bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal Surgery During COVID-19 Pandemic in Saudi Arabia
Authors: Konbaz Faisal , Alqahtani Taif , Alharthi Nada , Baraja Mohammad , Masud Nazish , Aleissa Sami , Alhelal Fahad , Abalkhail Majed
Published: November 2021

Introduction: The COVID-19 pandemic has challenged the healthcare system’s capacities around the world. Due to the alarming situation, medical activities have been restricted to allocate resources to treat COVID-19-infected patients. However, medical emergencies still need urgent medical intervention. Considering the lack of reliable data regarding spinal surgeries during the COVID-19 pandemic, the present study sought to analyze the pattern of spinal surgeries in KSA.
Methodology: A case series of patients who had urgent spine surgeries during COVID-19 pandemic was conducted in a tertiary care hospital. Data on patients’ demographics, COVID-19 test result, American Society of Anesthesia Score, SSS grade, diagnosis, and data related to surgery and postoperative findings were collected. All collected data were then processed and analyzed. Surgical outcomes based on source of admission were compared using Chi-square test.
Result: A total of 63 patients who underwent spine surgery during the COVID-19 pandemic were included. The mean age of the patients was 53 ± 18 years and males were predominant (59%). The positive COVID-19 patients were 3%. Almost half of the patients were classified into ASA II. The majority were categorized into grade B (65%) according to SSS. The frequently diagnosed condition was fracture (33%), followed by spinal stenosis (18%) and metastatic (10%), while the most mentioned location was lumbar (61%). Postoperative complications were found in 11% of the patients. The readmission rate within 30 days, unplanned return to OR and ICU admission were 19%, 13%, and 11%, respectively. While the mean duration between admission and surgery was 8 ± 20 days, the mean duration of length of stay was 20 ± 29 days. Further, a significant association was seen between the admission source and the surgical procedure performed and surgical indication.
Conclusion: It has been demonstrated that the surgical intervention was only provided to patients requiring immediate or urgent spinal management. However, the length of hospitalization and duration between hospital admission and surgery was substantially prolonged. Further studies are warranted to determine the factors leading to prolonged hospitalization and time between hospital admission and surgery.
Facet Joint Injections for the Management of Low Back Pain: A Clinical Review
Authors: AlJabari Aboud
Published: November 2021

Introduction: Lumbar facet joints have been implicated in chronic low back pain (LBP) in up to 45% of patients with LBP. Facet joint pain (FJP) diagnosis and management are always challenging for pain physicians. FJP is not diagnosed by specific demographic features, pain characteristics, or physical findings, despite the electrodiagnostic studies and imaging modalities being available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature.
Methodology: A randomized, controlled clinical trial was conducted to evaluate the effectiveness of lumbar facet joint injections. A total of 229 participants were enrolled to receive facet injections with bupivacaine and steroid, medial branch blocks, or saline.
Result: The results of this study showed that facet joint injections had little long-term therapeutic utility, but had a prognostic value compared to control injections before radiofrequency ablation. Thus, the results of this study emphasized the diagnostic value of facet joint injections.
Conclusion: FJP is not diagnosed by demographic features, pain characteristics, physical findings, electrodiagnostic studies, or radiological evaluation as other types of LBP. Diagnostic blocks using comparative local anesthetic blocks or placebo injections are the only reliable diagnostic measures according to the current literature. Their validity, specificity, and sensitivity are considered reliable in the diagnosis of FJP. Facet joint-related anatomical, clinical, and technical knowledge is essential for successful pain management. Pain physicians should embrace all aspects of FJP management, from diagnosis to interventional management.
Upper Thoracic Spine Fractures Outcomes and Complications in King Abdul-Aziz Medical City, Riyadh
Authors: Konbaz Faisal
Published: November 2021

Introduction: Upper thoracic spine fractures (T1-T6) are not uncommon. They are often high-energy injuries complicated by multiple life-threatening comorbidities. There is a controversial discussion in the literature regarding the treatment choices. Thoracic pedicle screw fixation has replaced all other fixation techniques for its success rate and safety. Despite the number of studies discussing upper thoracic spine fractures, data on literature reporting postoperative complications are deficient. The aim of the study was to assess, in a series of patients, the impact of traumatic upper thoracic fractures on sagittal alignment, the incidence of possible complications, and the effect of associated injuries.
Methodology: This retrospective chart review study included all adult cases diagnosed as traumatic upper thoracic spine fractures in KAMC in Riyadh. Data were obtained from the computerized database. The information reviewed included fracture characteristics, associated injuries, pre- and postoperative neurological status and sagittal alignment, follow-up duration, and the presence of complications.
Result: A total of 19 patients were included in the study. Of them, 17 (89.5%) were injured secondary to a motor vehicle accident. There were three patients with a fixation level crossing the CT junction, more blood loss and procedure time was noticed with these cases. There was a notable improvement in upper thoracic kyphosis by 9º when measuring pre- and postop fracture Cobb's angle. The mean preop angle was 28.98 and the mean postop was 20.76. Of all the 19 cases involved in the study, 3 patients had developed surgical site infection as a complication. No other complication was reviewed.
Conclusion: It is well-known in the literature that the correction of kyphosis and the absence of residual deformity postoperatively are indicators of the success and safety of the procedure used. Our findings correspond to the literature discussion that the current practice in managing traumatic upper thoracic spine fracture in KAMC in Riyadh is relatively safe and effective. Yet, further studies are needed to elaborate more on the relationship between the presence of other injuries and patients’ factors and postoperative outcomes.
Psychological and Social Factors Contributing to Post-traumatic Growth After Spinal Cord Injury
Authors: AlNamlah Mohammed
Published: November 2021

