Abdulhadi Yahya Algahtani

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.

Background: Aneurysmal bone cysts (ABCs) are reactive, proliferative, and highly vascular benign osseous lesions. They are very rare, and present significant diagnostic and treatment challenges. Case Description: For three months, an 18-year-old male developed progressive low back pain and mid-low back swelling. The computed tomography (CT) scan showed a mass invading the L1 vertebral body and right pedicle. The Magnetic resonance imaging (MRI) documented a complex cystic, osteolytic lesion measuring 7 cm × 7.7 cm × 5 cm that displaced the thecal sac to the left. After the biopsy confirmed an ABC, the patient underwent pre-operative embolization that reduced the vascularity by 80%; this was succeeded by en bloc total lesion resection with an instrumented fusion. Conclusion: ABCs rarely occur in the lumbar spine. The diagnosis should be established and confirmed utilizing both MR and CT studies. Biopsy should be followed by embolization (i.e., if appropriate), and gross total surgical resection with fusion if warranted.

Objectives: To address the gap in understanding post-surgical quality of life, depression, and anxiety among brain tumor patients in Saudi Arabia. Methods: This cross-sectional study was conducted at King Abdulaziz Medical City in Jeddah, Kingdom of Saudi Arabia. A total of 160 adult brain tumor patients who underwent surgical resection between January 2021 and October 2024 were included. Quality of life (QoL) was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT) questionnaire, and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Results: Among the 160 patients, high-grade gliomas were the most common tumor type (35%), followed by meningiomas (27.5%). WHO grade 4 tumors were most prevalent (43.12%), followed by grade 1 (35.62%). Patients with high-grade gliomas and metastatic tumors reported the lowest QoL scores. Interestingly, low-grade glioma patients showed higher levels of anxiety (44.4%) and depression (33.3%). In contrast, patients with meningiomas and pituitary adenomas had better QoL outcomes. Conclusion: Patients with high-grade gliomas experienced poorer QoL postoperatively. However, good QoL is still achievable, particularly among those with benign tumors such as meningiomas and pituitary adenomas.

BackgroundCerebrospinal fluid (CSF) leak is a known complication of spine surgery, and an effective protocol for prevention, recognition, and treatment of postoperative CSF leak is essential to avoid a cascade of associated adverse outcomes, such as durocutaneous fistula, wound infection, and intracranial hemorrhage. We aim to identify the incidence of CSF leak post spinal surgeries and to obtain the factors that could predict the risks of having a CSF leak following spine surgeries. MethodsThis study was conducted as a retrospective cohort study on patients who had CSF leaks post spinal surgery in King Abdul-Aziz Medical City, Jeddah, from June 2016 to January 2024. ResultsThe occurrence of cerebrospinal fluid (CSF) leak post-surgery was relatively low (2.6%), and more than 97% of the participants studied had no CSF leak. There is a statistically insignificant relation with age, gender, DM, BMI, hypertension, malignancy, and cardiovascular diseases. Still, there is a statistically significant relation with the attempt to watertight closure, and type of surgery (P value ≤ 0.05). ConclusionPostoperative CSF leak following spinal surgery is associated with morbidity and can lead to re-operation and infection. The incidence of CSF leaks among our study participants was about 2.6%, which is relatively low. Identifying predictors for CSF leaks can assist in counseling patients concerning surgical risk and expected postoperative recovery.

The article presents a case study on the surgical correction of a severe cervical kyphotic deformity that developed as a post-radiotherapy complication in a pediatric patient. This deformity was treated through a two-stage procedure involving gradual halo traction followed by combined anterior and posterior cervical fusion. The patient, a 15-year-old girl with a history of radiation therapy for a posterior fossa tumor, exhibited significant deformities that compromised her quality of life. Initial halo traction improved the curvature by approximately 60%, after which a 180-degree cervical reconstruction was performed to achieve near-complete correction. The first stage of the surgery involved posterior decompression and occipito-cervical fixation, while the second stage addressed anterior structural support through discectomy and fusion. The multidisciplinary approach led to a stable cervical alignment with notable functional recovery over an 18-month follow-up, including improvements in oral feeding, gaze stability, and motor function. The article discusses the complexities of managing radiation-induced spinal deformities in pediatric patients, emphasizing the importance of early diagnosis and a comprehensive surgical approach to optimize long-term outcomes

