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INTRODUCTIONThe consequences of spinal cord injury are multifactorial.1 Spinal cord injury reduces the quality of the life by developing several complications such as decubitus ulcers, chronic pain, spasticity, bowel/bladder dysfunction and compromised sexual function.2,3 A detailed literature about the etiology of spinal cord injury is available from the developed nationals. 4,5 Whereas in developing countries like India, though the risk factors are high, the availability of region/area wise literature support is lacking. 6 Hence it is necessary to conduct an epidemiological study to provide information about spinal cord injury trauma and its complications at a regional level like Chennai, a metropolitan city in India. Such studies may help to develop the precautionary actions which may decrease the risk of spinal cord injury. METHODSThe present study is to investigate the epidemiology of spinal cord injury in in-door patients of Rajiv Gandhi Government General Hospital, Chennai, India. Only the traumatic spinal cord injury patients who were admitted to the hospital were included in the study group. The following conditions of spinal cord injured patients were evaluated using the questioner which included the age, ABSTRACT Background: Spinal cord injury is a fearsome disability leading to increased rate of morbidity and mortality. Information about the incidence of spinal cord injury may provide support for the healthcare advancements. The aim of the present study is to investigate the epidemiology of spinal cord injury. Methods: The present study was carried out in Rajiv Gandhi government general hospital, Chennai, India. The study design was approved by the institutional human ethical committee. Questionnaire was used to collect the information from the patients in a prospective manner. The American Spinal Injury Association (ASIA) scoring systems was used to evaluate the severity of spinal cord injury. Results: A total of 245 cases of spinal injury were studied. Among them, 88 % (n=216) were male and 12% (n=29) were female. Spinal cord injuries of falls from height were prominent over the road traffic accident. Cervical level injuries are widespread in males and dorsal level Injuries are common in females. Conclusion: Hence awareness of the spinal cord injury and availability of healthcare facilities may minimise the consequences of spinal cord injury.

Background The COVID-19 pandemic has caused unprecedented concerns on the safety, well-being, quality of life(QOL), and training of the orthopedic resident physician workforce worldwide. Although orthopedic residency programs across the globe have attempted to redefine resident roles, educational priorities, and teaching methods, the global orthopedic residents’ perspective with regards to their safety, well-being, QOL, and training, taking into account regional variances remains unknown. Methods A 56-item-questionnaire-based cross-sectional survey was conducted online during the COVID-19 pandemic involving 1193 orthopedic residents from 29 countries across six geographical regions to investigate the impact of the COVID-19 pandemic on the well-being, safety, and training of orthopedic residents at a global level, as well as to analyze the challenges confronted by orthopedic residency programs around the world to safeguard and train their resident workforce during this period. Results The total response rate was 90.3%(1077/1193). Time spent on residency-training activities decreased by 24.7 h/week(95% CI, −26.5 to −22.9,p < 0.001), with 50.2%(n = 541) residents performing duties outside their residency curriculum. 80.5%(n = 869) residents had no prior experience working in infectious outbreaks. A greater percentage of residents from Middle East, Asia and Europe were redeployed to the COVID-19 frontlines, p < 0.001. Only 46.5%(n = 491) and 58.4%(n = 600) of residents underwent training in critical care or PPE(Personal Protective equipment) usage, respectively; 28.5%(n = 302) residents (majority from Africa, Middle East, South America) reported lack of institutional guidelines to handle infectious outbreaks; 15.4%(n = 160) residents(majority from Africa, Asia, Europe) had concerns regarding availability of PPE and risk of infection. An increase in technology-based virtual teaching modalities was observed. The most significant stressor for residents was the concern for their family's health. Residents' QOL significantly decreased from 80/100(IQR 70–90) to 65/100(IQR 50–80) before and during the pandemic, p < 0.001. Conclusions The COVID-19 pandemic has significantly impacted the safety, well-being, QOL, and training of the global orthopedic resident physician workforce to different extents across geographical regions. The findings of this study will aid educators, program leaderships, and policy makers globally in formulating flexible, generalizable, and sustainable strategies to ensure resident safety, well-being, and training, while maintaining patient care.

Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result in a kyphosis or hypolordosis, leading to back pain, spinal instability, and neurological deficits. The conventional treatment goals of lumbosacral tuberculosis are to correct and prevent a lumbar kyphosis, treat or prevent a neurological deficit, and restore global spinal stability. Instrumentation at the lumbosacral junction is technically demanding due to the complex local anatomy, the unique biomechanics, and the difficult fixation in the surrounding diseased bone. Methods We report a 21-year-old woman with tuberculosis from L1 to S2 with back pain and spinal instability. The radiographs showed a kyphosis of the lumbar spine. The magnetic resonance imaging and computed tomography scans revealed extensive destruction of the lumbar and lumbosacral spine. Spinopelvic stabilization combined with anterior debridement and reconstruction with free fibular strut graft was performed. Results The radiographs at follow-up showed a good correction of the kyphosis and excellent graft incorporation and fusion. Conclusions Anterior column reconstruction with a fibular strut graft helps restore and maintain the vertebral height. Posterior stabilization with spinopelvic fixation can be an effective surgical option for reconstructing the spine in extensive lumbosacral tuberculosis with sacral body destruction, requiring long fusions to the sacrum. It augments spinal stability, prevents graft-related complications, and accelerates the graft incorporation and fusion, thereby permitting early mobilization and rehabilitation. In spinal tuberculosis, antitubercular therapy may have to be prolonged in cases with large disease load, based on the clinicoradiographic and laboratory parameters.