Clinical utility of metagenomic next-generation sequencing in diagnosing spinal infections: a systematic review and meta-analysis Abdulrahim Saleh Alrasheed, Abdulrahman Mohammed Zawawi, Lama Mastour Alsulami, Fatimah Ahmed Alghirash, Sultan Othman Alsalmi, Ibrahim A. Alhalal European Spine Journal, 2026 Spinal infection (SI) presents a major diagnostic challenge due to nonspecific clinical features and the limitations of conventional culturing techniques. Metagenomic next-generation sequencing (mNGS) has recently emerged as a valuable tool that enables broad, unbiased pathogen detection. This meta-analysis evaluated the diagnostic performance of mNGS for SI diagnosis, comparing it with conventional culturing techniques, with a particular focus on its role in spinal tuberculosis (TB) diagnosis. A thorough literature search was conducted in PubMed, Web of Science, the Cochrane Library, and Scopus databases to retrieve potentially relevant articles. Data on diagnostic performance, including pathogen detection rate (PDR), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were extracted and analyzed. To assess the risk of bias of the included studies, the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tool was used. Subgroup analyses were used to evaluate the performance of mNGS in spinal TB. Meta-regression analysis was performed to account for covariate effects on diagnostic performance. A total of 17 Chinese studies with 1788 patients were included. In SI diagnosis, mNGS showed a significantly greater PDR than conventional culturing techniques (RR: 2.43; 95% CI: 1.73–3.43; p = 0.0001; I² = 88.6%). mNGS exhibited higher sensitivity (81% vs. 33%) and NPV (60% vs. 36%) indicating higher reliability in excluding infection, while conventional culturing techniques exhibited higher specificity (82% vs. 76%) and PPV (90% vs. 85%). In spinal TB, mNGS showed higher sensitivity (75% vs. 41%) and NPV (87% vs. 74%) while maintaining comparable specificity (99% vs. 100%) and PPV (94% vs. 100%). This meta-analysis confirms that mNGS provides superior sensitivity, broader pathogen coverage, and faster diagnostic capability than conventional culturing techniques, particularly in spinal TB, where early detection is critical. Nevertheless, these findings should be interpreted cautiously, as the included studies were limited by retrospective designs, geographic bias, and inconsistent diagnostic reference standards. While mNGS represents a valuable adjunct to standard diagnostics, further prospective multicenter studies, cost reduction, and standardized protocols are required to optimize its integration into clinical practice.
Predictive Value of MRI- Based Vertebral Bone and Endplate Bone Quality Assessments for Screw Loosening and Cage Subsidence in Degenerative Thoracolumbar Spine Surgery: A Systematic Review and Meta- Analysis Abdulrahim Saleh Alrasheed, Raghad Abdulaziz Almutairi, Rammaz Hussam Khoja, Saleh S. Baeesa, Óscar L. Alves, Ibrahim A. Alhalal, Sultan Othman Alsalmi International Journal of Spine Surgery, 2025 BACKGROUND: Thoracolumbar spine surgical interventions are often complicated by cage subsidence and screw loosening. The main risk factor for such conditions is poor bone mineral density. Vertebral bone quality (VBQ) and endplate bone quality (EBQ) scores are novel radiation-free magnetic resonance imaging (MRI)-based tools that have shown promise in predicting such conditions. This meta-analysis sought to assess the predictive value of VBQ and EBQ scores in identifying the risk of screw loosening and cage subsidence following thoracolumbar spine surgery. METHODS: PubMed, Scopus, Cochrane Library, and Web of Science databases were searched systematically to retrieve articles assessing the predictive potential of VBQ and EBQ scores for evaluating screw loosening and cage subsidence following thoracolumbar spine surgery. The quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tool was utilized to assess the quality of diagnostic accuracy studies. Data were synthesized using a random-effects model, assessing for potential heterogeneity among the included studies. RESULTS: 19 studies involving 2768 participants met the inclusion criteria. The cage subsidence and screw loosening groups showed significantly higher VBQ scores than the control group. The cage subsidence group showed significantly higher EBQ scores than the control group. CONCLUSIONS: MRI-based VBQ and EBQ scores demonstrate efficacy as predictive indicators of screw loosening and cage subsidence following surgical procedures for thoracolumbar degenerative disease. Consequently, preoperative assessment of bone quality is imperative for optimizing surgical outcomes.
