Effect on functional outcome of robotic assisted rehabilitation versus conventional rehabilitation in patients with complete spinal cord injury: a prospective comparative study.

STUDY DESIGN: Prospective Comparative Study. OBJECTIVE: This study aims to compare the functional outcomes of Robotic-assisted rehabilitation by Lokomat system Vs. Conventional rehabilitation in participants with Dorsolumbar complete spinal cord injury (SCI). SETTING: University level teaching hospital in a hilly state of northern India. METHODS: 15 participants with Dorsolumbar SCI with ASIA A neurology were allocated to robotic rehabilitation and 15 participants to conventional rehabilitation after an operative procedure. Pre-and Post-rehabilitation parameters were noted in terms of ASIA Neurology, Motor and sensory function scores, WISCI II score (Walking Index in SCI score), LEMS (Lower Extremity Motor Score), SCI M III score (Spinal Cord Independence Measure III score), AO Spine PROST (AO Patient Reported Outcome Spine Trauma), McGill QOL score (Mc Gill Quality of Life score), VAS score (Visual Analogue Scale) for pain and Modified Ashworth scale for spasticity in lower limbs. RESULTS: On comparing robotic group with conventional group there was a statistically significant improvement in Robotic-assisted rehabilitation group in terms of Motor score (p = 0.034), WISCI II score (p = 0.0001), SCIM III score (p = 0.0001), AO PROST score (p = 0.0001), Mc GILL QOL score (p = 0.0001), Max velocity (p = 0.0001) and Step length (p = 0.0001). Whereas LEMS score (p = 0.052), ASIA neurology (p = 0.264 (ASIA A); 1.000 (ASIA B); 0.053 (ASIA C)), VAS score (p = 0.099), Sensory score (p = 0.422) and Modified Ashworth scale for spasticity (p = 0.136) were not statically significant when comparing between two groups. CONCLUSION: Robot-assisted rehabilitation is superior than conventional rehabilitation in people living with SCI with AIS A neurology. Differences in the patient group, type of a lesion its and severity, duration from onset to initiation of rehabilitation, devices employed, administration of the therapies and regulation of interventions are likely the cause of variations in the findings seen in the literature for robotic assisted training. LEVEL OF EVIDENCE: III.

Dual Joystick Technique for Reduction of Torsional Profile in Pediatric Supracondylar Humerus Fracture With Delayed Presentation.

BACKGROUND: Reduction of some modified Gartland type III and IV supracondylar humerus fractures can pose difficulties, especially if they present late to the hospital. Various techniques of reduction have been tried for reducing the supracondylar humerus fracture for sagittal and coronal plane correction. This retrospective study assesses the dual joystick technique's possible effectiveness in achieving an anatomical reduction of the supracondylar humerus fracture. METHODS: Patients with modified Gartland's type III and IV supracondylar humerus fractures who underwent closed reduction and percutaneous pinning using the dual joystick technique at our trauma center between January 2020 and January 2022 were the subject of a retrospective review. Forty-six patients treated by the above technique who met the inclusion criteria were analyzed at the end of the final follow-up. RESULTS: The mean age of the children was 7.9+/- 2.25 years, with a male predominance at 32:14. The Right upper limb was more involved compared to the left side. The mean injury to hospital presentation was 2.67+/- 1.28 days, and the mean surgical duration was 24.57+/- 13.76 minutes. The average pin spread ratio at the fracture site was 35.17+/- 3.04%. Baumann angle at the final follow-up was 74.83+/- 2.56 degrees. The mean lateral rotation percentage was 2.8+/- 1.3%. 39 patients had excellent cosmetic outcomes, and 42 had excellent functional outcomes, whereas 7 and 4 patients had good cosmetic and functional outcomes, respectively, according to Flynn criteria. CONCLUSIONS: In modified Gartland type III and IV fractures with late presentation where reduction is challenging, this technique is shown to be convenient and easily reproducible and helps accomplish near anatomical reduction with reduced lateral rotation percentage and results in excellent to good outcomes.

