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Background: Metastasis is one of the most frequent causes of cancer-related deaths globally. Several studies have investigated the surgical outcome of a metastatic spine; however, the results are discordant. This research aims to study the mortality and morbidity rates of surgical intervention for metastatic spine disease and the predictors of postoperative complications in a tertiary care center. Materials and Methods: A retrospective chart review was conducted. The population consisted of patients who underwent surgical intervention for metastatic spine disease in a tertiary-care hospital from 2016 to 2020. The primary outcomes were intraoperative and postoperative complications, 30- day mortality, 90-day mortality, and the 1-year survival rates. Results: A total of 47 patients underwent a surgical intervention during the period. Breast cancer was the most frequent primary lesion for the metastasis, followed by multiple myeloma and lung cancer. Postoperative surgical complications occurred in 34% of the sample, and 41% reported marked neurological improvement following surgery. The 30-day and 90-day mortality rates were 2% and 12%, respectively. The overall one-year survival rate was 64%. Conclusion: The current study indicated that despite the risk and complexity of the surgical intervention to the metastatic spine, the surgery resulted in an acceptable rate of morbidity and mortality.

Deformitat; Escoliosi; Columna vertebral Deformidad; Escoliosis; Espina dorsal Deformity; Scoliosis; Spine Objective To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine. Methods Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥ 20°, pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM). Results Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages. Conclusion CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD

BACKGROUND Lumbar spine fusion is the mainstay treatment for degenerative spine disease. Multiple potential complications of spinal fusion have been found. Acute contralateral radiculopathy postoperatively has been reported in previous literature, with unclear underlying pathology. Few articles reported the incidence of contralateral iatrogenic foraminal stenosis after lumbar fusion surgery. The aim of current article is to explore the possible causes and prevention of this complication. OBSERVATIONS The authors present 4 cases in which patients developed acute postoperative contralateral radiculopathy requiring revision surgery. In addition, we present a fourth case in which preventive measures have been applied. The aim of this article was to explore the possible causes and prevention to this complication. LESSONS Iatrogenic foraminal stenosis of the lumbar spine is a common complication; preoperative evaluation and middle intervertebral cage positioning are needed to prevent this complication.

BACKGROUND Atlantoaxial rotatory dislocation (AARD) in children may be caused by neck trauma or an upper respiratory tract infection. Here the authors describe the very rare association between inflammatory bowel disease and AARD in a child. OBSERVATIONS A 7-year-old girl presented with an 11-month history of torticollis that occurred spontaneously without a trauma context. Her history revealed a recent diagnosis of Crohn’s disease. Physical exam of the cervical spine revealed a “cock-robin” posture. Neck radiography and three-dimensional computed tomography reconstruction established the diagnosis of AARD. Given the duration of the symptoms and failure of previous conservative treatments, the patient was taken to the operating room and underwent open reduction through posterior approach with a C1–2 fusion according to the Harms technique. The torticollis resolved with no recurrence at the last follow-up and minimal restriction of rotation. LESSONS This is the third report to describe the very rare association between inflammatory bowel disease and AARD but at a very early age, the youngest in the literature. One should be aware of such association as early diagnosis may prevent aggressive surgical management.

Objectives: Vertebral hemangiomas are benign, slow-growing tumors. They represent 2–3% of spinal tumors and are incidentally found. Various treatment protocols have been described for Enneking Stage III vertebral hemangiomas. However, a comprehensive treatment protocol is still lacking. This case series aimed to describe the management of Enneking Stage III vertebral hemangiomas in two centers. Methods: This case series was performed by retrospectively reviewing the medical records of all patients diagnosed with Enneking Stage III vertebral hemangiomas at two centers in Riyadh, Saudi Arabia, from 2010 to 2020. Results: Eleven patients had Enneking Stage III vertebral hemangiomas. Mean follow-up was 47.5 ± 24.1 (range 9–120) months. All patients were symptomatic; the most common presentations were neurological deficits with or without myelopathy (n = 6). Ten patients underwent surgical decompression with instrumentation. One patient refused surgery and underwent vertebroplasty and repeated sclerotherapy. All patients regained full neurological recovery during their follow-ups with a mean duration of 49.4 (range, 14–120) months. No recurrence was reported. Conclusion: In all 11 patients, they showed full recovery and clinical improvement regardless of treatment variety. Therefore, a larger study comparing various treatment methods is needed to reach a gold standard approach.

