Anxiety, depression and functional impairments are commonly reported by persons with multiple sclerosis (PwMS) but no data, to our knowledge, has emerged from an Arab Islamic population. The study aims to investigate the prevalence of anxiety, depression and related disabilities among PwMS attending tertiary care in Sultan Qaboos University Hospital (SQUH), one of the urban hospitals in Oman. Consecutive and consenting PwMS (n = 57) and healthy subjects (n = 53) completed the following measures: Hospital Anxiety and Depression Scale (HADS) which was used to measure anxiety (cut-point >7) and depression (>7); and Expanded Disability Status Scale (EDSS) to measure the level of disability (≥5). Characteristics such as socio-demographic and clinical variables were also explored. Fifty seven subjects with multiple sclerosis (MS) met the inclusion criteria. The majority of them were females who were 40 years old or younger and the majority were employed and unmarried. Approximately 86 % of the participants were using beta interferon, 96 % scored ≥5 in EDSS. MS of the Relapsing-Remitting type constituted the majority of the cohort (94 %). Approximately 35 % and 51 % endorsed symptoms of anxiety and depression respectively. The MS group scored significantly higher than controls on HADS measurements of depression and anxiety. Disability and symptoms of anxiety and depression are common among the PwMS attendees of tertiary care hospital in Oman. Such psychosocial variables have been largely unreported emerging from non-western populations. As these variables are strong indicators of the burden of MS, resolute effort is needed to address such psychosocial dysfunctions in the algorithms of care for PwMS in the Arab Islamic part of the world.

Introduction: The novel coronavirus has spread rapidly around the world with particularly high mortality in the elderly. Care and nursing homes have become the sites of greatest concentration of cases. We intended to review 30-day mortality of COVID-19 patients with hip fractures. This is relevant given the disease impact in this age group. Methods: Medline and Embase databases were searched for relevant studies linked to mortality and morbidity in COVID-19 patients who have undergone non-elective hip surgeries using the keywords “COVID-19”OR “SARS-cov-2”OR “Coronavirus Infections”; AND “Surgery”OR “Hip”OR “Fracture”OR “Orthopedics.” We included all patients with hip fractures, but excluded pathological fractures and other non-traumatic hip pathologies. Four-hundred and eighty-one articles were identified for screening, in addition to an unpublished case-series of 67 patients that have 3 cases turned positive for COVID 19, yielding a total of 50patients for the final review. Results: The study included 4 articles published until May 9th 2020 and a case-series: 26(52%) patients were females; the median age was 86years; hypertension(53.6%), diabetes mellitus type II(28.6%), and coronary artery heart disease(25%) were the most common comorbidities; 34(68%) patients had intertrochanteric hip fracture and 16(32%) patients had femoral neck fractures; 22(59.5%) patients underwent cephalomedullary nail fixation, 12(32.4%) patients had hemiarthroplasty, and for 3(8.1%) patients, the type of surgery was not documented; 20(40%) patients died(12patients died before the surgery and 8died after surgery at a median time of 3days), 29(76.3%) patients had an unremarkable course throughout hospitalization and were discharged including 1(2.6%) patient managed non-operatively, and 1(2.6%) patient was admitted to the ICU after the surgery but eventually discharged. Conclusion: COVID-19 infected elderly patients have a higher 30-days mortality rate compared to non-COVID-19 infected cases. Further studies are warranted to look at the morbidity and mortality rates in COVID-19 positive patients with hip fractures and to investigate how these outcomes can be improved. Level of evidence: Level IV

