Musab Alageel

Background/Objectives: Traumatic spinal injury (TSI) is associated with substantial morbidity, but factors contributing to in-hospital complications remain insufficiently defined. This study evaluated factors associated with in-hospital complications after TSI. Methods: We conducted a retrospective cohort study at a tertiary center (January 2018–May 2025). Among 5380 trauma patients screened by computed tomography, 413 admitted patients with TSI were included. The primary outcome was any documented in-hospital complication. Factors were assessed using multivariable logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: The median age was 28.0 years, 337 were male (81.6%), and four-wheel motorized vehicle accidents were the most common injury mechanism (57.1%). In-hospital complications occurred in 99 patients (24.0%). Pulmonary infection was most common (9.9%), followed by bloodstream infection (4.4%), urinary tract infection (3.9%), and surgical site infection (3.9%). Compared with patients without complications, those with complications had longer hospital stays, higher ICU admissions, longer ICU stays, and lower discharge home. In multivariate logistic regression, complications were associated with worse AIS grade (OR 1.690, 95% CI 1.241–2.302), inpatient physical therapy requirement (OR 4.385, 95% CI 2.494–7.711), greater number of associated non-spinal injuries (OR 1.729, 95% CI 1.463–2.042), and greater cervical vertebral injury burden (OR 1.479, 95% CI 1.061–2.062). Conclusions: Neurological severity, polytrauma burden, and cervical injury were independently associated with complications, supporting early risk stratification and multidisciplinary prevention in high-risk patients. Findings should be interpreted considering the retrospective single-center design, predominantly young male cohort, low spinal cord injury proportion, and limited post-discharge data.

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.

Background: The treatment of musculoskeletal (MSK) tumors involving the extremities has evolved over the past decade with the introduction of prosthesis and new chemotherapy regimen. The Toronto Extremity Salvage Score system (TESS) is a patient-filled questionnaire that measures the functional status of patients with MSK tumors who underwent limb-salvaging procedure. The purpose of this study is to translate TESS into Arabic (TESS-AR) and to examine its reliability and validity. Methods: Our study is a multi-center in Riyadh, Saudi Arabia. Arabic-speaking adults diagnosed with MSK tumors involving the extremities were included. TESS-AR was created following clear, user-friendly guidelines for translation. Moreover, reliability and validity were measured using the test-retest method and construct validity, respectively. Results: 108 participants completed the TESS-AR, 56% had lower limb tumors. The participants reported that the TESS-AR was clear and all questions and answers were understood. The test-retest reliability showed excellent reliability, with an interclass correlation coefficient of 0.965 for both the lower and upper extremity TESS-AR. Cronbach’s alpha of lower extremity TESS-AR was 0.972, whereas that of upper extremity TESS-AR was 0.969, indicating strong internal consistency. The construct validity between TESS-AR and SF-36 showed a strong and moderated correlation between most of the components, with a Pearson correlation coefficient >0.40. Similar results were found between TESS-AR and EORTC QLQ C30. Conclusion: The TESS-AR is a comprehensible, valid, and reliable score for assessing functional outcomes in patients with extremity tumors. We believe that TESS-AR can be used by clinicians, researchers, and patients alike.

Slipped capital femoral epiphysis (SCFE) is usually seen in patients with high body mass index (BMI) and endocrine diseases. SCFE is exceedingly rare among Cerebral palsy (CP) patients due to spasticity present in those patients. Percutaneous in situ fixation is the treatment option for SCFE patients. According to the literature, there’s no single case report with SCFE in a spastic CP patient with no prior history of trauma, seizure episodes, or endocrine disease. We report a case of an 11-year-old spastic cerebral palsy (CP) patient with a physical status of level 5 motor function on the gross motor function classification system. He was brought by his mother to the clinic complaining of bilateral hip pain. The mother denied any history of trauma or any seizure episodes. The pain had started spontaneously. Physical examination showed severe spasticity and bilateral hip abduction with external rotation. Drehmann’s sign was positive. Bilateral hip radiographs revealed bilateral partial open femoral capital physis with evidence of SCFE bilaterally. Also, the Southwick angle was measured, and it was severe. The patient was taken to the operating room and treated with closed reduction and percutaneous in situ fixation. He was seen multiple times following surgical intervention, reporting pain relief, and showing complete wound healing. This report concludes that paraplegic spastic CP patients may present with SCFE spontaneously without trauma, seizures, or an underlying endocrine disease. Also, severe spasticity might potentially be a risk factor for SCFE, although further investigations would be necessary to establish a conclusive link.

Background and Objectives: Hyponatraemia increases the morbidity and mortality risks of orthopaedic patients. When undergoing spine surgery, hyponatraemic patients have high risks of pneumonia and of staying in hospital for up to 1 day longer compared with non-hyponatraemic patients. This study aims to assess the occurrence of adverse events among patients with pre-operative hyponatraemia after undergoing lumbar surgery. Materials and Methods: A retrospective cohort study was conducted. Patients who underwent spinal surgery in 2011 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between hyponatraemic patients and normonatraemic patients. Post-operative adverse events, need for blood transfusion and length of stay were considered as clinical outcome data. Results: A total of 58,049 patients were included; pre-operatively, 55,012 (94.8%) were normonatraemic and 3037 (5.2%) were hyponatraemic. Multivariate analysis showed that hyponatraemic patients had higher rates of adverse events, blood transfusions and urinary tract infections. Specifically, 632 (20.8%) hyponatraemic patients developed adverse events, compared with 6821 (12.4%) normonatraemic patients; the hyponatraemic patients received transfusions, compared with 6821 (7.4%) normonatraemic patients; and 97 (3.2%) hyponatraemic patients developed urinary tract infections, compared with 715 (1.3%) normonatraemic patients. Finally, an extended length of stay beyond 6 days occurred in 604 (19.9%) hyponatraemic patients, compared with 4676 (8.5%) normonatraemic patients. Conclusions: Our study identified an association between pre-operative hyponatraemia and post-operative adverse events in spinal surgery patients. However, it is unclear whether hyponatraemia caused the higher adverse event rate.

Osteochondromas, classified as a new benign subtype of lipomas and characterised by chondroid and osseous differentiation, are rare lesions that have been infrequently reported in previous literature. The maxillofacial region was reported as the most frequent localization, with infrequent occurrence in the lower limb. This paper represents the first documented case report of osteochondrolipoma in the foot. A 51-year-old male patient presented with a chief complaint of right foot pain at the plantar aspect, accompanied by the observation of swelling between the first and the second metatarsal shafts. His complaint of pain and swelling started 10 and 4 years prior, respectively. Since their onset, both symptoms have progressed in nature. Imaging revealved a large mass exhibiting a nonhomogenous composition of fibrous tissue and bony structures. Surgical intervention through total excision was indicated. Osteochodrolipoma is a benign lesion that can affect the foot leading to decreased functionality of the foot due to the pain and swelling. Surgical excision is the recommended approach for this lesion, providing both symptomatic relief and confirmation of the diagnosis through histopathological examination.