Introduction: Spinal cord injury (SCI) results in significant changes in a person's life; it has a tremendous psychological impact not only at the individual level but also on their caregiver. There is still little known about the positive psychological changes following SCI. The aim of this study was to determine the psychological and social factors affecting post-traumatic psychological growth after SCI.
Methodology: This multi-center cross-sectional study was conducted on 66 patients with traumatic SCI between November 2020 and May 2021 using PWB-PTCQ, HADS, and social support scale. Data were analyzed using the SPSS program.
Result: This study included 66 patients from multilabel territorial centers. The Mean ± SD of the patients’ age was 32.1 ± 14.5 years, and 34 (51.5%) of them were aged <32 years. Male patients were more dominant compared to their female counterparts; 48 (72.7%) versus 18 (27.3%), respectively. The most common type of injury was ASIA-A 24 (36.4%), and the most common nature of stress was financial 33 (53.2%).
Conclusion: Anxiety and depression were less common among our patients with SCI, whereas there were high life stressors, and financial stress was the dominant type of stress among patients. The most affected dimension of PTG was a sense of mastery, whereas relationships and personal growth were the least affected among patients with SCI. Achieving PTG was significantly affected by depression, education level, and life stressors. There was a regression relation between PTG with depression and anxiety, thus PTG can predict depression and anxiety in patients with SCI.
Are Healthcare Providers Providing Appropriate Educational Material for People with Low Back Pain?
Authors: Alemam Dalia
Published: November 2021

Introduction: One of the contributing factors to the burden of low back pain (LBP) is the failure to provide patients with appropriate education and advice about diagnosis and management. To date, no information exists about whether the content of patients’ information and educational material provided in physiotherapy clinics in Saudi Arabia is in line with the Clinical Practice Guidelines and contemporary practice. Therefore, the aim of this study was to investigate the content of educational material provided by physiotherapy clinics, hospitals, or distributed by healthcare associations to people with LBP in Saudi Arabia, to determine whether this information is adequate to reassure patients and inform self-management. This study also seeks to explore whether these materials are consistent with CPGs for people with LBP.
Methodology: A sample of educational items (English or Arabic) in Saudi Arabia was collected. Content analysis was conducted to analyze data based on manifest content.
Result: Seventeen educational materials were included, originating from diverse sources; the Ministry of Health hospitals (n = 10), military hospitals (n = 4), private hospitals (n = 2), and multidisciplinary healthcare association (n = 1). Six main sub-themes were identified: epidemiological/anatomical data about LBP (n = 6); causes/risk factors (n = 10); exercise (n = 14) and physical activity-related recommendations (n = 3); treatment-related recommendations (n = 2); general health and lifestyle-related recommendations (n = 8); and postural and ergonomics-related recommendations (n = 13). Ultimately, one theme was formulated, namely, the content of educational materials was hindering reassurance and self-management for people with LBP. The items reviewed were heavily influenced by the biomedical model of pain.
Conclusion: The educational materials reviewed failed to properly report information about LBP from a biopsychosocial perspective and were inadequate to assure patients or inform self-management.
Intradural Extramedullary Lesions in Cervical Spine in Neurofibromatosis
Authors: Moshref Rana
Published: November 2021

Introduction: Neurofibromatosis (NF) is isolated into three diseases: NF type 1, type 2, and schwannoma. NF type 2 could be a disorder that's found roughly in 1/25,000–33,000 births with a mutation in gene 22q11.2, and it is passed through eras in an autosomal dominant fashion. Diagnosis is made with both clinical and radiological features. A few clinical features have been characterized in conclusion counting Manchester criteria. There is a scarce number of NF type 2 patients diagnosed with cervical lesions which are 25 in number. We report a case of an intradural extramedullary cervical lesion in a patient later diagnosed with NF type 2.
Case Report: A 30-year-old male presenting with gradual onset and progressive course of spastic quadriparesis of six months’ duration was admitted through the emergency unit. MRI spine showed intradural extramedullary masses in the right side of C4 and left side of C6. The patient underwent cervical intradural excision of two masses under general anesthesia with neuromonitoring. The tumor was sent for histopathology and reported as NF type 2.
Conclusion: NF is a common entity, but the diagnosis of cervical mass is judicious to avoid any complication in neurological function. It further needs a multidisciplinary approach and screening modalities.
Prospective and Observation Study of Selective Nerve Root Block on Patients with PIVD
Authors: Singh Vikas
Published: November 2021

