Mubarak Ali Algahtany

Spine surgery in the Kingdom of Saudi Arabia (KSA) has undergone remarkable transformation over the past three decades. It has evolved from a service concentrated in a handful of tertiary referral hospitals into a maturing, multidisciplinary specialty distributed across governmental, academic, and private institutions. We describe the current state of spine surgery in the context of its geography, demography, and rapidly reforming health system. The country’s vast territory and its young, urbanizing population of more than 35 million generate a distinctive burden of spine disease, including congenital deformities, trauma related to road traffic accidents, and a rising tide of degenerative spinal disorders driven by lifestyle changes, obesity, and increasing life expectancy. The main spine surgery centers, the spectrum of procedures typically performed, and the penetration of novel techniques are reviewed together with the enabling technologies now being introduced under the Vision 2030 Health Sector Transformation Program. In this editorial, we present the current state of spine surgery in KSA and shed light on priority areas for advancement, including a national spine registry, structured endoscopic and robotic training pathways, equitable regional access, and higher-quality international collaborative conferences and research.

Background: This study aimed to provide an up-to-date evaluation of the characteristics, quality, and publication trends of spine surgery research originating in Saudi Arabia through a bibliometric analysis of publications in PubMed-indexed spine and spinal journals. Methods: PubMed was searched on June 20, 2026, to identify articles published in PubMed-indexed spine and spinal journals with at least one author affiliated with a clinical center in Saudi Arabia. Data were extracted independently by two reviewers and included publication year, journal, journal impact factor (IF), authorship characteristics, international collaboration, study design, study topic, and level of evidence (LOE). Publication trends were analyzed across four periods: 1987-2000, 2001-2010, 2011-2020, and 2021-2026. Results: We identified 250 articles published in 12 spine journals. The most common journals were the European Spine Journal (29%), Global Spine Journal (18%), and Spine (16%). Publication output increased markedly over time, particularly after 2020, whereas the median journal IF remained stable at 3.2. Saudi-affiliated researchers were first authors in 54% of publications, and 74% of the publications involved international collaboration with investigators from 54 countries. Although the proportion of Saudi-affiliated authors per publication declined over time, this largely reflected the increasing participation in multicenter international collaborations. Studies providing LOE I–III accounted for 64% of publications, with a progressive improvement in higher-level evidence over time. Cohort studies (47%), case reports/series (18%), and systematic reviews/meta-analyses (14%) were the most frequent study designs. The principal research topics were scoliosis, degenerative spinal disorders, trauma, outcome assessment, and surgical techniques. Conclusions: Saudi spine surgery research has expanded substantially, with marked increases in publication output, international collaboration, and the generation of high-level clinical evidence. This growth appears to have been largely driven by sustained international academic partnerships and multicenter research networks. Continued investment in national collaborative research, spine registries, and prospective multicenter studies will further strengthen Saudi Arabia’s contribution to the international spine literature.

OBJECTIVE: Diabetes mellitus (DM) is a major global health concern and is as-sociated with high morbidity and mortality as well as poor quality of life. This health burden is most-ly due to complications associated with DM. Cra-nial nerve neuropathy is not a well-studied com-plication of DM. In this study, we aimed to study the prevalence and risk factors for the develop-ment of cranial neuropathy in diabetic patients.PATIENTS AND METHODS: This is a cross-sectional study among diabetics who are attending Almanhal Primary Healthcare Center, Abha, Aseer Province, Saudi Arabia. A total of 714 subjects were included, 238 of them were in the study group and 476 were controls chosen randomly from the same community. SPSS pro-gram was used to calculate demographic, clin-ical, and biochemical parameters as well as to measure the statistically significant differenc-es. Analysis was conducted using the SPSS sta-tistical package and p-value lower than or equal to 0.05 was considered statistically significant.RESULTS: The diabetic patients were signifi-cantly older than the control group; the mean standard deviation (SD) age was 59.78 (8.26), and 34.04 (9.45) for both study and control groups, respectively. The prevalence of crani-al neuropathy was higher in diabetic patients. Among diabetic patients, hyperlipidemia, ges-tational DM, compliance with DM treatment, and the presence of microvascular complications of DM are significant risk factors for the develop-ment of cranial neuropathy.CONCLUSIONS: Our results indicate that the prevalence of cranial neuropathy is higher in the diabetic population than in the non-diabetic pop-ulation. The oculomotor and trigeminal nerves were the most commonly affected nerves in dia-betic patients compared to the abducent and fa-cial nerves in non-diabetic patients.