Total disc replacement as a treatment for degenerative disc disease is gaining increased popularity. There is limited data in the literature about formation of a pseudotumor as a complication following this procedure. We report a very rare case of a pseudotumor after a lumbar total disc replacement with a review of the literature. A case study of a 49-year-old lady, who underwent L4-L5 total disc replacement and presented one year later with progressive back pain radiating to both lower extremities. Imaging revealed a soft tissue mass around the prosthesis. A review of the literature for similar cases has been done and reviewed. Imaging revealed a soft tissue mass around the prosthesis and left hydronephrosis. CT venogram for leg swelling showed total occlusion of the left common iliac vein. CT myelogram showed compression of the cauda from the pseudotumor. The prosthesis was removed and replaced by an allograft fusion cage and plate. Intraoperatively both extremities became pulseless and bilateral common iliac arteries thrombectomy was carried out. This occurred again after closure immediately and bilaterally femoral artery exploration and thrombectomy was carried out. Histopathology showed a soft tissue with fibrinous necrosis and lymphohistiocytic inflammation. Soft tissue reaction and pseudotumor formation can be induced by Metal-on-Metal total disc replacement prostheses. Neurologic, vascular, and visceral complications may occur. In this case implant removal can stopped progression of the soft tissue reaction. Most patients in the literature benefit from implant removal followed by spinal fusion.

Improper cage placement during spinal interbody fusion surgeries could lead to numerous post-operative complications. Biomechanical factors of such improper placement may result in loss of lumbar lordosis, foraminal stenosis, subsidence, and altered stress distribution to the tissues adjacent to the cage. The aim of the present study is to compare three different lumbar interbody cage designs, placed posterior, middle, and anterior, and their biomechanical effect on the aforementioned studied parameter. Cages and MRI-based lumbar spine models were developed using finite elements. A parametric comparative analysis was then designed to explore cage types, height, and location on lumbar lordosis, foraminal area, cage subsidence, along with normal and shear stresses resulting from each cage configuration under a 500 N compression load. First, the model was validated in light of published data. Simulated results showed that lumbar lordosis and foraminal area are inversely related. The 6-degrees bullet cage showed the highest gain in lordosis (16.5°), while it exhibited a large loss in foraminal area (34.2 mm²). Anterior placement of banana cages, however, showed the best trade-off, effectively recording a 14.5° lordosis gain, a 0.6 mm² loss in foraminal area, a subsidence as low as 0.27 mm, and a moderate cage stress of 13.6-23.1 MPa. Reported data favors banana cages for the highest lordosis gains without compromising the other explored biomechanical factors. However, it is still advised to thoroughly consider patient-specific factors at hand, possible complications of foraminal stenosis, cage migration, and endplates wear prior to choosing an appropriate cage morphology and placement.

Study Design: This was a single-institution, retrospective cohort study. Objective: The objective of this study was to assess a surgical technique for spinal reconstruction after corpectomy, integrating an allograft/autograft within a vertebral body replacement cage linked to spinal rods via pedicle screws. This method aims to enhance biomechanical stability and promote long-term fusion without cage endcaps. Summary of Background data: Recent advancements in spinal surgery feature innovative constructs that improve healing and fusion rates. FDA-approved mesh cages provide enhanced stability and superior fusion with fewer complications. Our approach combines allografts/autografts with vertebral replacements, using a pedicle screw through the cage for significant biomechanical enhancement. Methods: Two patients undergoing cervical and lumbar spinal reconstructions due to different pathologies were selected. The surgical technique involved shaping the allograft/autograft to fit precisely within the cage, extending beyond its ends to facilitate fusion at both ends, and securing the construct to the spinal rods with pedicle screws for added stability. Patient outcomes were assessed based on post-operative stability, fusion rates, and the presence of any complications. Results: Both cases successfully utilized the technique, achieving stabilization and fusion. Improvements were noted in post-operative recovery. There were no instances of cage subsidence, or any significant complications directly related to the novel construct. Conclusions: Our case series highlights a post-corpectomy reconstruction technique involving a mesh cage construct integrated with an autograft/allograft and connected to posterior instrumentation for enhanced stability. This technique was applied successfully in two cases, demonstrating its feasibility, durability, and potential to promote biological integration. Further studies with larger cohorts and extended follow-up periods are necessary to refine the approach for wider clinical use.