Spondylodiscitis refers to infection of the intervertebral disc and adjacent vertebral bodies, a condition that can destroy the structural architecture of the spine and compress the spinal cord. In tuberculosis-endemic regions, spinal tuberculosis, also known as Pott’s disease, is a leading cause of this syndrome. The bacterium responsible, Mycobacterium tuberculosis, typically reaches the spine through hematogenous dissemination from a primary focus, most often the lungs. Once seeded in the richly vascularized anterior portion of a vertebra, the infection erodes bone and disc tissue, producing collapse, deformity, and potential neurological catastrophe. Because the clinical presentation overlaps substantially with pyogenic and other infectious causes, laboratory confirmation is critical whenever feasible, though in resource-limited settings this is often easier said than done.

The research team, led by Hussein Salad Yusuf of the hospital’s Department of Neurosurgery, reviewed medical records of all eligible patients diagnosed with spinal infection between 1 August 2023 and 31 July 2024. Using total-enumeration sampling, they identified 121 patients with radiological evidence of spondylodiscitis on MRI, CT, or x-ray. The study was designed as a record-based analysis of routinely collected clinical data, with no additional research-specific laboratory testing performed. Ethical approval was obtained from the hospital’s Ethics Committee, and the requirement for informed consent was waived because the study used anonymized routinely collected hospital data.

The demographic profile showed a mean age of 48.8 years with a standard deviation of 18.1, and a median of 50 years, with the largest age group being 46 to 60 years at 31.4 percent of the cohort. Males comprised 53.7 percent of patients, showing only a modest male predominance. Most patients were urban residents, and the majority fell into low or middle socioeconomic categories, reflecting the recognized association between socioeconomic disadvantage and tuberculosis risk. The authors note that this distribution should not be interpreted as causal because the study did not include a population-based control group.

Clinically, back pain was nearly universal, documented in 92.6 percent of patients, while radicular pain, pain radiating along a nerve root distribution, affected 82.6 percent. Constitutional symptoms such as fever, weight loss, and night sweats were present in only half of the cohort, emphasizing that their absence does not exclude spinal infection. Neurological deficit was documented in 46.3 percent of patients, and spinal deformity in 38.0 percent. Among the 56 patients with neurological deficit, muscle-power grades ranged from grade 4, indicating mild weakness, to grade 0, indicating complete paralysis, with six patients at the most severe end of the spectrum.

Radiologically, the lumbar spine was the most frequently involved region at 48.8 percent, followed by the thoracic spine at 25.6 percent. Anterior-column involvement, the classic pattern of tuberculous spondylodiscitis, was present in 97.5 percent of patients, while middle-column involvement occurred in 72.7 percent and posterior-column involvement in 21.5 percent. Epidural abscess, a collection of pus within the spinal canal that can compress neural structures, was identified in 69.4 percent of patients. Associated disc herniation was present in 39.7 percent. The strong correlation between epidural abscess and middle-column involvement, with a Spearman coefficient of 0.762, is clinically coherent, as destruction of the middle column creates a pathway for infectious material to extend into the epidural space.

Microbiological or histopathological testing was performed in only 46 of the 121 patients, representing 38.0 percent of the cohort. Among those tested, 30 were positive for tuberculosis, yielding a positivity rate of 65.2 percent among tested patients and a confirmed tuberculosis proportion of 24.8 percent in the total cohort. The authors stress that these two denominators answer different questions and should not be conflated. Four patients had non-tuberculous organisms identified, including gram-positive cocci, Klebsiella species, mucormycosis, and Staphylococcus epidermidis, one case each. Drug-susceptibility results were available for 29 of the 30 tuberculosis-positive patients, with 25 showing no documented resistance and 4 showing monoresistance. No multidrug-resistant tuberculosis was identified among the tested confirmed cases, though the authors caution that this finding should be interpreted in light of the small number tested and incomplete susceptibility data.

