Multi-Omics Integration for Liver Cancer Using Regression Analysis.

Genetic biomarkers have played a pivotal role in the classification, prognostication, and guidance of clinical cancer therapies. Large-scale and multi-dimensional analyses of entire cancer genomes, as exemplified by projects like The Cancer Genome Atlas (TCGA), have yielded an extensive repository of data that holds the potential to unveil the underlying biology of these malignancies. Mutations stand out as the principal catalysts of cellular transformation. Nonetheless, other global genomic processes, such as alterations in gene expression and chromosomal re-arrangements, also play crucial roles in conferring cellular immortality. The incorporation of multi-omics data specific to cancer has demonstrated the capacity to enhance our comprehension of the molecular mechanisms underpinning carcinogenesis. This report elucidates how the integration of comprehensive data on methylation, gene expression, and copy number variations can effectively facilitate the unsupervised clustering of cancer samples. We have identified regressors that can effectively classify tumor and normal samples with an optimal integration of RNA sequencing, DNA methylation, and copy number variation while also achieving significant p-values. Further, these regressors were trained using linear and logistic regression with k-means clustering. For comparison, we employed autoencoder- and stacking-based omics integration and computed silhouette scores to evaluate the clusters. The proof of concept is illustrated using liver cancer data. Our analysis serves to underscore the feasibility of unsupervised cancer classification by considering genetic markers beyond mutations, thereby emphasizing the clinical relevance of additional global cellular parameters that contribute to the transformative process in cells. This work is clinically relevant because changes in gene expression and genomic re-arrangements have been shown to be signatures of cellular transformation across cancers, as well as in liver cancers.

Management of congenital craniovertebral anomalies: a single-centre experience of 71 cases by an algorithmic approach.

STUDY DESIGN: Retrospective study. OBJECTIVE: Congenital craniovertebral (CV) anomalies include a wide variety of conditions involving basilar invagination (BI), atlantoaxial dislocation (AAD), bony congenital anomalies and Chiari malformation. The management of these disorders is more surgeon dependent rather than based on clear guidelines. This study aims to provide a step-by-step algorithmic approach to the management of congenital CV anomalies to achieve good CV alignment, neural recovery and long lasting stability. MATERIALS: The study retrospectively analyses 71 patients of congenital CV anomalies treated by our algorithmic approach. Clinical assessment was done with the help of Nurick's grading pre- and post-operatively. Radiological outcome was assessed by plain radiographs, and computed tomographic scan was done at 12-month follow-up. RESULTS: Mean age at presentation was 17.9 years (6-41 years). Mean Nurick score pre-operatively was 3.8 which was reduced to 1.3 at a mean follow-up of 13.6 months. Sixty-one patients had type I BI, 6 had type II BI, and 4 patients had os odontoideum. Most common symptom at presentation was weakness in limbs, neck pain and difficulty in walking. Patients of isolated AAD with os odontoideum required posterior atlantoaxial fixation and fusion only. Thirty-two patients of type I BI and 4 patients of type II BI required anterior release procedures prior to occipitocervical instrumentation. Bony fusion was achieved in 96% (68) cases with the help of autologous bone grafting. Three patients of occipitocervical fusion developed pseudoarthrosis. CONCLUSION: Our retrospective analysis demonstrates that the algorithm is effective in ensuring long lasting results in all types congenital CV anomalies.

Role of communication for pediatric cancer patients and their family.

BACKGROUND: Communication is a key component in medical practice. The area of pediatric palliative care is emotionally distressing for families and healthcare providers. Inadequate communication can increase the stress and lead to mistrust or miscommunication. MATERIALS AND METHODS: Reviewing the literature on communication between physicians, patients, and their family; we identified several barriers to communication such as paternalism in medicine, inadequate training in communication skills, knowledge of the grieving process, special issues related to care of children, and cultural barriers. In order to fill the gap in area of cultural communication, a study questionnaire was administered to consecutive families of children receiving chemotherapy at a large, north Indian referral hospital to elicit parental views on communication. RESULTS: Most parents had a protective attitude and favored collusion; however, appreciated truthfulness in prognostication and counseling by physicians; though parents expressed dissatisfaction on timing and lack of prior information by counseling team. CONCLUSION: Training programs in communication skills should teach doctors how to elicit patients' preferences for information. Systematic training programs with feedback can decrease physicians stress and burnout. More research for understanding a culturally appropriate communication framework is needed.

