Background & Aim: Iatrogenic paraplegia during Spine surgery is a devastating complication. Preventing such complications is important. (IOM) serves to help such patients/surgeons with successful surgeries and better post-op outcome using the IOM modalities.Methods & Materials/Patients: A retrospective data review was done on 153 consecutive patients. Somatosensory- Evoked-Potentials (SSEPs), Transcranial-Motor-Evoked-Potentials (TcMEPs), Electromyograms (EMGs) & Triggered-Electromyograms (TEMGs/screw stimulation) were studied.Results: 153 patients (n=104 females, n=49 males) with average age of 17 years and cob-angle ranged between 40-140 degrees were studied. TcMEP changes were noticed in n=56, 36.6%.TcMEP change resulting from surgical maneuvers n=43, 28.10%. TcMEP changes resulted from direct injury to the cord n=16, 10.45% & mechanical intervention (decompression/hemivertebrectomy/correction) n=15, 9.80%. Mal-positioned screws n=12, 7.83%. Within this group n=9, 5.8% presented with both SSEP and TcMEP changes. Changes in TcMEP, due to anesthesia n=10, 6.53%. EMG irritation lasting>15 seconds in lumbar roots, n=14, 9.15%. Within this group, TcMEP drop noticed in 4 patients suggesting 25% predictability were observed. TEMG changes in n=81, 52.9%, where in n=42, 27.4% screws were<6mA.TcMEP change, n=12, 7.83%, all fell under this group of screws below 6mA.3018 screws were placed in 153 patients with 19.73 screws/ patient.89 scre ws, 2.94% fell under dangerous/severe category.Conclusion: Our data showed that enhanced safety with comprehensive IOM in deformity surgeries, hence IOM was extremely important during such procedures.

Background and Aim: SARS-COV-2 can present with pulmonary, renal, gastrointestinal, hematological, and neurological manifestations. Neurological manifestations may occur after or before COVID-19 symptoms and signs. Spine and spinal cord complications are documented as neurological complications of COVID-19. Spinal cord pathology following COVID-19 showed inflammatory myelopathy and suspected cord ischemia. The most frequent presentation of COVID-19 myelitis is non-enhancing central expansile cord T2 signal changes, but it can present with lateral and dorsal column-specific disease and in some cases with negative magnetic resonance imaging (MRI). There is no known documented mechanism for spinal cord involvement in COVID-19 infection, but it seems as a post-infectious immunological and post-inflammatory disorder and reaction. Viral infection of SARS-CoV-2 can cause demyelination of the brain and spinal cord and also can exacerbate the known primary demyelinating disorders. Methods and Materials/Patients: This is a narrative study about the spinal cord complications of COVID-19. To provide up-to-date information, we precisely reviewed COVID-19 articles on Spine and spinal cord complications. Based on the keywords COVID-19, SARS-CoV-2, Spine, and spinal cord, all the related articles were taken from Google Scholar, PubMed, and Medline and were precisely studied. Results: There are reported cases of COVID-19 Spine and spinal cord involvement. There is no documented mechanism for these involvements but the possible mechanisms are direct invasion, cytokine storm, coagulopathy, and an autoimmune response. The routine therapy of such complications is the treatment of these complications with other primary causes with a poor and unsatisfactory response of myelopathy to treatment; however, early diagnosis and vigilance of such involvement improve outcome. Conclusion: COVID-19 can cause Spine and spinal cord complications in some patients without a known incidence rate of such complications. The pathogenesis is not completely known; therefore, more conclusive studies are obligatory to improve our information on COVID-19 spinal cord and Spine complications.

Introduction: War injuries vary in severity, ranging from minor injuries to severe damage to tissues and structures. This study investigates the etiology, intricacies, and interventions for war injuries in patients admitted to the trauma emergency department of Baqiyatallah Hospital.Methods: A retrospective analysis was conducted on patients injured in the war and treated at Baqiyatallah Hospital between April 2016 and March 2019. The study encompassed patients with spinal cord injury (SCI) and all injured patients, except those with insufficient medical records or those that were inaccessible due to death or other conditions. Collected data includes demographic characteristics, etiology, location of the injury, severity, surgeries performed, length of hospital stay, and any associated injuries or complications. The data was analyzed using the SPSS version 26.0 software.Results: The study included patients with a mean age of 28.73 ± 9.10 years and a mean BMI of 24.56 ± 2.67. Cervical damage was the most prevalent spinal injury, occurring in 13 individuals (25%), whereas sacral damage was the least prevalent, affecting only two patients (3.8%). Gunshot wounds were the primary etiology of SCI in 44 cases (84.6%), and surgical complications were observed in 27 patients (51.9%). Most injuries (67.3%) were classified as open wounds, with GUSTILO 2 being the most common type (65.4%). The treatment options included no surgery in 15 patients (28.8%), anterior spinal fusion (ASF) in 6 patients (11.5%), posterior spinal fusion (PSF) in 16 patients (30.8%), and a combination of ASF and PSF in 4 patients (7.7%). Among the patients, the most prevalent form of spinal injury was a burst fracture, which was detected in 12 individuals (23.1%). A significant complication decrease was observed following the treatment (P<0.05).Conclusion: Gunshot wounds to the cervical Spine can result in burst fractures and neurosensory problems. PSF surgery is the most common treatment, which has demonstrated a substantial reduction in complications.

