Lumbar spinal stenosis (LSS) is a prevalent degenerative condition, with ligamentum flavum hypertrophy (LFH) contributing significantly to neural compression. Despite its clinical importance, few studies have evaluated longitudinal trends in LFH. This study investigates the temporal progression and demographic associations of LFH over the past decade. This retrospective cohort study included adult patients undergoing surgery for LSS at a tertiary academic center during two periods: 2013-2017 and 2018-2023. Exclusion criteria included prior spinal surgery, trauma, malignancy, or inadequate imaging. Two radiologists reviewed axial MRI images to measure ligamentum flavum thickness (≥4 mm indicated hypertrophy). Demographic data and coexisting spinal conditions were also recorded. A total of 202 patients were analyzed-98 from the initial and 104 from the later period. LFH prevalence rose from 24.5 % to 44.7 % over time. Patients aged ≥60 demonstrated significantly higher LFH rates in both periods (p = 0.004). Although female predominance persisted, it declined from 71.4 % to 55 %. LFH was most commonly associated with disc bulging, particularly at the same spinal level. Multilevel LFH increased from 25 % to 44.1 %, though L4-L5 remained the most affected segment. The incidence of LFH has increased substantially over the past decade, particularly among older adults. Given its role in LSS pathogenesis, greater attention to LFH in imaging and surgical planning is warranted. Further research is needed to clarify its etiology and guide effective management strategies.

Background: Scoliosis is a common musculoskeletal disorder that remains underrecognized in Saudi Arabia, where limited public awareness may delay early detection and treatment. This study assessed public knowledge, support for school-based screening, and attitudes toward treatment. Methods: A nationwide cross-sectional survey was conducted during the 2025 Saudi National Scoliosis Awareness Campaign through public venues and online platforms. A culturally adapted questionnaire assessed demographics, knowledge, symptom recognition, treatment preferences, barriers, and information sources. A total of 2055 responses were analyzed using descriptive statistics and chi-square tests. Results: While 70.9% of participants had heard of scoliosis, only 18.1% reported good understanding. Symptom recognition was limited, with spinal curvature, back pain, and uneven shoulders most often identified. Most respondents supported school-based screening (88.2%) and early detection (92.1%), with a mean preferred screening age of 8 years. Bracing (64.3%) and surgery (53.5%) were more accepted than observation (30.5%), though concerns about pain, effectiveness, and appearance were frequent. Social media was the most common initial information source (34.6%), while healthcare professionals were the preferred future source (79.2%). Reported barriers included lack of awareness (68.2%), difficulty accessing specialists (19.9%), and cost (8.9%). Conclusions: Public support for school-based screening is strong, but baseline knowledge remains limited, and treatment perceptions are shaped by psychosocial and cultural concerns. National campaigns, school curricula, and healthcare-led education, combined with accessible, low-cost screening, may enhance early detection and improve scoliosis management in Saudi Arabia.

BACKGROUND Research productivity is a cornerstone of academic medicine, driving evidence-based practice, innovation, and professional advancement. In surgical specialties such as orthopedics, active research engagement is essential to improving patient outcomes and advancing clinical techniques. However, despite notable progress in Saudi Arabia’s medical research landscape, orthopedic research output remains limited and concentrated within a few institutions. Understanding the barriers that hinder orthopedic surgeons from conducting research is therefore crucial to strengthening national research capacity and aligning with Saudi Vision 2030’s goal of fostering scientific excellence. AIM To identify the barriers that limit research productivity among orthopedic surgeons in Saudi Arabia and explore the goals and motivations influencing their engagement in research across different subspecialties and levels of practice. METHODS We used a descriptive, cross-sectional, quantitative design, employing a structured online questionnaire distributed to 105 orthopedic surgeons across Saudi Arabia. The questionnaire was adapted from validated tools and reviewed for validity. Participants reported practice patterns, research activity, and barriers to productivity. Associations between variables were analyzed using univariate and multivariate methods. RESULTS A total of 105 orthopedic surgeons completed the survey. A statistically significant association was found between prior research experience and having served as a primary investigator within the past 5 years. Additionally, a highly significant association was found with co-authorship in the last 5 years (P < 0.001), as 52 participants (55.3%) had contributed as co-authors at least once. However, there was no significant association between prior research experience and factors such as allocated research time (P = 0.280), level of practice (P = 0.147), years in practice (P = 0.826), or the number of patients seen per week (P = 0.885). Univariate analysis revealed several barriers to research productivity: (1) Insufficient research time (71; 67.6%); (2) Lack of research assistants (57; 54.3%); (3) Inadequate research training (48; 45.7%); (4) Lack of funding (42; 40%); (5) Lack of research collaboration (39; 37.1%); (6) Lack of reward/incentive (38; 36.2%); and (7) No personal interest (20; 19.04%). CONCLUSION Addressing protected time, support staff, and research training may enhance orthopedic research productivity. This study highlights key institutional and educational gaps that can guide policy reforms and strengthen national orthopedic research capacity.

Osteosarcoma is one of the most common primary bone malignancies, typically occurring around the knee. However, the forearm is a rare site, with tumors in the proximal ulna being extremely uncommon. Primary sarcoma in this location presents a surgical challenge due to the complex anatomy and limited reconstructive options. We report a rare case of a 19-year-old female with non-metastatic, high-grade giant cell-rich osteosarcoma involving the right proximal ulna. To our knowledge, this is only the second reported adult case of this histological subtype in this location. The patient was treated at a specialized oncology center with neoadjuvant and adjuvant chemotherapy, along with wide intra-articular resection for local tumor control. Reconstruction was achieved using a novel, customized 3D-printed articulating cement spacer mold with plate osteosynthesis. Artificial elbow ligamentous reconstruction was performed using FiberTape and FiberWire sutures passed through drill holes, and the triceps tendon was reattached to the cement mold using an endobutton. This cost-effective and personalized surgical approach allowed successful joint reconstruction while maintaining elbow stability and function. Our case highlights a feasible reconstructive option for rare and anatomically challenging osteosarcoma presentations, contributing to the limited literature on proximal ulna giant cell-rich osteosarcoma.