Lumbar Spine Ganglion Cyst: A Case Report.

Ganglion cysts are typically periarticular soft tissue lesions commonly found in the wrist and forearm, with spinal involvement being rare. We present a clinical case of a 54-year-old female with a ganglion cyst at the L3-L4 level, causing radiculopathy symptoms. Despite initial difficulty in diagnosis due to MRI findings, surgical resection confirmed the extradural mass as a ganglion cyst. Postoperative recovery was uneventful, with immediate relief of radiculopathy symptoms. Challenges included distinguishing between synovial and ganglion cysts and accurately locating the cyst intraoperatively. This case highlights the importance of considering ganglion cysts in the differential diagnosis of spinal lesions and underscores the efficacy of surgical management for symptomatic relief.

Returning to Work After Traumatic Spine Fractures: Current Status in a Military Hospital.

INTRODUCTION: The consequences of traumatic spine fracture (TSF) are complex and have a major burden on patients' social life and financial status. In this study, we aimed to investigate the return to work (RTW) after surgically treated TSFs, develop eventual predictors of delayed or failure to RTW, and assess narcotics use following such injuries. METHODS: This was a single-center retrospective cohort study that was performed in a tertiary care center. TSF patients who required surgical intervention from 2016 to 2021 were enrolled. Demographic, operative, and complication data, as well as narcotics use, were recorded. RTW was modeled using multivariate logistic regression analysis. RESULTS: Within the 173 patients with TSF, male patients accounted for 82.7%, and motor vehicle accidents were the most common mechanism of injury (80.2%). Neurologically intact patients represented 59%. Only 38.15% returned to work after their injury. Majority of the patients didn't use narcotics more than 1 week after discharge (93.1%). High surgical blood loss, operation time, and hospital length of stay were significantly associated with not returning to work. In multivariant regression analysis, every increase of 100 ml of surgical blood loss was found to decrease the chance of RTW by 25% (P = 0.04). Furthermore, every increase of one hour in operation time decreases the chance of RTW by 31% (P = 0.03). CONCLUSION: RTW is an important aspect that needs to be taken into consideration by health care providers. We found that age and high surgery time, blood loss, and hospital stay are significantly impacting patients' RTW after operated TSF.

Alkaptonuria Diagnosis Following a Discectomy: A Case Report.

Alkaptonuria is a rare genetic disorder characterized by the excessive production of homogentisic acid, leading to the formation and deposition of pigment polymers throughout the body. It is extremely rare, affecting only around one in 100,000 individuals. Despite the normal life expectancy, it can cause severe morbidities. Alkaptonuria is typically managed supportively with pain medication, dietary modifications, and surgical interventions, which are considered to be the gold standard of therapy. Here we present a case of a 33-year-old male with no previous medical or surgical history who presented with severe acute back pain radiating to the left leg. Genetic testing confirmed a homozygous pathogenic variant for alkaptonuria. This case highlights the challenges in diagnosing alkaptonuria, emphasizing the significance of early detection, and clinical evaluation for improved outcomes. Furthermore, it underscores the need to consider alkaptonuria as a multidimensional disease, necessitating further research to enhance our understanding and develop effective management. Therefore, this study serves as an opportunity for future trials and studies aimed at digging deeper into the intricacies of alkaptonuria to increase our understanding and establish comprehensive management plans for affected individuals.

Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature.

The surgical treatment of delayed, unstable sub-axial cervical spine injuries is challenging. Multiple treatment regimens have been described in the literature, although there is no consensus regarding the best treatment approach. This report presents a 35-year-old obese woman who experienced a delayed sub-axial fracture-dislocation following a motor vehicle accident (MVA) and was successfully managed after three weeks via pre-operative traction followed by a novel single-surgery, single-approach technique with pedicle screws and tension-band wiring as a reduction method. A 35-year-old obese woman with a body mass index (BMI) of 30.1 sustained a frontal impact MVA and suffered from complete quadriplegia below C5 (American Spinal Cord Association Injury A) three weeks prior to presentation. She was intubated and presented with a Glasgow Coma Scale score of 11/15. Trauma computed tomography (CT) showed an isolated spine injury. Moreover, whole-spine CT showed an isolated cervical spine injury involving a basin tip fracture, a comminuted C1 arch fracture, a C2 fracture, and a C6-C7 fracture-dislocation. In addition, magnetic resonance imaging revealed cord contusion at the same level, with C1-C2 left atlantoaxial joint instability. Neck magnetic resonance angiograms and carotid CT angiograms showed left vertebral artery attenuation. She was admitted to the intensive care unit and taken for C6-C7 reduction and instrumentation using only a posterior approach after medical optimization and the application of sufficient traction. Delayed cervical spine fracture-dislocation imposes a challenge for surgical reduction. However, a proper reduction can be achieved through a sufficient duration of pre-operative traction and an isolated anterior or posterior approach.

