Search

Background: Blunt spinal injuries (BSIs) are associated with substantial morbidity and mortality. Management typically involves stabilization of the spinal column and may include chemoprophylaxis for venous thromboembolism (VTE) prevention. The optimal timing of chemoprophylaxis initiation in operatively managed BSI patients remains debated. Objective: Analyze available literature on optimal chemoprophylaxis timing for the prevention of VTE in patients postinjury undergoing operative repair. Study Design: Systematic review and meta-analysis. Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and MEDLINE were searched for studies assessing chemoprophylaxis timing in adult BSI patients. Inclusion criteria focused on operatively managed BSIs and anticoagulant usage assessment. Results: Three studies involving 4345 patients were included. Early chemoprophylaxis initiation was associated with significantly lower deep vein thrombosis (DVT) and overall VTE incidence compared with late initiation. No significant differences were found in pulmonary embolism (PE) incidence or mortality. Conclusion: Early anticoagulant administration after spinal fixation for BSI reduces DVT and overall VTE risk without impacting PE incidence or mortality. Further research is recommended to solidify these findings and address existing gaps in the literature. Clinical Relevance: Early chemoprophylaxis initiation in operatively managed BSI patients reduces DVT and overall VTE risk without affecting PE incidence or mortality. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the demographic and physical characteristics of South Korean female elite rhythmic gymnasts with scoliosis. Twenty-eight female elite rhythmic gymnasts aged 16.1 ±3.0 years were enrolled and divided by Cobb angle into a scoliosis group and a non-scoliosis group. In addition to the baseline characteristics of each group, visual analogue scale (VAS) scores for lumbago and results of the 36-item health survey version 2 (SF-36v2) questionnaires were collected. The pelvic tilt degree, leg length, hip range of motion and back-muscle strength were also measured and analyzed together. Radiographs of the thoracolumbar spine were taken for each subject. The scoliosis group (n=17) had significantly higher age, height, weight, and body fat compared to the non-scoliosis group. Further, six of the scoliosis group gymnasts had lumbar compression fractures or spondylolysis. Spinal flexors and extensors of all the subjects were balanced in strength but the lateral flexors showed noticeable imbalance. Elite rhythmic gymnasts were found to be increasingly susceptible to scoliosis and other spinal disorders with age and years of training. Spinal lateral-flexor muscle imbalance was more severe with scoliosis. [ABSTRACT FROM AUTHOR]

Purpose: Spinal injuries resulting in neurological damage cause significant morbidity. Swift neurosurgical intervention can mitigate negative outcomes. However, variable mechanisms of injury may be associated with inappropriate transport (IAT), which may delay necessary surgical interventions. Patients with near shore spinal injuries (NSSI) presented with unique mechanisms, so we investigated factors associated with IAT in patients with NSSI.Methods: We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006 - 2017. We excluded patients transferred to other facilities, and those not injured in the water. Primary outcome was IAT, defined as patients with NSSI requiring transfer to another trauma center. To avoid heterogeneity in our analysis, we further excluded patients without NSSI who were inappropriately transported to a level I trauma center. We used multivariable logistic regression to assess association of independent variables (such as demographic, environmental, and clinical factors) with outcome.Results: We analyzed 278 patients with suspected NSSI, and found 14 (5.0%) had IAT. Compared to appropriately transported patients, diving was associated with higher percentages of IAT (28.6% vs. 3.9%, p = 0.014) and more were transported by air (50.0% vs. 20.6%, p = 0.01). In multivariable regression, patients' oxygenation saturation (odds ratio [OR] = 0.8, 95% confidence intervals [CI]: 077-0.98) and diving (OR = 7.5, 95% CI: 1.2-46) were significantly associated with IAT.Conclusion: Rate of IAT for patients with NSSI was low. However, first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT. [ABSTRACT FROM AUTHOR]

Spinal injury and back pain are a common problem facing patients seeking medical care including athletes, which can lead to significant disability, medical costs, and impaired performance for these patients. Rehabilitation including core muscle stabilization, Kinesio taping, and flexibility have been shown to help with treatment and prevention. Critical factors such as equipment, technique, and rule changes can also be an important part of spine injury prevention. [ABSTRACT FROM AUTHOR]

Objective: It remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury.Methods: We conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs).Results: We analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3).Conclusions: We identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately. [ABSTRACT FROM AUTHOR]