Can gabapentinoids decrease perioperative opioid requirements in orthopaedic trauma patients? A single-centre retrospective analysis.

INTRODUCTION: Perioperative pain control in patients with orthopaedic trauma/extremity fractures has gained a lot of attraction from the scientific community in the last two decades. In addition to multimodal analgesia, the use of non-opioid drugs like gabapentinoids for pain relief is gradually finding its place in several orthopaedic subspecialties like spinal surgery, arthroplasty, and arthroscopic procedures. We envisage investigating the effectiveness of gabapentin in perioperative pain control in patients with extremity fractures undergoing surgical fixation. METHODOLOGY: This was a retrospective comparative study conducted between January 2020 and January 2022. Patients with isolated fractures of the extremity involving long bones who were treated at our trauma centre, during the study period were divided into two groups based on the analgesics they received. Patients who received gabapentin and paracetamol were placed in group GP and those who received only paracetamol were assigned group NGP. Gabapentin was given in a single dose of 300 mg 4 h before surgery. Postoperatively, they were given 300 mg 12 hourly for 2 days. All patients in our trauma centre are usually managed with parenteral paracetamol administration pre and postoperatively. VAS score was calculated postoperatively at 2, 6, 12, 24 and 48 h. Patients requiring additional analgesics for pain relief were administered intravenous tramadol or a buprenorphine patch was applied. Patients in both groups were compared in terms of pain control, the additional requirement of opioid analgesics, and any adverse event related to medications. RESULTS: One hundred and nineteen patients were enrolled in the study. Out of 65 patients in the NGP group (non-gabapentin group), 74% of patients received additional opioid analgesics apart from paracetamol. Out of the 54 patients in the GP group (gabapentin group), only 41% required additional opioid analgesia for pain control. There was a significant difference in opioid consumption between the two groups (p < 0.01). VAS scores were not significantly different between the two groups at 2, 4, 6, 12, 24 and 48 h. Gender and fracture morphology did not affect opioid intake in the GP group. However, in the non-gabapentin group, there was a significant difference in opioid requirement in patients with intraarticular fractures (p < 0.01). CONCLUSION: Analgesic requirements vary from patient to patient depending on the injury's severity and surgery duration. However, there are no strict guidelines for pain relief in limb trauma surgeries which often leads to overuse and opioid-related complications or underuse and chronic pain. Gabapentinoids can supplement the analgesic effect of paracetamol in trauma patients during the perioperative period, decreasing the need for opioids.

Utility of clinicoradiological, microbiological, histopathological, and molecular methods in the diagnosis of spinal tuberculosis.

PURPOSE: The diagnosis of STB is mainly based on clinicoradiological observations substantiated by bacterial culture, staining, Gene Xpert, and histopathology. The purpose of the study was to correlate these methods to evaluate the effectiveness in the diagnosis of STB. METHODS: A total of 178 clinicoradiologically suspected cases of STB were included in the study. The specimens for diagnostic workup were collected either during surgery or by CT-guided biopsy. All these specimens were tested for tuberculosis through ZN staining, solid culture, histopathology, and PCR. The sensitivity, specificity, PPV, and NPV of each test were calculated using histopathology as a gold standard. RESULTS: Out of the 178 cases, a total of 15 cases were excluded from this study. Among the remaining 163 cases, TB was diagnosed in 143 [87.73%] on histopathology, 130 [79.75%] on Gene Xpert, 40 [24.53%] on culture, and 23 [14.11%] on ZN stain. The sensitivity, specificity, PPV, and NPV of Gene Xpert were 86.71, 70, 95.38, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of AFB culture were 27.97, 100, 100, and 16.26%, respectively. The sensitivity, specificity, PPV, and NPV of AFB stain were 16.08, 100, 100, and 14.29%, respectively. Gene Xpert showed a moderate agreement [Ƙc = 0.4432] with histopathology. CONCLUSION: No single diagnostic modality can ascertain the diagnosis, and it is desirable to have a combination of diagnostic batteries for better results. A combination of Gene Xpert and histopathology aids in early and reliable diagnosis of STB.