Introduction: PIVD is the most common cause of lower back pain in old age. The most common site is L4 L5 to L5 S1 in about 95% cases, and about 90% cases are associated with radiculopathy.
Methodology: This prospective study was conducted on 150 patients at the Jawahar Lal Nehru Hospital and Research Center between 2019 and 2021. We used 2–3 ml xylocaine and methylprednisolone. Results were assessed through clinical examination.
Result: Of the 150 patients, 130 experienced excellent results with no pain for more than six months.
Conclusion: We conclude that for mild cases, patients with PIVD have an alternative option of selective nerve root block other than surgery.
Effect of Magnesium Sulfate on the Total Anesthetic and Analgesic Requirements in Neurosurgery
Authors: Manaa Essam
Published: November 2021

Introduction: The intraoperative anesthetic and postoperative analgesic requirements are of great importance especially in neurosurgical anesthesia. This requires balancing a deep and effective anesthesia and postoperative analgesia versus the risks of delayed recovery and postoperative respiratory depression from excessive analgesics. Magnesium sulfate is an antagonist of the N-Methyl-D-Aspartate (NMDA) receptors in a voltage-dependent fashion. Propofol also inhibits the NMDA subtype of the glutamate receptor. Therefore, magnesium sulfate when coadministered with propofol potentiates anesthetic effect and NMDA antagonism of propofol. Majority of the studies that evaluated the anesthetic and analgesic requirement in patients receiving magnesium sulfate depended on the clinical parameters, for example, hemodynamic parameters and measurement of pain scores. In this study, we added bispectral index (BIS) and neuromuscular monitoring using train-of-four (TOF) to adjust intraoperative anesthetic requirements in addition to the clinical parameters.
Methodology: This randomized controlled double-blind study included 50 adult ASA I and II male and female patients undergoing neurosurgical maneuvers. Patients were randomly divided into two equal groups. Routine intraoperative monitoring including invasive BP and in addition TOF and BIS were applied. In a blind fashion, patient in group I (Magnesium group) received magnesium sulfate 20 mg/kg as bolus dose over 5 min followed by 0.1 ml/kg/hr of 10% solution as infusion, while patient in group II (Control group) received saline with the same bolus and infusion rates after the induction of anesthesia. Anesthesia was induced in both groups by fentanyl 2 µg/kg, propofol 1.5–2 mg/kg, and rocuronium in a dose of 0.6 mg/kg to facilitate ETT insertion. This is followed by continuous infusion of propofol 6–10 mg/kg/hr and fentanyl 1–2 mic/kg/hr. The parameters which were assessed included hemodynamic parameters (HR and BP), TOF, and BIS. Total consumptions of propofol, fentanyl, rocuronium, and postoperative analgesic requirements (PCA morphine) were recorded. In addition, recovery time and postoperative pain score by visual analog scale (VAS) were recorded.
Result: There was no significant difference in patient characteristics between the two groups. As regard the hemodynamic changes and BIS, no significant difference was seen between the two groups except the HR change which was significantly reduced (p = 0.005) with surgical stimulation in group I compared to the other group. Results also showed that the mean fentanyl, propofol, and rocuronium consumption, recovery time, degree of postoperative pain, and postoperative analgesic requirements were significantly less in patients that received magnesium sulfate infusion compared to those in the control group.
Conclusion: Magnesium sulfate is most likely a safe and cost-effective supplement to the general anesthesia in neurosurgery as it reduces the total anesthetic and analgesic requirements and postoperative pain.
Effectiveness of Topical Vancomycin in the Prevention of Spinal Surgical Site Infections: A Retrospective Cohort Study
Authors: Tafish Rawan
Published: November 2021

Introduction: The risk of surgical site infections (SSIs), particularly methicillin-resistant Staphylococcus aureus (MRSA) SSIs, post spinal surgeries is one of the most daunting experiences to patients and surgeons. In some practices, vancomycin powder is applied directly on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at a private Saudi hospital.
Methodology: A retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries between September 2013 and September 2019 were included and followed-up for up to 30 (for surgeries without implantation) or 90 (for surgeries with implantation) days. The odds ratio (OR) of the first SSI observed in the follow-up period between vancomycin users versus nonusers was estimated using logistic regression adjusting for the measured confounders. A sensitivity analysis was conducted using a propensity score analysis.
Result: We included 81 vancomycin users versus 375 nonusers with 28 infections. The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11–1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35–2.68]).
Conclusion: We could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Conducting larger multicenter studies would add more emphasis to the findings of this study.
Nonspecific Chronic Low Back Pain in Elderly Patients
Authors: Mowafy Amal
Published: November 2021