A bibliometric review study of Michael Burawoy.

This review article utilizes the technique of citation-based bibliometric analysis to provide a comprehensive understanding of the scholarly contributions made by sociologist Michael Burawoy. The most influential academic articles published by Burawoy were retrieved for analyses. Following this, scholars, journals and institutions that he most frequently collaborated with were traced. Further, country-wise analysis of his scholarship was carried out. Lastly, content analyses of retrieved articles identified prominent thematic domains in sociology to which Burawoy contributed, while temporal analyses helped to identify some emerging research hotspots. Findings reveal that historical and cultural context of Burawoy's research mostly remained confined to the U.S.A., however, he significantly contributed towards the foundation of sociology in the Global South and studied the ensuing global power imbalances. Contemporary sociological thought remains indebted to Burawoy for his comparative study of industrial relations in the 21st century, and recently, his elaboration upon the need for public sociology has taken the discipline in new intellectual directions that appeals to a broader sociological community.

Distal Lumbar Lordosis is Associated With Reoperation for Adjacent Segment Disease After Lumbar Fusion for Degenerative Conditions.

STUDY DESIGN: A single centre retrospective review. OBJECTIVE: Recent studies have suggested that distal lordosis (L4-S1, DL) remains constant across all pelvic incidence (PI) subgroups, whilst proximal lordosis (L1-L4, PL) varies. We sought to investigate the impact of post-operative DL on adjacent segment disease (ASD) requiring reoperation in patients undergoing lumbar fusion for degenerative conditions. METHODS: Patients undergoing 1-3 level lumbar fusion with the two senior authors between 2007-16 were included. Demographic and radiographic data were recorded. Univariate, multivariate binary logistic regression, and Kaplan Meier survivorship analyses were performed. RESULTS: 335 patients were included in the final analysis. Most had single (67%) or two (31%) level fusions. The mean follow-up was 64-month. Fifty-seven patients (17%) underwent reoperation for ASD at an average of 78-month post-operatively (R group). The R group had a significantly lower mean post-operative DL (27.3 vs 31.1 deg, P < .001) and mean PI (55.5 vs 59.2 deg, P < .05). On univariate analysis, patients with a post-operative DL of <35 deg had higher odds of reoperation for ASD than those with a post-operative DL of ≥35 deg (OR 2.7, P = .016). In the multivariate model, post-operative DL, low/average PI, and spondylolisthesis were all significantly associated with reoperation for ASD. CONCLUSION: This study provides preliminary support to an association between post-operative distal lumbar lordosis and risk of reoperation for ASD in patients undergoing fusions for degenerative conditions. Further multicentre prospective study is needed to independently confirm this association and identify the impact of restoration of physiological distal lumbar lordosis on long term patient outcomes.

Pseudomonas aeruginosa and related antibiotic resistance genes as indicators for wastewater treatment.

This review aims to examine the existence of Pseudomonas aeruginosa (P. aeruginosa) and their antibiotic resistance genes (ARGs) in aquatic settings and the alternative treatment ways. P. aeruginosa in a various aquatic environment have been identified as contaminants with impacts on human health and the environment. P. aeruginosa resistance to multiple antibiotics, such as sulfamethoxazole, ciprofloxacin, quinolone, trimethoprim, tetracycline, vancomycin, as well as specific antibiotic resistance genes including sul1, qnrs, blaVIM, blaTEM, blaCTX, blaAIM-1, tetA, ampC, blaVIM. The development of resistance can occur naturally, through mutations, or via horizontal gene transfer facilitated by sterilizing agents. In addition, an overview of the current knowledge on inactivation of Pseudomonas aeruginosa and ARG and the mechanisms of action of various disinfection processes in water and wastewater (UV chlorine processes, catalytic oxidation, Fenton reaction, and ozonation) is given. An overview of the effects of nanotechnology and the resulting wetlands is also given.

