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Актуальність. Збільшення кількості та питомої ваги поєднаної травми, а також тяжкості поєднаних травматичних пошкоджень — це основні риси травматизму сьогодення. Одним із різновидів поєднаної травми є вертеброторакальна травма. Мета дослідження. Вивчення впливу пошкодження хребта на перебіг травматичного процесу у постраждалих із поєднаною торакальною травмою. Матеріали та методи. Проведено порівняння двох груп постраждалих з поєднаною торакальною травмою: перша — 157 випадків із наявністю вертебрального компонента, друга — 157 випадків без вертебрального компонента. Групи сформовані за ознакою показників стандартизованої оцінки тяжкості травми ISS (Injury Severity Score). Результати. Встановлено, що пошкодження хребта мають вірогідний вплив на перебіг травматичного процесу насамперед у постраждалих із тяжкістю травми за шкалою ISS до 35 балів. Різні клініко-анатомічні форми пошкодження хребта мають різний за інтенсивністю та результатом вплив на перебіг травматичного процесу в постраждалих. Найбільш сильний негативний вплив мають пошкодження шийного відділу хребта у вигляді множинних пошкоджень хребців і переломовивихів, а також будь-які пошкодження, які згідно з класифікацією AO/ASIF відносяться до типу С, або пошкодження, що викликають порушення моторних і чутливих функцій за кваліфікаційним типом Frankel A та Frankel В. Висновки. Пошкодження хребта вкрай негативно впливають на перебіг і результат травматичного процесу в постраждалих із поєднаною торакальною травмою. Це обумовлено як характером та тяжкістю самого пошкодження хребта, так і впливом зазначеного пошкодження на інші компоненти поєднаної травми. Викладене вище необхідно враховувати у процесі формування та реалізації клініко-організаційного рішення щодо надання медичної допомоги постраждалим з вертеброторакальною травмою.

Background. Motor vehicle accident (MVA) is a global health hazard that results in spinal, thoracic, and abdominal injuries. Detailed studies on the association between MVA-related traumatic spinal injury (TSI) and thoracoabdominal injuries are lacking. This study aims to elucidate the prevalence, pattern of association between these injuries, and related outcomes in terms of in-hospital mortality. Methods. This is a retrospective single-center study of MVA-related TSI with thoracoabdominal associated injuries. Descriptive analysis was performed for gender, age, spinal injury level, thoracoabdominal injury region, admission day, hospital stay duration, and discharge category. The association between TSI and thoracoabdominal injury was analyzed, and the chi-square test was used to test the significance of differences. A statistically significant difference was considered at P values less than 0.05. Results. The cohort had a mean age of 33.6 ± 17.7 years with predominantly more males (85.1%). Thoracoabdominal injuries were present in 10.5% of MVA-related TSIs, and 9.2% of victims died during their hospital stay. There is a significant ( P = 0.045 ) association between the level of the spinal and the region of thoracoabdominal injuries. The presence of TSI-associated thoracic injury significantly ( P = 0.041 ) correlated with increased in-hospital mortality more than abdominal injury. Conclusion. Thoracoabdominal injuries concomitant with MVA-related TSI cause considerable mortality. A pattern of association exists between the level of spinal and region of thoracoabdominal injury. Knowledge of this pattern is helpful in the routine practice of trauma health partitioners.

A 41 year-old male that presented after a fall downstairs and the initial imaging was misinterpreted, missing a subtle abnormality, C5/6 subluxation. The patient presented later with neck pain and further imaging demonstrated bilateral facet dislocation with severe deformity requiring 360 spinal fixation.

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.

Nonaccidental trauma (NAT), causing spinal injury is rare and occurs in up to 3% of cases. Management of these injuries is typically conservative, and thus surgical management is not widely reported in the literature. In this case report, we presented three patients to review the effectiveness of spinal instrumentation and posterior fusion in pediatric patients due to NAT. All patients recovered well and were neurologically intact at last follow-up with no postprocedural complications noted. Spinal arthrodesis is a safe, effective way to manage spinal injuries due to NAT in cases of fracture-dislocation, distraction injuries, as well as cases involving neurologic compromise.