Traumatic spinopelvic dissociation: A case series.

Introduction: Spinopelvic dissociation was described first in 1969. It is an injury characterized by the separation of the lumbar spine, with parts of the sacrum, from the rest of the sacrum and pelvis with the appendicular skeleton through the sacral ala. Spinopelvic dissociation has an incidence of approximately 2.9% of all pelvic disruptions and corresponds with high-energy trauma. The objective of this study was to review and analyze a case series of spinopelvic dissociations that were treated in our institution from May 2016 to December 2020. Methods: This was a retrospective study reviewing medical records of a series of cases with spinopelvic dissociating. A total of nine patients were encountered. Demographic data including gender and age were analyzed with the mechanism of injury, fracture characteristics, and classifications in addition to neurological deficits. Fractures were classified by the AO Spine Sacral Classification System. Moreover, neurological deficits were classified using the Gibbon's classification score. Finally, the Majeed score was utilized for the assessment of the functional outcome after the injury. Results: A total of nine patients with spinopelvic dissociation were encountered, seven males and two females. Seven patients were due to motor vehicle accidents, one patient was due to a suicidal attempt, and one patient was due to seizure. Four patients suffered from neurological deficits. One patient needed an intensive care unit admission. Spinopelvic fixation was done for all patients. One patient had surgical wound infection with wound dehiscence, one had infected instruments with confirmed spine osteomyelitis, and one had a focal neurological deficit. Six patients went on to heal and showed complete neurological improvements. Conclusion: Spinopelvic dissociation injuries represent a variety of injuries that are commonly associated with high-energy trauma. The triangular fixation method has proven to be a stable construct in dealing with such injuries.

Iatrogenic contralateral foraminal stenosis following lumbar spine fusion surgery: illustrative cases.

BACKGROUND: Lumbar spine fusion is the mainstay treatment for degenerative spine disease. Multiple potential complications of spinal fusion have been found. Acute contralateral radiculopathy postoperatively has been reported in previous literature, with unclear underlying pathology. Few articles reported the incidence of contralateral iatrogenic foraminal stenosis after lumbar fusion surgery. The aim of current article is to explore the possible causes and prevention of this complication. OBSERVATIONS: The authors present 4 cases in which patients developed acute postoperative contralateral radiculopathy requiring revision surgery. In addition, we present a fourth case in which preventive measures have been applied. The aim of this article was to explore the possible causes and prevention to this complication. LESSONS: Iatrogenic foraminal stenosis of the lumbar spine is a common complication; preoperative evaluation and middle intervertebral cage positioning are needed to prevent this complication.

Consequences of neglected traumatic spinal cord injuries.

Objectives: Spinal cord injuries cause major disabilities and are devastating events for both patients and healthcare providers. Most traumatic spinal cord injuries (TSCIs) are due to motor vehicle accidents (MVAs). Neglected injuries result in complications and poor outcomes. Here, we investigated the causes, consequences, and outcomes of neglected TSCIs. Methods: This case series study was performed at King Abdulaziz Medical City, Riyadh, KSA. Of the 750 patients treated between February 2016 and February 2021, 18 patients met our inclusion criterion of neglected high-energy TSCI with neurological deficit, necessitating surgical intervention more than 14 days after the index trauma. Results: Of the 18 patients with neglected TSCIs, 72.2% were men. The patients' mean age at the time of injury was 36.8 years, 77.8% were from outside Riyadh, and all patients had MVA-induced TSCIs, 88.9% of which were attributable to delayed referral to a tertiary center. The mean duration of neglect was 43 days, and the longest duration was 125 days. The most common site of injury was the thoracolumbar region (55.5%). The American Spinal Injury Association impairment scale score improved in two patients. Bed sores occurred in 55.5%, and deep vein thrombosis occurred in 27.8% of patients. Postoperatively, 77% of patients required intensive care unit admission. Most patients (12) did not receive specialized spinal cord injury rehabilitation postoperatively. Conclusion: Early referral of patients with TSCIs is crucial to prevent short- and long-term complications.

The Effect of Visual Impairment on Postural Stability After Lumbar Spine Fracture: A Case Report and Review of the Literature.

