Sagittal alignment of lumbar spine (SALS) is the state of spine in sagittal plane. The spine is a single organ with multiple segments of varying structure and function. These segments are interrelated and can be the cause and effect of malfunction of the other. In addition, there is a significant role of pelvis and cranium in maintaining the global sagittal balance. The lumbar spine plays a vital role in maintaining global sagittal balance because of several factors. Lumbar lordosis (LL) is one of them which helps to distribute body weight evenly to maintain an upright position. In other words, by virtue of LL, human beings can stand upright and walk with perfect balance. LL is basically a compensatory posture and any change in it beyond the normal limit needs further compensation by other parts of the spine and pelvis in order to restore balance. This compensation occurs at the cost of excessive stress in those other parts. Ultimately it can affect overall spinal alignment leading to loss of sagittal balance which in turn results in series of clinical manifestations like chronic back pain and difficulty in walking, bending and standing. There are various parameters which help to define a perfect SALS. Spinal surgeons should have a good understanding of these parameters not only for the proper evaluation of any spinal problem but also for the appropriate planning of spinal surgery.

Multiple sclerosis (MS) continues to challenge clinicians and researchers alike with its non-specific and heterogeneous presentation and unpredictable course. Among its earliest and most presenting features is visual dysfunction—commonly optic neuritis—which not only reflects localized optic nerve inflammation but also serves as a harbinger of widespread central nervous system (CNS) pathology. This intimate relationship between vision and neurodegeneration positions the eye as a functional and structural biomarker of MS. Yet, for too long, neurology and ophthalmology have operated in parallel rather than in concert.

A study was conducted using the "Spinal neuroprosthesis neurostimulation device" specs 26.60.13-004-65248030-2021, which is designed to stimulate the dorsal roots of the cervical and lumbar spinal branches by rhythmic electrical stimulation during defined phases of the step cycle. The aim of the study was to evaluate the safety and efficacy of a neuroprosthesis to regulate motor functions in patients with the consequences of an acute cerebrovascular accident. Group 1 (main group): Patients who underwent transcutaneous electrical spinal cord stimulation with a neuroprosthesis and standard rehabilitation (therapeutic exercises, massage, physiotherapy). Group 2 (control): Patients who underwent electrical stimulation with a neuroprosthesis without current and standard rehabilitation. Primary efficacy point: improvement in walking performance in the 10-metre walk test and the 6-minute walk test. Secondary efficacy points: Improvement in performance tests on various scales: Fugl-Meyer, the Medical Research Council Scale for Muscle Strength , quantitative muscle strength assessment, Berg Balance Scale, Functional Independence Scale, modified Ashworth Scale and analysis of spatio-temporal and kinematic parameters assessed by laboratory methods, video recording of muscle activity. The rehabilitation course consisted of 12 daily procedures, each lasting 40-60 minutes and performed on a treadmill for 20 minutes. Tests were performed 1-2 days before the start of the rehabilitation course and the day after the rehabilitation course ended. The results of a clinical study showed that the use of a neuroprosthesis leads to a significant improvement in muscle strength, the ability to maintain balance, a decrease in spasticity and an increase in functional independence.

Introduction: Congenital Craniovertebral junction (CVJ) anomaly has always proved a surgical challenge due to the complex anatomical location, unique embryological development, high mobility of the joints and its intricate relationship to vital neuromuscular structures. Patients usually presents with myelopathy, neck pain, and functional disability, such as difficulty swallowing and a associated neck deformity. Such patients requires early surgical treatment to prevent irreversible neurological deficit. But usually such patient presents late and sometimes respond late to surgical management offered to them. Due to limited literature available regarding surgical outcomes in patients with pre- operative poor neurological grade. Our study is thus an effort to determine the impact of surgery in neurological outcomes in such patients. Materials and methods: In our study, 32 patients of Congenital CVJ anomalies who underwent surgeries were retrospectively analysed for Demographic data, duration of symptoms, clinical presentation, neuroimagings, type of surgery, complications and post surgical outcome. Results: . Clinical and radiological datas of 28 patients were retrospectively analysed and the patients were followed up for 6 months post operatively. Pre operative Nuricks grade were compared with follow up Nurick grade for any improvement in functional outcome. Other independent variables such as age, sex, time of presentation, clinical features were analysed for any correlation with final functional outcome in such patients. Conclusions: Early surgical intervention has better outcomes in congenital CVJ anomalies patients. However some patients with poor pre operative neurological grade also showed promising functional outcome thus emphasising the role of surgery in such patients.

