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Background: Andersson lesion (AL), also known as aseptic spondylodiscitis, is a pathological condition characterized by a destructive lesion in the vertebral or discovertebral region. The aim of this study was to assess functional, radiological, and neurological outcome of midline posterior surgery with transfacetal/transpedicular decompression and long-segment instrumentation and fusion in all patients with AL. Materials and Methods: A total of 36 consecutive patients with AL with or without neurodeficit were managed with midline posterior approach with long-segment fixation, decompression and anterior vertebral reconstruction added by same midline approach. The demographic data, visual analogue scale (VAS), modified Oswestry Disability Index (mODI), ankylosing spondylitis quality of life (ASQoL), local and global kyphosis angle, Frankel neurological grade, blood loss, duration of surgery, perioperative complications, and fusion rate were compiled and assessed. Results: The mean age of the patients was 52 years (26 males and 10 females). Among the patients, 9 patients had thoracic, 25 patients had thoracolumbar, and 2 patients had lumbar vertebral involvement. All patients in the study achieved fusion at final follow-up period of 24 months. The mean duration of hospital stay, intraoperative blood loss, and surgery duration was 6.17 days, 252 mL, and 130 min, respectively. VAS improved from mean 7.69 ± 0.98 to 1.67 ± 0.72, mODI from mean 70.28 ± 3.55 to 21.14 ± 2.13, ASQoL from mean 14.22 ± 1.59 to 7.17 ± 1.25, local kyphosis from 23.61 ± 1.67 to 18.52 ± 1.05, and global kyphosis from 57.02 ± 0.72 to 36.16 ± 1.23, leading to better sagittal balance. Except two patients all had full neurological recovery. Conclusions: Posterior midline approach with long-segment instrumentation and anterior decompression by transpedicular/transfacetal approach and bone grafting with selective use of cages can give satisfactory results with excellent fusion rates and good functional outcomes.

Study Design Retrospective cohort study. Purpose This study aimed to compare the efficacy of bisphosphonates and teriparatide in the management of osteoporotic vertebral compression fractures with regard to pain management, prevention of nonunion, and radiological as well as clinical outcomes. Overview of Literature Osteoporosis refers to a skeletal disorder characterized by decreased bone strength caused by poor bone density and quality causing fragility, resulting in long periods of pain-related immobilization. Methods In a 24-month follow-up retrospective study, 191 patients with osteoporotic vertebral compression fractures were randomly assigned to the bisphosphonate group (n=104) or the teriparatide group (n=87), with patients opting for their treatment between January 2016 and October 2020. Demographic data and patient-reported outcomes scores, including the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), union rates, and kyphosis progression, were assessed at baseline, 6 months, 1 year, and 2 years after treatment. Results Both groups had a significant decrease in VAS, from 8.38±0.74 to 3.15±1.40 in the bisphosphonate group and from 8.49±0.73 to 1.11±0.31 in the teriparatide group. The ODI scores reduced significantly at 2-year follow-ups, recording 25.02±13.94 and 15.11±2.17 in the bisphosphonate and teriparatide groups, respectively. Risks of nonunion development were slightly higher at 11.53% in the bisphosphonate group and 8.63% in the teriparatide group required operative intervention. The kyphosis progression angles were also significantly lower in the teriparatide group (4.97°±0.78°) than in the bisphosphonate group (8.09°±1.25°). Conclusions Over time, numerous studies have demonstrated the efficacy of bisphosphonates and teriparatide in ameliorating pain. In this study, the efficacy of teriparatide surpassed that of bisphosphonates in certain aspects, such as the initial 6-month union rates and reduction in the progression of segmental kyphosis. However, bisphosphonates and teriparatide yield similar and favorable union rates at 1 year and final follow-up.

Objective To study the incidence, risk factors, surgical outcomes of accidental durotomies (ADT) in patients of microendoscopic lumbar decompression surgeries (MLDS) and the postoperative patient mobilization protocol. Methods A total of 550 patients who underwent MLDS from January 2012 to march 2020 under single surgeon and single institute were included in the study and incidence of ADT risk factors like age, BMI, smoking status, diabetes mellitus, surgeon’s experience were studied for the same and early mobilization protocol for all the patients was followed. Results Age >60 years (p=0.0062), bilateral decompression with unilateral approach, surgeons experience in the first 3 years over next 5 years (p=0.037) were the statistically significant risk factors for increased incidence of ADT. Most of the ADT were small which did not require primary repair and managed with sealants like gelfoam and fibrin glue. Postoperative recovery in JOA and ODI scores in both ADT and non ADT cohorts were same. Conclusion MISS has low incidence of ADT and age >60 years and surgical technique of bilateral decompression with unilateral approach and surgeons expertise are the significant risk factors. MISS also has less risk of CSF leak symptoms and pseudomeningocele formation because of limited dead space formation in the soft tissue which helps in early postoperative mobilization and reduces the duration of hospital stay.