had incomplete level of spinal injury and ten had complete level of spinal injury. Incomplete injury patients had higher decayed, missing, and filled teeth, gingival bleeding, and periodontal pocket, OHIP score compared to complete injury patients. The mean OHIP was 16.22. There was a significant association between mean OHIP and oral health status of the study participants (P = 0.000). Discussion and Conclusion: Oral health appears to be compromised in people with SCI. There was a significant association between the oral health status and OHRQoL. Oral health education for patients and caregivers on oral health-care issues should be encouraged and facilitated.

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Cauda equina syndrome (CES) is an orthopedic emergency. The common causes of CES are intervertebral disc prolapse and traumatic injuries of the spine. We report an unusual case of vertebral endplate erosion into the spinal canal leading to CES. We report a 37-year-old male patient who had a history of low back pain radiating to both the legs for 1 month. He was receiving treatment at a local hospital. He presented to our emergency department with the inability to stand, walk, or void for 1 day. Radiographs and magnetic resonance imaging confirmed CES due to intervertebral disc prolapse. Our patient's diagnosis of vertebral endplate extrusion was made intraoperatively when the extruded material was found to be hard in consistency, and histopathological analysis confirmed the diagnosis. A diagnosis of vertebral endplate causing CES has been reported only in adolescents but never in adults. Preoperative computed tomography scans can help in easy diagnosis.

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Granulicatella species commonly known as nutritionally variant streptococci (NVS) are part of the normal oral flora and are found in the endocardium, dental plaques, dental abscesses, and endodontic infection. Severe complications may arise due to its ability to cause a variety of serious infections. The presence of Granulicatella species in spine or surgical site was never noticed or reported. Here, we present a rare case of G. adiacens in the muscular plane of L5–S1 vertebrae which were diagnosed radiologically and also microbiologically to give appropriate treatment to the patient for recovery.

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Solitary plasmacytoma arising as a primary bone tumor at the craniovertebral junction is very rare, with only a few cases reported in the literature. Here, we present a 62-year-old female who presented with complaints of neck pain and restricted neck movements of short duration. She had features of upper motor neuron involvement in all the limbs, but the motor power was preserved with no bladder symptoms. The magnetic resonance imaging of the cervical spine revealed an expansile lytic lesion at the craniovertebral junction, involving the C2 vertebral body and posterior elements of C1 and C2. The bulk of the mass was extending posteriorly and compressing the cord. Since there was a chance of neurological deterioration due to the extensive anterior and posterior column involvement, we went ahead with surgical decompression of the lesion posteriorly. The posterior component was near totally decompressed, and the spine was stabilized with occiput-C3 fixation and fusion using rib grafts and steel wires due to financial constraints. The postoperative period was uneventful, and she was followed up for 2 months during which there was no neurological deterioration. Subsequently, she was lost to follow-up. She did not undergo radiation therapy or myeloma workup due to financial limitation. The histopathological examination of the lesion revealed plasmacytoma.

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Purpose: To evaluate the reliability and validity of anonymous web-based surveys on back pain-related disability by comparing psychometric properties of identical Web-based and paper-based PROMs. Methods: The tested instrument was the Core Outcome Measure Index (COMI), a PROM specific to the low back pain. The WBS was open and anonymous, the Paper-Based Survey (PBS) was administered in several hospitals. Besides COMI both surveys contained assorted questions enabling testing of key psychometric properties. Results: A total of 2318 respondents completed the WBS, 2285 were included in the study, the response rate was 40.60%. 169 subjects completed the PBS, data of 164 was included. The properties evaluated with a single test administration, i.e.: floor and ceiling effect, internal consistency, exploratory factor analysis, and convergent validity were very similar in both groups. The test-retest validity requiring repeated test administration was negatively affected by the low rate of returning respondents in the WBS group. Conclusions: The comparison of two methods of survey administration shows that the open anonymous web-based surveys are valid and reliable sources of data.

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Background: Early-onset spinal deformities are still challenging to pediatric orthopedic surgeons. One still looks for the ideal treatment of these deformities. Preservation of thoracic motion, spine growth, and protection of cardiac and lung function are crucial to the success of the treatment. Purpose: The purpose of this review is to present the reader's brief description of available methods of treatment of early- onset scoliosis (EOS). Methods: Authors searched the PubMed for locating and selecting the data. Extracting and synthesizing the data were done by orthopedic surgeons based on their knowledge and experience in the treatment of EOS patients. Results: The current treatment techniques include nonsurgical strategies, such as body cast or brace in younger patients with a smaller curve (<50°). Surgical treatment of spinal deformity should be considered when progression increases. Definitive fusion is rarely indicated in young patients. Strategies based on compression (staples or tethers), distraction (growing rods, vertical expandable prosthetic titanium rib), and growth guiding (Shilla, growth guidance system) are presented with their advantages and disadvantages. Repeated surgeries – planned and unplanned are burdensome for patients. Although technology improves, the complication rates in the treatment are still high. Conclusion: Treatment of EOS is challenging. Although much is already known about the treatment of children with EOS, there is still no gold standard in proceedings.