Vertebral fractures are very common and primarily affect the thoracolumbar spine as the result of an isolated injury or in polytrauma patients. The majority of these fractures can be treated non-operatively. Surgical stabilization of thoracolumbar fractures may be indicated after high-energy trauma or in the multiply injured patient. Surgery aims to provide a stable spinal column to allow early mobilization and optimize neurological outcome. This article considers the principles of clinical assessment and decision-making in the surgical management of thoracolumbar fractures. The AO spine thoracolumbar classification system can be used to guide treatment because the choice of surgical strategy depends on the biomechanics of the injury. Most injuries can be stabilized through a posterior approach but anterior column reconstruction can be performed, either as a stand-alone procedure or in order to support a posterior stabilization. The use of minimally invasive techniques is discussed. Interventional spinal technologies for osteoporotic vertebral compression fractures are also considered. [ABSTRACT FROM AUTHOR]

Spinal injuries occur frequently in the polytrauma patient making the evaluation and management of these potentially catastrophic injuries very important. In the immediate moments following these injuries, steps can be taken to prevent further injury and promote neurological recovery. The use of damage control orthopaedics (DCO) over the past 30 years has improved the management of the polytrauma33 patient and spinal injuries. The advanced trauma life support (ATLS) polytrauma algorithm does include the management of the injured spine but only in general terms. This article reviews the current evidence on assessment and initial management of spinal injuries in the polytrauma setting. A thorough appreciation of these principles and how they relate to the ATLS framework is essential in the treatment of these injuries. [ABSTRACT FROM AUTHOR]

Fractures of the vertebral column are extremely common and mostly affect the thoracolumbar junction as this is the transitional area between the rigid thoracic and flexible lumbar spine where increased loads can be concentrated. The majority of these injuries can be successfully managed conservatively. A large number include insufficiency fractures due to osteoporosis but thoracolumbar fractures can also occur after high-energy injuries such as a fall from height or road traffic collisions. This article considers the principles of spinal stability and how it underpins the assessment of patients with thoracolumbar injuries. Classification and scoring systems based on the concept of spinal stability have been developed and help to guide surgical decision-making. This is particularly useful with burst fractures where there is no clear benefit of surgical over non-operative treatment. The methods of conservative treatment are discussed along with their outcomes and how these compare with surgical stabilization. [ABSTRACT FROM AUTHOR]

The average age of the population is increasing and spinal traumatic injuries of the elderly are significantly more common. This frail population is prone to suffering serious injuries from minor or low-impact trauma when compared to younger patients. The reduced agility and ability to avoid falls in the elderly population may be the result of a combination of decreased stability due to altered sensory mechanisms, progressive spinal deformity, increased rigidity, osteoarthritis and neurological disorders, reduced cognitive function and hypotension, along with polypharmacy. Associated risk factors, including metabolic and autoimmune conditions may significantly increase the risk of morbidity and disability in this group. The most frequent injuries are odontoid fractures, vertebral compression fractures and traumatic central cord syndrome, all of which may be frequently associated with other lesions. Patient resilience and expectations will determine selection of consensual treatment aiming for a balance between maintaining function and achieving recovery. Conservative management is often the preferred method of treatment in the most common spinal injuries in the elderly as non-union or some degree of spinal deformity may be clinically well tolerated. Surgical treatment may provide benefit in the presence of persistent cord compression or spinal instability in patients that can tolerate the procedure. Ultimately, treatment should be tailored individually. Prevention of these injuries should be the focus in a world population with an ever-increasing proportion of elderly people. [ABSTRACT FROM AUTHOR]

