Background: Caudal septal deviation is a challenging condition that affects nasal function and aesthetics. Objectives: The aim of the study was to evaluate surgical practices for caudal septoplasty among otolaryngologists in Saudi Arabia and compare them with international approaches. Methods: A cross-sectional electronic survey was distributed to otolaryngologists across academic, governmental, and private healthcare institutions in Saudi Arabia. A parallel systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using PubMed, Web of Science, and Scopus. Eligible studies published between 1954 and 2024 described techniques addressing caudal septal deviation with reported outcomes. The study protocol was prospectively registered before the study's start in PROSPERO (CRD42024621207). Results: Sixty otolaryngologists completed the survey. The most commonly used techniques were swinging door (76.6%), cartilage reshaping (51.7%), and suturing (48.3%). Only 16.7% had facial plastic surgery training. In the systematic review, 559 records were identified with 53 studies meeting the inclusion criteria involving 3564 patients, splinting or grafting (47.2%), and cartilage reshaping (30.2%) predominated. Patient-reported outcome measures (PROMs) were used in 66% of studies, primarily the Nasal Obstruction Symptom Evaluation scale, with scores improving from 70.2 to 16.1 postoperatively. Conclusions: Otolaryngologists in Saudi Arabia predominantly employ conservative caudal septoplasty techniques, with limited adoption of extracorporeal approaches and PROMs. These findings contrast with broader international practices and highlight the need for enhanced subspecialty training and standardized outcome evaluations. Level of Evidence: 5 (Therapeutic):

Intraspinal abnormalities are common in congenital scoliosis, yet estimates and associations with vertebral anomaly patterns and curve severity remain inconsistent. This meta-analysis aimed to estimate the pooled prevalence of intraspinal abnormalities in congenital scoliosis patients and evaluate relationships with sex, geographic region, vertebral anomaly type, and Cobb angle. PubMed, Web of Science, Scopus, and Cochrane were searched through January 1, 2026. Observational studies of congenital scoliosis patients who underwent MRI and reported intraspinal abnormalities were included. Two reviewers independently screened studies and extracted data. Methodological quality was assessed using MINORS. (PROSPERO: CRD420251276010). Eighteen studies reporting 4,463 patients were included; 1,474 had intraspinal abnormalities. Overall quality was moderate. Pooled prevalence was 35% (95% CI: 29%-40%), with substantial heterogeneity (I² = 91.1%) and a prediction interval of 16%-60%. Diastematomyelia was most frequent, followed by syringomyelia and tethered cord. Within each vertebral anomaly subgroup, pooled prevalence was 26% for failure of formation, 47% for failure of segmentation, and 40% for mixed defects. In unadjusted study-level comparisons, intraspinal abnormalities were associated with higher odds of failure of segmentation (odds ratio: 1.89 [95% CI: 1.39-2.56]) and mixed abnormalities (1.43 [1.09-1.88]). Cobb angle was higher in patients with intraspinal abnormalities than in those without, but the difference was not statistically significant (mean difference: 3.30° [95% CI: -1.53 to 8.13]; p = .1805). Intraspinal abnormalities affect one-third of congenital scoliosis patients. Failure of segmentation and mixed vertebral anomalies may identify higher-risk subgroups, supporting MRI-based evaluation for diagnosis and surgical planning.

Background/Objectives: Traumatic spinal injury (TSI) is associated with substantial morbidity, but factors contributing to in-hospital complications remain insufficiently defined. This study evaluated factors associated with in-hospital complications after TSI. Methods: We conducted a retrospective cohort study at a tertiary center (January 2018–May 2025). Among 5380 trauma patients screened by computed tomography, 413 admitted patients with TSI were included. The primary outcome was any documented in-hospital complication. Factors were assessed using multivariable logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: The median age was 28.0 years, 337 were male (81.6%), and four-wheel motorized vehicle accidents were the most common injury mechanism (57.1%). In-hospital complications occurred in 99 patients (24.0%). Pulmonary infection was most common (9.9%), followed by bloodstream infection (4.4%), urinary tract infection (3.9%), and surgical site infection (3.9%). Compared with patients without complications, those with complications had longer hospital stays, higher ICU admissions, longer ICU stays, and lower discharge home. In multivariate logistic regression, complications were associated with worse AIS grade (OR 1.690, 95% CI 1.241–2.302), inpatient physical therapy requirement (OR 4.385, 95% CI 2.494–7.711), greater number of associated non-spinal injuries (OR 1.729, 95% CI 1.463–2.042), and greater cervical vertebral injury burden (OR 1.479, 95% CI 1.061–2.062). Conclusions: Neurological severity, polytrauma burden, and cervical injury were independently associated with complications, supporting early risk stratification and multidisciplinary prevention in high-risk patients. Findings should be interpreted considering the retrospective single-center design, predominantly young male cohort, low spinal cord injury proportion, and limited post-discharge data.

Background: Clinical outcomes continue to be a concern after anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular tenodesis (LET) has reemerged as an adjunct procedure for enhancing knee function; however, its overall clinical effectiveness remains controversial. Hypothesis: The addition of LET to primary ACLR would result in superior clinical, functional, and patient-reported outcomes as compared with isolated ACLR. Study Design: Systematic review and meta-analysis; Level of evidence, 1. Methods: This study was conducted according to the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and registered in PROSPERO. Multiple databases were searched from 1995 to October 2025. Ten high-quality randomized controlled trials comparing ACLR with and without LET were included in the final meta-analysis. The outcomes assessed included graft failure, rotational and anterior knee stability, functional scores, patient-reported outcomes, and return-to-sport rates. Random effects models were used, and heterogeneity was evaluated. Results: When compared with isolated ACLR, ACLR augmented with LET demonstrated significantly lower graft failure rates (odds ratio [OR], −1.19; 95% CI, −1.73 to −0.65; P < .001) and improved rotational stability, as evidenced by superior pivot-shift outcomes (OR, −0.81; 95% CI, −1.11 to −0.52; P < .001). Significant improvements were also observed in Lysholm scores (OR, 1.98; 95% CI, 0.19-3.77; P = .030) and International Knee Documentation Committee (IKDC) subjective scores (OR, 1.65; 95% CI, 0.24-3.05; P = .22). No statistically significant differences were identified between the groups in KT-1000 measurements, Lachman test results, IKDC objective scores, Knee injury and Osteoarthritis Outcome Score subscales, Tegner activity scores, or return-to-sport rates. Heterogeneity was low across most outcomes ( I ² = 0%), except for the Tegner scale ( I ² = 83.12%). Conclusion: The addition of LET to primary ACLR was associated with significantly improved graft survival (log OR, −1.19; 95% CI, −1.73 to −0.65; P < .001); enhanced rotational stability as demonstrated by improved pivot-shift outcomes (log OR, −0.81; 95% CI, −1.11 to −0.52; P < .001); and better patient-reported knee function, including Lysholm scores (mean difference, 1.98; 95% CI, 0.19-3.77; P = .030) and IKDC subjective scores (mean difference, 1.65; 95% CI, 0.24-3.05; P = .22). However, no significant benefits were observed in anterior laxity or return-to-sport rates.