Treatment patterns reflected the diagnostic constraints of the setting. Eighty-five patients, representing 70.2 percent of the cohort, received empirical anti-tuberculosis treatment regardless of microbiological confirmation. The authors emphasize that this proportion represents presumptive treatment exposure and cannot be used as confirmation of tuberculosis prevalence. Forty-six patients underwent an operative or procedural intervention, with instrumentation combined with biopsy being the most common procedure, reflecting the dual need for spinal stabilization and tissue diagnosis in selected patients. Percutaneous biopsy was appropriately classified as a diagnostic procedure rather than a therapeutic intervention.

Outcome data were available for only 65 patients, or 53.7 percent of the cohort. Among these, 15 achieved complete recovery, 31 achieved partial recovery, and 19 had no recovery, yielding a favorable-outcome proportion of 70.8 percent among patients with documented follow-up. The authors explicitly caution that this estimate applies only to patients with documented follow-up and should not be generalized to the entire cohort, because 46.3 percent of patients lacked any documented outcome data, creating potential attrition bias whose direction and magnitude remain uncertain. In bivariate analysis, a history of tuberculosis exposure was significantly associated with clinical outcome, with a p-value of 0.003, while operative or procedural intervention was not significantly associated with outcome, with a Fisher’s exact p-value of 0.399. Economic status also showed an association, though the authors note this should be interpreted cautiously because only five patients were classified in the high-status category.

The study’s limitations are substantial and openly acknowledged. The retrospective single-center design limits generalizability and introduces potential selection and information bias. Microbiological confirmation was available in only 38 percent of patients, limiting accurate determination of the etiological spectrum and creating potential misclassification, particularly because empirical anti-tuberculosis treatment was common. Systematic testing for Brucella, an important differential diagnosis in Somalia whose spondylodiscitis can closely mimic spinal tuberculosis both clinically and radiologically, was not documented, so the contribution of brucellar infection cannot be assessed. ASIA and Frankel neurological grades were not consistently available or linked to outcomes at the patient level, preventing granular neurological recovery analysis. Because only 19 unfavorable outcomes were available among the 65 patients with documented follow-up, multivariable logistic regression was not retained in the final analysis, meaning all outcome comparisons are unadjusted and may be affected by confounding.

Despite these constraints, the study provides valuable local data from a setting where published descriptions of spondylodiscitis have been scarce. The authors conclude that improved microbiological diagnosis, consideration of alternative infections such as brucellosis, systematic neurological grading, and prospective multicenter follow-up are needed to better define the etiological spectrum and outcomes of spinal infection in Somalia. Until such studies are conducted, clinicians in tuberculosis-endemic settings must continue to navigate the difficult balance between treating presumed spinal tuberculosis empirically and pursuing the laboratory confirmation that would allow more precise diagnosis and targeted therapy.

Subject of Research: Epidemiology, clinical presentation, radiological findings, and outcomes of spondylodiscitis in a tuberculosis-endemic setting in Somalia

Article Title: Spondylodiscitis in a tuberculosis-endemic setting in Somalia: epidemiological, clinical, radiological, and outcome findings from a retrospective study

Article References: Salad Yusuf, H., Abukar, A. A., Adan, M. S., Mohamed, A. S., Mohamed, Z. Y., Ulusow, M. A., Alasow, M. O. D., Ibrahim, A. A., & Dahir, N. A. (2026). Spondylodiscitis in a tuberculosis-endemic setting in Somalia: epidemiological, clinical, radiological, and outcome findings from a retrospective study. Frontiers in Tuberculosis, 4, Article 1971442. https://doi.org/10.3389/ftubr.2026.1971442

Image Credits: AI Generated

DOI: 10.3389/ftubr.2026.1971442

Keywords: spondylodiscitis, spinal tuberculosis, Somalia, Mogadishu, tuberculosis, epidural abscess, neurological deficit, retrospective study, Frontiers in Tuberculosis, diagnostic gaps, empirical anti-TB treatment, spinal deformity