Introduction: Low back pain is one of the most common causes of disabilities in old people often due to lumber degeneration (osteoarthritis) and spinal canal stenosis. In our study, we determine the prevalence and associated changes of low back pain that increase with age.
Methodology: This observational cohort study was carried out from March 2019 to March 2021 at the El-Moussenin Center in Port Said. The study included 300 patients aged ≥65 years with a chronic nonspecific low back pain for at least six months, a Visual Analogue Scale (VAS) score of 3 and more, and an absence of spinal pathology such as infection, tumor, fracture, spondylolisthesis, or spinal degeneration of grade 2 and above. Patients were divided into two groups: (i) a study group including patients with a mean age of 75 years with nonspecific chronic LBP (n = 150) and (ii) an age- and sex-matched control group (n = 150) with no chronic low back pain using propensity score-matched analysis. All patients underwent whole spinal X-ray, lumbar MRI, CBC, and DXA.
Result: We analyzed laboratory finding, radiological finding for global spinal parameter, and lumber degeneration body composition analysis using whole body dual energy X-ray absorptiometry. We found increase in red blood cell distribution width (it is an index of aging), it was higher in geriatric with CLBP (32) and in control (6.9) with a p-value < 0.001. Skeletal muscle mass index was 6.23 ± 0.92 in the studied group and 6.43 ± 1.02 in the control group with a p-value = 0.045. Increase in fat mass was noted in both the studied (32.17 ± 7.07) and the control (29.28 ± 7.48) groups with a p-value < 0.001. Moreover, those patients had lower lumbar lordosis, higher sagittal vertical axis regarding decrease in muscle mass in trunk and extremities.
Conclusion: Red blood cell distribution width which is a sign of aging was high in geriatric group with CLBP. Moreover, geriatric CLBP is often associated with osteoporosis which affects the pain threshold and triggers CLBP due to age-related loss of skeletal muscle mass and spinal sagittal malalignment.
Incidence of Deep Vein Thrombosis in Spine Surgery Patients at a Tertiary Care Hospital
Authors: Aldusari Rakan
Published: November 2021

Introduction: The prevalence of deep venous thrombosis (DVT) and pulmonary embolisms (PE) has not been established accurately. Reported literature suggests an incidence rate of either DVT or PE ranging from 0.27% to as high as 60% in special cases. We aimed to discern the incidence rate in our local population post spinal surgery.
Methodology: A retrospective chart review was conducted on 892 adult patients who were admitted to our center either electively or in an emergent manner between January 1, 2016 and January 1, 2019 at KAMC, Riyadh. The collected data included information on: demographics, diagnosis, complaint-to-surgery time, type of surgery, location, approach, functional status, days till max function for each patient, blood loss, smoking history, and type of trauma if it was a traumatic case. In addition, DVT/PE status of each patient with their previous or existing health conditions was also included.
Result: Eight hundred patients met our inclusion criteria. Our sample was predominantly male at 422 patients (52.8%) with a mean age of 49.8 ± 18.83 years for both genders. The mean BMI was 28.9  ±  7.03 kg with the average weight being 75.9 ± 18.81 kg. Additionally, 422 (52.8%) participants were cardiac patients and 295 (36.9%) were diabetics. We had 30 (3.8%) instances of either DVT or PE out of the 800 patients, isolated cases of DVT being 18 cases (2.3%). The cervical region was found to be protective against DVT/PE (P = 0.0227). The length of stay was also significant for the development of DVT/PE (P < 0.0001).
Conclusion: Our study is one of the largest conducted in our region, especially in spinal surgical patients. We found that the incidence for DVT/PE (3.8%) was consistent with the lower end of reported literature. We found significance especially in cervical operations being protective against the development of DVT/PE in comparison to other sites. Length of stay was also significant for the development of DVT/PE unlike the length of the operation itself. While we did not observe a significant difference between the prophylactic protocols for the development of DVT/PE in our patients, we had an overall low number of venous thromboembolic events, especially when comparing it to the reported literature.
Use of Patient-reported Outcome Measures (PROMs) by Orthopedic Surgeons in Saudi Arabia
Authors: Alanazi Thamer
Published: November 2021

Introduction: There is increasing literature on the usefulness of patient-reported outcome measures (PROMs), but far fewer studies to determine their use by orthopedic surgeons and the barriers they face in applying PROMs in their daily clinical activity.
Methodology: Cross-sectional study using a questionnaire that was distributed in both soft and hard copy formats to a sample of 262 orthopedic surgeons. Participants included orthopedic surgeons who are employed by the Ministry of Health (MOH) in Riyadh and the Eastern Province, Saudi Arabia. The questionnaire was distributed through on-site visitations to orthopedic departments in MOH hospitals as well as through online correspondence by email, WhatsApp, and social media.
Result: The study sample included 262 orthopedic surgeons (13.7% females and 86.3% males). Surgeons aged < 34, 35-44, and 45-54 years old represented 28.66%, 38.9%, and 20.2% of the study sample, respectively. The majority of the included surgeons did not use PROMs (69.1%), and some (17.2%) used it for research purposes. Only 5% used it regularly in daily clinical work.
Conclusion: The clinical use of PROMs among orthopedic surgeons was negligible, even though an overwhelming majority were interested in using PROMs. The reasons provided included a lack of knowledge on how to use PROMs and the perception that it is too time-consuming to add to regular clinical routine. There should be more efforts towards training surgeons on how to use PROMs, whereas increasing compatibility with existing software tools used by MOH hospitals may help offset time-related reservations.
How Often MRI Would Change the Fracture Classification or Decision-making in Thoracolumbar Fractures Compared to CT Alone?
Authors: Ali Mohamed
Published: November 2021