Objectives: Major differences exist in the anatomy and biomechanics of the growing Spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases (93 boys, 44 girls) of pediatric cervical Spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical Spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical Spine and spinal cord injury in a pediatric age group and compare the findings with current literature.Materials & Methods: One hundred and thirty seven children with cervical Spine injuries, seen over twelve years, were divided into two age groups: 54 patients were in group one (0-9 years) and 83 patients were in group two (10-17 years). We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically (52 wore a halo brace and 38 wore different hard collars and braces). T-test and Chi squares were used to analyze differences between groups.Results: The most common cause of injury was motor vehicle accidents (MVA). Our younger patients (Group 1) had sustained more neurological injuries than the older ones (Group 2), 77% vs. 48%; upper cervical Spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/ subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fracutes (38%). Solid fusions were demonstrated in all patients at late follow-up review (mean 6 years). None of the children developed neurological deterioration; however 18% mortality was documented. Various fusion techniques were used and neurological and fusion outcomes improved as compared with the previous reports.Conclusion: Outcomes of cervical Spine injuries in children are more positive than in adults, particularly in patients with incomplete injuries. The prognosis for children with complete spinal cord injuries, however, is still discouraging. Upper cervical Spine injuries are more common between birth and 9 years of age; however fractures and fracture/subluxation are rare in this group. Surgical intervention with appropriate instrumentation and fusion are very effective in children with cervical Spine instability.

Background: Traumatic spinal cord injury (SCI) is one of the most traumatic events threatening patients’ well-being and places a financial burden on health care system. The first step in determination of the exact impact of SCI is to estimate the pattern of traumatic injuries in a population and also the type of frequently occurred co-injuries. Hence, this study was conducted to assess the frequency of anatomy, type of Spine injuries, and associated co-injuries in patients with trauma in Poursina Hospital of Guilan province in Iran. Methods: A descriptive cross-sectional study was carried out on traumatic Spine patients admitted to the Poursina hospital of Rasht, a referral therapeutic center for trauma in north of Iran, in Rasht during 2015 to 2019. Data were extracted from the SCI registry of Poursina Hospital, Rasht, Guilan, Iran. Results: A total of 274 records were reviewed. Seventy-six patients were females and 198 patients were males. Mean± SD of age of the patients was 42. 27± 16. 83 years. Based on this survey, most of the patients (43. 8%) had SCI in lumbar region. Locked facet was seen in 12 patients. Fifty-seven patients (20. 8%) complained about having pain. The median of VAS score was 6 (range=6). Co-existence of associated injuries (e. g. limb fractures, TBI, Internal bleeding, etc. ) was found in 27. 4% of the patients. According to ASIA (The American Spinal Injury Association) impairment scale, three patients (2. 9%) had score A, and 100 patients (97. 1%) had score E neurological defects. Conclusion: The most telling reiteration to be drawn is that men mostly suffered from Spine trauma. Lumbar region was the most susceptible location of SCI. Moreover, most of the patients experienced score E (normal neurological charcteristics) according to ASIA.

Bilateral vocal cord paralysis is a rare and preventable complication of anterior cervical discectomy and fusion. Herein, we report a fatal case of bilateral vocal cord paralysis after anterior cervical discectomy and fusion (ACD/F). A 65-year-old man with cervical Spine trauma and anterior cord syndrome, following car overturn presented to our emergency department. The patient had C6-T10 prolapsed discs for which ACD/F was performed. In the recovery room he developed stridor and respiratory distress immediately after extubation, and was reintubated. Otolaryngological evaluation revealed bilateral vocal cord paralysis. He later required a tracheostomy but finally died in a rehabilitation center after an acute coronary event. Awake fibroptic intubation is recommended in patients at high risk for preoperative recurrent laryngeal nerve injury. Intraoperative tracheal tube cuff pressure monitoring and modification of surgical approach to neck are recommended to prevent bilateral nerve damage.