The Lifetime Achievement Award occupies a singular place among the honors conferred by the Scoliosis Research Society. Founded to advance the science and treatment of scoliosis and related spinal deformities, the society reserves this distinction for members whose entire careers have produced a lasting impact on the field through clinical care, research, education, and leadership. It is not an award for a single discovery or a single operation, but for a body of work that reshapes how a discipline cares for its patients. In selecting Dr. Polly, the society recognized a surgeon whose influence has been felt simultaneously in the operating room, in the research literature, in military medicine, and in the classrooms and clinics where young physicians learn the craft of spine surgery.

For Dr. Polly, the recognition carries a deeply personal resonance. In remarks accompanying the announcement, he described the honor in terms of lineage and gratitude, saying that he stands on the shoulders of giants and that the people who were his professional heroes were themselves members of the Scoliosis Research Society. To now be recognized by his peers and included among those who came before him, he said, is incredibly meaningful, calling it the ultimate professional honor and adding that he is deeply humbled to receive it. That framing reflects a career built less on individual celebrity than on participation in a collective, international effort to improve outcomes for patients with some of the most technically demanding conditions in orthopedics.

Dr. Polly’s path to this distinction began with his graduation from medical school in 1985, launching a career in medicine that has now stretched across more than forty years. A defining chapter of that career unfolded in the United States military, where he served for twenty-five years. Among his most consequential assignments was a decade at Walter Reed Army Medical Center, one of the nation’s flagship military medical institutions, where he served as Chief of Spine Surgery and Chair of Orthopedic Surgery. In those roles he was responsible not only for the surgical care of service members with severe spinal injuries but also for the organization and leadership of an entire orthopedic department, experience that would shape his later emphasis on systems-level thinking in patient care and research.

In 2003, Dr. Polly joined the University of Minnesota, adding an academic dimension to a career already distinguished by military service. Three years later, in 2006, he began his work with Shriners Children’s Twin Cities, the pediatric specialty hospital that would become the center of his clinical identity for nearly two decades. There he devoted his practice to children with complex spinal conditions, including severe scoliosis and other deformities that demand meticulous planning, advanced surgical technique, and long-term follow-up through a child’s growth. He officially retired from his clinical practice at Shriners Children’s in 2023, leaving behind a program and a culture of care that colleagues describe as transformative for the institution and its patients.

Reflecting on his years at the hospital, Dr. Polly described the work as one of the most rewarding parts of his career. Children, he observed, are often dealt a bad hand in life, and part of the physician’s task is to help them deal with it. He recalled one patient in particular, a child with spondyloepiphyseal dysplasia, a rare genetic skeletal disorder that produces profound spinal and orthopedic challenges. The boy faced a series of complex medical problems, and his care was a genuine challenge, yet he carried the most positive attitude of almost anyone Dr. Polly said he had ever encountered. That child, in the surgeon’s telling, remains a vivid example of the resilience of children and the strength they can display in the face of adversity, a reminder of why pediatric spine work demands both technical mastery and profound empathy.

Beyond his individual surgical practice, Dr. Polly played a pivotal role in advancing the care of children with complex spinal conditions by building and leading research collaborations that have improved outcomes for patients around the world. Multicenter research has become the engine of progress in spinal deformity medicine, where rare and heterogeneous conditions make single-institution studies insufficient, and Dr. Polly’s career has been closely tied to this collaborative model. His work has helped establish the evidence base that guides modern surgical decision-making, from the timing of intervention in growing children to the long-term assessment of deformity correction. Colleagues note that this combination of clinical volume and research leadership is precisely the profile the Scoliosis Research Society seeks to honor with its lifetime distinction.