Simultaneous decompression of all stenotic regions versus decompression of only the most symptomatic region in patients with tandem spinal stenosis: a systematic review and meta-analysis.

PURPOSE: Selection of anatomic region of spine for decompression in patients with symptomatic tandem spinal stenosis (TSS) remains a challenge due to the confusing clinical presentation as well as uncertain evidence. A systematic review and meta-analysis of observational studies were conducted to compare the outcomes between simultaneous decompression of all stenotic regions (cervical and lumbar, Group 1) and decompression of only the most symptomatic stenotic region (cervical/lumbar, Group 2) in patients with TSS. METHODS: A systematic review was conducted, and a comprehensive literature search with well-established inclusion and exclusion criteria with JOA score as an outcome measure was done on PubMed, Google Scholar, and EMBASE database (till January 2021). Observational studies reporting outcomes after simultaneous decompression or only the most symptomatic region were included. NIH quality assessment tool was used to check the quality of each study, and treatment effects were calculated using Dersimonian and Laird random effects model. RESULTS: Ten studies were included in the analysis out of which all were retrospective observational studies (Level 4 evidence) except one (Level 3 evidence). Overall proportional meta-analysis showed no significant difference in change in JOA scores, operative time, blood loss, total and major complications between Group 1 and Group 2. However, minor complications were significantly increased on performing decompression of both regions simultaneously (p = 0.04). On performing subgroup analysis comparing cervical surgery cohort with lumbar surgery cohort, no difference was found in change in JOA score and requirement of second-stage surgery. CONCLUSION: Decompression of the most symptomatic region alone irrespective of its location has equal clinical outcomes with less complication rate than simultaneous decompression in patients with TSS.

Conundrum in surgical management of three-column injuries in sub-axial cervical spine: a systematic review and meta-analysis.

STUDY DESIGN: Systematic Review and Meta-analysis. PURPOSE: Three-column injuries making the spine unstable require adequate fixation which can be achieved by anterior alone, posterior alone or combined anterior-posterior approach. There is no general consensus till date on a single best approach in sub-axial cervical spine trauma. This study comparing the three approaches is an attempt to establish a firmer guideline in this disputed topic. MATERIAL AND METHODS: The protocol was registered with PROSPERO. PubMed, Embase and Google Scholar were searched for relevant literature. For each study, pre-defined data were extracted which included correction of kyphosis, loss of correction, hospital stay, operative time, blood loss during surgery as the outcome variables. Studies were also screened for the complications. RESULTS: Eleven studies were evaluated for qualitative analysis and quantitative synthesis of the data in our review. The result demonstrated significant difference with most correction achieved in combined approach subgroup. Though no significant difference was found, the anterior group was having maximum loss of correction. Combined approach showed significantly more operative time and blood loss followed by posterior approach and then anterior approach alone. The improvement in VAS was significantly more in anterior subgroup when compared to combined approach. CONCLUSION: Cervical alignment is best restored by combined approach compared to the other two. Anterior only approach showed more correction than posterior approach. However, there is no significant difference between all three approaches in loss of correction at long-term follow-up. Anterior only approach is superior to posterior and combined approach on basis of intraoperative and perioperative parameters. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Outcomes of Dorsolumbar and Lumbar Spinal Tuberculosis Treated by Minimally Invasive and Open Techniques: A Prospective Comparative Study.

