The Effect of Rod Bending on Long-term Lumbar Sagittal Parameters in Spondylolisthesis Patients Treated With Short Segment Posterior Fusion: A Randomized Clinical Trial

Background and Aim: Although rod bending is a universal method for maintaining lumbar lordosis (LL), its long-term efficacy in short-segment posterior fusion is still a challenge. This study aimed at evaluating the long-term effect of rod bending in patients with grade one L4/L5 spondylolisthesis with a short segment fusion. Methods and Materials/Patients: A double-blind prospective randomized clinical trial was conducted from 2016 to 2018 and patients who met the inclusion criteria were enrolled in the study. The participants were randomized into two treatment arms: open posterior fusion with rod bending and without rod bending. The baseline data, including leg and back pain scores, were evaluated before surgery. Lumbar, focal, and segmental lordosis were measured before surgery. After surgery and a one-year follow-up, pain scores and lordosis measurements were re-evaluated and compared between and within groups. Results: A total of 60 patients were analyzed. Leg and back pain scores improved significantly after the follow-up in both groups (P<0.0001). However, there was no significant difference between the two groups before and after the surgery. LL did not change in either group after surgery. Focal and segmental lordosis significantly increased in both groups but showed no difference between the groups at either time. Complications were not significantly different in either group. Conclusion: In this study, no significant difference concerning the radiological and pain outcomes was observed in either group; therefore, rod bending to reach the desired LL may be an unnecessary spend of time

Transverse sinus obstruction caused by extradural supra‐infratentorial hydatid cyst: A case report and literature review

Abstract Approximately 1–3% of cases of hydatid disease involve the central nervous system (CNS). This study aims to report an extremely rare case of supra‐infratentorially located epidural hydatid cyst with transverse venous sinus obstruction which presented with chronic cerebral vein thrombosis (CVT) signs and symptoms

A case of atlantoaxial instability following skull base osteomyelitis: Tips for diagnosis and management

Abstract Skull base osteomyelitis is a rare but dangerous consequence of untreated malignant otitis externa. Pseudomonas aeruginosa is responsible for most cases with typical presentation. Here, we discuss a diabetic 54‐year‐old female presented with malignant otitis externa and bilateral facial paresis followed by cervical spondylitis and C1‐C2 instability. Skull base osteomyelitis confirmed by clinical presentation, imaging, and laboratory data. Fortunately, she responded well to antibacterial and antifungal therapy. Due to limited data, there is no confirmed standard of treatment for cervical instability secondary to SBO. It seems antibiotic therapy is the mainstay of treatment. In case of poor response to antibiotic therapy, surgical intervention is inevitable. This article introduces the first case of SBO‐related AAI successfully managed with conservative treatment

A case of chronic ossified hematoma presented as a skull lesion: A literature review on two rare conditions, cephalhematoma, and intradiploic hematoma

Abstract Cephalhematoma is a frequent condition in newborn infants due to birth‐related trauma, but ossified cephalhematoma (OCH) is a rare condition, especially when it presents as a skull lesion in the older pediatric population. Chronic intradiploic hematoma (CIH) is another rare condition caused by an organized hematoma between the inner and outer tables of the skull. Differentiating CIH from OCH could be difficult for young neurosurgeons. We present an 18‐month‐old girl with an OCH presented as a skull lesion, which was managed with craniectomy and en‐bloc excision of the organized hematoma. This manuscript discusses the differences between OCH and CIH in diagnosis and management

Incidentally diagnosed multiple intradural extramedullary spinal hydatidosis in a young adult: A case report and review of the literature

Key Clinical Message Although quite rare, vertebral hydatidosis should always be considered as a differential diagnosis for spinal presentations, particularly in endemic areas for echinococcosis. Abstract In this paper, we report a rare case of asymptomatic multiple intradural, extramedullary spinal hydatidosis, incidentally diagnosed in a patient with signs and symptoms of a true protruded disc. Although quite rare, vertebral hydatidosis should always be considered as a differential diagnosis for spinal presentations, particularly in endemic areas for echinococcosis

The efficacy of intrathecal methyl-prednisolone for acute spinal cord injury: A pilot study

Study design: Randomized clinical trial. Objectives: To evaluate the safety and effectiveness of intrathecal methyl-prednisolone compared to intravenous methyl-prednisolone in acute spinal cord injuries. Setting: Imam Reza Hospital, Tabriz University of Medical Sciences. Methods: Patients meeting our inclusion and exclusion criteria were enrolled in the study and divided randomly into two treatment arms: intrathecal and intravenous. Standard spinal cord injury care (including surgery) was given to each patient based on our institutional policy. Patients were then assessed for neurological status (based on ASIA scores, Frankel scores) and complications for six months and compared to baseline status after injury. To better understand the biological bases of methyl-prednisolone on spinal cord injuries, we measured two biomarkers for oxidative stress (serum malondialdehyde and total antioxidant capacity) in these patients at arrival and day three after injury. Results: The present study showed no significant difference between the treatment arms in neurological status (sensory scores or motor scores) or complications. However, the within-group analysis showed improvement in neurological status in each treatment arm within six months. Serum malondialdehyde and total antioxidant capacity were analyzed, and no significant difference between the groups was seen. Conclusion: This is the first known clinical trial investigating the effect of intrathecal MP in acute SCI patients. Our finding did not show any significant differences in complication rates and neurological outcomes between the two study arms. Further studies should be conducted to define the positive and negative effects of this somehow novel technique in different populations as well

Combined treatment with Minocycline and methylprednisolone in acute traumatic spinal cord Injury: A pilot study

Objective: This randomized clinical trial (RCT) aimed to compare the neurologic outcomes of spinal cord injury (SCI) patients treated with Minocycline plus methylprednisolone (MCMP) versus MP (Methylprednisolone) alone. Methods: This double-blind, single-center parallel RCT study was conducted in a community-based setting from 2022 to 2023 on consecutive patients with acute SCI within 12 h of injury. The intervention group (MPMC) received a bolus infusion of MP 30 mg/kg in 15 min intravenously, followed by a 5.4 mg/kg infusion of MP for 24–48 h and 50 mg Minocycline orally every 12 h for one week. The control group received the same amount of MP alone. Neurologic exam according to the Frankel Grading System compared two groups. Results: A total of 54 patients completed the 6-month follow-up with a mean age of 42.5 and 41.5 in the MP (n = 27) and MPMC (n = 27) groups, respectively. The Baseline Frankel score was similar between the two groups (P = 0.92).During the follow-up period, 7.4 % and 22.2 % of the MP and MPMC groups improved to the Frankel score of D and E in the three months but insignificant between the groups (OR: 1.34, 95 % CI: 0.997–1.813, P = 0.052). At the 6-month follow-up, 33.3 % and 48.1 % of patients in MP and MPMC groups improved to Frankel scores D and E, respectively, which was significant in the mixed-effect analysis (OR: 1.45, 95 % CI: 1.074–1.952, P = 0.015). Conclusion: Combination therapy with Minocycline and MP might be more effective in improving neurological recovery and reducing inflammation and tissue damage in SCI patients in the short term

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019Research in context

Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences &amp; Sichuan Provincial People's Hospital (2022QN38)