Introduction: This study aimed at analyzing the frequency and predictor of the change in classification of TLFs after performing MRI compared with CT alone.
Methodology: This retrospective review included 235 consecutive patients with acute TLFs (T1-L5) who presented at a single level-1 trauma center between 2014 and 2021 and underwent both CT and MRI. Patients with translation injury, neurologic deficit, or osteoporotic fracture were excluded. Three reviewers independently classified all fractures according to AOSpine and Thoracolumbar Injury classification (TLISS) by CT and then MRI. A fourth reviewer only looked at the MRI images. Posterior ligamentous complex Injury was diagnosed on CT and MRI by two positive CT findings and black stripe discontinuity. Mc-Nemar test was used to evaluate the difference in the proportions of AO type A and B.
Result: The AO classification by CT was type A in 181 patients (77%) and type B in 54 patients (23%). The addition of MRI after CT changed AO classification in 25/235 patients (10.6%, P < 0.0001) due to an 8.5% (20/235) upgrade from type A to type B and 2.1% (5/235) downgrade from type B to type A. When PLC injury in CT was defined by one positive CT finding and in MRI by high signal intensity, it significantly increased the rate of fracture reclassification by MRI compared to default analysis (22% and 33% vs 11%, respectively; P < 0.0001). The best predictor of upgrade from type A to type B and downgrade from type B to type A was a single positive CT finding, and the presence of only two CT signs as opposed to three signs, respectively (reclassification rate 26% vs 4.6%, P < 0.0001 and 17% vs 0%, P = 0.03, respectively). Thoracic and thoracolumbar fractures showed a significantly higher reclassification rate than low lumbar (20% and 10% vs 0%, respectively, P = 0.07).
Conclusion: Using appropriate CT/MRI criteria of PLC injury, the rate of fracture reclassification by MRI can be as low as 10%. The use of alternative CT/MRI criteria or inaccurate image interpretation could significantly increase the rate of fracture reclassification up to 20–30%. The rate of change of fracture classification by MRI could be predicted by the number of positive CT findings on CT or fracture level.
The Effect of Ageing and Degeneration on Glycosaminoglycan Concentration in the Intervertebral Disc
Authors: Taterra Dominik
Published: November 2021

Introduction: The correct spatial distribution and high negative charge of glycosaminoglycans (GAGs) within the intervertebral disc (IVD) are responsible for discs water imbibition, proper osmotic pressure, and as such IVD’s physiological swelling behaviors and compressive properties. The aim of this study was to investigate the association of the concentration and distribution of GAG with IVD degeneration as measured by Pfirrmann et al. and Thompson et al. grading systems.
Methodology: Full spinal columns (vertebrae L1-S1 and IVD between them) were harvested from fresh cadavers through an anterior dissection. MRI scans were taken of all spinal columns and were assessed using Pfirrmann grading system. All vertebral columns were cut in the midsagittal plane. The level of degeneration was assessed morphologically using Thompson et al. grading system. Samples from five regions of the L5/S1 IVDs were taken for GAG concentration analyses. Standard curve spectrophotometry was utilized for this purpose.
Result: One hundred lumbar spine columns (L1-S1) were harvested from cadavers. Radiologic assessment using the Pfirrmann grading system and morphological Thompson grading system classified majority of discs as grade 3 and 4. A total of 478 samples from five regions of L5/S1 IVDs were included in the analysis of GAG content. The samples from the nucleus pulposus showed on average the highest concentration of GAG, although the differences were not statistically significant. The one-way analysis of variance (ANOVA) showed no statistically significant differences in the mean GAG mass between different Pfirrmann grades (F = 1.85, p = 0.13) and between different Thompson grades (F = 1.17, p = 0.33).
Conclusion: Our study showed no association between GAG concentration levels and degeneration grade of the IVD as measured by radiological Pfirrmann and morphological Thompson grading systems.
Rare Case of Lumbosacral Conjoint Root Diagnosed as Sequestered Disc by MRI: A Case Report
Authors: Awadallah Akram
Published: November 2021