The role of vision in maintaining postural stability is crucial, and its loss, whether congenital or acquired, can significantly impact sensory-motor interactions, leading to musculoskeletal abnormalities and defective gait patterns. This case report discusses the complex interplay between visual impairment, post-traumatic kyphosis, and the development of spinal deformity in a 79-year-old blind patient. The patient sustained a simple fall resulting in an L1 compression fracture in 2016. Despite conservative treatment for the fracture, progressive spinal deformity became evident both clinically and radiographically. Further assessments, including evaluation of bone healing, facet arthroplasty, disc degeneration, and canal compromise, were performed. The patient's altered gait and postural abnormalities were indicative of the impact of visual impairment on postural stability. After addressing osteoporosis through endocrinology consultation and medical management, the patient underwent posterior spinal instrumentation and deformity correction, leading to a successful post-operative recovery with a return to baseline functional status. Visual impairment disrupts postural stability by limiting sensory input and prompting compensatory mechanisms, which may increase postural sway and instability. This abnormal gait further contributes to spinal deformities, and the fear of falling can exacerbate postural instability, limiting mobility. Over time, persistent postural imbalance leads to the creation of a state of continual asymmetric stress related to the spinal axis, which can progress to the development of spinal deformities, creating a self-perpetuating cycle.  This case underscores the significance of vision in postural stability and the adverse effects of visual impairment on spinal alignment. The development of spinal deformities in visually impaired individuals, especially in the presence of risk factors like osteoporosis, emphasizes the need for early intervention and postural training to prevent irreversible deformities. Decisions regarding surgical or non-surgical interventions for spinal deformities in visually impaired patients must consider multiple factors, including clinical symptoms, appearance, pain, functional limitations, and social issues. Future research should explore effective interventions for improving postural stability in visually impaired individuals and preventing the development of spinal deformity.

Unusual presentation of aneurysmal bone cyst with scoliosis: a case report.

BACKGROUND: Aneurysmal bone cysts are benign bone tumors that not uncommonly involves the spine. However, this involvement can cause scoliosis, albeit rarely. This report focuses on the importance of proper management for complete tumor resection to prevent recurrence and spinal deformity. CASE PRESENTATION: A 12-year-old Middle Eastern boy, with a history of T11 aneurysmal bone cyst resection and bone grafting carried out at another hospital, presented with spine deformity of 4 months' duration. The deformity was not associated with pain or neurological deficit. A whole-spine magnetic resonance imaging with contrast confirmed the recurrence of the aneurysmal bone cyst. Posterior spinal instrumentation with corpectomy of T11 was then performed, and confirmed with histopathology the recurrence of aneurysmal bone cyst. Two years post-corpectomy, deformity correction was done from T5-L4. CONCLUSION: Management of aneurysmal bone cysts requires meticulous planning and full excision to prevent recurrence, especially in the growing spine. If neglected, it can cause major spinal deformities and cord compression, which places a medical burden on the patient and family. To avoid such complications, treating aneurysmal bone cysts along with scoliosis correction can prevent deformity progression.

Prevalence and Predictors of Scoliosis and Back Pain in 591 Adolescents: A Randomized, Stratified, Cross-Sectional Study in Riyadh, Saudi Arabia.

Purpose Owing to the difficulty of establishing a screening program for scoliosis and back pain, along with their disabling consequences and the lack of local prevalence rates, we sought to study the prevalence of scoliosis and back pain in adolescents in Saudi Arabia and the burden reported by the affected age group on the health system. Materials and methods A school-based, cross-sectional pilot study covering all school districts in Riyadh, Saudi Arabia, was conducted. Students between 12 and 18 years of age were included. Students with any spinal or neurological disorders were excluded. Physical examinations to screen for scoliosis and student-filled questionnaires to assess back pain and health-related quality of life were performed. Results Of the 700 students, 591 met the inclusion criteria. High suspicion of adolescent idiopathic scoliosis (AIS) was considered in 174 students (29.44%). In addition, 45.42% of the students had a history of back pain. The Oswestry Disability Index showed that 87 students had disabilities. The average Scoliosis Research Society-22 score was 3 out of 5. A significant difference was found in the self-image and mental health domains for AIS (p = 0.04, p = 0.02, respectively). Age showed a significant increase in the odds ratio of a positive physical exam for every increase of one year in age (p < 0.01). Conclusion Identifying the prevalence rates and early associated factors during adolescence would help lower the burden on the health system and benefit public health in general. A nationwide study is required to identify the relationship between scoliosis and back pain.

Neurological Impairment Recovery in Surgically Treated Patients With Nontraumatic Spinal Cord Injury.

