Objective: A significant portion of traumatic spinal fractures involves the thoracolumbar spine. Fracture stabilization using pedicle screws initially demanded fixation of two levels above and below the fractured vertebra to achieve a stable construct. Over the years, a short-segment pedicle screw fixation was found to be adequate. Balloon kyphoplasty (BKP) is commonly used as a minimally invasive treatment for vertebral compression fractures. At times, lumbar burst fractures can extend to the posterior elements. These recently acknowledged subtypes of fracture do not cause posterior column instability other than coronal bipedicular dissociation. BKP alone is inadequate in these cases; a combination of BKP addressing anterior column reduction and support with a middle column stabilization by transpedicular fixation has the potential to treat all fracture elements without losing motion segments through a minimally invasive technique. This study aims to describe this novel concept and technique. Methods: Five patients were treated with the intravertebral fixation (IVF) technique for coronal bipedicular dissociation fractures. We describe the surgical technique and review the pertinent literature. Results: The IVF technique is clinically safe in stabilizing the specified fractures, with good clinical and functional outcomes. Conclusion: IVF is a promising surgical technique and an exciting treatment concept for unique fracture types involving bipedicular coronal dissociation with or without burst fracture. Further studies are required to assess long-term results and possible complications. Study Design: Case series for a new surgical technique.

Background: Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical radiculopathy and myelopathy. While generally effective, diabetes mellitus may increase postoperative complications and healthcare costs. This study evaluated the impact of type 2 diabetes on perioperative outcomes in ACDF patients. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016–2019), including 85,585 single-level ACDF patients. Propensity score matching (PSM) was applied, creating two balanced cohorts (16,260 diabetic and 16,260 non-diabetic patients). Outcomes analyzed included postoperative complications, length of stay, hospital charges, and mortality. Results: Diabetic patients had significantly higher risks of ACDF-specific complications, including cerebrospinal fluid leaks (2×), dysphagia (2.5×), dysphonia (2.9×), and cervical spinal cord injury (5×). General complications were also increased, with higher rates of pulmonary embolism (2.4×), sepsis (3×), stroke (3×), pneumonia (3.3×), and heart failure (12×). Diabetic patients had longer hospital stays (1.99 vs. 1.79 days, p < 0.001) and higher hospital charges (USD 71,884 vs. USD 67,998, p = 0.004). Conclusions: T2DM significantly increases postoperative risks, length of stay, and costs for ACDF patients. Optimized perioperative management and glucose control are essential to improve outcomes in this high-risk population.

Introduction: Acute compartment syndrome (ACS) is a surgical emergency that requires urgent intervention in order to prevent permanent structural damage and irreversible functional disability. The diagnosis of ACS depends on a high index of suspicion, relying on the following diagnostic criteria commonly known as the 5 Ps; Pain, Paresthesia, Paralysis, Pallor, and Pulse-lessness. When the diagnosis is uncertain, intracompartmental pressure greater than 30 mmHg is suggestive of ACS. Case Presentation: We report a case of an underdiagnosed ACS, with a lack of classical presentation in a thirty-seven-years-old male patient with a history of myopathy. The patient was admitted to the emergency room due to direct trauma to his right hip, without a significant Visual Analogue Score. On his hip radiograph a subtrochanteric fracture of the right femur was demonstrated. An additional masked ipsilateral subcapital fracture was detected during the operation. The diagnosis of ACS was made during the operation while relying on the clinical appearance of the thigh and the clinical findings during surgery. Fasciotomies were performed, and open reduction with internal fixation via Proximal Femoral Nail was done. The diagnosis of ACS was confirmed later on, by the biopsy results. Conclusion: This case suggests that myopathy can mask the classical presentation of ACS. Furthermore, the extent of pain complaints and accompanying paresthesia cannot be relied on in this regard and other clinical features should be considered in order to diagnose ACS.

Background: Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical radiculopathy and myelopathy. Severe obesity (BMI ≥40 or BMI ≥35 with comorbidities) is associ-ated with increased perioperative risks. This study examines the impact of severe obesity on out-comes in patients undergoing single-level ACDF. Methods :Data from the Nationwide Inpatient Sample (2016-2019) were analyzed, including 85,585 patients who underwent single-level ACDF. Patients were classified as severely obese (n = 4,935) or non-obese (n = 80,650). Outcomes such as length of stay, complications, and in-hospital mortali-ty were compared using SPSS and MATLAB, with a significance level of p < 0.05. Results: Severely obese patients were younger (54 vs. 55.7 years, p < 0.001) and had more comor-bidities like type 2 diabetes (38% vs. 17.8%, p < 0.001) and obstructive sleep apnea (31.1% vs. 9.5%, p < 0.001). They experienced longer hospital stays (1.92 vs. 1.65 days, p < 0.001) but similar in-hospital mortality (0.1%, p = 0.506). Severe obesity was linked to higher odds of complications, the risk of developing dehiscence was 8.2 times higher in severely obese patients. Respiratory failure had an odds ratio of 6.5, while myocardial infarction showed an odds ratio of 5.5. Horner syn-drome was 4.7 times more likely to occur, and pulmonary edema had an odds ratio of 4.5. Dural tear risk was also significantly elevated, with an odds ratio of 4.1.The risk of developing acute kid-ney injury were 2.6 times higher, while the risk of pulmonary embolism was 2.5 times higher. Dysphonia was also more common in severely obese patients, with an odds ratio of 2.2. Conclusion: Severe obesity is associated with higher complication rates and longer hospital stays following ACDF. Tailored perioperative management is essential to mitigate risks and improve outcomes in this high-risk population.

Introduction: A dual malignancy with both Ewing Sarcoma and Prostate Adenocarcinoma has not been reported in the English literature. We report a case of simultaneous diagnosis of Ewing sarcoma and prostate adenocarcinoma with profound clinical manifestation. Case presentation: A 53-year-old male with advanced metastatic prostate cancer (Gleason-9) admitted with classical presentation of cauda equina syndrome including incontinence, back pain, and paresis following bilateral nephrostomy insertion for the treatment of bilateral renal hy-dronephrosis. The patient was diagnosed with an epidural abscess at the level of L5-S1 and an emergency surgical spine decompression was performed. No abscess was found, and pathology results showed a concomitant primary Ewing sarcoma in the spine. Conclusions: Very rare occurrences of a dual primary malignancy, in this case, Ewing sarcoma and prostate adenocarcinoma, should be kept in mind in patients suffering from complex clinical course of malignancies.