Purpose of Study: To compare the outcomes of minimally invasive and open techniques in the surgical management of dorsolumbar and lumbar spinal tuberculosis (STB). Methods: Skeletally mature patients with active STB involving thoracolumbar and lumbar region confirmed by radiology (X-ray, MRI) and histopathological examination were included. Healed and mechanically stable STB, patients having severe hepatic and renal impairment, coexisting spinal conditions such as ankylosing spondylitis and rheumatoid arthritis, and patients unwilling to participate were excluded from the study. The patients were divided in to two groups, group A consisted of patients treated by MIS techniques and group B consisted of patients treated by open techniques. All the patients had a minimum follow-up of 24 months. Results: A total of 42 patients were included in the study. MIS techniques were used in 18 patients and open techniques were used in 24 patients. On comparison between the two groups, blood loss (234 ml vs 742 ml), and immediate post-operative VAS score (5.26 vs 7.08) were significantly better in group A, whereas kyphotic correction (16° vs 33.25°) was significantly better in group B. Rest of the parameters such as duration of surgery, VAS score, ODI score and number of instrumented levels did not show significant difference between the two groups. Conclusion: MIS stabilization when compared to open techniques is associated with significant improvement in immediate post-operative VAS scores. The MIS approaches at 2-year follow-up have functional results similar to open techniques. MIS is inferior to open techniques in kyphosis correction and may be associated with complications.

A perioperative predictive model of early mortality in acute cervical spinal cord injury: A prospective cohort study.

Background: Traumatic cervical spine injury is common among spinal cord injury which requires an intensive, multidisciplinary approach which can affect the immediate postoperative hospital survival rate. By identifying the risk factors leading to early mortality in cervical spine trauma patients, the prognosis of patients with TCSCI can be better predicted. Objective: The study aims to analyze the variables influencing in-hospital mortality in cervical spine trauma patients treated at a Level I trauma Center. Methods: Prospective study was conducted on subaxial cervical spine injuries from July 2019 to March 2022. Patients were divided into two groups: Group A, with in-hospital mortality, and Group B, who got discharged from hospital, and mortality predictors were reviewed and analyzed for as potential risk factors for in-hospital mortality. Results: Out of 105 patients, 83.8 % were male with mean age of 40.43 ± 12.62 years. On univariate analysis, AIS (p-value: <0.01), ICU stay (p-value: <0.01), level of injury (p-value: <0.01), and MRI parameters like the extent of Parenchymal damage (p-value: <0.01), MSCC (p-value: <0.01), and MCC (p-value: <0.01) were potential risk factors for in-hospital mortality. On multivariate regression analysis AIS at presentation (p-value: 0.02) was the only significant independent parameter for in-hospital mortality. Conclusions: AIS grading at presentation, duration of ICU stay, level of injury, rate of tracheostomy, and MRI parameters like the extent of parenchymal damage, MCC, and MSCC influence and predicts in-hospital mortality, whereas AIS is the only independent risk factor.

Epidemiology of Traumatic Spinal Cord Injury in the Himalayan Range and Sub-Himalayan region: A Retrospective Hospital Data-Based Study.

OBJECTIVE: To compile epidemiological characteristics of traumatic spinal cord injury (TSCI) in the Northern Indian Himalayan regions and Sub-Himalayan planes. METHODS: The present study is a retrospective, cross-sectional descriptive analysis based on hospital data conducted at the Department of Physical Medicine and Rehabilitation and Spine Unit of Trauma Centre in a tertiary care hospital in Uttarakhand, India. People hospitalized at the tertiary care center between August 2018 and November 2021 are included in the study sample. A prestructured proforma was employed for the evaluation, including demographic and epidemiological characteristics. RESULTS: TSCI was found in 167 out of 3,120 trauma patients. The mean age of people with TSCI was 33.5±13.3, with a male-to-female ratio of 2.4:1. Eighty-three participants (49.7%) were from the plains, while the hilly region accounts for 50.3%. People from the plains had a 2.9:1 rural-to-urban ratio, whereas the hilly region had a 6:1 ratio. The overall most prevalent cause was Falls (59.3%), followed by road traffic accidents (RTAs) (35.9%). RTAs (57.2%) were the most common cause of TSCI in the plains' urban regions, while Falls (58.1%) were more common in rural plains. In both urban (66.6%) and rural (65.3%) parts of the hilly region, falls were the most common cause. CONCLUSION: TSCI is more common in young males, especially in rural hilly areas. Falls rather than RTAs are the major cause.

