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"Coccydynia" unresponsive to a trial of conservative treatment should be evaluated promptly. Otherwise we may be fraught with the danger of serious complications. Sacral tumors are often quiescent to start with. They may achieve enormous size before they become symptomatic. Here is a case report and literature review of such a case in a 63 year old male, which was initially treated as coccydynia, till he became severely symptomatic. Chordomas are the most common primary tumor of the sacrum in adults. They are locally aggressive with immense potential for local recurrence and metastasis to lungs and other bones. If they get to the right hands at the right time, they are mostly curable. Total sacrectomy (Enbloc resection) is the treatment of choice for sacral chordomas. In early stages, a low sacral resection all from behind is possible. Lesions extending higher than S3 requires high sacrectomy and lumbopelvic fixation depending on the integrity of the sacroiliac joints. High sacrectomy has high morbidity of permanent colostomy and bladder catheterization. A 63 year old man presented with coccydynia of long duration and was diagnosed as chordoma of the sacrum upon imaging and image guided biopsy. He was treated with anterior, posterior and anterior surgeries in a single sitting, through a multi disciplinary approach. [ABSTRACT FROM AUTHOR]

Aneurysmal bone cysts (ABCs) are benign, highly vascular expansile lytic lesions of bone, which has haverare occurrences in the cervical spine (2% of all cases). ABCs of the cervical spine has havea higher incidence in the pediatric population, and mostly involves the posterior elements of one vertebral level, with occasional extension to the facets and body. Surgical treatment of cervical ABC in pediatric patients is challenging because of the danger to neurovascular structures and the remaining growth of the spine. While complete tumor resection should be attempted for the best chance for cure, spinal fusion and instrumentation should be added to minimize the risk of post-operative instability. Our case report presents an ABCAneurysmal Bone Cyst of C2 cervical spine in a 9-year-old boy with the involvement of posterior elements and facets. Surgical treatment in this patient included complete tumor excision and posterior instrumented fusion in a single stage without any neurovascular injury and uneventful follow follow-up of 5 years. [ABSTRACT FROM AUTHOR]

Spinal tumors are uncommon lesions and affect only a minority of the population. Spinal tumors comprise 15 % of all CNS tumors, with an incidence of 2-10 per 1,00,000. Location of the tumor is the most important aspect in the diagnosis of spinal tumor with regard to treatment and prognosis. Extradural lesions are more common (60% of all spinal tumors), with majority of lesions originating from the vertebrae. The clinical symptoms are often nonspecific and include back pain, radicular symptoms, and slowly progressive neurological deficits. Primary and most important diagnostic modality for intradural spinal tumors is MRI scan. Contrast material (defining the extent of intramedullary neoplasms and identifying areas of blood brain barrier break-down) and multiplanar imaging have broadened the use of MRI. Gross total tumor resection while preserving and improving the neurological function is the usual goal of surgery. If the complete removal of the tumor demands removal of more than one column of the spine, instrumented fusion of the adjacent levels may be deemed necessary. Here we discuss the literature review of intradural extramedullary tumors in a glance and clinical presentation, symptomatology, and prognosis of 40 extramedullary intradural tumor cases that we have operated on in a span of 15 years. Out of these 40 cases, majority were schwannomas. The incidence of schwannoma was found to be higher in the 30-50 age group. 5 cases of meningiomas, 5 cases of cystic schwannomas and 1 each of intradural metastasis, paraganglinoma, AV malformation, ependymoma, cellular schwannoma, intradural hematoma and intradural lipoma with tethering. All cases had postoperative improvement in neurological status to normalcy. [ABSTRACT FROM AUTHOR]