Ventriculoperitoneal shunt (VPS)-related abdominal pseudocyst (APC) is a rare cause of shunt malfunction. Variable VPS function due to APC has not been described before. A 21-year-old male with hydrocephalus and bilateral VPS presented with a right-sided shunt malfunction. After a routine abdominal ultrasound (US), that proved to be unremarkable, the patient had a clinical and radiological improvement followed by a relapse. An abdominal computed tomography scan subsequently showed an APC around the peritoneal catheter tip. Laparoscopic intervention on the APC cured the shunt malfunction. We believe that the APC emptied during the compression involved while performing the abdominal US. The pseudocyst collapse led to missing it on the abdominal US and explains the short-lived clinical and radiological improvement. We introduce the concept of APC-related variable VPS function, discuss the possible mechanisms by which the pseudocyst deflated, and make suggestions toward this diagnostic problem. Key Messages: A collapsible abdominal pseudocyst could result in a variable ventriculoperitoneal shunt function. Starting the abdominal ultrasound examination over the location of the peritoneal catheter tip may overcome the collapse. Contrasted computed tomography is superior to ultrasound in diagnosing the pseudocyst. Abbreviations:APC: Abdominal pseudocyst, CSF: Cerebrospinal fluid, CT: Computed tomography,MRI: Magnetic resonance imaging, US: Ultrasound, VPS: Ventriculoperitoneal shunt. doi: https://doi.org/10.12669/pjms.38.6.6278 How to cite this:Algahtany MA, Kojadinovic Z, Algahtany A. Deflating abdominal pseudocyst causing temporary normalization of ventriculoperitoneal shunt malfunction. Pak J Med Sci. 2022;38(6):1720-1723. doi: https://doi.org/10.12669/pjms.38.6.6278 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Aim. To determine the pattern and in-hospital mortality of thoracoabdominal injuries associated with head injuries (HI) due to motor vehicle accidents. Settings and Design. A single-center retrospective study in a tertiary care hospital, level 1 trauma center in the southern region of Saudi Arabia. Methods and Materials. Descriptive analysis was conducted to evaluate sex, age, types of head injury, associated thoracoabdominal injuries, particular admission day, duration of hospital stay, and discharge category, and associations between different variables and outcomes were analyzed. Results. The cohort had a mean age of , with a predominance of men (86.9%). Thoracoabdominal injuries were present in 6.8% of MVA-related HI, and 14.3% of victims expired during their hospital stay, mostly within the first 10 days. All expired patients had posttraumatic brain lesions. Moreover, there was a significant association between intensive care unit (ICU) admission and poor prognosis. Conclusions. Existence of posttraumatic brain lesions and requirement of ICU admission are significant variables affecting outcomes in patients with motor vehicle-associated HI with concomitant thoracoabdominal trauma in this study. Patients who survived the first 10 days after trauma seemed to have a better prognosis. More efforts are needed to reduce the health burden of this lethal injury.

Objectives: This study aimed to provide information on the epidemiology, trend, associated traumatic spinal cord injury (TSCI) and non-spinal injuries, and risk factors affecting the in-hospital outcome of RTA-related traumatic spinal injury (TSI) over the past decade in Aseer province, Saudi Arabia. Methods: In this retrospective study, we included all RTA-related traumatic injuries (5797) admitted to ACH from 1st January 2010 to 31 December 2019, from which 810 cases were TSIs. The cases were identified through the hospital database registry.. Descriptive analysis was performed for gender, age, level of spinal injury, admission day, type of care unit, associated injuries, presence of TSCI and discharge category. Results: TSIs accounted for 13.97% of RTA-related injuries with a predominantly male population. The patients had a mean age of 30.7 years, 46.67 % of victims were between 19 to 30-years old. There was a significant decrease in the number of RTA-related TSIs over the study period. Lumbar and cervical injuries were more prevalent (32.47 and 31.36 %, respectively). Most (73.58 %) TSIs occurred during working days, and 6.54% required critical care admission. Associated non-spinal injuries occurred in 50.25% and TSCI in 6.91% of patients. The in-hospital mortality was 5.18%. The Age, level of spine injury, need for critical care, associated injuries, and TSCI significantly affected the likelihood of improvement. Conclusion: The latest government initiatives to reduce RTA like speed limits and waring of seat belts have resulted in a concordant decline in TSI incidence with good consistency between police and health registration data doi: https://doi.org/10.12669/pjms.38.3.5288 How to cite this:Algahtany MA. Epidemiology, trend and in-hospital outcome of traumatic spinal injuries due to road traffic accidents. Pak J Med Sci. 2022;38(3):492-497. doi: https://doi.org/10.12669/pjms.38.3.5288 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVE: The main objectives of this study were to describe the epidemiological characteristics, the associated factors and outcomes of extra-axial hematoma (EAH) in patients of traumatic brain injury (TBI) due to road traffic accident (RTA) and to assess their survival probability after 6 and 12 months to RTA. PATIENTS AND METHODS: This was a retrospective record-based study. A total of 520 patients diagnosed with EAH due to RTA-related TBI were studied. This study covered ten years from January 1, 2010, to December 31, 2019. Descriptive statistics, including frequencies, percentages, mean, standard deviation, median and range were used. To test for significance in the difference between proportions, a chi-square test was applied and adjusted standardized residual to confirm the differences between groups. The Kaplan-Meier curve was plotted, and mean survival rates were calculated for each type of EAH. A two-sided p-value less than 0.05 (5%) at 95% CI was considered to be statistically significant. RESULTS: EAH occurred in 42.1% of RTA-related TBI. Subdural hematoma (SDH) was the most common RTA-related EAH. Age and sex differences exist in the type of EAH with male preponderance and a significantly higher rate of SDH in patients aged 55 years or above. The total EHA mortality was 18.7%, and most occurred within the first month of the incident. Traumatic subarachnoid hemorrhage (tSAH) was associated with poorer outcome in terms of mortality. Epidural hematoma (EDH) has the best prognosis and survival probability at six months and one year from the accident. CONCLUSIONS: Extra-axial hematomas are very common in RTA-related TBIs and have high mortality. SDH is the most common, tSAH had the highest mortality, while EDH has the best survival. Aggressive efforts are compulsory to reduce RTA-related TBI.