Healing Assessment of Spinal Tuberculosis: A Systematic Review.

OBJECTIVE: Deciding the healing end point in spinal tuberculosis (STB) remains a controversial topic. The current systematic review aims to address the controversy existing in the literature to find a comprehensive method to assess healing in STB. METHODS: A thorough literature search was carried out for studies with the assessment of healing parameters in STB. Data extraction was carried out manually, which included study characteristics and healing criteria evaluated in each study. RESULTS: Qualitative analysis of 8 included studies showed that healing parameters were described in 3 domains: clinical, hematologic, and radiologic response of the patient to antitubercular chemotherapy. Each domain included various individual parameters, with clinical and radiologic assessment criteria being used in most of the studies. Improvement in terms of pain, constitutional symptoms, weight gain, neurology; variation in erythrocyte sedimentation rate and C-reactive protein; and changes in radiography, magnetic resonance imaging, and positron emission tomography/computed tomography were found to be promising predictors in the assessment of healing. CONCLUSIONS: Radiologic response parameters emerged as the maximally used criteria to assess healing in STB. However, in the absence of any statistical analysis and an observed lag in radiologic response, the cumulative effect of all the parameters in 3 domains (clinical, hematologic, and radiologic) can be used to declare a spinal tubercular lesion nonhealing, healing, or healed.

Is it Safe to Save Levels and Choose the Lowest Instrumented Vertebra as Touched Vertebra While Selectively Fusing Lenke 1/2 Curves? A Proportional Meta-Analysis of Existing Evidence.

STUDY DESIGN: Meta-analysis. OBJECTIVE: To compare the clinical and radiological outcomes in patients with Adolescent Idiopathic scoliosis (AIS) treated by selective thoracic fusion (STF) with lowest instrumented vertebra (LIV) at touched vertebra (TV) vs stable vertebra (SV). METHODS: The databases PubMed, Embase and Google Scholar were searched until November 2020.Studies which had Lenke type 1 curves and Lenke type 2 curves in adolescent population treated by STF and which reported pre- and post-operative curve characteristics including correction percentage and complications were included. Studies which did not report the LIV selection, curve correction percentages and whose full text could not be acquired were excluded. RESULTS: Eight studies were included for analysis of which seven were found to be retrospective studies (level III evidence) and one was prospective study (level II evidence) each. Overall proportional meta-analysis found no significant difference in correction rate, total srs-22 scores, and complication rates. CONCLUSION: The evaluation of SV group and TV group as LIV for selective thoracic fusions in AIS reveals a comparable outcome in terms of curve correction, patient satisfaction scores and complication rates. The TV can be chosen safely as the LIV especially in type A and B Lenke 1&2 curves, as it saves more motion segments when compared to SV.

Deformity Correction with Interbody Fusion Using Lateral versus Posterior Approach in Adult Degenerative Scoliosis: A Systematic Review and Observational Meta-analysis.

This study was designed to systematically review and meta-analyze the functional and radiological outcomes between lateral and posterior approaches in adult degenerative scoliosis (ADS). Both lateral (lumbar, extreme, and oblique) and posterior interbody fusion (posterior lumbar and transforaminal) are used for deformity correction in patients with ADS with unclear comparison in this cohort of patients in the existing literature. A literature search using three electronic databases was performed to identify studies that reported outcomes of lateral (group L) and posterior interbody fusion (group P) in patients with ADS with curves of 10°-40°. Group P was further subdivided into minimally invasive surgery (MIS-P) and open posterior (Op-P) subgroups. Data on functional, radiological, and operative outcomes, length of hospital stay (LOHS), fusion rates, and complications were extracted and meta-analyzed using the random-effects model. A total of 18 studies (732 patients) met the inclusion criteria. No significant difference was found in functional and radiological outcomes between the two groups on data pooling. Total operative time in the MIS-P subgroup was less than that of group L (233.86 minutes vs. 401 minutes, p <0.05). The total blood loss in group L was less than that in the Op-P subgroup(477 mL vs. 1,325.6 mL, p <0.05). Group L had significantly less LOHS than the Op-P subgroup (4.15 days vs. 13.5 days, p <0.05). No significant difference was seen in fusion rates, but complications were seen except for transient sensorimotor weakness (group L: 24.3%, group P: 5.6%; p <0.05). Complications, such as postoperative thigh pain (7.7%), visceral injuries (2%), and retrograde ejaculation (3.7%), were seen only in group L while adjacent segment degeneration was seen only in group P (8.6%). Lateral approach has an advantage in blood loss and LOHS over the Op-P subgroup. The MIS-P subgroup has less operative time than group L, but with comparable blood loss and LOHS. No significant difference was found in functional, radiological, fusion rates, pseudoarthrosis, and complications, except for transient sensorimotor deficits. Few complications were approach-specific in each group.

