Nouf Abdulaziz Altwaijri

Background: Posterior spinal fusion is the mainstay of treatment for Cobb angle over 50 degrees with satisfactory long-term results. In the surgical management of scoliosis, surgeons usually focus on the amount of coronal curvature correction because it can determine the surgical outcome. Nevertheless, there are many factors that contribute to patients’ satisfaction after surgery, and achieving shoulder balance is one of the most vital factors of a successful surgery. Our objective is to study the differences in managing idiopathic scoliosis with pedicle screws versus hybrid fixation with regard to shoulder imbalance postoperatively. Methods: Continuous variables were described using mean and standard deviation, whereas categorical variables were described using frequencies. The association between predictor independent variables with the analyzed outcomes were expressed as (beta coefficients) with their associated 95% confidence intervals. The Alpha significance level was considered at 0.050 level. Results: The mean angle of the clavicle measured a significant drop post-surgery compared to their pre-surgical measured mean clavicular angle, p-value < 0.001, and so did the coracoid height difference: p-value < 0.001. Furthermore, the participants had measured a significantly lower mean angle of the clavicle compared to their baseline; p-value = 0.029, regardless of their surgery type. The participants mean measured coracoid height difference score had correlated positively with their mean angle of the clavicle: beta coefficient = 1.654, p-value < 0.001; when the coracoid height difference increased, so did the mean angle of the clavicle. Conclusions: Posterior spinal fusion is effective in correcting coronal curvature and improving radiographic shoulder asymmetry in AIS. Significant improvements were observed in Cobb angle, clavicle angle, and coracoid height difference, with pedicle screw constructs providing superior curve correction. These findings reinforce the value of individualized surgical planning that considers coronal, sagittal, and cosmetic alignment goals.

3M syndrome is a rarely inherited autosomal recessive disorder caused by mutations in cullin-7 (CUL7), obscurin-like 1 (OBSL1), and coiled-coil domain containing protein 8 (CCDC8). It is associated with multiple dysmorphic features, including characteristic facial dysmorphism (a face that is triangular, full lips, frontal bossing, a nasal tip that is fleshy, long philtrum, protruding ears and macrocephaly), severe growth retardation prenatally and postnatally and normal intelligence. Although there are multiple skeletal manifestations of the syndrome, such as joint laxity, there is no mention of developmental dysplasia of the hip (DDH) to be associated with it anywhere in the literature. Therefore, we present the first case of bilateral DDH in a patient with 3M syndrome, which was managed similarly to other DDH cases with operative reduction, pelvic osteotomies, and femoral shortening, with a satisfactory outcome after 3 years of follow-up.

The unicameral bone cyst (UBC) is a benign lesion that affects children and adolescents between 4 and 14 years of age. They are defined by an osteolytic cavity filled with serous fluid, enclosed by a thin fibrous membrane. Moreover, they are closely associated with skeletal growth and biomechanical stresses during development. Surgical management of UBCs is crucial, particularly in weight-bearing bones, to reduce the risk of pathological fractures and maintain structural stability. These surgical procedures (such as curretage and bone grafting) aim to restore bone stability, prevent recurrence, and enhance long-term functional outcomes. Studying UBCs provides insight into the natural history and behavior of benign bone lesions, emphasizing the importance of growth and mechanical factors in skeletal pathology. This case report seeks to present our experience in managing UBCs of the proximal femur in Riyadh, Saudi Arabia, focusing on the tips needed in the surgical technique that can aid surgeons in the management of such cases.

Background: Anatomic variations of the popliteal artery are critical to recognize during preoperative planning to avoid complications. The aberrant anterior tibial artery (AATA) arises higher than the usual site of the anterior tibial artery, and it passes between the posterior tibial cortex and anterior to the popliteus muscle. Purpose: To assess AATA prevalence, magnetic resonance imaging (MRI) landmarks, intraoperative vascular injuries, and surgeon acknowledgment of the AATA presence. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was conducted in 2 stages. During the first stage, 787 knee MRIs were reviewed to detect the AATA prevalence. In the second stage, 10 board-certified knee and sports surgeons were invited to comment on 10 knee MRIs, 5 of which showed AATA variation. This assessment was performed 3 times: (1) at baseline; (2) immediately after an instructional orientation session; (3) 2 weeks after the orientation session. Results: The prevalence of the AATA was found to be 2.03%. MRI measurements revealed that the AATA was, on average, 5.69 mm from the tibial attachment of the posterior cruciate ligament (PCL) and 9.89 mm from the posterior horn of the lateral meniscus. The anatomic variation of the AATA was most consistently visualized at the level of the tibial attachment of the PCL in 81.25% of cases. Before instructional orientation, observer surgeons failed to identify the presence or absence of the AATA on all MRI images. However, after the orientation, all observers accurately identified the AATA in both positive and negative cases immediately and after 2 weeks, achieving 100% intraobserver reproducibility. Conclusion: Popliteal artery anatomic variations may often be overlooked in preoperative planning; a detailed understanding of these variations is crucial to prevent unfortunate intraoperative complications. None of the surgeons detected the AATA on the first encounter. This highlights the importance of education in improving the detection and diagnosis of the AATA.