Myxopapillary Ependymoma–a Case Report of Rare Multicentric Subtype and Literature Review Faisal AlMatrafi, Abdullah Aseeri, Mohammad AlQahtani, Liqa AlMulla, Saeed Jubran, Majed AlOmair, Sultan AlSalmi, Rawan AlAnazi Medical Archives, 2023 Background: Myxopapillary ependymoma is a rare type of primary spinal tumor, it is distinctly a slow-growing tumor that originates in the conus medullaris, cauda equina, or film terminals and is rarely identified as a multicentric type. Myxopapillary ependymoma has a unique histological characteristic and is associated with a generally better prognosis. Objective: We present a case of a rare multicentric myxopapillary ependymoma. Case presentation: A 28-year-old male with 1-year history of low back pain and 3 months of radiating pain to left lower limb with perianal anesthesia. Magnetic resonance imaging (MRI) exhibited a large intradural intramedullary lesion from the level of the conus medullaris extending to the filum terminals at the level of T12 to L3 with smaller multiple enhancing lesions seen opposite to L4 and L5 level as well as within the exiting nerve roots, at the left side of L1/L2 and L2/L3 and right side of L3/L4 and L5/S1 level. The patient underwent surgical resection with significant improvement in symptoms and no tumor progression on follow up MRI scan. Conclusion: We hereby present a case of multicentric myxopapillary ependymoma with a literature review of the previous reported cases. We believe that our study will make a significant contribution to the literature and will be of interest to the readership regarding of the rarity of multicentric Myxopapillary ependymoma and it will help in decision making for the proper surgical Intervention on these kinds of cases.
Intradural extramedullary spinal cord meningioma with a rare extradural foraminal extension: A case report Faisal Almatrafi, Majed Alomair, Abdulrazaq Alojan, Mohammed Alkhaldi, Noor Alsafwani, Abdullah Aseeri, Abdulelah Alshahrani, Sultan Alsalmi, Mohammad Alqahtani Frontiers in Surgery, 2023 BackgroundMeningiomas are mostly benign and slow-growing neoplasms of the central nervous system. Spinal meningiomas account for up to 45% of all intradural spinal tumors in adults and up to 25%–45% of all spinal tumors. Spinal extradural meningiomas are rare and may be easily confused with malignant neoplasms.Case descriptionA 24-year-old woman was presented to our hospital with paraplegia and loss of sensation in the T7 dermatome and lower body. MRI findings showed T6-T7 right-sided intradural extramedullary and extradural lesion, measuring 1.4 cm × 1.5 cm × 3 cm, extending to the right foramen, compressing the spinal cord, and displacing it to the left. Hyperintense lesion on T2 and hypointense lesion on T1 were observed. The patient reported improvement after surgery and during follow-up. We recommend maximizing the decompression during surgery to achieve better clinical outcome. Extradural meningiomas represent 5% of all meningiomas; therefore, having an intradural on top of extradural meningioma with extraforaminal extensions makes this a unique and rare case.ConclusionMeningiomas can be easily missed in diagnosis depending on imaging and the pathognomonic pattern it represents, which can mimic other pathologies, such as schwannomas. Therefore, surgeons should always suspect their patient having a meningioma even if the pattern is not typical. Moreover, preoperative preparation, such as navigation and defect closure, must be taken in case it turns out be a meningioma instead of the presumed pathology.
