Introduction: Spondylodiscitis in the lumbar spine caused by the bacterium Serratia marcescens is a rare infectious disease described in the world literature in only a few cases, mainly in immunocompromised patients, as well as in elderly patients after elective spine surgery. Case report: We present the case of a 45-year-old man who presented with pain in the lower back, with an elevated body temperature up to 39C, with no history of previous injury, infection or any chronic disease. An NMR of the LS spine was performed, which showed clear signs of spondylodiscitis in the L2/L3 region with a prevertebral abscess collection. The patient was initially treated conservatively, with combined parenteral antibiotic therapy for a period of four weeks, and then with oral antibiotic therapy for another two weeks. After the conservative treatment, the patient still had pain in the lower back, despite calm parameters of inflammation in the laboratory findings, while the control NMR LS spine showed a stationary finding compared to the previous one. Considering the clinical findings, NMR findings and previous treatment, an indication for operative treatment (intervertebral fusion and stabilization of L2-L3) as well as biopsy was established, and the presence of Serratia marcescens bacteria in large numbers was proven intraoperatively from the obtained biopsy. Conclusion: Despite the availability of modern diagnostics (NMR, laboratory analyses), isolating the causative agent of spondylodiscitis is still a challenge, especially when dealing with previously healthy patients and a rare bacterium that causes the most frequent intrahospital urinary infections in immunocompromised patients.

Tuberculosis is an endemic disease in our country. Spinal localization represents a serious form, given the risk of neurological complications and loss of spinal statics. Sometimes, the clinical and radiological picture is atypical and may mimic a tumoral pathology.
Case report
A 52-year-old woman complained of 8 months of low back pain associated with left cruralgia and partial functional impotence of the left lower limb.
The blood count showed a hemoglobin level of 10.3g/dl and a normal leukocyte count. The patient had an erythrocyte sedimentation rate of 48 mm/h and a C-reactive protein of 45 mg/l. Standard X-ray showed narrowing of the intervertebral space between L5 and S1.
MRI showed a heterogeneous hyperintense anterior mass extending to the presacral region. MRI was followed by CT scan, which showed heterogeneous enhancement of the lesion margin.
Given this clinical and radiological picture, neoplastic pathology was suspected.
In view of this picture, we opted for a scano guided biopsy.
Anatopathological and bacteriological examination confirmed the diagnosis of tuberculosis.

Given the absence of neurological deficit and the preservation of spinal statics, we opted for medical treatment without recourse to surgery.
The patient progressed well on ATB therapy adapted to the Tunisian protocol, with no complications.
Tuberculosis in its osteoarticular, and more specifically spinal, location may mimic a neoplastic form, hence the need for an appropriate diagnostic approach.

Background: Percutaneous kyphoplasty (PKP) effectively treats osteoporotic vertebral compression fractures (OVCFs), providing rapid pain relief and restoring vertebral height. The occurrence of sandwich vertebral bodies (SVBs) after PKP has become increasingly common. However, there is still controversy regarding the optimal timing for PKP surgery and whether SVBs are more prone to fractures.
Objectives: This study evaluated PKP timing's impact on outcomes and compared post-op fractures between SVBs and adjacent vertebrae to guide clinical decisions.
Research design and methods: We analyzed 824 OVCF patients treated conservatively or with PKP from January 2018 to December 2023. Groups included conservatively treated (Group A), PKP within a week (Group B), and PKP after a month (Group C). Pain (VAS), function (ODI), vertebral height (AVH), and kyphosis were assessed pre- and post-operatively. Post-op fractures in SVBs vs. adjacent vertebrae were compared in Groups B and C.
Results: Early PKP (Group B) showed comparable or better pain relief, function, height restoration, and kyphosis correction than conservative (Group A) or delayed (Group C) treatment. SVBs and adjacent vertebrae had similar VAS (2.67 ± 0.69 vs 3.49 ± 1.14, P=0.241) and ODI scores (28.41 ± 7.16 vs 29.31 ± 4.31, P=0.395). SVBs had a 16.3% new fracture rate, similar to adjacent vertebrae (12.7%).
Conclusions: Early PKP optimizes OVCF treatment outcomes. Although SVBs may have higher fracture rates, prophylactic PKP isn't necessary; regular anti-osteoporosis treatment suffices.
Keywords: Percutaneous kyphoplasty; Sandwich vertebral bodies; osteoporotic Vertebral compression fractures