Reinforcement-Learning-Based Localization of Hippocampus for Alzheimer's Disease Detection.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder primarily impacting memory and cognitive functions. The hippocampus serves as a key biomarker associated with AD. In this study, we present an end-to-end automated approach for AD detection by introducing a reinforcement-learning-based technique to localize the hippocampus within structural MRI images. Subsequently, this localized hippocampus serves as input for a deep convolutional neural network for AD classification. We model the agent-environment interaction using a Deep Q-Network (DQN), encompassing both a convolutional Target Net and Policy Net. Furthermore, we introduce an integrated loss function that combines cross-entropy and contrastive loss to effectively train the classifier model. Our approach leverages a single optimal slice extracted from each subject's 3D sMRI, thereby reducing computational complexity while maintaining performance comparable to volumetric data analysis methods. To evaluate the effectiveness of our proposed localization and classification framework, we compare its performance to the results achieved by supervised models directly trained on ground truth hippocampal regions as input. The proposed approach demonstrates promising performance in terms of classification accuracy, F1-score, precision, and recall. It achieves an F1-score within an error margin of 3.7% and 1.1% and an accuracy within an error margin of 6.6% and 1.6% when compared to the supervised models trained directly on ground truth masks, all while achieving the highest recall score.

Synthetic Methodologies and SAR of Quinazoline Derivatives as PI3K Inhibitors.

PI3K is an important anticancer target as it controls cellular functions such as growth, transformation, proliferation, motility and differentiation. Plasma cell cancer (multiple myeloma) occurs more than 10% among all haematological malignancies and accounts for 2% of all cancer-related deaths each year, it is mainly regulated by PI3K/AKT signaling cascade. Quinazoline derivatives have been reported as promising PI3K inhibitors. Lapatinib, afatinib, gefitinib, erlotinib, idelalisib and copanlisib are quinazoline-based, FDA-approved PI3K inhibitors, while compounds like NVPBYL719, GDC-0032, AZD8186, AZD-6482, etc. are under different stages of clinical trials. In light of the above-mentioned facts, in the present study, we have reported different synthetic approaches, mechanisms of anticancer action, and structure-activity relationship analysis of reported quinazoline derivatives as PI3K inhibitors to help researchers working in the field in designing better and isoform-selective PI3K inhibitors.

The Impact of Menopause on Cardiovascular Aging: A Comprehensive Review of Androgen Influences.

Menopause represents a critical life stage in women, characterized by hormonal changes that significantly impact cardiovascular health. While the decline in estrogen levels has long been recognized as a major contributor to cardiovascular aging in menopausal women, the role of androgens, particularly testosterone, has gained increasing attention in recent years. This comprehensive review aims to provide a thorough understanding of the impact of menopause on cardiovascular aging, with a specific focus on the influences of androgens. A literature search was conducted to gather relevant studies and clinical evidence exploring the relationship between menopause, androgens, and cardiovascular health. The review integrates findings from various studies to present a holistic view of the topic. The review outlines the changes in hormone levels during menopause and discusses the cardiovascular risk factors associated with this transition. Furthermore, it explores the impact of menopause on cardiovascular structure and function, elucidating the underlying mechanisms that contribute to cardiovascular aging. Androgens' significance in maintaining cardiovascular homeostasis is discussed, followed by exploring the effects of androgen decline during menopause on lipid profiles, insulin sensitivity, vascular function, and other cardiovascular parameters. The review delves into the mechanisms of androgen action on the cardiovascular system, emphasizing the role of androgen receptors and the intricate interplay between androgens, estrogens, and other hormones. Clinical evidence supporting the effects of androgens on cardiovascular aging is presented, including studies investigating the association between androgen levels and cardiovascular outcomes. Additionally, the impact of androgen replacement therapy (ART) on cardiovascular risk markers and events in menopausal women is examined, along with controversies and conflicting findings surrounding the use of androgen therapy in cardiovascular aging. This structured review provides a comprehensive understanding of the impact of menopause on cardiovascular aging, with a specific focus on the role of androgens. By highlighting the significance of androgens in cardiovascular health during menopause, this review aims to create an initial impression and interest among readers, inviting potential citations in the future. The findings underscore the need for further research and offer insights into managing cardiovascular aging in menopausal women, including lifestyle interventions, pharmacological approaches, and the potential role of personalized medicine and precision therapies.

