Design, development, manufacturing and biomechanical testing of Stand-alone cage for posterior lumbar interbody fusion

Introduction: The most common method of spinal fusion includes pedicle screws instrumentation, either with or without interbody cage fusion. This thesis aimed to develop and test a novel stand-alone intervertebral device that eliminates the need for pedicle screws and rods. Method: The stand-alone cage was designed in collaboration with spinal surgeons and engineers using computer assisting drawings, and manufactured in titanium by 3D printing. Biomechanical testing comparing the stand-alone cage with standard posterior lumbar interbody fusion (PLIF) in sawbones (n=6) and cadavers (n=8). Result: Compared to PLIF, the stand-alone cage demonstrated no significant difference in range of flexion, lateral bend or axial rotation in sawbones; however, significant increase in range of extension was observed. Among cadavers, the stand-alone cage demonstrated a significant increase in range of motion (ROM) for flexion, extension, lateral bending to the right and total lateral bend ROM; but no significant increase to ROM in axial rotation. Conclusion: Due to the increased ROM associated with the stand-alone cage, this devise is not advisable to use as a fusion implant. Keywords Lumbar spine, anatomy, biomechanics, Posterior lumbar fusion, interbody fusion

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

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

Consequences of neglected traumatic spinal cord injuries

الملخص: أهداف البحث: تسببت إصابات الحبل الشوكي بإعاقات كبيرة تعتبر أحداثا مدمرة ومحبطة لكل من المرضى ومقدمي الرعاية الصحية. معظم إصابات الحبل الشوكي الرضحية تنسب الى الحوادث المرورية. الإصابات المهملة تؤدي الى مضاعفات ونتائج سيئة. في هذا الدراسة نبحث في أسباب وعواقب ونتائج إصابات الحبل الشوكي الرضحية المهملة طرق البحث: تم إجراء هذه الدراسة في مدينة الملك عبد العزيز الطبية في الرياض، المملكة العربية السعودية. من بين ٧٥٠ مريضا تم علاجهم في الفترة بين فبراير ٢٠۱٦ الى فبراير ٢٠٢۱ استوفى ۱٨ مريضا معيار التضمين الخاص بالدراسة وهي إصابة رضحية عالية الطاقة للحبل الشوكي مصاحبة لعجز عصبي، مما استلزم تخل جراحي بعد۱٤ يوم أو أكثر من تاريخ الإصابة. النتائج: من بين ۱٨ مريضا يعانون من إصابات الحبل الشوكي الرضحية المهملة، كان ٧٢٫٢٪ منهم ذكور. كان متوسط عمر المرضى وقت الإصابة ۳٦٫٨ عاما، كان جميع المرضى يعانون من إصابات في النخاع الشوكي ناتجة عن حوادث مرورية، وكان ٧٧٫٨٪ من خارج مدينة الرياض والتي تعزى الى تأخر الإحالة الى مركز ثلاثي متخصص عند معظم الحالات (٨٨٫٩٪). بلغ متوسط مدة الإهمال ٤۳ يوما، واطولها ۱٢٥ يوما. كان أكثر مواقع الإصابة شيوعا هو منطقة الصدر القطني (٥٥٫٥٪). تحسن لدى ٢ من المرضى مقياس الضعف بناء على مقياس جمعية إصابات العمود الفقري الأمريكية. حدثت تقرحات الفراش لدى ٥٥٫٥٪ وتجلط الأوردة العميقة في ٢٧٫٨٪ من المرضى. بعد الجراحة، احتاج ٧٧٪ من المرضى الى دخول العناية المركزة. لم يتلق معظم المرضى (۱٢) تأهيل متخصص لإصابات النخاع الشوكي بعد الجراحة الاستنتاجات: الإحالة المبكرة للمرضى الذين يعانون من إصابات الحبل الشوكي الرضحية ضرورية لمنع المضاعفات القصيرة والطويلة -الأجل. Abstract: 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

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

PurposeThe 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.MethodsOn 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.ResultsIn 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.ConclusionsSPINE20'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

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population