The most crucial goal of intraoperative neuromonitoring (IONM) in spinal surgery is to preserve the functional integrity of sensory and motor nerve pathways. Multimodal IONM combines somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs). The amplitudes and latency of the obtained potentials are used in interpreting the results. Warning criteria are decreasing amplitude by 50% and prolonging latency by 10% compared to baseline.For the application of IONM to be feasible, an adequate selection of drugs and anesthesia techniques is required. Goals can be best achieved using target-controlled infusions (TCI) or total intravenous anesthesia (TIVA), with depth of anesthesia monitoring with bispectral index (BIS). Before induction, it is safe to give dexamethasone, pregabalin, and acetaminophen as part of preemptive analgesia. Midazolam and other benzodiazepines can be given preoperatively for sedation but should be avoided during surgery because they reduce MEP signals. Neuromuscular blockade should be avoided, except for intubation, when using succinylcholine or rocuronium, as it allows rapid spontaneous decurarization. Inhalation anesthetics and nitrous oxide reduce SSEP and MEP amplitudes and are not suitable for maintaining anesthesia. Propofol and remifentanil are most suitable for maintenance of anesthesia, with fentanyl boluses if necessary. During surgery, patients are ventilated with an O2:AIR gas mixture. Adequate neurophysiological monitoring is ensured by normotension, normothermia, euvolemia, adequate depth of anesthesia, absence of anemia, muscle relaxants, and inhalation agents. TCI is expensive and requires multiple infusion pumps; rapid titration and change of depth of anesthesia is impossible.

Spinal aspergillosis is a rare but fatal disease. This case report describes a 58-year-old male patient who was admitted with a 3-month history of back pain. The patient had a history of hepatitis B-related cirrhosis, chronic liver injury, and schistosomiasis. On admission, the patient presented with back pain, fever, elevated ESR, and elevated C-reactive protein. Imaging studies showed infection of the T3, T4, and T5 vertebrae. The patient was initially diagnosed with spinal tuberculosis and received anti-tuberculosis treatment. However, the patient's symptoms did not improve, and pathological examination suggested non-tuberculous infection. Eventually, the patient was definitively diagnosed with spinal aspergillosis after surgery. The patient was treated with a combination of linezolid and voriconazole for antifungal therapy, and follow-up at 1 month showed that the infection was under control.Literature review revealed that spinal aspergillosis has diverse and nonspecific clinical manifestations, making diagnosis difficult. Early diagnosis and treatment are crucial. Surgical debridement combined with antifungal therapy is an effective treatment for spinal aspergillosis.

Introduction:
Cervical Pott's disease, a rare manifestation of tuberculosis affecting the spine, poses significant challenges due to its potential for neurological complications if left untreated. We present a case highlighting the importance of prompt diagnosis and intervention in managing this condition.

Methods:
A 39-year-old woman presented with cervical spine stiffness, neck pain, and cervicobrachial neuralgia, progressing to paraparesis and significant weight loss. Radiological and MRI evaluations confirmed C7 vertebral body compression with associated cortical lysis and medullary replacement lesion at the 6th cervical vertebra. Emergency surgical intervention involved anterior spinal cord decompression, corpectomy of C6 and C7, and tumor excision, followed by histopathological confirmation of tuberculous etiology and initiation of antituberculous therapy.

Discussion:
Cervical Pott's disease is a serious condition, often leading to neurological deficits if not promptly treated. Surgical decompression, combined with medical management, is essential, particularly in cases of rapid and severe spinal cord compression. Timely intervention is crucial to prevent permanent neurological impairment and optimize patient outcomes.

Conclusion:
Early recognition and comprehensive management, including surgical intervention when warranted, are essential in addressing cervical Pott's disease and minimizing its potential for neurological sequelae. This case underscores the importance of a multidisciplinary approach and highlights the significant role of surgical decompression alongside antituberculous therapy in achieving favorable patient outcomes.

To evaluate the disadvantages of interlaminar intervention versus transforaminal surgery.

Introduction:
Traditional interlaminar surgery, which is more than a century old, is still valid for the surgical solution of pathologies that cause medullary or root compression, whether discogenic or not.It was accepted as the gold standard five decades after interlaminar surgery began to be performed with microscopic assistance with the development of optical systems.While transforaminal surgery defined the concept of minimally invasive surgery in spine surgery, the introduction of endoscopy with interlaminar approach attempted to reduce the tendency towards traditional surgery in central disc problems.The long learning curve of transforaminal surgery has led traditional interlaminar surgeons away from this surgery, as they can more easily adapt to unilateral uniportal and unilateral biportal surgical treatments.In fact, the drawbacks of interlaminar surgery continue even though it is performed by endoscopically.

Material and methods:
The retrospective single-center study which were included failed back spine surgery patients who had undergone interlaminar surgery at least once and at most seven times. Results before and after treatment using Oswestry disability index and visual analog score. compared
Results
 All patients underwent transforaminal foraminoplasty and decompression. The result was significant differences(p < 0.05). There was no significant difference were observed During the up to 6 years follow-up (average 3 years), observed in postoperative VAS and ODI scores
Conclusion:
Percutaneous full endoscopic transforaminal lumbar disc surgery is a safe and effective procedure instead of interlaminar approach. Transforaminal endoscopic technique can be performed safely for recurrent and failed back spine.