Floating Thoracic Spine Due to Noncontiguous Fracture-Dislocations of the Thoracolumbar Spine.

The thoracolumbar spine is the most commonly afflicted area in vertebral column injuries. Here we bring up a case of a 20-year-old male who presented to our emergency department with a history of a high-velocity road traffic accident with noncontiguous two-level fracture-dislocations of the thoracolumbar spine with blunt trauma to the chest. The patient was managed with posterior reduction and instrumented postero-lateral fusion. Such an injury pattern has been reported only rarely in the literature. This report expects to highlight the unusual fracture pattern of a common injury and the challenges of managing such severe injuries intra-operatively and in the post-operative period.

Kneeling Stress Radiography: A Forgotten Yet Dependable Tool for Postero-lateral Knee Instability.

Introduction: Diagnosing postero-lateral knee instability is a challenge from both clinical and radiologic perspective and can lead to significant morbidity if left untreated. Delayed diagnosis leads to a more demanding surgery and prolonged rehabilitation for the patient. Kneeling stress radiograph is a lost art but remains invaluable in the assessment of postero-lateral knee instability. Methods: This prospective observational study is aimed at re-exploring the undeniable utility of this forgotten tool in early diagnosis of posterolateral knee instability and identifying the mean posterior tibial translation distance (PTTD) and also assessing side to side difference (SSD) between the injured and the contralateral normal knee. Results: Total 27 patients were included in the study, with males being 4.4 times more commonly injured as compared to females. The most common mode of injury was motor vehicle accident (MVA). Out of 27 patients, 11 had isolated PCL (posterior cruciate ligament) injury while the rest had PLC (posterolateral corner) involvement. The mean SSD of PTTD was 8.79 mm in patient with isolated PCL. This was increased by 1.65 times (14.52 mm) in patients with co-existing PLC involvement. Conclusion: Stress radiography is an indelible tool and serves as an adjunct to MRI imaging. It is not a substitute for clinical assessment but assists in early diagnosis and management, facilitating surgical planning and furnishing objective evidence of PCL/PLC functionality which is not possible with any other imaging modality.

Management of Andersson lesions of spine: A systematic review of the existing literature.

Introduction: Andersson lesions also termed as aseptic spondylodiscitis, spinal pseudoarthrosis are known to occur in patients with ankylosing spondylitis. Trauma as well as inflammation has been cited as factors responsible for the causation of these lesions. A variety of surgical approaches have been described in the literature such as anterior, posterior, combined anterior and posterior, with or without reconstruction of the anterior column defect. Controversy still exists regarding the optimal management these lesions. Objective: To address the optimal method of management, levels of instrumentation, requirement of fusion and anterior instrumentation and general epidemiological profile of the patients with Andersson lesions. Materials and methods: An electronic search for studies on the surgical management of Andersson lesions of spine was performed. Quality assessment of the included articles was done by two independent authors according to the criteria used by researchers previously in systematic reviews. Results: Males were found to have an increased incidence with the thoracolumbar junction being the most common level. Posterior approach was the most favoured with reconstruction of the gap in the anterior column. Posterior osteotomy with correction of deformity was done commonly for an optimal healing environment. Instrumenting 2-3 levels above and below the lesion is favoured by most. Conclusion: Conservative management for Andersson lesions can be employed in the setting of acute trauma and stable fractures involving a single column. Surgical management of these lesions with a posterior long segment fixation and anterior column reconstruction is the favoured treatment in majority of the cases.

