Introduction: Magnetic resonance imaging (MRI) has become the choice of imaging modality for lumbar canal stenosis (LCS) due to limitations and radiation risks of computed tomography (CT) and spinal radiography. The radiological criteria for diagnosis of LCS are still ambiguous. Aim of this study is to find out the radiological dimensions on MRI of lumbar spinal canal in Indian patients and the critical dimensions at which the symptoms occur. Materials and Methods: A cross-sectional study was conducted in ESI Hospital, New Delhi from July 2011 to 2013. Two study groups were studied, the symptomatic LCS group, consisted of 30 individuals of either sex in age group of 45-65 years. The control group consisted of 30 asymptomatic age matched individuals. MRI scans were performed on 1.5 Tesla scanner. Dimensions of lumbar canal at all the levels (L1-L5) of lumbar vertebra of 60 patients were measured. Results: In our study, in symptomatic group, narrowest mid-sagittal diameter antero-posterior (mean 10.61) was at L5-S1 level. The interligamentous diameter (ILD) showed no significant difference between the two groups. Lateral recess depths showed a significant difference between the two groups at all levels except L1 on right side and L1 and L2 on left side. Critical canal dimension was found to be 11.13 mm. Conclusion: MRI can effectively evaluate the lumbar canal stenosis. The critical canal dimensions at which symptoms of stenosis appear were 11.13.

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At one point or another in their lives, most people will experience some degree of shoulder pain. It may be secondary to a variety of underlying pathology. We report a case of shoulder pain caused by a granulocytic sarcoma (chloroma) in chronic myeloid leukemia (CML) patient misdiagnosed initially as synovitis. Although granulocytic sarcoma has many classic musculoskeletal manifestations, to our knowledge, a case of CML concurrent with chloroma of the shoulder joint has not been reported in the literature. We must not forget that the shoulder pain arising from granulocytic sarcoma may be the initial presenting feature of underlying hematological malignancy such as CML.

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Intraosseous ganglion is a benign bony cyst that mainly involves the epiphysis and metaphysis of long bones. Intraosseous ganglions are rare in talus, and in all the cases reported in literature, the patients had symptoms pertaining to the ankle joint. No case has been reported where the lesion in the talus has caused symptoms specific to the subtalar joint. A 20-year-old female presented to our hospital with pain in the right foot from last 6 months. Ankle joint movements were within normal limits, but the subtalar movement were significantly reduced. Plain radiographs of the foot and ankle were normal. Computed tomography (CT) scan of the foot and ankle showed a cystic lesion (0.5 × 0.5 cm) involving the base of the talar body which communicated with the subtalar joint. The patient was treated by curettage of the lesion through a curvilinear incision over the medial aspect of the subtalar joint. The clinical results after 3 months were excellent. The patient returned to her regular and light recreational activities with full, painless range of motion. There was no recurrence of symptoms at 6 months. Intraosseous ganglion is of talus is a rare entity. Symptomatic patient should be treated surgically.

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There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body. Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc.

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Introduction: Giant cell tumor (GCT) also called osteoclastoma of bone is the most common osteolytic bone tumor encountered by an orthopedic surgeon. En bloc resection of major joints creates a problem for the reconstruction of large defects. Recent advances in tumor resection defects involve the use of custom-built joints for the reconstruction of defects near joints. This article analyzes the functional outcomes after resection of juxta articular GCTs and reconstruction by custom mega prosthetic arthroplasty. Aims and Objectives: To study the functional results of custom mega prosthetic reconstruction in juxta articular GCTs with intra articular extension. Materials and Methods: Four patients with juxta articular GCTs around the hip and knee with mean age of 40 yrs (range 30 to 50 yrs) underwent resection and reconstruction by custom mega prosthetic arthroplasty during the period 2011 to 2013. Two patients were males and two were females. All of them were in Enneking stage 3. Proximal femur was involved in one patient, distal femur in one and proximal tibia in two patients. Results: Functional results were analyzed using Ennekings criteria. Excellent results were obtained in all the patients without recurrence, periprosthetic fractures, infections or aseptic loosening. Conclusion: By using the technique of custom mega prosthetic reconstruction in juxta articular GCTs with pathological fractures or intra articular extension, the desired goals of reconstruction with good functional results and least complications can be achieved.

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Osteoid osteoma is a benign tumor with peculiar severe pain disproportionate to its small size (less than 2 cm). Osteoid osteoma usually is monofocal and has single nidus. The reported case is a patient with intolerable leg pain and four nidus in proximal femur.

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Systemic candidiasis is usually associated with immunosuppression. Fungal arthritis due to candidal organism in an immunocompetent patient is rare. We describe one such rare occurrence in a young boy without any predisposing factors, who developed knee arthritis caused by Candida albicans.

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Non-Hodgkin's lymphomas (NHL) is the most common primary bone lymphoid malignancy, and diffuse large B-cell lymphoma (DLBCL) accounts for the greatest percentage of cases. Here we report a 34-year-old male presented with pain and swelling of left shoulder joint of 2-month duration. There was no history of trauma. A diagnosis of intraosseous NHL-Diffuse large B-cell lymphoma (DLBCL) was made. He was treated with six cycles of with R-CHOP (Rituximab, Cyclophosphamide, Vincristine, Doxorubicin and Prednisolone) chemotherapy. Our report suggests that primary intraosseous high-grade NHL, e.g. DLBCL can present as fracture in an unusual site in a young adult.

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