Upper cervical schwannoma is rare, and belongs to benign tumors that is usually asymptomatic. It accounted for only ten percent of schwannomas cases and mostly occurs in 40–50 years old patients. Aggressive and total resection is the treatment of choice for this tumor. Preoperative diagnosis is difficult, relying on clinical suspicion, and confirmed by surgical pathology. We report a 54-year-old male patient with chief complain of progressive weakness and numbness of his right arm for four months. He had a history of lymph node tumor in 2007 and excised in 2011. Neurological decrease was found on the right arm. The radiographic examination showed lytic lesion on the second, third, and fourth cervical spine. Computed tomography scan showed destruction extending to the first cervical vertebra. Capsulated extradural and extramedullary mass and compression to the spinal cord was found from the magnetic resonance imaging. Two-stage operation was performed. The first stage was posterior decompression with occipitocervical fusion and instrumentation, while the second was anterior decompression and iliac strut graft. Both operations performed using the surgical ultrasonic dissector. During three months' follow-up, it showed neurological improving. Neurological deficit appears when there is compression on the spinal cord. Total resection is the treatment of choice for these tumors. Preoperative imaging should be performed to exclude malignant tumor and found tumor extension.

The incidence of spinal trauma in the world is 0.019-0.088% per year. However, the epidemiological data from each country varies according to the specificities of each country. Until now, there have been no reports of epidemiological research for vertebral trauma in Indonesia. This research is a descriptive analytic study. The sample of this study were all patients with vertebral fractures who entered the Dr. Soetomo Hospital in 2013-2017. The data were obtained through medical records and electronic data in hospital databases. The data are displayed in tables and graphs and comparative analysis of variables is carried out. Based on data from 2014-2017, there were a total of 442 patients with vertebral fractures, with male and female ratio of 3.3: 1. The mean age of patients was 43.6 year. The causes of vertebral fractures are due to fall from altitude (38%), traffic accidents (34%), and direct impact / hit burden (10%). Based on fracture level, most fractures were at the lumbar level (153 patients, 34,6%). At the lumbar level, the most fracture subtypes were type A with a percentage of 91.5% and the most mechanism of injury was due to falling from a height. Based on the fracture subtype, type A (compression or burst) fracture is the most common type of fracture. Lumbar vertebral fracture is the most fractured in vertebral fractures. The most common cause of fracture in the vertebrae is trauma with great energy due to falling from a height.Keywords: Epidemiology, vertebral fractures, spinal traumaCorrespondence to : dr.donnypermana@gmail.com Abstrak Insiden trauma spinal di dunia tercatat sebesar 0,019% hingga 0,088% per tahun, namun data epidemiologi dari masing-masing negara adalah berbeda-beda, sesuai dengan kekhususan dari masing-masing negara. Hingga saat ini, belum terdapat laporan penelitian epidemiologi untuk trauma vertebra di Indonesia. Penelitian ini merupakan penelitian deskriptif analitik. Sampel penelitian ini adalah seluruh pasien dengan fraktur vertebra yang masuk di RS Dr. Soetomo Surabaya pada tahun 2013-2017. Data penelitian ini didapatkan melalui data berkas rekam medis dan database elektronik rumah sakit. Data ditampilkan dalam bentuk tabel dan grafik serta dilakukan analisa komparasi dari variabel. Berdasarkan data tahun 2014-2017 didapatkan total 442 pasien dengan fraktur vertebra, dengan perbandingan laki-laki dan perempuan sebesar 3,3:1.  Rerata usia pasien adalah 43,6 tahun. Penyebab fraktur vertebra adalah akibat jatuh dari ketinggian (38%), kecelakaan lalu lintas (34%), dan benturan langsung/ tertimpa beban (10%). Berdasarkan level fraktur, fraktur terbanyak sejumlah 153 pasien (34,6%) pada level lumbal. Pada level lumbal didapatkan subtIpe fraktur terbanyak adalah tipe A dengan persentase 91,5% dan mechanism of injury terbanyak adalah akibat jatuh dari ketinggian. Berdasarkan subtipe frakturnya, fraktur tipe A (kompresi atau burst) merupakan jenis fraktur yang paling banyak terjadi. Fraktur vertebra lumbal adalah fraktur terbanyak pada kasus fraktur pada vertebra. Penyebab terbanyak fraktur pada vertebra adalah trauma dengan energi besar akibat jatuh dari ketinggian. Laki-laki 3 kali lebih banyak mengalami fraktur vertebra dibanding perempuan.Kata kunci: Epidemiologi, fraktur vertebra, trauma spinalKorespondensi  : dr.donnypermana@gmail.com