A comprehensive 3D CT based classification of intertrochanteric fracture.

Introduction: Despite advancements in surgical techniques complications like implant failure is very common after the fixation of intertrochanteric fractures. Classifying these complex fractures based on plain radiographs underestimates the complexity of these fractures which in turn leads to complications. We propose a comprehensive classification of the intertrochanteric fractures based on 3D Non Contrast Computed Tomography (3D NCCT) scan. Material and methods: A total of 102 patients (51 males and 51 females) with intertrochanteric fractures were included in this study conducted over a time period of 22 months in a Tertiary care center in North India. NCCT proximal femur of the intertrochanteric fracture patients was done to formulate a new CT classification system and classify all fractures. Intra and inter-observer reliability was tested using kappa variance. Results: New classification system was proposed which included 3 main and a total of 6 groups. All the fractures were classifiable into the new system. Kappa variance of the study showed a good intra and interobserver reliability (0.95 and 0.90) proving clinical agreement of the classification. Conclusion: This new 3D-CT based classification has the advantages of being easy, comprehensible with high intra and inter-observer reliability. This 3DCT based classification can prove to be useful to detect occult intertrochanteric fractures undetectable in plain radiographs as well as choosing the optimum treatment plan.

Neglected floating cervical spine fracture with myelopathy and Anderson lesion of D2 D3: report of an unusual case.

INTRODUCTION: The cervical spine is the most commonly affected region in traumatic spine injuries of patients with Ankylosing Spondylitis (AS), accounting for 75% of cases, followed by the thoracic and lumbar spine. The fracture may not be detectable in plain radiographs alone due to pre-existing kyphotic deformity with distorted anatomy and high-riding shoulders. CASE PRESENTATION: We present a case with a floating cervical spine following a trivial trauma injury and with cervical myelopathy symptoms. After posterior fixation of the cervico-thoracic spine, the patient improved with Nurick score and mJOA score improvement. After 6 months follow up the patient was walking without support, and myelopathy symptoms were negligible. DISCUSSION: In this patient, a posterior approach was performed. We obtained a rigid construct so that we were able to mobilize a patient on the very next day and his myelopathy symptoms improved with minimal postoperative complications.

Acute spine care services during covid-19 pandemic and 'lockdown': case series and our perspective from a level 1 trauma centre.

STUDY DESIGN: Case Series. OBJECTIVE: Sudden 'lockdown' to contain spread of SarsCoV-2 infection had far-reaching consequences on the Spine Unit of our tertiary care hospital, situated in a hilly-region of Northern India. We intend to share our experience of providing care for acute spinal disorders from 23rd March, 2020, when nationwide lockdown and closure of elective services started in our country, to till 12th May, 2020, and to formulate few recommendations at the end. SETTING: Northern India. METHODS: Between 23rd March, 2020 and 12th May, 2020, data of all patients with spinal conditions presenting to Emergency Department for acute care services were collected prospectively. Existing protocols were modified in line with changing national and institute policies for functionality of the spine unit, challenges faced and steps taken were noted. RESULTS: All elective cases were postponed for an indefinite period at the starting of 'Lockdown'. A total of 24 patients were received in ED during study period and 14 (58%) were managed operatively. The majority (79%) were with traumatic spine injury, and fall from height was most common mechanism of injury in traumatic spine patients (84%). There was higher incidence of surgical site infections (14%) among operated patients, compared to our previous average. We had modified routine policies to tackle challenges faced and till date of writing this article, none of the members of spine team or patients treated by us tested positive for SARSCoV-2. CONCLUSION: To continue providing care for acute spinal conditions and maintaining academic activities of spine unit during 'lockdown' needs innovative policies in line with national protocols.