Education and mentorship form the third pillar of the career now being celebrated. Dr. Polly has taken great pride in training the next generation of physicians, and he speaks about teaching with the same blend of humility and ambition that characterizes his view of the award itself. The greatest honor, he has said, is to have a student exceed the teacher. He counts himself fortunate to have had several students who fall into that category, and he expects that some of them will one day receive the same Lifetime Achievement Award. Knowing that you have helped prepare the next generation of physicians, and that they may go on to accomplish even more than you did, is one of the most gratifying parts of the field, he reflected, articulating a philosophy in which a surgeon’s legacy is measured as much in successors as in operations.

That legacy is visible in the testimony of those who trained and operated alongside him. Dr. Christopher Vara, a pediatric orthopedic surgeon at Shriners Children’s Twin Cities, performed numerous spine surgeries with Dr. Polly and said he greatly values the knowledge and experience he gained through their work together. Working with Dr. Polly, Dr. Vara explained, has been one of the highlights of his career, describing his colleague as always generous with his time and committed to helping everyone around him become better physicians. In Dr. Vara’s assessment, the Lifetime Achievement Award could not go to a more deserving individual, one who has changed the lives of countless patients and whose mentorship and friendship have left a permanent mark on the surgeons who worked beside him.

The 2026 Lifetime Achievement Award thus arrives as both a capstone and a passing of the torch. From Walter Reed to the University of Minnesota to the operating rooms of Shriners Children’s Twin Cities, Dr. Polly’s career has traced the modern arc of spine surgery itself: the rise of evidence-based multicenter research, the refinement of surgical techniques for the most severe pediatric deformities, and the professionalization of mentorship as a deliberate discipline. As the Scoliosis Research Society gathers in Sydney this October to honor him, the recognition affirms a simple but demanding standard, that the highest achievement in medicine lies in the combination of skilled hands, rigorous science, generous teaching, and an abiding commitment to children whose conditions would once have left them without hope. For the patients, students, and colleagues who filled those four decades, the award confirms what many have long believed about the man they call their teacher, their partner, and their friend.

Subject of Research: Lifetime Achievement Award for pediatric spine surgeon Dr. David Polly Jr. from the Scoliosis Research Society

Article Title: Shriners Children’s Twin Cities Dr. David Polly Jr. earns prestigious Lifetime Achievement Award

Article References: Shriners Children’s Twin Cities Dr. David Polly Jr. earns prestigious Lifetime Achievement Award. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: David Polly Jr, Scoliosis Research Society, Lifetime Achievement Award, spine surgery, pediatric orthopedics, scoliosis, Shriners Children's Twin Cities, spinal deformity, Walter Reed Army Medical Center, medical mentorship, spondyloepiphyseal dysplasia, orthopedic surgery

The 2021 fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System formally recognizes four spinal entities: spinal ependymoma, spinal ependymoma with MYCN amplification, spinal subependymoma, and spinal myxopapillary ependymoma. Diagnosis is no longer a matter of histology alone. Instead, clinicians must integrate the anatomical compartment, the microscopic appearance of the tumor, and its molecular signature, most often assessed through DNA methylation profiling. That shift matters because the subtypes behave very differently. Myxopapillary ependymomas, for example, were upgraded from grade 1 to grade 2 after clinicians realized that incompletely removed tumors, once watched passively, could recur with spread through the subarachnoid space, a complication that typically forces craniospinal irradiation and carries substantial morbidity.

Pediatric-specific molecular data are beginning to sharpen this picture. In the HIT-MED spinal cohort of 83 patients aged 22 or younger, methylation classes broke down as 63 percent myxopapillary, 33 percent conventional spinal ependymoma, and 4 percent MYCN-amplified. Strikingly, within this pediatric population the molecular class did not clearly separate risk levels between the two most common groups; instead, the extent of surgical resection and the WHO grade remained the dominant determinants of progression-free survival. Molecular profiling, in other words, refines biological classification, but for most children the scalpel and the microscope still tell the most important part of the story.

