This study was done to determine the effectiveness of percutaneous autologous bone marrow injection in fracture healing and to determine if centrifuged bone marrow is more effective in bone healing as compared to uncentrifuged marrow.

This is a randomized interventional trial of 106 patients who had bone marrow injection. The study was done in 2 parts. In the first part, 51 patients were divided into three groups – a) Fresh fractures,(within 6 weeks of injury) b) Delayed union – (8 to 12 weeks after injury) c) Non union – more than 16 weeks after injury. All patients in the first part of the study underwent percutaneous autologous bone marrow injection and were followed up at 6,8,10 and 12 weeks and every 4th week thereafter. Forty seven out of 51 patients united. The second part of the study was done to compare centrifuged and uncentrifuged bone marrow injections. Fifty five patients having either tibial or femoral fractures were divided into two groups, centrifuged and uncentri-fuged and appropriate marrow injection was done. All patients were followed up every 6 weeks till 36 weeks. 48 patients out of 55 united. Equal number of patients united in the centrifuged and uncentrifuged group.

We conclude that percutaneous autologous bone marrow injection is a simple and effective tool which can be used for fracture healing and centrifugation of bone marrow yields no added advantage in bone healing.

Anterior debridement, grafting of the defect and posterior instrumentation as a single-stage procedure is a controversial method of managing pyogenic vertebral osteomyelitis. Between 1994 and 2005, 37 patients underwent this procedure at our hospital, of which two died and three had inadequate follow-up. The remaining 32 were reviewed for a mean of 36 months (12 to 66). Their mean age was 48 years (17 to 68). A significant pre-operative neurological deficit was present in 13 patients (41%). The mean duration of surgery was 285 minutes (240 to 360) and the mean blood loss was 900 ml (300 to 1600). Pyogenic organisms were isolated in 21 patients (66%). All patients began to mobilise on the second post-operative day. The mean hospital stay was 13.6 days (10 to 20). Appropriate antibiotics were administered for 10 to 12 weeks. Early wound infection occurred in four patients (12.5%), and late infection in two (6.3%).

At final follow-up, the infection had resolved in all patients, neurological recovery was seen in ten of 13 (76.9%) and interbody fusion had occurred in 30 (94%). The clinical outcome was excellent or good in 30 patients according to Macnab’s criteria.

This surgical protocol can be used to good effect in patients with pyogenic vertebral osteomyelitis when combined with appropriate antibiotic therapy.

Aim of Study: (A) To study what causes Anterior Column Deficiency in Burst Fracture of Dorso Lumbar Spine in the acute and later phase. (B) To analyse radiologically, the significance of adjacent disc injuries in burst fracture of dorso lumbar spine. (C) To look into the effectiveness of posterior short segment stabilisation by pedicle screw fixation and fusion in these injuries, in relation to deformity and anterior column deficiency.

Methods and Materials: Twenty consecutive cases of Superior Burst-split fracture of Dorsolumbar spine were studied prospectively. All cases underwent reduction, posterior short segment stabilisation by Steffee type pedicle screw fixation and two level posterolateral fusion. The average follow-up duration was 30.2 months. Standardised AP and lateral radiograph were taken pre-operatively and post-operatively at regular intervals (every three months). Radiological assessment using seven parameters (Vertebral body angle, Upper disc angle, Lower disc angle, Kyphotic angle, etc) were done from these radiographs.

Result and Significance: The total average correction of kyphosis (in degree) at surgery was 21.5°, and the proportion of correction during surgery was – Upper disc 29% (6.3°), Vertebral body 68% (14.6°) and Lower disc 3% (0.6°). So 68% of the correction was at the vertebral body level and 32% at the adjacent discs levels. At follow-up, the total average loss of correction was 16.5°, and the proportion of loss at follow-up was – Upper disc 44% (7.2°), Vertebral body 14% (2.3°) and Lower disc 42% (7.0°). There was loss of 14.2° at the disc levels compared to 2.3° only at the vertebral body level. So 86% of the loss was at the adjacent disc levels.

Conclusion: Distraction at the adjacent disc levels occurred at surgery while contouring the vertebral body using dorsal instrumentation. The distraction at the upper disc level was significant. Distraction at adjacent disc levels resulted in more anterior column deficiency.

At follow-up, the loss in the vertebral body was minimal and most of the loss occurred at the adjacent disc levels. The anterior column deficiency caused by the injury to the adjacent disc is very major cause for failure of dorsal instrumentation than the deficiency caused by the vertebral body. The upper disc is more severely injured than the lower disc in the superior burst split fracture and so the degeneration is rapid in the upper disc and gradual in the lower disc. The CT cuts at the end plate levels of the vertebral body can help to judge roughly the extent of injury to the adjacent disc.

Posterolateral fusion and late disc degeneration after consolidation of fusion result in collapse of the disc in kyphotic angulation, as it prevents collapse of posterior disc height.

We present a prospective study of patients with tuberculosis of the dorsal, dorsolumbar and lumbar spine after combined anterior (radical debridement and anterior fusion) and posterior (instrumentation and fusion) surgery. The object was to study the progress of interbody union, the extent of correction of the kyphosis and its maintenance with early mobilisation, and the incidence of graft and implant-related problems. The American Spinal Injury Association (ASIA) score was used to assess the neurological status.

The mean preoperative vertebral loss was highest (0.96) in the dorsal spine. The maximum correction of the kyphosis in the dorsolumbar spine was 17.8°. Loss of correction was maximal in the lumbosacral spine at 13.7°. All patients had firm anterior fusion at a mean of five months. The incidence of infection was 3.9% and of graft-related problems 6.5%.

We conclude that adjuvant posterior stabilisation allows early mobilisation and rehabilitation. Graft-related problems were fewer and the progression and maintenance of correction of the kyphosis were better than with anterior surgery alone. There is no additional risk relating to the use of an implant either posteriorly or anteriorly even when large quantities of pus are present.