Spinal procedures are generally associated with intense pain in the postoperative period, especially for the initial few days. Adequate pain management in this period has been seen to correlate well with improved functional outcome, early ambulation, early discharge, and preventing the development of chronic pain. A diverse array of pharmacological options exists for the effective amelioration of post spinal surgery pain. Each of these drugs possesses inherent advantages and disadvantages which restricts their universal applicability. Therefore, combination therapy or multimodal analgesia for proper control of pain appears as the best approach in this regard. The current manuscript discussed the pathophysiology of postsurgical pain including its nature, the various tools for assessment, and the various pharmacological agents (both conventional and upcoming) available at our disposal to respond to post spinal surgery pain.

Background: The hypoglossal canal (HC) is in basal part of cranium that transmits the nerve that supplies the motor innervations to the muscles of tongue. Study on morphometry of (HC) and its variations has been a considerable interest field to neurosurgeons and research workers especially because of their racial and regional. Material and Methods: In this retrospective study, 26 adult dry human crania of no sex known were studied for (HC) and its variants. Thirty five skulls were observed for any damage of post cranial fossa and those in good condition (26 skulls)were selected. Sliding Vernier caliper was used for morphometric analysis. Results: There were significant difference between distances of: a-(HC) till anterior tip of condyles (right and left), b-(HC) till posterior tip of condyles (right and left), c-(HC)till lower border of occipital condyles (right and left), d-(HC) till external border of foramen jugular (right and left), e-(HC) till opisthion(right and left), f-(HC) till carotid canal (right and left), g-(HC) till jugular tubercle (right and left). There wasn't significant difference in other parameters. Conclusion: Detailed morphometric analysis of (HC) will help in planning of surgical intervention of skull base in safer and easier ways.

Purpose: The cervicothoracic junction (CTJ) represents a transition from the semirigid thoracic spine to the mobile subaxial cervical spine. Pathologic lesions are prone to kyphotic deformity. The aim of this study was to review our experience with surgical stabilization of metastatic lesions affecting the CTJ (C7-T2). Materials and Methods: We reviewed all surgical stabilizations of metastatic spine lesions over the preceding 4 years in our institution. A total of 14 patients with CTJ lesions were identified. Case notes and radiology were reviewed to determine the presentation, outcomes, and specific complications. Results: The mean survival was 405 days (standard deviation [s.d.] 352). 8/14 died at a mean time from surgery of 193 days (s.d. 306). Most cases were a result of either lung or breast primary tumors. Half were stabilized with an anterior only approach and two had staged anterior-posterior. There were no cases of neurologic deterioration in this cohort as a result of surgery. There were two cases of deep surgical site infection and two documented cases of pulmonary embolus. There were no reported construct failures over the follow-up period. Conclusion: Patients with cervicothoracic metastatic lesions can be treated with either anterior or posterior approaches or a combination after considering each individual's potential instability and disease burden.

Background: The clinical significance of diffusion tensor (DT) magnetic resonance imaging (MRI) parameters was analyzed to predict postoperative functional recovery in patients with cervical myelopathy. Materials and Methods: Sixteen patients with cervical myelopathy caused by cervical spondylosis, disk herniation or ossification of the posterior longitudinal ligament who underwent surgical intervention in our institute were enrolled in this retrospective study. There were 7 men and 9 women, with a mean age of 62.8 years. Clinical assessment was done before surgery and at least 3 months after surgery. All patients underwent whole-body 3.0-Tesla MRI before surgery. DT images (DTIs) were obtained using a single-shot fast spin-echo-based sequence. Mean values of mean diffusivity (MD) and fractional anisotropy (FA) at 6 disk levels of the cervical spine were measured using manual setting of regions of interest. The MD and FA values at the most compressed part were analyzed. Absolute MD and FA values at the most compressed spinal level in patients were transformed into the normalized values with a z-score analysis. Results: MD-z may decrease with the severity of cervical myelopathy. Receiver operating characteristic analysis of MD-z and FA-z suggested that both MD-z and FA-z have clinical validity for predicting the efficacy of surgical intervention, but MD-z was considered to be the most appropriate value to predict the efficacy of surgery. Conclusions: DTIs may be a promising modality to predict functional recovery after surgery. MD changes may reflect spinal cord condition and its reversibility.

Background: Scoliosis is a three-dimensional spinal deformity characterized by lateral curvature and rotational deformity of the spine. Various methods have been used to investigate the performance of the subjects during walking with an orthosis, but nobody study the biomechanics of orthotic use by understanding the length of the muscles and the force produced by them. Therefore, the aim of this research is to test the effect of the orthosis on the muscular force, tendon length during walking with and without orthosis. Materials and Methods: A 12-year-old scoliosis subject was recruited in this study. The forces produced by trunk musculature, joint reaction force, length of trunk musculature were some parameters selected in this study. Open SIMM and Visual 3D software were used to model the subject. Results: The results of this research showed that the length of erector spine muscles increased follow the use of orthosis. Moreover, the force produced by trunk muscles differed during walking with and without orthosis and also between right and left sides. Discussion: It seems that Open SIMM software can be used to predict the length of muscles, active-passive forces produced by muscles in scoliotic subjects. Therefore, it is recommended this research be done on more number of subjects.

We are presenting a case of cervical (C4) aneurysmal bone cyst in a 13-year-old girl, came to the outpatient department with neck pain and stiffness since 6 months and normal neurology. We did an en bloc excision of locally aggressive tumor through anterior plus posterior approach and stabilization by lateral mass screw fixation and anterior cervical instrumentation. Involvement of several adjacent cervical vertebrae by an aneurysmal bone cyst is rare, and conventional treatment with curettage and bone grafting is most likely to carry a high rate of recurrence and spinal instability. We recommend complete excision of the tumor and instrumentation in a single stage to avoid instability.

Spinal ependymoma commonly presents as an intramedullary tumor. We present a rare case of multicentric intradural extramedullary spinal ependymoma. A 59 years old female presented to us with spastic quadriparesis for 10 months. Magnetic resonance imaging of the spinal cord showed discretely located enhancing tumor masses from at C1-C2, C6-C7, and D4 to L3 level. Subtotal resection of the symptomatic tumor at C6-C7 and D7-D9 was done. The patient underwent radiotherapy with 50.4 Gy. At follow-up of 11 months, patient is doing well. The relevant literature is reviewed.