The exception is the MYCN-amplified subtype, which the review describes as one of the most aggressive entities in the entire ependymoma family. These tumors tend to relapse early, typically within about 2.3 years, and can prove fatal despite aggressive multimodal treatment regardless of the age at diagnosis. Identifying MYCN amplification therefore has immediate clinical consequences: high-risk counseling, intensified craniospinal surveillance, and consideration of clinical trials or novel therapeutics. The authors argue that every spinal ependymoma specimen should undergo reflex testing for MYCN amplification alongside formal WHO 2021 grading and, where available, methylation profiling. Even the ostensibly indolent myxopapillary tumors carry sobering long-term statistics, with a 10-year progression-free survival of roughly 59 percent in mixed-age datasets, and within pediatric myxopapillary disease, methylation subtype B showed a trend toward better five-year progression-free survival than subtype A, 86 percent versus 56 percent, though the difference has not reached statistical significance.

Clinically, these tumors announce themselves quietly. Adults and older children typically report progressive sensory disturbance, gait imbalance, weakness, axial back pain, or radicular pain, and most patients are still ambulatory at diagnosis. The insidious tempo, however, often means the tumor has extended over multiple spinal segments by the time imaging is obtained. In preverbal children the presentation can be maddeningly nonspecific: torticollis, regression of motor milestones, refusal to walk or crawl, or simple irritability, signs easily misattributed to musculoskeletal or developmental causes. The review stresses that any suspicion demands gadolinium-enhanced MRI of the entire neuraxis, including the brain, because drop metastases occur in a minority of patients and missing them leads to under-staging and inadequate adjuvant planning.

On imaging, the intramedullary subtypes typically show symmetric cord expansion, well-demarcated margins, contrast enhancement, polar cysts, and syringomyelia in 40 to 70 percent of cases. A rim of hemosiderin at the tumor poles, the so-called cap sign, hints at a distinct gliotic plane that surgeons can exploit for dissection. MYCN amplification itself cannot be seen radiographically, but irregular margins, infiltrative extension, multifocal nodularity, or leptomeningeal enhancement should raise suspicion for high-risk molecular disease. Myxopapillary tumors behave differently, arising extramedullary at the filum terminale with a lobulated, avidly enhancing morphology that displaces rather than infiltrates neighboring nerve roots.

Surgery sits at the center of management, and the review frames every operative decision along three fronts: whether gross total resection is anatomically feasible, what functional neurological risks it carries, and what the biological risk of recurrence or dissemination happens to be. Gross total resection is the most consistent modifiable predictor of progression-free survival, with contemporary series reporting rates of roughly 72 to 83 percent. Continuous multimodal intraoperative neuromonitoring, combining somatosensory evoked potentials, transcranial motor evoked potentials, and D-wave recording, allows real-time assessment of the dorsal columns and corticospinal tract, and a sustained deterioration in motor potentials or a significant D-wave drop strongly predicts permanent motor deficit. When signals fail irreversibly, a deliberate subtotal resection may be the wiser course, and early postoperative MRI within 24 to 48 hours guides whether a second-look operation should precede any adjuvant therapy. For myxopapillary lesions, meticulous capsule preservation is paramount, because capsular violation is associated with local recurrence, cerebrospinal fluid dissemination, and the need for radiotherapy; en bloc resection is preferred when technically feasible.

In children, the spine itself becomes a battleground. Postoperative deformity is arguably the most important surgical morbidity in this population, and the data are stark: in one series of 161 children, 27 percent eventually required fusion, with risk rising sharply in those under 13, those with preoperative scoliosis, tumor-associated syrinx, thoracolumbar junction involvement, or each additional resection. Another study found deformity in 38 percent of children before surgery and 69 percent afterward, even when laminoplasty was used throughout, underscoring that tumor biology and preoperative status drive much of the risk. Neither laminoplasty nor laminectomy reliably prevents kyphosis, and instrumented fusion, while stabilizing, permanently sacrifices motion and growth potential and can degrade the quality of the lifelong surveillance MRI these patients need. Radiation adds its own age-dependent hazard: a comprehensive PENTEC review found clinically significant scoliosis at vertebral doses as low as 15 Gy in infants under two, with rates exceeding 30 percent above 20 Gy in children aged two to six, thresholds substantially below the 45 to 59.4 Gy focal doses typically prescribed.