Background Increased demand for arthroplasty also increases the number of complications of arthroplasty, especially surgical site infection (SSI). One of the effective strategies in preventing surgical site infection is the use of appropriate prophylactic antibiotics. Objective To identify and analyse information from clinical studies regarding factors affecting the effectiveness of prophylactic antibiotics in arthroplasty patients. Methods A scoping review was conducted through the PubMed, Scopus, and Google Scholar databases within a publication range from January 2004 to August 2020. Study data are extracted and analysed by a minimum of two reviewers. Results The search results found 2.419 articles, with 39 articles were included for further analysis. Cefazolin monotherapy was the most frequently studied antibiotic (15 articles) followed by vancomycin monotherapy (8 articles). Most widely used antibiotics in arthroplasty were cefazolin mono-therapy (997.599 procedures with SSI incidence range: 0,20–16,05%) followed by vancomycin mono-therapy (125.170 procedures with SSI incidence range: 0.27–3,88%) The correct antibiotic dose has a lower percentage of the SSI than the wrong antibiotic dose. Meanwhile, administration of antibiotics within single dose or <24 h had a lower SSI percentage than administration of antibiotics >24 h. Administration antibiotics before incision also have a lower SSI percentage than after incision. There were no studies that discussed re-dosing of antibiotics in this scoping review. Conclusions There is still a need for further research related to the duration and specific timing of first dose of prophylactic antibiotics, especially regarding single dose or multiple dose antibiotics to obtain maximum effectiveness of antibiotic prophylaxis

Cell-based therapies such as Scaffold, stem cells, and secretome, are one of the alternatives to enhance the regeneration of hyaline-like cartilage in cases of cartilage defects. This study is an in-vivo experiment using animal models, in which we apply a composite of DFLP (Dwikora-Ferdiansyah-Lesmono-Purwati) Scaffold and Adipose-Derived Stem Cells (ASCs) or Secretome to an injury model on the distal femoral trochlea of New Zealand White Rabbits. The animals were divided into four groups: (1) control (K); (2) Scaffold only (S); (3) Scaffold + ASCs (SA); (4) Scaffold + Secretome (SS). Animals were terminated in the 12th week, and an immunohistochemistry (IHC) evaluation for Collagen type I and II were done. Statistical analysis shows that collagen type I IHC between groups shows no significant difference (p = 0.546). Collagen type II IHC shows significant difference between groups (p = 0,016). The findings in this study showed that Scaffold + ASCs group and Scaffold + Secretome have better collagen type II expression compared to the control group. DFLP Scaffold composite with ASCs or Secretome shows potential for cartilage regeneration therapy by increasing type II collagen expression as in hyaline-like cartilage which may be used for regenerative therapy for cartilage defects. Keywords             : DFLP Scaffold; Adipose-Derived Stem Cells (ASCs); Secretome; Collagen Type I; Collagen Type IICorrespondence    : ianperbowo@me.com

Background: Among all the thoracolumbar fractures, 50-60% affects the thoracolumbar transitional zone, and 51% AO Type C Fractures has a neurological deficit. We experienced treating a case of unstable lumbar fracture-dislocation treated with long segment pedicle screw instrumentation.Case: A 26-year-old man came to the ER after his back hit by a canopy while working 2 hours before admission. The motoric function was diminished from the L2-S1 level and hypoesthesia at the T12 level. Plain X-Ray showed Fracture-Dislocation Lumbar Vertebral 1-2 Denis Classification Flexion Rotation (AO Type C) ASIA A. The patient underwent reduction, decompression, and long-segment posterior pedicle screw instrumentation.Discussion: The surgery’s primary purpose is to restore alignment and stability to improve the patient’s quality of life by enabling daily activity in a wheelchair without significant pain. Short segment or long segment pedicle screw instrumentation remains a debate. In this case report, we apply long segment pedicle screw instrumentation for lumbar vertebral fracture-dislocation.Conclusion: Thoracolumbar fracture and dislocation fixation aim to restore alignment and stability, to reduce kyphotic deformity, and to decompress the spinal canal. The long segment pedicle screw instrumentation can resist the deforming force of thoracolumbar fractures and dislocations that will inevitably collapse into further kyphosis, resulting in a better outcome.