Although cerebellar hemangioblastoma is histologically benign, it can exhibit malignant clinical behavior during long-term follow-up. This report presents the case of a 51-year-old male with von Hippel-Lindau (VHL) disease, characterized by multifocal hemangioblastomas in the spine and cerebellum, as well as multiple cystic lesions in the kidneys and pancreas. The patient underwent nine surgeries for recurrent cerebellar hemangioblastomas and received cranial radiotherapy for multiple intracranial masses. Additionally, he was diagnosed with and treated for renal cell carcinoma arising from a renal cyst. This case highlights the potential for cerebellar hemangioblastoma recurrence and malignant progression of associated lesions in VHL disease, even after complete resection.

Cardiac arrest inside the neurosurgical theatre is a grave crisis which can end up in a remarkably high mortality rate. It is an uninvited crisis to both the neurosurgeon and the neuroanesthetist. It has numerous causes and can happen during different kinds of surgeries along with positions. Management of cardiac arrests in neurosurgical patient population is a territory that is not well elucidated. Conventional ALS protocols cannot be straightaway applied in neurosurgical patients at all times. With a good comprehension, practitioners can be better geared up to tackle unfavourable cardiac emergencies which can be gruelling to the whole neurosurgical team.

Spinal cord infarction secondary to Anterior Spinal Artery Syndrome is a very rare condition. It usually occurs secondary to aortic surgery, thromboembolism, aortic dissections and hypoperfusion. We present here a rare case of a 64 year old patient who presented with acute onset of quadriparesis and was found to have Anterior Spinal Artery syndrome. Initial imaging was normal while repeat imaging after forty eight hours showed features of cervical cord infarction. He was managed conservatively with intravenous corticosteroids, low molecular weight heparin and anti platelet agents and had improvement in motor power after treatment.

Intramedullary spinal cord metastatic tumors are rare clinical entity, with primary tumors like ependymomas and astrocytomas being most common. With the improved survival due to early detection and advanced therapeutic management of cancer patients, incidence of intramedullary spinal cord metastasis (IMSCM) is increasing. Conus metastasis is very uncommon among intramedullary spinal cord metastasis in published literature. We present a short series of two cases of conus medullaris (CM) metastasis from primary lung cancer treated surgically at our institution and discuss the surgical outcome and review of literature.

Evidence-based medicine (EBM) emphasizes the systematic and judicious use of the best available evidence in clinical decision-making aligning treatment options with individual patients’ values and circumstances. It integrates clinical expertise, patient preferences, and research evidence to optimize patient care. By adopting EBM principles, clinicians improve care quality, ensure ethical decision-making, and adapt to the evolving landscape of medical science. This dynamic paradigm advances patient outcomes while providing a compassionate and evidence-driven healthcare environment. However, challenges such as information overload, resource constraints, and variations in evidence quality necessitate continuous learning and systematic approaches. This article explores the historical evolution of EBM, its foundational principles, and the structured five-step process: Assess, Ask, Acquire, Appraise, and Apply.

Introduction: Cervical spondylotic myelopathy resulting from a highly migratory disc prolapse is an infrequent occurrence, typically associated with patients presenting with poor Nurick grades. The debate around the choice of therapy between discectomy versus corpectomy is a topic of contention. In this study, we describe our findings on the utilization of corpectomy as the preferred therapeutic approach. Methods: In this retrospective study a cohort of 12 patients were included during the study period. The variables studied encompassed demographic aspects, clinical presentation, radiological data, as well as the rates of recovery for both Nurick and mJOA (Modified Japanese orthopedic association) scales. Results: The average age at presentation was 52.8 years, with a range of 42 to 64 years. The male-to-female ratio was 1:1. At presentation, the mean Nurick grade was four and the mean mJOA score was 9.8. The average duration of the symptoms was 17 months. The median follow-up period was 25 months (range:12-72 months). Based on pre operative MRI scans, the migration distance of disc prolapses ranged from 6.5-18.8 mm with mean of 9.9 mm. At follow-up, the mean Nurick grade recovery rate was 49.58 + 22.74 % and the mean mJOA recovery rate was 58.42 + 24.77% (p=0.04). There were no complications. Conclusion: Based on our empirical observations, corpectomy appears to be an optimal surgical approach for patients presenting with highly migrated disc prolapse. This procedure offers a broader surgical field, facilitating the removal of fragments located posterior to the vertebral body and those that are adherent to the thecal sac.