There remains significant variability in the use of postoperative opioids. On one end, it is proven that appropriate pain control is a critical aspect of patient management; on the other end, past few decades have been associated with major increases in opioid-related overdoses and addiction treatment. We hypothesized that several pre- and postoperative risk factors affecting long-term opioid use could be identified.Evaluation of factors associated with minimum 5-year postoperative opioid use following adult spinal deformity surgery.Prospectively followed study group database.Adult spinal deformity patients who underwent elective spine surgery between 2009 and 2016 were included.Opioid usage or otherwise at minimum 5 years follow-up. Use of nonopioid analgesics, weak and strong opioids METHODS: Retrospective analysis of patients undergoing elective spinal deformity surgery. A total of 37 factors comprising patient characteristics, radiographic measurements, operative details, preoperative and early postoperative opioid use, and mechanical complications and revisions were analyzed. Details on identified factors were provided.A total of 265 patients (215F, 50M) from five sites were included. The mean follow-up duration was 68.4±11.7 (60-102) months. On average, 10.6±3.5 levels were fused. Preoperatively, 64 (24.2%) patients were using opioids. The rate of opioid users increased to 33.6% at 6 weeks and decreased to 21.5% at 6 months. During follow-up, there were patients who discontinued opioids, while others have started and/or restarted using opioids. As a result, 59 (22.3%) patients were still on opioids at the latest follow-up. Multivariate analyses showed that factors independently affecting opioid use at an average of 68 months postoperatively, in order of significance, were opioid use at sixth weeks, preoperative opioid use and opioid use at sixth months with the odds ratios of 2.88, 2.51, and 2.38 respectively. At these time points, factors such as age, number of comorbidities, tobacco use, the time of the last prior spine surgery and postoperative sagittal plane alignment affected opioid usage rates.Opioid usage at 6 weeks was found to be more predictive of long-term opioid use compared to preoperative use. Patients should be well informed to have realistic expectations regarding opioid use when considering adult spinal deformity surgery.

Introduction:Spine Surgery is considered a moderate risk for developing Venous Thromboembolism (VTE). To our knowledge, no study has been done to determine the incidence of VTE in our local population. We aim to study this and determine the factors associated with developing VTE post spine surgery. Material and Methods:A retrospective chart review was conducted to analyze 892 adult patients who underwent either an elective or emergency spine surgery. Demographics, length of surgery and hospital stay, diagnosis, and location of surgery in addition to the type of trauma, if applicable, were collected. Furthermore, spiral computed tomography was used to diagnose pulmonary embolism (PE), and duplex ultrasound was used to diagnose deep vein thrombosis (DVT) pre- and post-operatively. Results:800 patients were included. The overall incidence of VTE was 4.1%. In addition, Lumbar spine was the most common location operated on. Increasing age and length of hospital stay were both significantly associated with development of VTE. Furthermore, cervical spine surgery had a lower incidence of VTE compared to other locations which was statistically significant. Lastly, non-ambulatory patients had a higher risk of having VTE compared to patient who were able to ambulate post-operatively. Conclusion:The incidence of VTE after spine surgery is considered low but carries high rates of morbidity and mortality. Increased age and prolonged hospital stay increases its risk while early ambulation lowers it. Larger prospective study is needed to identify the best prophylactic anticoagulation regimen. Prophylactic measures against VTE are highly recommended, especially amongst high-risk patients. IRB approval:This study has been submitted and approved by the Institutional Review Board (IRB).