INTRODUCTION: The incidence of nontraumatic spinal cord injury (NTSCI) is reported to be higher than that of traumatic spinal cord injury in many countries, making it an area of growing significance. OBJECTIVES: With the aging of the global population in coming decades, it is anticipated that the incidence of NTSCIs will increase dramatically. Our aim was to identify and report the causes, patterns, and outcomes of NTSCI in a tertiary care center. METHODS: We have reviewed all adult patients who had a NTSCI and were surgically treated with a minimum follow-up of 12 months postoperatively. Demographic and clinical data were collected. Preoperative and postoperative American Spinal Injury Association (ASIA) impairment scales and past follow-up outcomes were assessed. RESULTS: Of 164 patients, 95 (58%) had full recovery and reached ASIA E score at their last follow-up while 69 (42%) were not able to achieve full recovery till ASIA E score. Urinary incontinence and/or bowel incontinence on admission, degenerative pathologies, and thoracic injury level were all notable indicators of limited ASIA score improvement at the last follow-up. CONCLUSIONS: Surgically treated NTSCI could result in good neurological recovery with a low complication rate.

SPINE20 recommendations 2021: spine care for people's health and prosperity.

PURPOSE: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. METHODS: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. RESULTS: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. CONCLUSIONS: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Aggressive L3 vertebral hemangioma coexisting with adult thoracolumbar scoliosis: Case report.

Vertebral hemangiomas are benign vascular tumors that are commonly asymptomatic. A low percentage might become aggressive; however, they are not known to be associated with scoliosis. We present a case of a third lumbar vertebral lesion coexisting with a moderate thoracolumbar scoliosis. The patient's initial presentation was back pain with bilateral lower limb radiculopathy and neurogenic claudication. Diagnosis was established using CT and MRI, which showed classical findings of an aggressive vertebral hemangioma. The patient underwent Partial hemangioma excision and scoliosis correction, with satisfactory outcome at 1 year follow up.

The Current Practice of Adult Idiopathic Scoliosis Surgical Treatment Among Spine Surgeons in Saudi Arabia.

BACKGROUND: Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae. The goal of corrective scoliosis surgery is to restore alignment of the spine and maintain motion. However, there is no global agreement among spine surgeons on the best method of surgical intervention, and little is known about the variations in practice among spine surgeons in Saudi Arabia. OBJECTIVES: The aim of this study is to examine the current surgical practices relating to adolescent idiopathic scoliosis and to establish the degree of variation and consensus among spine surgeons in Saudi Arabia. METHODS: This was a cross-sectional study conducted among spine surgeons in Saudi Arabia, using a self-administered questionnaire. The questionnaire addressed four areas: surgeons' demographics, pre-operative assessment, operative assessment, and infection control practices. There were a total of 27 questions. Data was analyzed using statistical package for social sciences (SPSS) software (SPSS Inc., Chicago, IL, USA). RESULTS: A total of 150 surgeons were included in this study. Of these, 73 responded to the questionnaire (response rate: 48.6%), 46 (63.01%) of whom were fellows. All respondents were males, and 37 (51.39%) were aged between 30 and 40 years. Fifty five (75.34%) were orthopedic surgeons. The most commonly used pre-operative health assessment test was an echocardiogram. Sixty six (90%) surgeons requested scoliosis anteroposterior (AP) view and lateral radiograph for curvature between 40 degrees and 90 degrees, and 65 (89%) requested it for curvature greater than 90 degrees. For the posterior construct, 29 (45.31%) did not use cross-links for fewer than 10 levels, and 23 (35.94%) did not use cross-links for more than 10 levels. In addition to a local bone graft, the most commonly used transplant method was allograft 37 (50.68%). Fifty five (85.94%) respondents favored an all-screw pedicle construct over a hybrid construct. CONCLUSION: A large variation in surgical practices was observed. This was especially apparent in practices including the use of cross-links, intra-operative cell salvage, and the intra-operative use of traction. Some degree of variation was observed in pre-operative imaging assessment practices. Surgical guidelines should be developed to build a consensus among surgeons. A unified surgical training curriculum may help in achieving this goal.

Management of thoracic spine dislocation by total vertebrectomy and spine shortening: case report.