Introduction: Conjoint nerve root is embryological nerve root abnormality mainly affecting lumbosacral region. The atypical roots present primarily as a bifid, conjoined structure originating from a wide area of the dura. The conjoint roots are highly liable to trauma due to their size and attachment to surrounding structures. The effects of compression and entrapment are augmented in the case of having stenosis of the lateral recesses where developmental changes and disc herniations deplete the available reserve space. Conjoined nerve roots are a relatively uncommon finding but are frequently left undiagnosed on preoperative imaging studies. Misinterpretation as sequestered disc can lead to devastating results especially during limited spine approach.
Case Report: A 43-year-old male patient presented with low back pain gradually progressing over the last three years. Pain was radiating to his left leg associated with tingling sensation and a mild weakness in his left foot. Clinical examination revealed normal muscle bulk and tone. Strength was full bilaterally except the mild weakness 3/5 on toe dorsiflexion of the left foot. Deep tendon reflexes were 3+ at the left knee and ankle. Plantar responses were flexor. Sensation was intact, and there was no loss of sphincters control or bladder dysfunction. A standard plain lumbosacral MRI was performed. The patient was admitted for L5/S1 discectomy. Surgical intervention was recommended, during the surgery we recognized the huge conjoint root. Adhesiolysis and discectomy was done carefully without causing any serious neural injury to the conjoint root. Clinical surgical outcome was good. Pain and tingling sensation disappeared only paresthesia over the S1 dermatome. Postoperative course was uneventful, and the patient was discharged after his neurological improvement on day 7, post operation. However, the patient complained of recurrent pain on follow-up visit and continues being followed-up.
Conclusion: The conjoined nerve root anomaly diagnosis is not easy and has several points of significance. If misdiagnosed, it could be incorrectly treated as a case for a herniated disc. Neurosurgeons should consider these anomalies in their differential diagnosis. Cases of conjoined nerve root anomaly may be wrongly managed and result in wrong level of surgery with a poor outcome. Researchers conclude that the correct diagnosis of root anomalies is vital for the patient, any misinterpretation could lead to catastrophic consequences.
Experiences of Adults Living with Ankylosing Spondylitis-related Inflammatory Low Back Pain: A Qualitative Study
Authors: AlRashed AlHumaid Lolwah
Published: November 2021

Introduction: Inflammatory low back pain (ILBP) is a key clinical symptom and a significant problem in ankylosing spondylitis (AS), its high socioeconomic costs are mainly attributed to disability. To the best of our knowledge, no study has specifically explored the ILBP experience in adults with AS. This study aimed to explore the experiences of ILBP from the perspective of adults with AS.
Methodology: This study followed a qualitative descriptive design. Participants were recruited from rheumatology and physiotherapy outpatient clinics of two major hospitals in Dublin, and from AS patient support groups in Ireland. A total of 19 adults with AS-related inflammatory low back pain (AS-ILBP) (mean age 47.8 years [SD 11.2]) participated in semi-structured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim, coded, and analyzed thematically.
Result: Analysis of experiences revealed five themes: (i) experiences and perception surrounding diagnosis, (ii) perceived ILBP trajectories, (iii) impact of AS-ILBP, (iv) behavioral responses toward ILBP, and (v) experience with AS-ILBP treatments. Adults with AS-ILBP experienced a delay in diagnosis, in which ILBP was negatively perceived, and dysfunctional LBP beliefs and behaviors were reported. ILBP appeared to have a multidimensional nature and impact, with the greatest impact suggested on physical function and psychological health. Many individuals with AS held negative ILBP beliefs that drove dysfunctional behaviors. The primary received ILBP treatment was medication and to a lesser extent physiotherapy; both described treatments had limited effects.
Conclusion: This study was the first to reveal the unique experience of ILBP from the perspective of adults with AS. AS-ILBP appear to have a varying course and a multidimensional associated factors that determine its trajectory. AS-ILBP was suggested to affect all aspects of individual's life. A bidirectional relationship between ILBP and the psychosocial factors was proposed; these factors were perceived as aggravators and consequences of ILBP. This study also points to the limitations of current AS-ILBP management, which were mainly biomedically oriented. Thus, healthcare providers are advised to incorporate a multidimensional pain screening with their routine physical assessments of adults with AS-ILBP. This could help in designing tailored individualized, effective AS-ILBP management programs.
Traumatic Spinal Injuries in Saudi Arabia: A Retrospective Single-center Medical Record Review
Authors: Alsabieh Mohammed
Published: November 2021

Introduction: The aim of this retrospective medical record review was to describe the patterns and outcomes of traumatic spinal injuries (TSIs) in a tertiary care trauma center in Riyadh, Saudi Arabia.
Methodology: Data of all patients who presented at a setting level-1 trauma center with any type of spinal trauma between February 1, 2016 and December 31, 2018 were review. The data obtained included age, gender, nationality (as Saudi and non-Saudi), date of presentation, site of fracture/injury, associated injuries, mechanism of injury, presence of neurological involvement, and hospital mortality. The main outcome of the review was frequencies of different types of TSI across various subgroups.
Result: We identified 692 patients who presented with TSI during the study period. The mean age was 36.9 years. Males represented 83.2% (n = 576) of the sample size, and the most common mechanism of injury was motor vehicle collision (MVC), accounting for 66.8% of the cases (n = 462), while fall-related injuries were seen in 31.6% of the cases (n = 219). A total of 454 (65.6%) of all patients were Saudi, and 332 (73.1%) of the TSIs in Saudis were due to MVC. Non-Saudi cases accounted for 238 (34.4%) of all patients, and 89 (37.4%) of the non-Saudi injuries were due to falls from height, this association was statistically significant (p < 0.001).
Conclusion: TSI was not thoroughly examined in Saudi Arabia; therefore, this study is considered the first to be done in the Kingdom using a representative sample. The fact that non-Saudi patients had a higher proportion of falls as a mechanism of injury should be taken into consideration in terms of raising awareness and taking more safety precautions, as most construction workers tend to be expatriates.
Assessment of Radiological and Morphological Grading Systems of Intervertebral Disc Degeneration
Authors: Krupa Kamil
Published: November 2021