Time-Dependent Changes in Stiffness-Related Functional Disability After Long Segmental Fusion in Elderly Patients With Adult Spinal Deformity-Minimum 2-Year Follow-up Results.

BACKGROUND: Although several studies were performed to measure stiffness-related functional disability (SRFD) after long segmental fusion for adult spinal deformity, the evaluation of SRFD was done at a single point in time. We do not know whether the disability will stay the same, worsen, or improve over time. OBJECTIVE: To evaluate the time-dependent changes of SRFD and any factors affecting these changes. METHODS: Patients who had ≥4-segment fusion with the sacrum were reviewed retrospectively. Specific Functional Disability Index (SFDI), consisting of a 12-item tool with 4 categories (sitting on the floor, sanitation activities, lower body activities, and moving activities), was used to assess the severity of SRFD. The SFDI taken at 3 months, 1 year, and 2 years postoperatively and at the last follow-up were used for evaluating the changes in SRFD. The presumed factors affecting these changes were analyzed. RESULTS: This study included 116 patients. Total SFDI scores significantly improved from 3-month to the last follow-up. Among the 4-category of SFDI, sitting on the floor showed the highest scores followed by lower body activities, sanitation activities, and moving activities at all time points. All categories except for sitting on the floor showed significant improvement from 3 months until the last follow-up. This improvement was most pronounced between 3 months and 1 year. American Society of Anaesthesiologists grade was identified as the only factor affecting time-dependent changes. CONCLUSION: SRFD was highest at 3 months, but it improved over time except for sitting on the floor. The improvement was observed greatest between 3 months and 1 year. Patients with less American Society of Anaesthesiologists grade experienced more improvement in SRFD.

Recovery of Long Standing Neurological Deficit in Pediatric Dorsal Spinal Tuberculosis: A Single Center Experience of 13 Cases.

STUDY DESIGN: Retrospective analysis of case series. OBJECTIVE: The aim is to study the recovery of neurological deficit in pediatric spinal tuberculosis cases presenting to us more than 6 months after onset of motor weakness in lower limbs. METHODS: This is a retrospective analysis of 13 consecutive patients of pediatric spinal tuberculosis presenting to us at least 6 months after the onset of neurologic deficit. All these patients underwent surgical intervention at our center and their neurological recovery was noted in terms of improvement in Frankel grading and spasticity improvement by modified Ashworth scale. All the patients were followed up to at least 18 months post op and final neurologic status was assessed at that time. RESULTS: The mean age of the patients at presentation was 8.5 years. The mean duration of neurologic deficit at the time of presentation was 10.23 months (6-24 months). Seven patients had a Frankel grade B at presentation out of which 6 improved to Frankel grade D and one improved to Frankel C at final follow up. Out of the other 3 patients with Frankel A at presentation, 2 improved to Frankel grade D and 1 to Frankel grade C. The remaining 3 patients presented with Frankel grade C at presentation, 2 improved to Frankel D and one improved to Frankel E at the time of final follow up. CONCLUSION: Neurologic recovery in patients with neurological deficit is possible even in cases of long standing deficit more than 6 months and in some cases upto 24 months as shown in our study.

Characteristics of patients undergoing revision surgery for proximal junctional failure after adult spinal deformity surgery: revalidation of the Hart-International Spine Study Group proximal junctional kyphosis severity scale.