Traumatic spinal injury (TSI) is a serious trauma-related injury with a significant risk for mortality and morbidity. Road traffic accident (RTA) is the leading cause for the spinal and orthopedic injuries globally. Detailed information on the association of orthopedic fractures with TSI and its influence on outcomes is lacking. In this study, RTA-related TSI with orthopedic associated fractures in terms of demographics, prevalence, patterns, and outcomes were studied. This was a single-center retrospective study conducted over ten years in the largest tertiary hospital in Southern Saudi Arabia. A total of 184 patients suffered TSI associated with orthopedic fractures out of the 810 RTA-related TSIs (22.71%) were recruited. The majority was males (86%), and 55% of the cohort was between 21-40 years. The commonest spinal injury level was lumbar (25%) followed by the sacral spine (24.5%), while multiple regions orthopedic fractures and fracture pelvis were the commonest orthopedic fractures, 27.2% and 25%, respectively. The mortality rate was 4.3% and significantly correlated with the spinal injury level (p=.018). The region of orthopedic fracture has significant associations with the gender and hospital length of stay (p=.020 and p=.005, respectively). We also found a significant association between the spinal injury level and orthopedic fracture location (p<0001). Traumatic spinal injuries due to traffic accidents are commonly associated with orthopedic fractures. This association has distinct patterns and influences the patient's outcomes.

Background. Traumatic head injury (THI) due to road traffic accidents (RTAs) is a global health problem. Studies exploring the association between RTA-related THI and concurrent orthopedic fractures are lacking. We aim to provide a detailed analysis of this association and its impact on inhospital outcomes. Methods. Retrospective analysis of RTA-related THI associated with orthopedic fractures admitted to a large tertiary center, Southwest, Saudi Arabia, over ten years. Descriptive statistics for participant demographics and clinical outcomes were represented by percentages. The associations between head injury diagnosis or orthopedic fractures region and patient demographics are analyzed using the Chi-square test. Post hoc analysis for the significant Chi-square values was carried out by calculating the significant adjusted residuals. Adjust value was obtained by using the Benjamini-Hochberg procedure to control for multiplicity testing. A value less than 0.05 was considered statistically significant. Results. Concurrent orthopedic fractures are present in one-tenth of RTA-related THI. The cohort was dominated by young males, with 46.5% of the population between 18 and 29 years old. There was a significant association between the head injury diagnosis and the region of orthopedic fracture ( ). The type of head injury had significant associations with mortality and duration of hospital stay ( and , respectively). The region of orthopedic fracture significantly ( ) affected the duration of hospital stay, with fractures in the clavicle/shoulder region significantly ( ) having a short course of hospital admission. Conclusion. Orthopedic fractures concomitant with RTA-related THI are common. The associations between the two injuries tend to happen in specific patterns. The inhospital stay duration and mortality significantly correlated with the site of the head or orthopedic injury. Knowledge of these patterns improves the care of THI victims, triaging, and resource allocations.