Introduction. The implantation of DIAM in interspinous space is believed to act as facet joints and provides stability to operated segment by shifting instantaneous axis of rotation forward in lordotic disorders. In this retrospective study, the patients who underwent lumbar surgery with DIAM (Medtronic Sofamor, Danek) spacer implants were followed up with an aim to evaluate the clinical outcomes. To our knowledge, this is the largest series with longest follow up. Material Methods. Patients who underwent lumbar surgery (discectomy and decompression) with concomitant placement of DIAM spacer within a 36-months period were included. A total of 52 patients including equal number of male (n=26) and female (n=26), were followed up for 12 to 45 months (Mean: 22 months). Results. Total of 77 DIAM implanted; L1/2 (n=1), L3/4 (n=9), L4/5 (n=31), L5/S1 (n=26). 27 patients received DIAM at one level and 25 at 2-levels. Patients experienced significant pain reduction and functional improvement at final follow up. In single level surgery, mean ODI improved from 50.03 pre-operatively to 31.23 post-operatively. The mean pre op VAS-BP & VAS-LP scores were 7.66 & 7.03, which were reduced to 4.29 & 3.55 respectively. In two level surgery mean pre op ODI, VAS-BP VAS-LP were 45.71, 6.71 & 6.42 pre-operatively which improved to 32.20, 3.97 and 3.82 at follow up respectively. Conclusion. Significant improvement of pain and function have been noted following the use of DIAM. Furthermore, DIAM interspinous implantation is less invasive and preserves much of the deep posterior structures compared to semi rigid instrumented dynamic stabilisation devices. Our long-term results of the cohort demonstrate that DIAM spacer implantation is effective in relieving pain and improving functional outcome

The optimal method for the management of neglected traumatic bifacetal dislocation of the subaxial cervical spine has not been established. We treated four patients in whom the mean delay between injury and presentation was four months (1 to 5). There were two dislocations at the C5-6 level and one each at C4-5 and C3-4. The mean age of the patients was 48.2 years (27 to 60). Each patient presented with neck pain and restricted movement of the cervical spine. Three of the four had a myelopathy.

We carried out a two-stage procedure under the same anaesthetic. First, a posterior soft-tissue release and partial facetectomy were undertaken. This allowed partial reduction of the dislocation which was then supplemented by interspinous wiring and corticocancellous graft. Next, through an anterior approach, discectomy, tricortical bone grafting and anterior cervical plating were carried out.

All the patients achieved a nearly anatomical reduction and sagittal alignment. The mean follow-up was 2.6 years (1 to 4). The myelopathy settled completely in the three patients who had a pre-operative neurological deficit. There was no graft dislodgement or graft-related problems. Bony fusion occurred in all patients and a satisfactory reduction was maintained.

The posteroanterior procedure for neglected traumatic bifacetal dislocation of the subaxial cervical spine is a good method of achieving sagittal alignment with less risk of iatrogenic neurological injury, a reduced operating time, decreased blood loss, and a shorter hospital stay compared with other procedures.