Children with spinal problems present to a wide range of healthcare providers. These providers include the emergency department, their GPs, physiotherapy and the paediatric medical and surgical clinics (including orthopaedics). They may present with a variety of symptoms, but the common complaints are: back pain, leg pain or a change in back shape (spinal deformity). Some children may experience a combination of these problems. A systematic approach to the history and examination with knowledge of the common spinal conditions in children will allow you to select the best investigations. This will maximize the chance of making the correct diagnosis and providing appropriate care. This article aims to give an overview, appropriate for surgeons in the early years of their training. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Oligodendrocyte precursor cells (OPCs) differentiate into oligodendrocytes (OLs) that provide nutrients to neurons. Adrenal medulla is (ADM) involved in nerve damage. MiR-24 participates in various diseases. However, the regulation and mechanism of miR-24 in oligodendrocyte precursor cell differentiation after spinal injury is unclear. MATERIALS AND METHODS: Wistar rats were divided into sham operation group and model group. Real Time-PCR detects miR-24, PDGFRa and NG2 and MBP expression. OPC cells were cultured and divided into control group, miR-24 group, and si-miR-24 group followed by analysis of miR-24 expression by Real Time-PCR, expression of PDGFRa, NG2 and MBP by Western blot, as well as ADM content and secretion of IL-6 and TNF-a by enzyme-linked immunosorbent assay (ELISA). RESULTS: Expression of miR-24, PDGFRa, and NG2 was increased in the model group and MBP and ADM expression was decreased with increased secretion of IL-6 and TNF-a. Compared with control group, the difference was statistically significant (p<0.05). Upregulation of miR-24 promoted the expression of PDGFRa and NG2, decreased MBP and ADM level, and increased IL-6 and TNF-a secretion. Compared with control group, the difference was statistically significant (p<0.05). Downregulation of miR-24 reversed the above changes, and the difference was statistically significant (p<0.05). CONCLUSIONS: MiR-24 expression is increased in spinal injury. Upregulation of miR- 24 expression reduces adrenal medulla expression and inhibits oligodendrocyte precursor cell differentiation. [ABSTRACT FROM AUTHOR]

Abstract This study aims to determine spinal injury patterns and identify crash factors commonly associated with serious spinal injury as a result of motorcycle crashes. Data was retrospectively collected from motorcyclists sustaining spinal injuries from road crashes treated at Kuala Lumpur Hospital, Malaysia, over the 5-year period from 2005 to 2009. Each patient's injuries were analyzed by reviewing his or her medical records for radiographic imaging and computed tomography scans. A total of 151 patients were included in this study, of which, males accounted for over 87%. The first lower lumbar (L1) was the most commonly injured vertebral level, followed by the adjacent thoracic vertebra (T12). Fracture to the vertebral body without dislocation was found to be the most frequently observed spinal injury pattern. Injury severities for a majority of patients (65%) were measured at Maximum Abbreviated Injury Scale (MAIS) of 2. Serious spinal injury was associated with thorax or upper-extremity injury. Prevalence of lumbar spinal injury in the study reflects a predominantly low-speed crash among the motorcyclist in the region. Motorcyclists are at greater odd to sustain severe spinal injury when directly striking an object compare to striking the ground during the crash event. Highlights • The first lumbar vertebra (L1) was the most commonly injured vertebral levels • Association of thorax or upper-extremity injuries with serious spinal injury • The high occurrence of neurologic injury accompanied thoracic spine • Motorcyclists are at greater odd to sustain severe spinal injury upon directly striking an object compared to the ground [ABSTRACT FROM AUTHOR]

• Prevalence of non-immobilized spinal fractures decreased under selective protocol. • Due to no differences in adverse patient outcomes, a larger study is discouraged. • >85% of immobilized trauma patients do not have a spinal fracture. A new selective preventive spinal immobilization (PSI) protocol was introduced in the Netherlands. This may have led to an increase in non-immobilized spinal fractures (NISFs) and consequently adverse patient outcomes. A pilot study was conducted to describe the adverse patient outcomes in NISF of the PSI protocol change and assess the feasibility of a larger effect study. Retrospective comparative cohort pilot study including records of trauma patients with a presumed spinal injury who were presented at the emergency department of a level 2 trauma center by the emergency medical service (EMS). The pre-period 2013–2014 (strict PSI protocol), was compared to the post-period 2017–2018 (selective PSI protocol). Primary outcomes were the percentage of records with a NISF who had an adverse patient outcome such as neurological injuries and mortality before and after the protocol change. Secondary outcomes were the sample size calculation for a larger study and the feasibility of data collection. 1,147 records were included; 442 pre-period, and 705 post-period. The NISF-prevalence was 10% (95% CI 7–16, n = 19) and 8% (95% CI 6–11, n = 33), respectively. In both periods, no neurological injuries or mortality due to NISF were found, by which calculating a sample size is impossible. Data collection showed to be feasible. No neurological injuries or mortality due to NISF were found in a strict and a selective PSI protocol. Therefore, a larger study is discouraged. Future studies should focus on which patients really profit from PSI and which patients do not. [ABSTRACT FROM AUTHOR]