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Purpose: Our project focuses on assessing the possibility of spinal cord regeneration after its injury. Trying to find an effective therapy is possible nowadays because of modern pharmacology and molecular biology achievements. Materials and Methods: The object of research is male Wistar C rats. To obtain a selective and repeatable spinal tissue damage, we use the pressure impactor. Then, rats are administered with various types of therapeutic substances, which are considered to have a neuroprotective function. Afterward, the effect of our experiment is precisely measured by CatWalk XT device which measures numerous gait parameters. Results: It was found that several parameters significantly varied between therapeutic groups, in particular, MaxContactArea, PrintLength, PrintWidth, PrintArea, SwingSpeed, and StrideLength. Conclusions: CatWalk testing is a simple yet robust tool gait analysis in rats after spinal cord injury.

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Context: The Diffusion Tensor Imaging (DTI) is a modality of the MRI describing the integrity white matter tracts of the neural tissue by mean of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Aims: The aim of the study is to assess the usefulness of DTI in the acute assessment of patients after cervical tSCI. Settings and Design: Pilot prospective control-matched non-randomised experimental study. Materials and Methods: Five cervical tSCI patients were prospectively enrolled into the study. Neurological examination was followed by the MRI scan with DTI FA and ADC of the injured segments of the cervical spine. Obtained values were compared to the reference (healthy volunteers) by mean of statistical analysis. Statistical Analysis Used: SPSS 21.0 and MedCalc 12 software; non-parametric Spearman's rank correlation was used. The significance level was established as P < .05. Results: The FA correlated negatively with the ASIA motor score (-0.90, P = 0.037) and severity of neurological deficits (ASIA type A-E) (-0.95, P = 0.014). The ADC was positively correlated with ASIA motor score for upper limbs (0.86, P = 0.046). Two patients found with ADC higher than the reference presented early neurological recovery. Conclusions: DTI appears to be useful in the early assessment of tSCI. The FA reflects functional status of the spinal cord whilst ADC may serve a potential prognosticator.

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Purpose: The purpose of the study was to determine the influence of the loading history on changes in the recorded pressure in the intervertebral disc (IVD) and the influence of changes in the support conditions as a result of the removal of facet joints on changes in pressure. Materials and Methods: The tests were carried out on motion segments of the thoracic spine for the physiological system (with articular processes preserved) and the pathological system (with articular processes removed). Our analysis assessed changes in intradiscal pressure for three consecutive loadings, i.e., cyclic compression loading, compression loading constant in time, and unloading. The tests were conducted while maintaining full hydration of the IVD. Results: During cyclic loading, we observed a progressive decrease in intradiscal pressure. Suppression of the pressure decrease is clearly visible in the system with the preserved complete articular triad, which should be regarded as characteristic of a properly functioning system. Constant compression loading caused a progressive decrease of intradiscal pressure in all tested systems. In general, greater decreases were recorded in the systems with articular processes removed. A decrease in intradiscal pressure leads to a simultaneous change in the stiffness of the analyzed systems. The process of relaxation was unstable and showed an upward trend throughout the unloading period. Conclusion: The obtained results clearly indicate that facet joints play an important role in the transmission of loads by the spinal column and that those structures play a protective role in the overload conditions of the IVD.

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Low back pain is a frequently encountered issue in pregnant women affecting >50%; incidence of low back pain secondary to lumbar disc herniation in pregnancies is low (1:10000). Cauda equina syndrome from lumbar disc herniation is a serious complication; delay in diagnosis and treatment can be a cause of chronic disability secondary to neurological sequelae. Numerous cases of disc herniation in pregnancy have been reported; however, cauda equina syndrome as a result of disc herniation is rare (2%). Here we are reporting a rare case of cauda equine syndrome in a pregnant woman at 16-week gestation is presented. We present a rare case of 30-year-old woman (G3P2L0) at 16-week gestation, presented initially at an emergency department at a district level hospital with low backache radiating to both the lower limbs treated with pain medications; 48 h later, the patient presented to us with bilateral foot drop with saddle anesthesia, urinary and fecal incontinence. On physical examination, the patient has bilateral foot drop with complete weakness of extensor hallucis longus and ankle inversion of both feet. The lumbar magnetic 'g (MRI) scan showed massive central disc herniation in L4–L5 level with severe central canal stenosis. After assessment by the anesthesiology and gynecology departments using a posterior approach under prone position, bilateral laminotomy and discectomy was performed at L4-L5 level. No complications were observed in the mother and the fetus during and after the surgery. Pain has subsided immediate post-op, three months after surgery, the patient was walking normally with minimal saddle hypoesthesia. The pregnancy proceeded normally, and she gave birth for full-term baby without any complications delivered by cesarean section. Clinical picture of low back pain is very frequent during pregnancy. However, we should perform an MRI scan for sudden onset of sciatica associated with loss of strength, bowel, and bladder disturbance. Patient diagnosed with cauda equina syndrome should undergo emergency surgery to minimize neurological sequelae.