Safety measures for COVID-19: A review of surgical preparedness at four major medical centres in Saudi Arabia Mohammad A. Alsofyani, Haifaa M. Malaekah, Ahmed Bashawyah, Mohammed Bawazeer, Khalid Akkour, Sultan Alsalmi, Abdu Alkhairy, Nayef Bin Dajim, Salahaddeen Khalifah, Ibrahim A. Almalki, Farid Kassab, Mohammad Barnawi, Mosfer Almalki, Mohammed Alharthi, Majed Alharthi, Abdulaziz Almalki, Abdullah H. Almalki, Anouar Bourghli, Ibrahim Obeid Patient Safety in Surgery, 2020 In view of the worldwide coronavirus disease 2019 (COVID-19) pandemic, hospitals need contingency planning. This planning should include preparation for an unexpected patient surge. This measure is evolving concomitantly with the implementation of the needed infection control rules. Here, we present our experience in contingency planning at four large tertiary hospitals in Saudi Arabia during this global pandemic, with a focus on dealing with COVID-19 patients who need to undergo surgery. The planning covers response measures required in the operating room and supporting units, including the administrative department, intensive care unit, and different sections of the surgical department. Furthermore, it covers the role of education and simulation in preparing health care providers and ensuring smooth workflow between all sections. We additionally discuss the guidelines and policies implemented in different surgical specialties. These measures are necessary to prevent the transmission of COVID-19 within healthcare facilities. Throughout the COVID-19 pandemic, the healthcare system should develop a comprehensive pandemic plan and set guidelines addressing the management of urgent and malignant cases. The guidelines should be in concordance with internal guidelines.
Robot-assisted intravertebral augmentation corrects local kyphosis more effectively than a conventional fluoroscopy-guided technique Sultan Alsalmi, Cyrille Capel, Louis Chenin, Johann Peltier, Michel Lefranc Journal of Neurosurgery Spine, 2019 OBJECTIVEIntravertebral augmentation (IVA) is a reliable minimally invasive technique for treating Magerl type A vertebral body fractures. However, poor correction of kyphotic angulation, the risk of cement leakage, and significant exposure to radiation (for the surgeon, the operating room staff, and the patient) remain significant issues. The authors conducted a study to assess the value of robot-assisted IVA (RA-IVA) for thoracolumbar vertebral body fractures.METHODSThe authors performed a retrospective, single-center study of patients who had undergone RA-IVA or conventional fluoroscopy-guided IVA (F-IVA) for thoracolumbar vertebral body fractures. Installation and operating times, guidance accuracy, residual local kyphosis, degree of restoration of vertebral body height, incidence of cement leakage, rate of morbidity, length of hospital stay, and radiation-related data were recorded.RESULTSData obtained in 30 patients who underwent RA-IVA were compared with those obtained in 30 patients who underwent F-IVA during the same period (the surgical indications were identical, but the surgeons were different). The mean ± SD installation time in the RA-IVA group (24 ± 7.5 minutes) was significantly shorter (p = 0.005) than that in the F-IVA group (26 ± 8 minutes). The mean operating time for the RA-IVA group (52 ± 11 minutes) was significantly longer (p = 0.026) than that for the F-IVA group (30 ± 11 minutes). All RA-IVAs and F-IVAs were Ravi’s scale grade A (no pedicle breach). The mean degree of residual local kyphosis (4.7° ± 3.15°) and the percentage of vertebral body height restoration (63.6% ± 21.4%) were significantly better after RA-IVA than after F-IVA (8.4° ± 5.4° and 30% ± 34%, respectively). The incidence of cement leakage was significantly lower in the RA-IVA group (p < 0.05). The mean length of hospital stay after surgery was 3.2 days for both groups. No surgery-related complications occurred in either group. With RA-IVA, the mean radiation exposure was 438 ± 147 mGy × cm for the patient and 30 ± 17 mGy for the surgeon.CONCLUSIONSRA-IVA provided better vertebral body fracture correction than the conventional F-IVA. However, RA-IVA requires more time than F-IVA.