Background The coexistence of an unstable spinal fracture with a pending aortic lesion is potentially catastrophic and a therapeutic challenge as to timing of treatment, assigning priorities and selecting the best approach. Case report A 41 year-old healthy male victim of bike accident. Imaging revealed a fracture of 6th and 7th thoracic vertebrae with a bone fragment in close proximity to the descending thoracic aorta. After consultation with spine/vascular surgeons and interventional radiologists it was decided to secure the potential aortic injury with an endovascular stent-graft followed by posterior vertebral instrumentation for fracture’s reduction. Discussion/conclusion A multi-specialists teamwork approach is mandatory. Vascular lesion is priority, followed by vertebral surgery. As to the treatment options, we suggest a “best but still safest” philosophy: endovascular repair and posterior spinal instrumentation should be considered first in the acute stage. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to look at the long-term effects of conservative management of odontoid peg fractures. Methods We reviewed 48 consecutive patients with type II (32) and 16 type III, odontoid peg fractures. The clinical & radiological outcomes were assessed over an average period of follow up of 8 years. Union rate was determined and we discussed several factors that may affect it. Patients were treated conservatively with an average period of bed rest of 4 weeks followed by bracing for an average of 9 weeks. Results Bony union was established in 25 of 32 (78%) type II fractures. Of 7 cases of no bony union 4 were stable probably with fibrous union. 3 remained unstable. In 13 of 16(83%) type III fractures bony union was established. 2 of the 3 with no bony union were considered stable. Conclusion Osseous non-union was higher in patients with displacement of >5 mm, but there is no correlation between union and age, gender or angulation of the fracture in both types. [ABSTRACT FROM AUTHOR]

Children with spinal problems present to a wide range of healthcare providers. These providers include the emergency department, their GPs, physiotherapy and the paediatric medical and surgical clinics (including orthopaedics). They may present with a variety of symptoms, but the common complaints are: back pain, leg pain or a change in back shape (spinal deformity). Some children may experience a combination of these problems. A systematic approach to the history and examination with knowledge of the common spinal conditions in children will allow you to select the best investigations. This will maximize the chance of making the correct diagnosis and providing appropriate care. This article aims to give an overview, appropriate for surgeons in the early years of their training. [ABSTRACT FROM AUTHOR]

The concepts of spinal stability are central to the decision-making processes following spinal trauma. In order to completely understand spinal stability knowledge of the local anatomy and basic biomechanics of the spine is required. This article aims to revise these concepts and discuss their impact on stability of the spine. Mechanisms of injury in the cervical, thoracic and lumbar spine are discussed alongside the biomechanics of structural failure at each level. The basic concepts of clinical spinal stability are explored with comment on the biomechanical considerations for specific fracture patterns. [ABSTRACT FROM AUTHOR]

Lumbo-sacral fractures are complex injuries that often occur alongside pelvic ring trauma. They are often missed on initial assessment and plain radiography, and delayed treatment can lead to pain, reduced mobility and neurological compromise. Careful clinical examination is essential and identification of the fracture pattern often requires CT imaging. A large number of classification systems are available to help guide decision-making and these have recently been summarised in the comprehensive AO Spine sacral fracture classification system. Surgical intervention includes both neurological decompression and stabilisation and is indicated for patients with neurological compromise, lumbo-sacral instability and significant soft tissue injuries. [ABSTRACT FROM AUTHOR]

Summary Background and aim Pressure sore treatment in spinal injury patients is challenging. A multidisciplinary approach with joint management by the plastic surgery and spinal injury teams was initiated at our institution in 2005 to improve patient care and surgical outcomes following reconstruction. This study assessed the surgical outcomes following reconstruction using the team approach and to compare inpatient stay and readmissions for complications before and after the multidisciplinary protocol was introduced. Methods A retrospective review of consecutive patients in the multidisciplinary pressure sore clinic was performed. Data were collected on patient demographics, reconstructive techniques, surgical outcomes and readmission for any complications. Results In total, 45 patients with 60 pressure sores (grade 3 or 4) were reviewed in the joint clinic between 2005 and 2011. The majority of patients were paraplegic (78%), while the remaining 22% were tetraplegic. Ischial sores were the most common (45%) followed by trochanteric (23%) and sacral (20%) sores. Multiple sores were noted in 44% of patients. Flap reconstruction was required in 32 patients (71%); after a mean follow-up time of 33 months (range 25–72 months), there were three (9%) major complications (two recurrences of pressure sores and one sinus) and seven (22%) minor complications. After introduction of patient care pathways through the multidisciplinary approach, the rate of readmission for complications decreased from 14% to 5.5% and inpatient stay upon readmission reduced from 65 to 45 days. Conclusions Implementation of a multidisciplinary approach was key to optimising surgical outcomes, achieving a low recurrence rate (6%) and reducing readmissions. [ABSTRACT FROM AUTHOR]