Background: Over the past two decades, endoscopic endonasal skull base surgery (EESBS) has revolutionized the treatment of skull base tumors by enabling minimal access to resect significant pathologies such as meningiomas, pituitary adenomas, and chordomas. Despite its efficacy, complications such as cerebrospinal fluid (CSF) leak pose significant challenges, with an average incidence of 8.9% following EESBS. Therefore, our study aims to investigate the risk factors associated with postoperative CSF leak after employing an endoscopic endonasal approach for skull base surgery, focusing on patients treated at King Abdul-Aziz Medical City in Jeddah and King Abdullah Medical City in Makkah, Saudi Arabia. Methods: A retrospective review of patients who underwent an endoscopic endonasal approach for the resection of intradural skull base pathology between January 2016 and December 2022 was performed with a total of 51 patients. Basic demographic data were collected, along with patient comorbidities, presenting symptoms, tumor pathology, tumor site, the extent of resection, and outcomes. Results: 51 participants were analyzed, with a mean age of 43.41. Male participants comprised (58.8%), while headaches were the most common symptom (74.5%), followed by visual disturbances (51.0%). Nonsecretory tumors predominated, primarily located in the sellar and suprasellar regions (58.8%). Gross total resection was performed in the majority (56.9%), with a 9.8% incidence of postoperative CSF leak. Notably, all four patients with CSF leak experienced preoperative headaches. Hypertension was prevalent in Cases 1 and 4, with Case 4 having a history of neurological disease and radiation therapy. Anterior skull base tumors were most frequent in Cases 3 and 4. Conclusion: The incidence of CSF leakage after surgery in this study was similar to that previously reported. It is worth noting that repeated surgeries may increase the risk of postoperative CSF leakage. Therefore, it is important to carefully evaluate the surgical approach for tumor removal and skull base reconstruction, considering the tumor characteristics and the patient’s overall condition.

Introduction: The coronal subluxation of C2-C3 (lateral leisthesis or non-hangman fracture) is extremely rare and difficult to manage. In this paper, we report a case of a 21-year-old male who came to the ER after a motor vehicle accident (MVA) with C2-C3 lateral leisthesis and, surprisingly, mild neurological symptoms. Method: This systematic review was conducted following the recommendations of the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) checklist. On January 1, 2022, a comprehensive electronic search was conducted through Scopus, PubMed, and Web of Science databases to retrieve original studies. Results: Seven articles were found reporting on non-hangman traumatic C2/C3 subluxation, with only two cases reporting coronal subluxation or lateral listhesis of C2 over C3. The first case was reported by Rajasekaran et al. Singh reported the second case. Both cases were unilateral facet dislocations with no radiological evidence of intervertebral disc disruption or herniation. We will report the third case in the literature of a non-hangman C2/C3 coronal dislocation. The patient underwent intraoperative manual traction under continuous neurophysiology monitoring. After the satisfactory reduction, fixation was carried out using lateral mass and pars screws from C1 to C3. Postoperatively, the patient recovered well, showed no signs of motor impairment during examination, and was discharged on the fifth day. Conclusion The impact of cervical spine injury is tremendous at every level. Management of cervical spine dislocation injury is full of controversies. The C2/C3 traumatic coronal translation with no disc involvement and unilateral facet dislocation may have a better outcome.

Background: Subdural hematoma (SDH) is considered spontaneous in the absence of trauma history. It is a common presentation in the geriatric age group due to the many influential factors. Most cases have a known underlying etiology that explains the incidence, otherwise, they are considered idiopathic. We present a rare case report of idiopathic nontraumatic bilateral SDH with a literature review of similar cases. Case Description: A 28-year-old fit individual presented to the Emergency Department with a chronic history of severe headache and neck pain, associated with behavioral changes in the last 2 days. He reported that his symptoms started after lifting a heavy object 2 months ago; however, they became worse after a neck chiropractor therapy session. He is not on any chronic medications, and there was a negative history of trauma, seizure, hematological diseases, family history of neurological conditions, smoking, alcohol, or drug abuse with an unremarkable systemic review. A brain computerized tomography (CT) showed bilateral SDHs, for which he underwent bilateral mini craniotomies and drainage. The symptoms improved after surgery and the follow-up brain CT showed no recurrence. Conclusion: Idiopathic spontaneous bilateral SDH in the adult age group is an extremely rare pathology and the literature review only revealed three similar cases. With the absence of any pathology that would explain the presentation after extensive investigations, we hypothesized that a sudden rise in vascular pressure was the underlying etiology, especially with the fact that the symptoms became unbearable after the neck chiropractor therapy session.