Adjuvant therapy follows a risk-adapted logic. After gross total resection of a grade 2 spinal ependymoma, most contemporary evidence supports surveillance without routine radiotherapy, since a clear benefit has not been consistently demonstrated. After subtotal resection or biopsy, focal conformal radiotherapy is recommended because incomplete resection consistently predicts inferior progression-free survival. Grade 3 tumors receive focal radiotherapy regardless of resection extent, and craniospinal irradiation is considered when dissemination is present or suspected. For myxopapillary tumors the role of postoperative radiotherapy remains genuinely contested, with some retrospective series, including pediatric cohorts, suggesting improved control even after complete resection, particularly with dose escalation above 50.4 Gy or when high-risk features exist, while other adult-dominant datasets support observation alone. A recent multi-institutional pediatric and young adult series of high-risk myxopapillary disease reported five-year overall survival of 100 percent and progression-free survival of 60.8 percent, but patients still relapsed outside the treated field and intracranially, arguing for vigilance beyond the radiation volume rather than dose escalation alone. Chemotherapy, meanwhile, has no established frontline role; it is reserved for recurrent or disseminated disease, clinical trials, or as a deliberate strategy to defer radiotherapy in infants, an approach validated for intracranial ependymoma but never formally studied in the spine.

The review’s most candid contribution may be its systematic accounting of what medicine does not know. Nearly every management domain, from radiotherapy dosing and timing to the value of molecular stratification beyond MYCN, rests on adult or mixed-age retrospective cohorts, and no prospective pediatric-specific data address whether current thresholds should differ for a growing child. Local recurrence remains the dominant failure pattern even after complete resection, and craniospinal dissemination can appear years later, which is why the authors recommend lifelong MRI surveillance for every patient, with intensified brain and full-neuraxis imaging for those with dissemination or high-risk subtypes. For isolated recurrences, repeat maximal safe resection remains the mainstay, followed by focal radiotherapy in radiation-naive patients, though cumulative dose tolerance to the spinal cord and the specter of radiation-induced deformity weigh heavily in children who face a far longer horizon of potential exposure. The path forward, the authors conclude, requires prospective multicenter studies, validated molecular risk models, and novel systemic therapies for the aggressive subtypes, so that the next generation of children with spinal ependymoma can be treated on evidence of their own rather than borrowed from adults.

Subject of Research: Molecular classification and management of pediatric spinal ependymoma

Article Title: Spinal ependymoma: a comprehensive review of molecular classification, management guidelines, and clinical outcomes with a focus on the pediatric population (Part III of ependymomas across compartments)

Article References: Price, A. M., Fredricks, N. S., Koutsouras, G., Vallejo, F. A., Bonfield, C., Pastakia, D. J., Luo, L. Y., Boop, F., Ramaswamy, V., & Dewan, M. C. (2026). Spinal ependymoma: a comprehensive review of molecular classification, management guidelines, and clinical outcomes with a focus on the pediatric population (Part III of ependymomas across compartments). Journal of Neuro-Oncology, 180(1), Article 6. https://doi.org/10.1007/s11060-026-05816-9

Image Credits: AI Generated

DOI: 10.1007/s11060-026-05816-9

Keywords: spinal ependymoma, pediatric neuro-oncology, MYCN amplification, myxopapillary ependymoma, WHO CNS5 classification, gross total resection, intraoperative neuromonitoring, adjuvant radiotherapy, spinal deformity, DNA methylation profiling, craniospinal irradiation, lifelong surveillance