OBJECTIVE: Score on the proximal junctional kyphosis severity scale (PJKSS) has been validated to show good correlations with likelihood of revision surgery for proximal junctional failure (PJF) after surgical treatment of adult spinal deformity (ASD). However, if the patient has progressive neurological deterioration, revision surgery should be considered regardless of severity based on PJKSS score. This study aimed to revalidate the correlation of PJKSS score with likelihood of revision surgery in patients with PJF but without neurological deficit. In addition, the authors provide the cutoff score on PJKSS that indicates need for revision surgery. METHODS: A retrospective study was performed. Among 360 patients who underwent fusion of more than 4 segments including the sacrum, 83 patients who developed PJF without acute neurological deficit were included. Thirty patients underwent revision surgery (R group) and 53 patients did not undergo revision surgery (NR group). All components of PJKSS and variables other than those included in PJKSS were compared between groups. The cutoff score on PJKSS that indicated need for revision surgery was calculated with receiver operating characteristic curve analysis. Multivariate analysis with logistic regression was performed to identify which variables were most predictive of revision surgery. RESULTS: The mean patient age at the time of index surgery was 69.4 years, and the mean fusion length was 6.1 segments. All components of PJKSS, such as focal pain, instrumentation problem, change in kyphosis, fracture at the uppermost instrumented vertebra (UIV)/UIV+1, and level of UIV, were significantly different between groups. The average total PJKSS score was significantly greater in the R group than in the NR group (6.0 vs 3.9, p < 0.001). The calculated cutoff score was 4.5, with 70% sensitivity and specificity. There were no significant between-group differences in patient, surgical, and radiographic factors (other than the PJKSS components). Three factors were significantly associated with revision surgery on multivariate analysis: instrumentation problem (OR 8.160, p = 0.004), change in kyphosis (OR 4.809, p = 0.026), and UIV/UIV+1 fracture (OR 6.462, p = 0.002). CONCLUSIONS: PJKSS score positively predicted need for revision surgery in patients with PJF who were neurologically intact. The calculated cutoff score on PJKSS that indicated need for revision surgery was 4.5, with 70% sensitivity and specificity. The factor most responsible for revision surgery was bony failure with > 20° focal kyphotic deformity. Therefore, early revision surgery should be considered for these patients even in the absence of neurological deficit.

RCC (reinforced criss-cross construct): an easy and effective multi-rod thoraco-lumbar posterior reconstruction technique.

STUDY DESIGN: Surgical technical note and literature review. OBJECTIVES: To describe a technique that uses 4 rod constructs in cases of complex thoracolumbar spinal deformity correction or revision surgeries based on the hybrid use of two different types of purchase points by a staggered pedicle screw fixation. It utilizes two rods on either side of the spine using a lateral and medial entry point of pedicle screws in the vertebral body. METHODS: Pedicle screws using extra-pedicular technique are more converging screws and are inserted alternately in the vertebral body and connected by rods. The left-out alternate vertebral bodies are fixed by a relatively straighter pedicle entry screw and connected to each other by a separate rod. So, two trajectories are independently used for a four-rod construct. This reconstruction has been named RCC (reinforced criss-cross construct). The screws in the index case were placed by free hand method, but we have increasingly utilized navigation guidance for placement of screws in recent times. RESULTS: We present a surgical technical note in a patient with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV-AIDS). He was diagnosed to have multi-drug-resistant (MDR) tuberculous spondylodiscitis, complicated with Immune reconstitution inflammatory syndrome (IRIS) and implant failure resulting in kyphosis and thoracic myelopathy. RCC with pharmacological management achieved healing and union, which was maintained at 4 years follow-up. Our method of four-rod construct provides a strong and lasting construct in the management of spinal deformities and three-column osteotomies. It provides good structural support to the spine till bony union is achieved. CONCLUSION: Hybrid multi-rod construct like RCC provides a rigid mechanical support to the instrumentation and reduces the chances of rod failure especially in complex thoraco-lumbar spinal deformity correction surgeries.

Factors Affecting Stiffness-Related Functional Disability After Long Segmental Fusion for Adult Spinal Deformity.

BACKGROUND: In general, stiffness-related functional disability (SRFD) is expected to increase as longer fusion length, but there have been no studies on factors affecting SRFD besides fusion length. OBJECTIVE: To identify the factors affecting SRFD after long segmental fusion in patients with adult spinal deformity (ASD). METHODS: We retrospectively reviewed the patients who underwent ≥4-segment fusion including sacrum for ASD. The severity of SRFD was evaluated using the Specific Functional Disability Index (SFDI) consisting of 12 items with 4 categories as follows: sitting on the floor, sanitation activity, lower body activity, and moving activity. Each category contains 3 items which was given a maximum of 4 points. The presumed factors affecting SFDI were analyzed. RESULTS: A total of 148 patients were included in the study with their mean age of 67.3 years. The mean fusion length was 6.4 segments. The mean score of each SFDI category was highest in sitting on the floor (9.9), followed by lower body activities (7.6), sanitation activities (6.0), and moving activities (5.9). The total sum was 29.3 points. In multivariate analysis, total sum of SFDI was significantly higher in female sex, patients with higher American Society of Anesthesiology grade, and longer fusion length. However, the sagittal parameters did not show a significant correlation with SRFD, except pelvic incidence-lumbar lordosis which correlated with only one category (lower body activities). CONCLUSION: This study showed that female sex, higher American Society of Anesthesiology grades, and longer fusion length influenced SRFD after long segmental fusion for ASD. Sagittal parameters related to the degree of deformity correction did not significantly affect SRFD.