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Fusobacterium necrophorum is an anaerobic Gram-negative bacillus classically associated with the Lemierre syndrome. Although it can cause a localized infection, it is rarely a culprit of a spinal epidural abscess. We report a case of a spinal epidural abscess caused by Fusobacterium necrophorum complicated by meningitis. The patient, two years earlier treated surgically for cervical spondylotic myelopathy with corpectomy, presented with a new-onset severe neck pain and progressive tetraparesis. Based on imaging studies spinal epidural abscess was diagnosed. Despite intensive surgical treatment and subsequent antibiotic therapy the patient gradually deteriorated and eventually died. Fusobacterium necrophorum was identified as a culprit. Fusobacterium necrophorum is a very rare cause of spinal epidural abscess (SEA). Because of high virulence of this pathogen localized infection can progress rapidly into a generalized septicemia and life-threatening neuroinfection.

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Background: Os odontoideum is a congenital anomaly or a posttraumatic event of the C2 vertebra (dens), in which the odontoid process is separated from the body of the axis by a transverse gap. Trivial trauma aggravates the condition resulting in atlantoaxial dislocation (AAD) which needs stabilization. Materials and Methods: In our study, we have five patients with os odontoideum, who had developed quadriparesis after minor cervical trauma. All of them underwent C1–C2 posterior stabilization by Harms technique (C1 lateral mass screw and C2 pedicle screw with rod reconstruction), and postoperatively, all the five patients showed a significant improvement from the quadriparesis. Results: All the patients in this case series showed significant improvement in motor power following posterior C1 C2 stabilization. Conclusion: AAD following a trivial trauma in cases of os odontoideum needs to be stabilized to form solid fusion. To achieve that, the Harms technique of C1–C2 fusion is a very effective method.

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Objective: The objective of this study was to verify whether semaphorin 3A (Sema3A) participate in the immunoregulation of T helper 17 cells related inflammatory process and to identify novel serum markers in the immunoregulation in ankylosing spondylitis (AS). Methods: A total of 59 untreated male AS patients and 61 age-matched male normal controls were recruited for the study. The study was approved by the Institutional Review Board. The venous blood of all participants was drawn from just above the elbow with patients' consent. Serum Sema3A, tumor necrosis factor-α (TNF-α), and interleukin-21 (IL-21) levels were evaluated using enzyme-linked immunosorbent assay analysis in both AS patients and normal controls. The optical density was assessed at 450 nm using a microtiter plate reader. Then, the concentration of the target serum marker was measured on the constructed standard curve. Results: We found that serum levels of Sema3A, TNF-α, and IL-21 were all higher in AS patients than normal control (47.5 ± 5.3 vs. 40.2 ± 4.0, 182.6 ± 38.1 vs. 47.5 ± 7.7, 190.3 ± 29.8 vs. 93.3 ± 21.0, P < 0.01). Serum level Sema3A was demonstrated to be statistically significantly positive correlated with both TNF-α and IL-21. Serum levels of Sema3A, TNF-α, and IL-21 were all higher in AS patients than normal control. Conclusion: Sema3A was a potential novel putative factor in the immunoregulation of inflammatory response in AS.

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Background and Objective: Spinal surgery becomes ever safer and the success rate is constantly increasing. Nevertheless many patients present poor outcomes despite apparent technical success. Proper selection of patients is key, but it is virtually impossible to provide a clear algorithm as there are great many aspects to be considered. The purpose of this study was to assess the potential of anonymous web surveys as screening tools for factors predicting poor outcomes of surgery. The hypothesis was that frequent users of health-care services (FUOHS) are worse surgical candidates. Methods: An open anonymous and interactive web surveys were placed within a web portal concerning the spinal health. It was comprised of three sections: first one focused on demographics and information regarding the surgery, second being the Core Outcome Measures Index questionnaire, and the third containing additional information. Results: A total of 425 subjects completed the questionnaire. After removing multiple entries, the final number of subjects included in the study was 411. The relative risk of an unfavorable outcome in a FUOHS group was 3.63 compared with the rest. Likewise, the relative risk of reporting complications in this group was 1.94 though it reached the statistical significance only in the subgroup of patients who had a surgery on a lumbar segment. Discussion and Conclusions: The web surveys can help identify factors that can predict bad outcomes of surgical treatment. In this case, it was shown that frequent visits to doctors' office for reasons other than spine-related is a negative prognostic factor for good outcome of spine surgery.

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