Introduction: Intervertebral disc (IVD) degeneration is considered to be one of the main pathophysiological causes of low back pain. Several grading systems have been developed for both morphological and radiological assessment. The aim of this study was to assess the morphological and radiological characteristics of IVD degeneration and validate popular radiological Pfirrmann scale against morphological Thompson grading system.
Methodology: Full spinal columns (vertebrae L1-S1 and IVD between them) were harvested from cadavers through an anterior dissection. MRI scans of all samples were conducted. Then, all vertebral columns were cut in the midsagittal plane and assessed morphologically.
Result: A total of 100 lumbar spine columns (446 IVDs) were included in the analysis of the degeneration grade. Morphologic Thompson scale graded the majority of discs as grade 2 and 3 (44.2% and 32.1%, respectively), followed by grade 4 (16.8%), grade 1 (5.8%), and grade 5 (1.1%). The Radiologic Pfirrmann grading system classified 44.2% of discs as grade 2, 32.1% as grade 3, 16.8% as grade 4, 5.8% as grade 1, and 1.1% as grade 5. The analysis on the effect of age on degeneration revealed significant, although moderate, positive correlation with both scales. Analysis of the agreement between scales showed weighted Cohen’s kappa equal to 0.61 (p < 0.001). Most of the disagreement occurred due to a 1-grade difference (91.5%), whereas only 8.5% due to a 2-grade difference.
Conclusion: With the increase in the prevalence of IVD disease in the population, reliable grading systems of IVD degeneration are crucial for spine surgeons in their clinical assessment. While overall there is an agreement between both grading systems, clinicians should remain careful when using Pfirmann scale as the grades tend to deviate from the morphological assessment.
Intrawound Low-dose Vancomycin (250 mg) Powder has Lower Risk of Wound Dehiscence than Higher Doses in Spine Surgeries
Authors: Sonbol Ahmed
Published: November 2021

Introduction: Surgical site infection post spinal surgery is a known complication which can be serious and may require aggressive intervention. Intrawound vancomycin powder application is an evolving method to prevent such complication. Although it has very low systemic complications, wound dehiscence with negative culture is reported in the literature. The aim of this study was to find the risk of wound dehiscence with low-dose intrawound vancomycin in comparison to 1 gr and its effectiveness in prevention of surgical site infection.
Methodology: A chart review of all patients who underwent posterior thoracic, lumbar or sacral spine surgeries from December 2009 to September 2016 in a single center was done. Patients were categorized into three groups. First, patients who did not receive any intrawound vancomycin; second, patients who received high-dose vancomycin (1 gr); and third, patients who received low-dose vancomycin (250 mg). Additionally, patients’ demographic information, clinical data, and surgical variables were collected. Primary outcome was the presence of wound dehiscence or surgical site infection.
Result: In total, 391 patients were included in this study, of which 56 (14.3%) received high-dose intrawound vancomycin, 126 (32.2%) received low dose, and 209 (53.5%) did not receive any. The overall incidence of wound dehiscence was 6.14% (24 out of 391 patients). Wound dehiscence was statistically and significantly higher (p = 0.039) in the high-dose vancomycin group in comparison to the patients who received low dose. The overall incidence of postoperative infection was 2.05% (eight patients). There was no statistically significant difference between the groups.
Conclusion: The use of intrawound low-dose vancomycin (250 mg) has less wound dehiscence in comparison with other higher standard doses. Further trials are needed to evaluate the effectiveness of this dose in preventing postoperative infections.
Editorial – Born to Lead
Authors: Alturkistany Ahmed
Published: November 2021

On the 9th of September 2015, the Saudi Spine Society (SSS) was birthed. Now, the society is six years old and, despite its comparative youth, it has become a regional and global leader in the field of spine care.
The Saudi Spine Society is a multidisciplinary scientific association which aims to promote spine care in the Kingdom of Saudi Arabia. Its membership includes a wide range of specialist fields concerning the prevention, management and rehabilitation of all spine related ailments.
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Editorial – The Launch of a New Intellectual Journey in Spine Care
Authors: S. Baeesa Saleh
Published: November 2021

On behalf of the editorial board, I am pleased to announce the launch of the official journal of the Saudi Spine Society, the Journal of Spine Practice (JSP), an international peer-reviewed, open access, academic, multidisciplinary, and interdisciplinary journal that encompasses every aspect of spine care and research.
Our goal is to see JSP grow into a space for multidisciplinary scholarly dialogue among spine practitioners to showcase their clinical research, basic science research, health services research, economic analysis, health professionals education, as well as evidence-based statements and guidelines. JSP aims to promote excellence in spine care and produce a significant academic contribution to the field.
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Editorial – The Role of Spine Societies in Clinical Spine Practice
Authors: C. Wang Jeffrey
Published: November 2021

