Correlation of pelvic incidence and pelvic parameters in lumbar spondylolisthesis.

Background: Pelvic incidence (PI) and pelvic parameters (PP) regulate the sagittal alignment of the spine and the pelvis in normal populations. Correlation of PI even more so than PP with lumbar spondylolisthesis (LS) would be useful for surgical planning. Methods: This study included 45 patients randomly selected with LS. They were divided into two groups; Group S had LS and Group C had low back pain due to other causes. All patients received lateral standing radiographs of the spine and pelvis. Based on these films, we measured the sacral slope, pelvic tilt, PI, and lumbar lordosis (LL). Results: There were significant correlations between the PI and the sacral slope, pelvic tilt, and LL in Group S (P < 0.05). The majority of patients with LS presented with middle (60%) followed by high PIs (26.67%). Low PI was observed among just 13.33% patients with LS. Conclusion: Changes in spinopelvic parameters reflecting pelvic compensatory mechanisms differ depending on the extent of PI in patients with LS. In short, higher PI values correlated with more significant degrees of degenerative LS in Group S population.

Torticollis in an 8-year-old child due to Grisel's syndrome - A case report.

Background: Grisel's syndrome is a nontraumatic atlantoaxial subluxation resulting from an ongoing local inflammatory process. Case Description: An 8-year-old male presented to the emergency department with neck pain which was sudden in onset without any history of any significant fall or trauma. On physical examination, the patient had torticollis with a head tilt to the left side and the chin rotated to the right. The CT scan confirmed atlantoaxial subluxation with C1 rotated to the right on the odontoid process without anterior displacement. The patient was managed conservatively with antibiotics, anti-inflammatory agents, and head-halter traction. Conclusion: As Grisel's syndrome can have catastrophic outcomes, early diagnosis and treatment are critical. It must be considered in patients presenting with acute torticollis following an infection or prior surgery.

Isolated costotransverse joint tuberculosis - A rare location for tubercular arthritis.

Background: Posterior element involvement of the spine with tuberculosis (TB) is very uncommon. Case Description: A 25-year-old immunocompetent female presented with dull mid-back ache and tenderness over the inferior angle of the left scapula and left 7th costovertebral junction. The MRI showed erosion and enhancing soft tissue in the periarticular region of the left 7th costotransverse joint. After the CT-guided biopsy confirmed the diagnosis of TB, she was successfully managed with antitubercular chemotherapy. Conclusion: In a 25-year-old female, the early diagnosis of atypical TB involving the left T7 costotransverse joint allowed for allowed for its successful treatment/resolution with antitubercular chemotherapy.

Lateral lumbar interbody fusion in adult spine deformity - A review of literature.

INTRODUCTION: Surgery for adult spine deformity presents a challenging issue for spinal surgeons with high morbidity rates reported in the literature. The minimally invasive lateral approach aims at reducing these complications while maintaining similar outcomes as associated with open spinal surgeries. The aim of this paper is to review the literature on the use of lateral lumbar interbody fusion in the cases of adult spinal deformity. METHODS: A literature review was done using the healthcare database Advanced Research on NICE and NHS website using Medline. Search terms were "XLIF" or "LLIF" or "DLIF" or "lateral lumbar interbody fusion" or "minimal invasive lateral fusion" and "adult spinal deformity" or "spinal deformity". RESULTS: A total of 417 studies were considered for the review and 44 studies were shortlisted after going through the selection criteria. The data of 1722 patients and 4057 fusion levels were analysed for this review. The mean age of the patients was 65.18 years with L4/5 being the most common level fused in this review. We found significant improvement in the radiological parameters (lordosis, scoliosis, and disk height) in the pooled data. Transient neurological symptoms and cage subsidence were the two most common complications reported. CONCLUSION: LLIF is a safe and effective approach in managing adult spinal deformity with low morbidity and acceptable complication rates. It can be used alone for lower grades of deformity and as an adjuvant procedure to decrease the magnitude of open surgeries in high-grade deformities.

Contiguous Three-Level Vertebral Collapse in Thoracic Spine: A Novel Presentation of Chronic Recurrent Multifocal Osteomyelitis in 12 years old and Review of Literature.

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoimmune disorder of childhood and adolescence which often manifests as recurring episodes of inflammatory bone pains. Spinal involvement is rare; however, recent studies advocate full body magnetic resonance imaging in all suspected cases to pick up asymptomatic lesions early to prevent complications. Spinal involvement may manifest as fractures, scoliosis, or kyphotic deformity. Case Report: We present a case of a 12-year-old boy who had three-level involvement of thoracic spine, T6-T8, and was worked up and managed for pathological fracture of spine. He underwent biopsy for the same and was later diagnosed as CRMO. Here, we discuss the diagnostic challenges involved in CRMO, need for biopsy, and the management options available. Conclusions: Identifying CRMO is challenging and remains a diagnosis of exclusion. Nonsteroidal anti-inflammatory drugs often constitute the first line of treatment and other drugs such as bisphosphonates and biologics such as TNF-alpha antagonists are reserved for more severe cases. Although CRMO is considered a benign disease, recent data suggest up to 50% rate of residual impairments despite optimal management.

Van Neck-Odelberg Disease: A Rare Case Report.

INTRODUCTION: Pain in groin without any history of trauma or positive clinical findings of infection or stress fracture in ischiopubic ramus poses challenges in diagnosis of the condition in prepubertal age. "Osteochondrosis of ischiopubic synchondrosis (IPS)" also called as "Van Neck-Odelberg" disease. Left leg dominant patient presented with pain in groin and limping with left leg dominance. Differential diagnosis - such as stress fractures, osteomyelitis, tuberculosis, post-traumatic osteolysis, or any neoplasia - is need be ruled out to arrive at diagnosis. The literature is reviewed with modern technologies for diagnosis of the same. CASE REPORT: A 12-year-old, left limb dominant boy with tenderness in the right groin as the only clinical finding and sclerotic shadow over ischiopubic region on X-ray posed a challenge for diagnosis. With further studies by computed tomography and magnetic resonance imaging diagnosis was done. Hence, we are presenting a case labeled as Van Neck-Odelberg disease. CONCLUSION: Diagnosis of Van Neck-Odelberg disease is a challenging diagnosis. Other conditions such as post-traumatic osteolysis, osteomyelitis, and stress fractures in prepubertal age need to be ruled out. Clinical symptoms must be present to label it as osteochondritis of IPS on radiographs as unilateral delayed fusion of the same is a physiological process in asymptomatic cases.