Abnormal compressive loading plays a crucial role in the progress fo the intervertebral disc degeneration (IDD). Several microRNAs (miRNAs) have been reported to be involved in IDD. However, mechanically responsive miRNAs in IDD have not been fully investigated. Furthermore, the deficiency of an effective miRNA delivery system is a key prerequisite for achieving intradiscal therapy.In this study, to identify miRNAs in the progress of IDD and explore an efficiency miRNA-delivery system to treat IDD, mechanically responsive miRNAs is identified via miRNA-sequencing in compression-induced IDD of rats and confirmed in clinical sample. Extracellular vesicle-mimetic nanovesicles integrate with mechanically responsive miRNAs are developed by extruding NP cells and locally injected into IDD rats, and the therapeutic effect is assayed by imaging examination and histological analyses, respectively. As results, MiR-1249 is identified be down-regulated in compression-induced IDD of rats, which exerts a protective effect on the metabolism of the extracellular matrix of the nucleus pulposus (NP) by targeting Nrarp. Extracellular vesicle-mimetic nanovesicles are developed by extruding NP cells as a miRNA therapeutic system to integrate with miR-1249 mimics (NV-mimics). In vivo, the local injection of NV-mimics could effectively alleviate the progression of abnormal compressive stress-induced IDD, including the retention of the water content and height of the discs, and the conservation of the NP tissues. Thus, our study uncovers the mechanically responsive miR-1249 rescue NP from degeneration, while providing an NV-based miRNA drug delivery system that targets NP cells with mechanics-response, which is a promising platform for intervening in the progression of IDD.

Introduction: In recent years, the minimally invasive concept has been fully demonstrated in lumbar fusion. We developed a set of percutaneous lumbar interbody fusion instruments and applied them in a novel technique (rapid transforaminal lumbar interbody fusion, Q-TLIF) to treat degenerative lumbar disease and evaluate its efficacy. Methods: From May 2021 to December 2022, 153 cases of lumbar degenerative diseases were treated with Q-TLIF, including 46 cases of lumbar disc herniation (LDH), 67 cases of lumbar spinal stenosis (LSS) and 40 cases of degenerative lumbar spondylolisthesis (DLS). The operative process and perioperative indexes of all patients were recorded and analyzed. Results: All patients were successfully operated. Operation time: LDH 98.35±9.49 min, single segment LSS 109.46±10.67 min, double segment LSS 141.57±17.38 min, DLS 113.78±15.12 min. Postoperative lumbar and leg pain was significantly relieved in all patients. VAS score: Preoperative vs Day 1 vs Day 3 vs week 1 =5.94±0.97 vs 1.93±0.59 vs 1.56±0.47 vs 1.03±0.38, and the difference was statistically significant at all-time points after surgery (P < 0.05). All patients wore waist girth to get out of bed on day 1 or 2 after surgery. The mean fusion time of all patients was 7.56±1.47 months. Conclusion：Q-TLIF is feasible and effective in the treatment of degenerative lumbar spine diseases. Q-TLIF technology enriches the minimally invasive treatment of degenerative lumbar spine diseases and has a wide range of clinical application value.

Introduction:
Traumatic spinal cord injuries (TSCI) have a significant impact on global health and economic systems due to their high treatment costs.
According with literature, there are approximately 23.0 TSCI cases per million habitants annually, most result from falls and motor vehicle accidents (MVA). These data change according to countries specificities, therefore understanding epidemiological trends of each country is crucial for prevention and may also help to improve outcomes in care of TSCI.
This is particularly important in Portugal since it´s the first epidemiologic study addressing TSCI.
Objectives:
To determine the incidence, mortality rate and evaluate the characteristics of newly injured patients with TSCI in Portugal over a 3-year period (2020-2023)
Methods:
A cohort retrospective study was conducted over a period of 3 years.
Results:
Over a 3-year period, 679 new patients with TSCI were identified in Portugal. The mean annual incidence of TSCI was 21.9 per million. Falls (60.1%) and MVA (24.9%) were the leading causes of injury. Among patients > 65 years, 72.6% were injured by falling and 53.0% became tetraplegic. The incidence of TSCI was higher during the summer and autumn months. The intrahospital mortality rate was 15.2%, with age and neurological injury being predictive factors. 60.2% of fatalities were due to cervical lesions.
Conclusion:
The mean annual incidence of TSCI was 21.9 per million corresponding to 226 new annual cases in Portugal.