INTRODUCTION: The treatment of thoracic spine fracture-dislocations is now well established with the recent progress in spine surgery. Although most affected individuals have a degree of spinal cord injury (SCI), early surgical reduction, and stabilization of the unstable deformity allow an immediate program of rehabilitation. Vertebrectomy is considered as the last surgical technique reserved for the most persistent spinal deformities that cannot be brought to an acceptable correction with less invasive methods. CASE PRESENTATION: We present a case of a 19-year-old male with a sub-acute thoracic spine fracture-dislocation at the level of T7-T8 who underwent a posterior T8 vertebrectomy with reduction and instrumentation from T4 down to T1. The individual had excellent results during follow-ups regarding alignment, fusion, and rehab program. DISCUSSION: In this case, we present the good outcome of vertebrectomy and spine shortening in an individual with thoracic spine fracture-dislocation, and the advantages of posterior approach.

Traumatic sacralization of L5 vertebra with severe extension type spinopelvic dissociation: A case report.

BACKGROUND: Spinopelvic dissociation is considered a very complex orthopedic injury. The presence of intrapelvic displacement and L5 traumatic sacralization makes our report a very rare presentation. THE CASE: A 60-year-old gentleman presented with a rare traumatic fracture dislocation of the lumbosacral complex with intrapelvic displacement and L5 sacralization; treated with two surgical stages: 1) pelvic external fixation and posterior pelvic tension band plate, and 2) T10 to pelvis posterior fixation. CONCLUSION: Intrapelvic displacement of S1 in the presence of spinopelvic dissociation is very rare injury that requires high mechanism of injury, surgical management is important to improve functional outcome.

Anterior Cervical Discectomy and Fusion Complications and Thirty-Day Mortality and Morbidity.

Background Anterior cervical discectomy and fusion (ACDF) is a commonly used procedure. However, few studies reported post-operative complications. This study looks into the prevalence of possible complications and the mortality rate in the first 30 days postoperatively.  Methods A retrospective review of patients who underwent ACDF for degenerative disc disease from 2008-2017, in a single center in Riyadh, Saudi Arabia was performed. Patient demographic data, comorbidities, operative notes, immediate and delayed complications were all collected, with a minimum of 30 days follow-up.  Results Out of 434 medical charts reviewed, 163 met the inclusion criteria. Mean population age was 52 ± 11 years. Elective cases comprised 90% of sample and most patients had one or two levels operated on, 95% had ACDF and only 5% had corpectomy. The drain was left in 69% of patients and planned intensive care admission was done for 3%. Instrumentation and graft was used, with 92% needing a cage plus plate. Intraoperative complications were minimal. Mean hospital stay was 12.5 ±18 days. Majority of population had no complications in a 30 days period (98.2%). Only one case underwent revision surgery.  Conclusions While ACDF is considered a safe procedure, postoperative complications may have long-term implications. This study showed minimal complications in the immediate postoperative period, but due to the limited sample size, a study with larger population is needed to further confirm the results.

Spinal Pseudoaneurysms Mimicking an Osteogenic Tumor: A Case Report.

AIM: This study presents a rare case of pseudoaneurysm mimicking a tumor on the back, with no history of fever, trauma, or surgical intervention. In which no identifiable symptoms or warning signs were present. This pseudoaneurysm arises from intercostal arteries and segmental arteries. Both of which, to the limit of our knowledge, have not been discussed before. METHOD: This study was done using chart and literature review. We present a case of a 46-year-old man with a known case of left-sided intracranial hemorrhage due to hypertension and an old cerebrovascular accident. The patient has a positive history of hypertension, which could have attributed to the pseudoaneurysm; however, he has no history of vascular disease otherwise. The patient reports of back swelling and intermittent back pain for the past 3 years. On MRI, the mass showed a pulsating pattern around it. It also showed a layering effect because of different wall thicknesses and enhanced patterns, and the enhancement ratio was increased. In addition, it showed flow artifacts with T1 hyperintense areas because of associated thrombus and blood products. These changes noted on the MRI prompted the team to do a color Doppler study to confirm the presence of an aneurysm and if present, to do a CT angiography. The color Doppler showed a turbulent flow, that is, there was a bidirectional pulsatile flow which further confirms the presence of a pseudoaneurysm. Spine CT with contrast showed a right paraspinal lesion at the T9-T11 level. It had contrast enhancement and flow inside, consistent with a partially thrombosed aneurysm. The CT also showed evidence of bone remodeling in the adjacent thoracic vertebrae. The patient opted for spinal vascular emobilization and vascular sheath removal. The right and left intercostal arteries were selected at the level of left and right T4, left T8, bilateral T9, and bilateral T10. CONCLUSION: Differentiating between pseudoaneurysms and osteogenic tumors is essential to target later investigations accordingly. In addition, if pseudoaneurysms are left untreated, they could cause bony erosions of the vertebra, which lead to compression fractures. They can further compress the adjacent neurovasculature, which worsens the morbidity.