Objective: This study aimed to investigate the characteristics and epidemiological trends of pediatric injuries among patients visiting emergency departments on Jeju Island, Korea.Methods: Using a community-level serial cross-sectional analysis, we targeted pediatric patients 18 years or younger who visited emergency departments for injuries over a 10-year period. A comprehensive examination of injury characteristics and epidemiological trends was performed using the data sourced from the Jeju Injury Surveillance System. This included an evaluation of the annual incidence and overall trends in pediatric injury cases.Results: The study found toddlers (42.5% of cases) to be the most frequently injured age group. Male patients were more prone to injuries, with a male to female ratio of 1.7:1. Injuries among visitors accounted for 17.3% of cases, with a seasonal spike in summer, evenings, and weekends. Most incidents occurred at home, were predominantly accidental in nature, with adolescents more likely to require emergency medical system services. The common mechanisms of injuries were blunt force (49.2%), slips/falls (22.0%), and motor vehicle collisions (13.2%), leading to bruises, cuts, and sprains. Over the decade, a general increase in pediatric injuries was observed. Accidental injuries initially surged but later stabilized; however, self-harm/suicide and assault/violence injuries showed a concerning upward trend. Age-specific analysis revealed increasing trends in infants and adolescents.Conclusion: The results of the present study underscore the crucial need for targeted injury prevention and resource allocation strategies, particularly for high-risk groups and time of injury, to effectively mitigate pediatric trauma on Jeju Island.

Enhanced recovery after surgery (ERAS) protocols have been widely adopted in various surgical disciplines to accelerate recovery and improve patient outcomes. However, the application of these programs in spinal surgery, particularly with an integrative medicine approach, remains limited. This study aimed to evaluate the effects of a customized integrative medicine-based program on postoperative recovery and to analyze patient-reported preferences for future protocol refinement. This study evaluated the enhanced recovery after spinal surgery (ERAS-K) program in single- and multi-segment spinal fusion surgeries, targeting improved activity as the primary endpoint. Secondary endpoints included pain, digestive dysfunction, and muscle weakness. Patients aged >40 years were divided into ERAS-K and non-ERAS-K groups. Statistical analyses, including ANCOVA and chi-square tests, adjusted for covariates, revealing significant outcomes ( P -values adjusted via Benjamini–Hochberg). This study evaluated the ERAS-K program in single- and multi-segment spinal fusion surgeries, with improved activity as the primary endpoint. Secondary endpoints included pain, digestive dysfunction, and muscle weakness. Patients aged >40 years were divided into ERAS-K (N) and non-ERAS-K (M) groups. Postoperative recovery metrics showed no significant differences in numeric rating scale-axial ( P = .5588) or numeric rating scale-leg ( P = .8576) pain scores at baseline. Postoperatively, axial pain reduction showed a near-significant trend ( P = .0525, ANCOVA; ERAS-K: 4.2 ± 1.1, non-ERAS-K: 4.8 ± 1.3). Short form-36 physical ( P = .1989; ERAS-K: 42.5 ± 8.2, non-ERAS-K: 41.3 ± 7.9) and mental component scores ( P = .9572) were similar. Mean days to improved activity were 4.81 ± 0.9 (ERAS-K) versus 4.96 ± 1.0 (non-ERAS-K; P = .63551). Non-ERAS-K patients preferred physical therapy ( P = .053). Outcomes suggest ERAS-K’s integrated rehabilitation may reduce the need for standalone physical therapy, though statistical significance was not achieved. Although the ERAS-K program did not demonstrate a statistically significant impact on conventional pain and quality-of-life metrics, this study highlights the critical importance of program standardization in future research. The findings also underscore strong patient-driven demand for the integration of traditional Korean medicine into conventional postoperative care pathways, suggesting that a holistic, patient-centered approach may improve satisfaction and outcomes beyond traditional metrics.

Background and Objectives: This study aimed to identify radiographic predictors and optimal cut-off values for determining the need for additional pedicle subtraction osteotomy (PSO) in patients with iatrogenic flatback syndrome following short-segment (≤3 levels) fusion surgery. Materials and Methods: From 2011 to 2022, a total of 49 patients who underwent deformity correction for iatrogenic flatback following short-segment fusion at a single institution were included. We divided all patients into group A (n = 33, only anterior column realignment, ACR) and group B (n = 16, ACR combined with PSO). Among group A patients, we further divided them into two subgroups: The Excessive group, who developed excessive anterior disc height distraction (EADH) during surgery, and the Non-excessive group, who did not. The Receiver Operating Characteristic (ROC) curve was used to determine the cut-off values for spinopelvic parameters associated with the decision to perform additional PSO. Results: Group A had a significantly lower number of previously fused segments compared to Group B (p < 0.001). Preoperative C7 sagittal vertical axis (C7SVA, p = 0.026) and its correction (p = 0.003) in group B were greater than those in group A. Group B showed a significantly more kyphotic preoperative fused segment angle (FSA) compared to Group A (p = 0.001). Postoperatively, EADH occurred in 7 patients (21.2%) in Group A, while no cases were observed in Group B. Subgroup analysis revealed that the dynamic segment angle (DA) was significantly lower in the Excessive group compared to the Non-excessive group (p < 0.001). The optimal cut-off values of preoperative radiographic parameters for selecting PSO were: C7-SVA > 242.8 mm, FSA > −3.2°, and DA < 4.3°. Conclusions: ACR alone and ACR combined with PSO showed satisfactory outcomes in patients with iatrogenic flat back. For selected patients with preoperative C7SVA > 242.8 mm, FSA > −3.2°, or DA < 4.3°, additional PSO may be reasonable to help optimize sagittal alignment.

Chronic constipation can lead to fecal impaction in the large bowel, which can cause pressure necrosis followed by perforation, known as a stercoral ulcer. In extensive posterior thoracolumbar surgery, a long operation time, large blood loss, and perioperative narcotic use may aggravate constipation. Moreover, sacral root palsy due to cauda equina syndrome (CES) can lead to the deterioration of fecal impaction. This report describes the case of a 77-year-old woman with CES who presented with saddle anesthesia, neurogenic bladder, bowel incontinence, and paraplegia. Five days prior, she had undergone extended posterior lumbar interbody fusion from L1 to L5. Lumbar magnetic resonance imaging (MRI) showed an extended epidural hematoma. After urgent neural decompression, she gradually recovered from the saddle anesthesia, leg pain, and paraplegia over 3 weeks. Thereafter, the patient suddenly developed massive hematochezia and hemorrhagic shock. Urgent colonoscopy was performed, and a stercoral ulcer in the sigmoid colon was diagnosed. After 4 weeks of intensive care for hemorrhagic shock, pneumonia, and systemic sepsis, the patient was transferred to a general ward for intensive rehabilitation. One year after the operation, she was able to walk with assistance, and her urinary and bowel incontinence completely recovered. Chronic constipation, a common clinical problem, can sometimes cause relatively obscure but potentially life-threatening complications such as stercoral ulceration. Possible factors including advanced age, extensive spinal surgeries, prolonged operation time, significant blood loss, perioperative narcotic use, and the presence of spinal cord injury might contribute to the development of this condition. It highlights the importance of recognizing the potential development of stercoral ulcers in patients with CES and emphasizes the need for prompt diagnosis and management to avert catastrophic complications.