It is a great honor to participate as a guest editor for the inaugural issue of the Journal of Spine Practice, which is affiliated with the Saudi Spine Society. I have closely watched the early years of the relatively young Saudi Spine Society, and have been truly amazed by the growth and the multiple focused initiatives that the society has created. As I watch the tremendous growth of the Saudi Spine Society, I am pondering the purpose of any given spine society in the clinical practice of spine surgeons in any specific region, country, city, spine group, or individual practice. What follows are some personal thoughts on the relationship of spine societies with clinical practice.
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Predicting the Mental Health of the Staff of an Industrial Complex Based on Perceived Organizational Support, Workaholism, and Organizational Citizenship Behavior
Authors: SHAHSAVANDI Peyman , MOOSAVI Zohre
Published: November 2021

Background: Mental health has long had a special place in the organization and has been considered as one of the most important factors determining the level of organizational productivity and quality of working life of employees. Organizational support, workaholism, and organizational citizenship behavior are other important factors considered in occupations. Therefore, this study aimed to predict the health and mental health of the staff of an industrial complex based on perceived organizational support, workaholism, and organizational citizenship behavior.
Methods: This descriptive-analytic study was conducted on 16000 employees in a large industrial complex in 2017, 386 of whom were selected by available sampling method. The 34000 standard questionnaire was used to measure the dependent and independent variables and SPSS software for data analysis. The data were analyzed using descriptive statistics (mean and standard deviation), Pearson correlation test, and multiple linear regression analysis.
Results: The results of Pearson correlation showed that the relationship between mental health and workaholism (r = -0.05, p = 0.57) which did not indicate a significant relationship, but the mental health and health of the staff had a direct and significant relationship with perceived organizational support (372/372). R = 0, p <0.001). There was also a significant relationship between health and psychological health with organizational citizenship behaviors of the staff (r = 0.207, p = 0.008). The results of multiple linear regression showed that organizational citizenship behavior (B = 0.345) and perceived organizational support (B = 0.291) had the ability to predict mental health; however, workaholism in this study did not have this ability.
Conclusion: Considering the ability of citizenship behavior and organizational support in predicting mental health, measures to increase the staff’s willingness to perform voluntary (citizenship) organizational behaviors as well as the maximum organizational support, can be used to reduce the mental health reduction of the staff and provide factors to improve it, leading to increased productivity.
Determining the prevalence of musculoskeletal injuries and its relationship with workplace posture in copper industry repairmen
Authors: KARAMI Masuomeh , EZABADI Saeid Ghane , KARAMI Zohreh , SAHRANAVARD Yaser
Published: November 2021

Introduction: Musculoskeletal disorders are one of the most common causes of occupational injuries that mainly affect the low back, neck, and upper limbs. Preventing these discomforts requires assessing workplace posture using ergonomic job analysis methods. The aim of this study was to determine the rate of musculoskeletal injuries of mechanical repairs using REBA method in 2018 in Sarcheshmeh copper mine.
Methods: In this descriptive-analytical study, the workplace posture of 65 mechanical repairs were evaluated using REBA method. The prevalence of musculoskeletal disorders was also obtained using the Nordic questionnaire. The collected data were analyzed by SPSS 20.
Results: In this study, the prevalence of wrist discomfort was 43.07%, neck 18.46%, shoulder 33.84%, low back 53.85%, and leg 27.70%. Regarding the risk level of the right limb, 9.25% of the subjects were at a low level, 46.15% at a medium level, 32.30% at a high level, and 12.30% at a very high level. Also, regarding the risk level of the left limb, 4.62% of the subjects were at a low level, 64.61% at a medium level, 26.15% at a high level, and 4.62% at a very high level.
Conclusion: These results indicated that the workplace posture of the subjects needed to be improved. To prevent the occurrence of these disorders, education is required to recognize biomechanical risk factors and correct methods of working, use of appropriate tools and appropriate to the work process, and improvement and control of stressors and environmental factors.
Predicting nurse's depression based on self-compassion and resilience
Authors: HOSSEINI Fateme-Sadat , FARNIA Farahnaz , VAZIRI Saeed
Published: November 2021

Introduction: Depression is one of the most important health problems in nurses. Despite the obvious protective role of some human abilities against psychological problems, there is limited information about the predictive role of self-compassion and resilience with depression in nurses. The purpose of present study was to determine the relationship of self-compassion and resilience with nurses’ depression.
Method: This descriptive correlational study was conducted on170 nurses working in Yazd Afshar Hospital selected by convenience sampling method. Data collection tool was a questionnaire, including demographic characteristics, Beck Depression, Neff Self-compassion, and Connor and Davidson resilience completed through self-report. The data were analyzed by SPSS using Pearson correlation coefficient and multiple regression analysis.
Results: Most of the subjects were female (62.35%) and had bachelor’s degree. Mean ± standard deviation of depression, self- compassion, and resilience scores were72/17 ±28/8; 65/31±46/1; 65/33 ±06/1, respectively. There was a significant relationship between depression and self-compassion, as well as depression and resilience. Furthermore, multiple regression analyses showed that self-compassion and resilience can predict depression (R=0.627).
Conclusion: The results indicated the importance and protective role of self-compassion and resilience against depression in nurses. Therefore, designing counseling systems and self-compassion and resilience educational programs are recommended to reduce the problems caused by the stressful conditions of the profession.