Ossification of Posterior Longitudinal Ligament in Cervical Spine and Its Association With Ossified Lesions in the Whole Spine: A Cross-Sectional Study of 2500 CT Scans.

STUDY DESIGN: A retrospective study. OBJECTIVE: To identify the prevalence and characteristics of ossified posterior longitudinal ligament (OPLL) in the cervical spine and its association with other spinal ligament ossifications. METHOD: This study is a retrospective review of whole spine CT scans of polytrauma patients from 2009 to 2018. Patients were screened for cervical OPLL (C-OPLL), thoracolumbar OPLL, thoracic ossified ligamentum flavum (OLF), cervical and thoracolumbar ossified anterior longitudinal ligament (C-OALL AND T-L OALL), ossified nuchal ligament (ONL) and, diffuse idiopathic skeletal hyperostosis (DISH) using CT scans. Their prevalence and distributions were assessed using statistical tools. Chi-square tests were used to determine statistical association between the categorical parameters. RESULTS: Out of 2500 patients, 128 had C-OPLL with a prevalence rate of 5.12% with mean age of 55.89 year. The most commonly affected level was C5, followed by C6, and C4. The segmental OPLL was highest in number (77.7%), followed by localized type (14.8%). While the prevalence rate of thoracic OPLL was 0.56%, OLF was 9.9%. Ossifications that coexisted along with C-OPLL were thoracic OPLL (7.81%), thoracic OLF (36.71%), cervical OALL (29.68%), thoracolumbar OALL (37.5%), DISH (27.34%) and, ONL (7.03%). CONCLUSION: Our study indicated a prevalence rate of 5.12% for C-OPLL with a predominance of segmental OPLL (77.7%). Among these patients, approximately 36% had coexisting thoracic OLF. In patients with symptomatic OPLL induced cervical myelopathy, MRI analysis of whole spine with relevant CT correlation may help in detecting additional ossification sites of compression.

The Role of Riluzole in Acute Traumatic Cervical Spinal Cord Injury with Incomplete Neurological Deficit: A Prospective, Randomised Controlled Study.

Introduction: Riluzole, a benzothiazole sodium channel blocker is acknowledged as a neuroprotective agent in spinal cord injury (SCI). Most of this evidence is based on pre-clinical studies and its effectiveness in clinical setting is undetermined, heretofore. Methods: A prospective, randomised-controlled study was conducted between April 2019 and March 2020 at a tertiary-level centre. Patients aged 18-65 years with sub-axial cervical spine injury, who presented within 72 h of injury with incomplete neuro-deficit, were included. They were randomised into groups A (riluzole was administered) and B (no adjuvants). All patients were followed up at 6 weeks/3/6/12 months, and clinical [ASIA motor/sensory scores/grade, SCIM3, and NRS (neuropathic pain)] and radiological evaluation was performed. Results: Twenty-three and 20 patients were included in groups A and B. Two in group A were females, while others were males (p = 0.49). Mean age in groups A and B was 47.7 ± 14.8 and 51.2 ± 14.1 years (p = 0.44). Five patients died prior to 6th-week follow-up. Among the others, there was significant improvement in all neurological parameters in both groups (post-injury vs 1-year; motor score: p < 0.001, sensory score: p < 0.001, SCIM3: p < 0.001, NRS: p < 0.001). In both groups, initial significant improvement was noticed even at the 6th-week follow-up, which further continued until the end of 1 year. There was no statistically significant difference between groups A and B with respect to these neurological parameters (motor: p = 0.15, sensory: p = 0.39, SCIM3: p = 0.68, NRS: p = 0.06). Conclusion: Administration of riluzole did not significantly improve neurological outcome/neuropathic pain in our cohort. Nevertheless, both our groups demonstrated an overall improvement in neurological outcome at 1 year, as compared with immediate post-injury status.

Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy.

STUDY DESIGN: Prospective comparative cohort study. OBJECTIVES: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. METHODS: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. RESULTS: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). CONCLUSIONS: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

Delayed presentation of urinoma mimicking spondylodiscitis secondary to ureteric injury following carrot stick fracture in ankylosing spondylitis.

INTRODUCTION: Ureteric injuries are rarely associated with spinal trauma with an incidence of less than 1%. Missed injuries can lead to urinoma collection, urosepsis and even death. MATERIALS AND METHODS: A 75-year-old man presented 1 month following fall with high-grade fever and severe back pain mimicking spondylodiscitis clinically. Plain radiograph showed features of ankylosing spondylitis with a suspicious trans-discal injury at L3-L4. Hyper-intense fluid within L3/L4 disk space communicating to a large psoas collection measuring 13 × 6 cms mimicking spondylodiscitis with abscess formation was observed in magnetic resonance imaging (MRI). MRI with contrast enhancement demonstrated a leak through left ureter into the psoas muscle raising suspicion of a ureteric injury. Plain computerized tomography revealed a three-column fracture at L4, and a ureteric leak into the psoas collection with proximal hydronephrosis was seen after contrast administration, establishing the presence of a ureteric fistula resulting in urinoma. RESULTS: Following initial symptomatic improvement after ureteric stenting, the patient succumbed to urosepsis at 3 months. CONCLUSION: We report for the first time a post-traumatic urinoma secondary to ureteric injury clinically mimicking spondylodiscitis. Clinicians need to be aware of the possibility of ureteric injury in hyperextension lumbar fractures occurring in ankylosing spondylitis and treat them early to avoid urological complications.