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To compare the Thoracolumbar Injury Classification and Severity (TLICS) scoring system with its modified (mTLICS) version based on their agreement with the surgeon's opinion regarding treatment for patients with thoracolumbar injuries. Moreover, the Posterior Ligamentous Complex health was compared between intraoperative examinations and magnetic resonance imaging (MRI) reports.MRI was obtained from 114 patients suffering thoracolumbar spinal trauma; the TLICS and mTLICS scores were measured. Approaches 1 and 2 were designed in both scoring systems based on assuming a total score of 4 as surgery and conservative management indication, respectively. Kappa was used to estimate the agreements between each approach and the surgeon's opinion on treatment. The receiver operating curve calculated the appropriate cut-off scores for the above systems over which surgical management was preferred. A P0.05 was considered significant.All the approaches showed moderate agreements with the surgeon's opinion on therapeutic management (TLICS: κThe surgeon's treatment plan agreed moderately with suggestions of the TLICS and mTLICS systems; surgery was the preferred management for the patients with a score of 4. Moreover, radiologic suspicion of Posterior Ligamentous Complex injury seemed to indicate a damaged ligament rather than a healthy one.

Background Atlantoaxial instability is mainly caused by trauma. C2 nerve is usually needed to be sacrificed for adequate exposure of the lateral mass and screw insertion. Objectives This study aimed to investigate the clinical outcome of postoperative complications of C1 and C2 screw-rod fixation using the Goel-Harms technique for C1-C2 instability after sacrificing the C2 nerve root. Methods Amongst forty patients with C1-C2 pathology, twenty-seven cases were enrolled into the study, then variables, including age, sex, primary pathology, operation duration, postoperative pain, paresthesia, anesthesia, and other specific conditions, were documented. Data analyzed by an expert biostatistician. p-value Results Regardless of gender, the most postoperative adverse effect was occipital anesthesia (81.5%). Most of the patients (63%) had both occipital pain and anesthesia one-month post-surgery. At 3- and 6-months post-surgery, occipital pain and anesthesia were seen in 40.7% and 14.8%, respectively. Conclusion The most common postoperative adverse effect of C2 nerve root scarification after C1-C2 fixation is occipital anesthesia followed by occipital paresthesia and pain, which are reduced in severity over time.

Background Dermoid cysts are benign congenital tumors that develop early in life. These tumors are classified by the presence of all 3 germ layers. Spinal intradural extramedullary teratoma is a rare disease, which is more common in children under 5 years of age than in adults. Case Description A 12-year-old girl with a dermoid cyst at the lower lumbar level presented with 2-month low back pain and intermittent lower extremity radicular symptoms on the right side. Magnetic resonance imaging scan of the spine revealed an intradural extramedullary mass lesion at L4-5. Surgical excision of the cyst was successfully performed. Surgical and histopathologic findings confirmed extramedullary ruptured matured teratoma. Postoperatively, the patient had remarkable clinical improvement. Conclusions Although dermoid cysts are uncommon, they should be considered in the differential diagnosis of spinal lesions in patients with lower back pain. It can be successfully treated with surgical excision.

Expression of matrix metalloproteinases correlates to blood-brain barrier disruption in Neuromyelitis Optica disease (NMO). Matrix metalloproteinase-9 (MMP9) −1562C/T polymorphism which influences the transcriptional activity of this gene is considered to play a role in some neuroinflammatory diseases. In the present study, the possible association of MMP9 –1562C/T polymorphism in Iranian NMO patients is studied. Association of the mentioned gene polymorphism of MMP9 with NMO susceptibility was evaluated via genotyping of DNA extraction from the blood samples of unrelated Iranian subjects referred to AlZahra Hospital, Isfahan, Iran during 2017 to 2019. Frequency distribution of MMP9 genotypes has a significant relationship with NMO disease; in such a way that CT + TT genotypes was more seen in NMO patients. Altogether, Since the MMP9 is one of the potential target molecules for future alternative treatment, the result of this study should be taken into account for further research. However, more studies should carry out to confirm our results in larger populations and reveal the convoluted role of MMP9 in Devic's disease.