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Purpose The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. Methods The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. Results The areas of immediate concern were “Aging spine,” “Future of spine care,” “Spinal cord injuries,” “Children and adolescent spine,” “Spine-related disability,” “Spine Educational Standards,” “Patient safety,” and “Burden on economy.” Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10–11, 2020 held from the G20 platform. Conclusions This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence.

BACKGROUND A traumatic spinal fracture (TSF) is a serious condition that has a tremendous impact on patients and their families. Understanding the causes and patterns of TSF is critical in developing prevention programs. OBJECTIVES Identify causes and patterns of TSF and explore predictors of neurological disability in Saudi Arabia. DESIGN A retrospective medical record review. SETTING Level 1 trauma center in Riyadh. PATIENTS AND METHODS The analysis included all consecutive patients who met the inclusion criteria for any acute TSF in patients 18 years of age and older from January 2001 to January 2016. A multivariate logistic regression model was used to identify predictors of neurological disability following TSF. MAIN OUTCOME MEASURES Neurological disability in patients sustaining TSF. SAMPLE SIZE 1128 patients. RESULTS Of 1128 patients, 971 patients (86%) were male with a mean (SD) age 34.4 (16.6) years. The most common mechanism of injury was motor vehicle accidents (88.4%). Cervical spine was the most commonly affected region (48%, n=468) with a mortality rate of 7.6%. Neurological disability occurred in 74 (6.7%) patients, and 41 (8.7%) of those with cervical fractures died in the hospital. The Injury Severity Score was a significant predictor of neurological disability following TSF. CONCLUSION A high proportion of neurological disability following TSF was found. Further studies should attempt to improve the documentation rate of seatbelt status in all traumatic cases including mild injuries. This data will increase our understanding of adult TSF and possibly facilitate injury prevention strategies. LIMITATIONS Single hospital and may not be generalizable.

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Background: Infection is the most common and devastating complication of open fractures, with a reported incidence of 3-40%. Tibia bone along its anteromedial surface has relatively thin soft tissue coverage; hence the open tibia fracture incidence rate ranges from 49.4% to 63.2%. Open fractures are usually classified based on the Gustilo & Anderson classification system, which is used by surgeons as an index for the severity of an injury and as a prognostic tool. Our current practice follows the 6-h rule of irrigation and debridement (I&D). Nevertheless, there is little support for this opinion in the literature. Our study concentrates on identifying the risk factors of infection in open tibia fractures and comparing the rate of infection if surgical irrigation and debridement was delayed. Methods: The medical records of 389 patients with open fractures were reviewed. Of these cases, 113 patients with open tibia fracture who presented to our Hospital from the period 1997 to 2008 fit the inclusion criteria and were included in a retrospective cohort study. Results: A total of 113 tibia fractures were reviewed, with an average patient age of 31.70 years; 87.1% of the fractures were high-energy fractures, and the most common mechanism of injury was a motor vehicle accident (62.4%). The data analysis revealed no difference in overall infectious outcome when comparing initial I&D performed within 6 h to when I&D was performed after 6 h (P = 0.201). The data analysis showed a significant relationship between infection and wound closure in first surgery in both univariate and multivariate analysis (P = 0.0003 and P = 0.014), respectively. Conclusion: This study showed no significant evidence to support the 6-h rule, but it did demonstrate a significant relationship between the Gustilo stage and infection, as well as an increased infection rate if external fixation was used or if the wound was left open during the initial irrigation and debridement. We believe that more studies are required to identify the relationship between infection and the delay in irrigation and debridement; a meta-analysis of the currently available data may provide an answer to this question.

Objectives: Vertebral hemangiomas are benign, slow-growing tumors. They represent 2–3% of spinal tumors and are incidentally found. Various treatment protocols have been described for Enneking Stage III vertebral hemangiomas. However, a comprehensive treatment protocol is still lacking. This case series aimed to describe the management of Enneking Stage III vertebral hemangiomas in two centers. Methods: This case series was performed by retrospectively reviewing the medical records of all patients diagnosed with Enneking Stage III vertebral hemangiomas at two centers in Riyadh, Saudi Arabia, from 2010 to 2020. Results: Eleven patients had Enneking Stage III vertebral hemangiomas. Mean follow-up was 47.5 ± 24.1 (range 9–120) months. All patients were symptomatic; the most common presentations were neurological deficits with or without myelopathy (n = 6). Ten patients underwent surgical decompression with instrumentation. One patient refused surgery and underwent vertebroplasty and repeated sclerotherapy. All patients regained full neurological recovery during their follow-ups with a mean duration of 49.4 (range, 14–120) months. No recurrence was reported. Conclusion: In all 11 patients, they showed full recovery and clinical improvement regardless of treatment variety. Therefore, a larger study comparing various treatment methods is needed to reach a gold standard approach.

Introduction The treatment of thoracic spine fracture-dislocations is now well established with the recent progress in spine surgery. Although most affected individuals have a degree of spinal cord injury (SCI), early surgical reduction, and stabilization of the unstable deformity allow an immediate program of rehabilitation. Vertebrectomy is considered as the last surgical technique reserved for the most persistent spinal deformities that cannot be brought to an acceptable correction with less invasive methods. Case presentation We present a case of a 19-year-old male with a sub-acute thoracic spine fracture-dislocation at the level of T7-T8 who underwent a posterior T8 vertebrectomy with reduction and instrumentation from T4 down to T1. The individual had excellent results during follow-ups regarding alignment, fusion, and rehab program. Discussion In this case, we present the good outcome of vertebrectomy and spine shortening in an individual with thoracic spine fracture-dislocation, and the advantages of posterior approach.