Background: Thoracolumbar fractures are classified into four categories according to the mechanism of injury and fracture morphology into compression fracture, burst fracture, flexion-distraction injury, and fracture dislocation. Unfortunately, the management of spinal fracture has lacked standardization given the many unanswered yet relevant questions regarding the outcome. However, management is generally divided into surgical and nonsurgical treatment such as orthosis. We aim to compare the clinical and the radiological outcomes of operative spinal fractures in patients with thoracolumbar spinal orthoses (TLSO) and patients without TLSO. Up to our knowledge, there are no similar studies comparing such management approaches in Saudi Arabia. Methods: This is a retrospective cohort study conducted in King Saud Medical City which included patients over 18 years of age from the past 10 years who underwent spinal fixation with or without the use of orthotics and had at least 6 months follow-up. We have excluded any patients with degenerative diseases, spinal tuberculosis or spinal tumors. Our primary outcome was radiological outcomes and clinical outcomes among groups using orthotics postoperatively versus groups who didn’t use orthotics. Statistical analysis was done utilizing The Statistical Package for the Social Sciences (SPSS) IBM statistical computing program version 21 was used for the statistical data analysis and the alpha significance level was considered at 0.050 level. Results: The patients were divided into two groups, patients given TLSO postoperatively (group A) (53.1%) and patients not given TLSO postoperatively (group B) (46.9%). Most of the patients had a burst fracture and most (86.4%) had endured a single level spine fracture. Bivariate Pearson’s correlations test showed the patients mean perceived pain level [the visual analogue scale (VAS)] had correlated negatively and significantly with their emotional well-being (EM-WB) score, r=−0.132, PU test showed that the patients who used TLSO had perceived significantly greater general health (GH) score (mean GH score =77.44) compared to those who have not used TLSO (mean GH score =70.79), Z=2.38, P=0.02. Group A perceived significantly lower satisfaction with their social limitations (mean score =71.32) compared to group B (mean score =89.47) on average, Z=2.10, P=0.040. Group B (n=38) measured a significant decline in their pain level across the three time-point measured pain levels (PConclusions: Our study concludes that both groups have noticeable reductions in pain postoperatively and have shown decent results with regards to the Short Form 36 (SF-36) scores. However, further research is necessary to gain a comprehensive understanding of the varying effects of bracing versus non bracing long-term outcomes in upper thoracic and thoracolumbar fractures.

A 32-year-old male was brought to our emergency department following trauma due to fall of heavy object (tree) on his back. After Advanced Trauma Life Support (ATLS) protocol implementation, the patient was noted to have a complete perianal tear and loss of power in L3-S1 measuring 1/5 complete loss of sensation below the level of L2. Imaging showed spinopelvic dissociation with cauda equina syndrome. Spinopelvic fixation and fusion with rigid fixation done. The patient regained normal function following extensive physiotherapy. This paper concludes that good and prompt surgical intervention facilitated neurological recovery following decompression.

Fractures of the cervical spine can cause devastating long-term effects on patients. Spinal cord injuries can occur in up to 50% of cases in association with cervical spine fractures. Therefore, it is vital and of utmost importance to recognize cervical spine injuries early on to avoid the exacerbation of an existing injury and its detrimental effects on the patients. We report a case of a C6-C7 fracture dislocation with an associated neurological insult that improved dramatically following fixation and rehabilitation. Unfortunately, patients with this presentation may have long-term neurological insults rather than regain normal function; however, our case notes the importance of prompt intervention and its effect on the outcome.

Osteochondromas are bone lesions composed of medullary and cartilaginous bone covered by a cap of hyaline cartilage. The presence of medullary and cortical bone with the continuity of the tumor is pathognomonic for osteochondroma and aid in establishing the diagnosis. We report a case of a two-year-old girl who presented to our clinic following her mother noticing a palpable, growing, and painful mass on her left scapula. There was no limitation in the range of motion. A clear-cut mass was seen on the dorsal aspect and palpated measuring around 2.5x3 cm. Surgical excision of the mass followed by histologic examination confirmed osteochondroma. Upon follow-up, the patient had no pain and had a full range of left shoulder motion without discomfort or pain. In conclusion, scapular exostoses are very rare and more so when they present dorsally. Symptomatic lesions can be managed effectively with surgical excision of exostosis.

Background: Mental health disorders are common in Saudi Arabia with a 34% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective: We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods: This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results: Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions: Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population.