Gorham-Stout disease: A multirod lumbar reconstruction with off-label suppression-remission therapy.

Background: Gorham-Stout disease (GSD), a fibro-lymphovascular entity in which tissue replaces the bone leading to massive osteolysis and its sequelae, rarely leads to spinal deformity/instability and neurological deficits. Here, we report a 12-year-old female who was diagnosed and treated for GSD. Case Description: A 12-year-old female presented with back pain, and the inability to walk, sit, or stand attributed to three MR/CT documented L2-L4 lumbar vertebral collapses. Closed biopsies were negative. However, an open biopsy diagnosed GSD. She underwent a dorsal-lumbar-to-pelvis fusion (i.e., T5-T12 through L5/S1/S2) using multilevel pedicle screw/rod stabilization and human leukocyte antigens (HLAs) matched allograft (i.e. from her father). Postoperatively, she was treated with "off-label" teriparatide injections, bisphosphonates, and sirolimus. Four years later, while continuing the bisphosphonate therapy, she remained stable. Conclusion: Surgical multirod stabilization from T5 to S2, supplemented with HLA compatible allograft, and multiple medical "off-label" therapies (i.e., teriparatide, sirolimus, and bisphosphonates) led to a good 4-year outcome in a 12-year-old female with GSD.

A Rare Case Report of Flexion Teardrop Cervical Fracture with Blunt Vertebral Artery Injury Leading to Stroke.

Non penetrating trauma to vertebral artery is a known complication in craniovertebral trauma. They are mainly reported with facet dislocations or injuries involving the foramen transversarium. Such a type of injury is rarely seen with flexion injuries. We report such a case leading to cerebellar stroke in a young male presenting to us with hemiparesis. A 43-year-old male presented to us 1 month post trauma after a motor vehicular accident with complaint of weakness of right half of the body since the trauma. He suffered blunt trauma to head and neck and complained of a flail right upper limb since trauma and weakness of the right lower limb which had partly improved. He was conservatively managed elsewhere. Radiographic investigations revealed complete occlusion of the right vertebral injury above the level of 6th cervical vertebra and flexion teardrop fracture of 5th cervical vertebra. He was managed conservatively for the vertebral artery injury (VAI) and corpectomy of C5 vertebra with anterior cervical plating and fusion. Such a rare type of injury can present with unexplained neurodeficit which needs appropriate radiological investigations for diagnosis before ascribing the cause to cord trauma. Hence, all high velocity motor vehicular accidents with associated fractures and neurodeficit should be screened for blunt VAIs.

Triple Clipped Histogram-Based Medical Image Enhancement Using Spatial Frequency.

In this paper, a novel triple clipped histogram model-based fusion approach has been proposed to improve the basics features, brightness preservation and contrast of the medical images. This incorporates the features of the equalized image and input image together. In the initial step, the low-contrast medical image is equalized using the triple clipped dynamic histogram equalization technique for which the histogram of the input medical image is split into three sections on the basis of standard deviation with almost equal number of pixels. The clipping process of the histogram is performed on every histogram section and mapped to a new dynamic range using simple calculations. In the second step, the sub-histogram equalization process is performed separately. Approximation and detail coefficients of equalized and input images are separated using discrete wavelet transform (DWT). Thereafter, the approximation coefficients are modified using some basic calculation-based fusion which involves singular value decomposition (SVD) and its inverse. Detail coefficients are fused using spatial frequency features. This yields modified approximation and detail coefficients for an enhanced image. Finally, inverse discrete wavelet transform (IDWT) has been applied to the modified coefficients which result in an enhanced image with improved visual quality. These improvements are analyzed qualitatively and quantitatively.

Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? - A Long-Term Retrospective Analysis of 78 Patients.

STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine. OVERVIEW OF LITERATURE: Literature shows varied results regarding the approach to be chosen. Most studies prefer a combined approach since biomechanically forms more stable construct. The isolated posterior approach is preferred by many as it is easy to reduce and fix three-column injuries. There are very few studies which show the isolated anterior approach to be better than the other two. MATERIALS AND METHODS: Seventy-eight patients of three-column injury operated by anterior approach with follow-up of atleast 2 years were included and retrospectively analyzed. Clinical data included age, sex, time to surgery, methods of reduction, postoperative mobilization, and neurological evaluation using the ASIA scale. Radiological data included pre- and postreduction X-ray, computed tomography, and magnetic resonance imaging (MRI). X-rays taken post-operatively at 1,3, 6 months, 1yr and 2yrs. Variables like fracture type (AO Classification), overall alignment, localized kyphosis, time for fusion and grade of fusion mass were noted. RESULTS: Of 78 patients, 61 had bifacetal dislocation and 17 unifacetal. The most common site was C5-6, followed by C3-4 and C6-7. The mean patient age was 35.98 years with 60 males and 18 females. The mean time to surgery was 4.4 days. Forty dislocations were reduced by closed method and 38 by open anterior approach. Fifty-six percent of patients had traumatic disc injury on MRI. All are managed by single-level anterior cervical discectomy and fusion with iliac crest autograft for fusion. The mean preoperative lordosis: 4.44° (range -13.4° to 25°) and mean postoperative lordosis: 28.57° (P < 0.0001) mean loss of alignment: 2.59° by 2 years, 100% fusion with mean time - 22.82 weeks, neurological recovery in 34.6% with atleast one grade improvement in ASIA scale. No neurological worsening or need for revision surgery was observed. CONCLUSION: The goal of surgery in cervical injury is bony stabilization and fusion using a least morbid approach and one with good long-term outcome. Above study concludes that only anterior stabilization after reduction of three-column injury would suffice with good long-term outcome, thereby obviating need for global fusion.

Functional outcome of surgically treated patients of ossified posterior longitudinal ligament of cervical and dorsal spine in Indian population - A single center retrospective analysis of 40 patients.

AIMS: The aim of the study was to retrospectively evaluate the neurological outcome in operated patients of ossified posterior longitudinal ligament (OPLL) of cervical and/or dorsal spine using modified Japanese orthopedic association (mJOA) score and find out the factors affecting the outcome. SETTINGS AND DESIGN: The study design was a retrospective study. MATERIALS AND METHODS: Forty operated patients of cervical and/or dorsal spine OPLL were included in the study. Neurological examination was conducted and analyzed using mJOA score pre- and postoperatively at 1, 6, and 12 months. Improvement in the mJOA score based on age, sex, type of OPLL, duration of symptoms, type of surgical procedure, and radiological parameters were calculated, analyzed, and compared with previous records of the patient. RESULTS: Significant improvement in mJOA scores with mean preoperative being 12.27 ± 1.95 with 1-year postoperative 13.85 ± 2.02 (P < 0.0001) noted. There is a significant difference in mean mJOA scores in posterior approach with instrumentation (P < 0.0001) as compared with laminoplasty group (P < 0.005). Patients with occupancy ratio <60% had better results (P < 0.0001) as compared to those with occupancy ratio of >60% (P = 0.003). Patients with duration of symptoms >1 year had poorer results compared to those of <1 year duration. Mean ossification kyphosis angle was 19.4° ± 5.73°. CONCLUSION: OPLL is a progressive disease which causes severe neurological deficit if left untreated. OPLL in a young patient with short duration of symptoms, low occupancy ratio, and low ossification kyphosis had better chances of neurological recovery. Type of OPLL and sex of patient do not affect the recovery. OPLL managed early and surgically has better results irrespective of anterior or posterior approach with significant improvement in mJOA score. Decompression with fusion has better results than decompression alone.