Spine is the most frequent site of spinal metastasis after liver and lung due to its extensive arterial supply. The cancer tissue replaces the spinal elements leading to its destruction and resultant instability and compression of the neural structures4. 10% of tumor patients develop asymptomatic spinal metastasis and spinal cord compression(5,6). The purpose of treating patients with spinal metastasis are to relieve pain, stabilizing spinal structures , recovering or maintain neural function, controlling the metastasis in the local area and improving quality of life. This goal is achieved through a multidisciplinary approach. The aim of this article is to describe an algorithm for the management of solitary spinal metastasis. Different factors need consideration in planning treatment for solitary metastasis. Age, quality of life, tumor borders etc should be discussed in detail with the patient and his/her care givers. A multidisciplinary approach and a tumor board meeting would bring out the right choice for a given patient. Treatment may vary from irradiation, biopsy/surgery, chemotherapy, immuno-modulation, hormone therapy or palliative treatment alone [ABSTRACT FROM AUTHOR]

Introduction: A Surgical management of spinal metastasis controversial in terms of average life expectancy of the patient[1]. No one can accurately determine the exact life expectancy of a patient. Materials and methods: The purpose of this present study is to evaluate the effectiveness of surgery in indicative cases of spinal metastasis patient. This is a retrospective study from May 2003 to May 2018 (15 years). 150 patients with spinal metastasis from various cancers underwent anterior/posterior or anterior + posterior decompression, instrumentation fusion to reduce pain/or improve neurological status. There were 76 males and 74 females, age group ranged from 37 years to 82 years. These patients were followed up for a minimum of 6 months and a maximum of 10 years. All these patients improved neurologically after surgery to at least one grade and some recovered completely neurologically. There were no intraoperative deaths, three of them died (in 6-week post-surgery) in the perioperative period, 10 of them had pneumonia, 10 had superficial wound infection, 7 had bedsore, and 4 had implant loosening and three of them had deep infection which required reentry to the OT (wound debridement and washout). Conclusion: In conclusion, posterior/anterior or combined anterior + posterior surgery in spinal metastatic patients is an effective treatment and can improve the quality of life of the patient. [ABSTRACT FROM AUTHOR]

Spondylodiscitis is usually caused by Staph. Aureus. Salmonella spondylodiscitis is a rare condition that is more prevalent in patients with sickle cell anemia or immunosuppression. We report a case of back pain of 3 months duration which was ultimately diagnosed as Salmonella Spondylodiscitis and managed medically. [ABSTRACT FROM AUTHOR]

Osteochondroma is a benign tumour of bone located mainly in the metaphysis of long bones with more than 35% of cases affecting the bones around the knee. They are not uncommon to occur in the scapula. On the ventral surface of the scapula, they can produce various manifestations due to mass effect. Authors report a rare presentation of osteochondroma on the ventral superomedial aspect of the scapula in a 10-year old girl, successfully managed by open excision. The girl had no evidence of recurrence at the time of 11 month follow-up. [ABSTRACT FROM AUTHOR]

Pedicle screw fixation in the lower and middle cervical spine has been considered very risky, but pedicle screw fixation has bio mechanically proven its superior stabilising effect.A thorough knowledge of the local anatomy and the surgical techniques is a must before embarking on cervical pedicle screw fixation. Pre operative evaluation of vertebral artery is a must, because if the dominant vertebral artery is injured, serious neurological complications can occur. The article describes in details the technique of screw placement in the cervical vertebra. [ABSTRACT FROM AUTHOR]

Simultaneous asymmetric dislocations of the hips are very rare injuries. The authors report a case of bilateral asymmetric dislocation of both hips in an obese nineteen-year-old obese man with quadrilateral plate injury of the left acetabulum. Due to the morbid obesity and the attitude of the limb the posterior dislocation of the right hip was not obvious clinically. [ABSTRACT FROM AUTHOR]

Author reports a case of osteopoikilosis in a 26-year old lady, without family history of similar lesions and who is on treatment in the Orthopaedic clinic for the last 6 years for recurrent attacks of arthritis involving the wrists and ankles. All investigations during the episodes of effusion were normal except for transient escalation of erythrocyte sedimentation rate (ESR). Patient is managed with antiinflammatory medication during episodes of recurrence of arthritis. [ABSTRACT FROM AUTHOR]