Objetivo: Fue realizar una caracterización sociodemográfica de los para atletas chilenos. Métodos: Consistió en la aplicación del cuestionario diseñado para la especificidad de las informaciones intencionadas, y las variables relacionadas pesquisadas fueron con relación a la edad, sexo, región donde vive, tipo de discapacidad, deporte que practica, nivel educacional de las y los para atletas. Resultados: Participaron 176 deportistas, 39 mujeres (22.15%) y 137 hombres (77.84%). El deporte con mayor cantidad de participantes para las mujeres es el Goalball (30,76%) , y para los hombres fue el Fútbol 7 (24.81%). Respecto a la distribución por deficiencia la mayoría de los deportistas corresponden a la discapacidad física (80,68%). De los diagnósticos médicos la mayoría es lesión cerebral (32,38%), y en el caso de las mujeres la lesión medular y deficiencia visual (29,73%). De los niveles de formación educacional podemos observar que la mayoría escolar media/técnica de modo completo 72(40,90%). Al observar la distribución por región, la mayoría se encuentran en la región Metropolitana de Santiago con un 53,98%. Conclusión: La información recabada es de alta importancia para generar políticas que permitan distribuir los recursos y los programas a nivel nacional

Verletzungen der Halswirbelsaule (HWS) zeigen sich mit einer Inzidenz von uber 3 % bei Unfallopfern und haben sogar eine deutlich grosere Inzidenz im hoheren Alter. Sie konnen posttraumatisch zu schwerwiegenden neurologischen Defiziten fuhren und mussen deshalb schnell und suffizient diagnostiziert und therapiert werden. Abhangig vom Verletzungsmuster (knochern, ligamentar oder neuronal) ist eine konservative, meist jedoch eine operative Therapie indiziert. Die verschiedenen operativen Therapiekonzepte abhangig vom Verletzungsmuster werden in diesem Beitrag dargestellt und anhand von Fallbeispielen illustriert. Halswirbelsaulenverletzungen sollten in einem Traumazentrum mit Wirbelsaulenexpertise versorgt werden. Bereits direkt nach dem Unfallereignis ist ein schonender, immobilisierender Transport wichtig. Durch moderne operative Therapiekonzepte und eine gute intensivmedizinische perioperative Therapie gelingt gerade im hoheren Alter eine schnelle Stabilisierung der HWS. So ist eine zugige Mobilisation und weitere Therapie moglich. Dadurch kann die Morbiditat und Mortalitat durch Vermeidung von Folgeschaden verringert werden.

Spinal cord injury (SCI) involves damage to any level of the spinal cord and can result in significant disability. It is principally caused by trauma and is treated with long-term rehabilitation, the majority of which takes place in the community. Currently, no comprehensive guidelines exist on the long-term management of SCI in the community. This article, therefore, aims to amalgamate the current literature and provide a guide of how to manage SCI in the community, along with a brief overview of its epidemiology and aetiology.

Decompression illness (DCI), a syndrome following inadequate reduction in environmental pressure, has two forms: decompression sickness and arterial gas embolism after pulmonary barotrauma. Recompression therapy using oxygen, a kind of hyperbaric oxygen therapy, has been considered the gold standard treatment for DCI, although there is no randomized controlled trial evidence for its use. We evaluated the effectiveness of recompression therapy in treating DCI by reviewing the reported therapeutic results of serious DCI, especially neurological disorders. Early or ultra-early recompression therapy did not dramatically improve clinical recovery from DCI symptoms, including spinal cord disorders. In contrast, early first aid normobaric oxygen inhalation highly improved or stabilized clinical conditions of DCI. Based on these clinical results, the international committee for hyperbaric and diving medicine has stated that cases of mild DCI may be managed without recompression therapy. Further work is needed to clarify the clinical utility of recompression therapy for spinal injury as a common symptom of DCI. We also point out that the Japanese decree "Ordinance on Safety and Health of Work under High Pressure", which describes work under hyperbaric environments, has some serious issues and should be amended on the basis of scientific evidence.

Background The SARS-CoV-2 pandemic has had profound implications on healthcare institutions. Aims This study aims to assess and compare referral patterns during COVID-19 to corresponding dates for the preceding 3 years (2017–2019), in order to preemptively coordinate the logistics of the surgical unit for similar future experiences. Methods Retrospective review for our institution, a national tertiary referral centre for spine pathology. Two distinct time-points were chosen to represent the varied levels of social restriction during the current pandemic: (i) study period 1 (SP1) from 11 November 2020 to 08 June 2020 represents a national lockdown, and (ii) study period 2 (SP2) from 09 June 2020 to 09 September 2020 indicates an easing of restrictions. Both periods were compared to corresponding dates (CP1: 11 March–08 June and CP2 09 June–09 September) for the preceding 3 years (2017–2019). Data collected included age, gender, and mechanism of injury (MOI) for descriptive analyses. MOIs were categorised into disc disease, cyclist, road-traffic-accident (RTA), falls 2 m, malignancy, sporting injuries, and miscellaneous. Results All MOI categories witnessed a reduction in referral numbers during SP1: disc disease (−29%), cyclist (−5%), RTAs (−66%), falls 2 m (−17%), malignancy (−33%), sporting injuries (−100%), and miscellaneous (−58%). Four of 8 categories (RTAs, falls 2 m) showed a further reduction (−34%, −27%) during SP2. One category (sporting injuries) portrayed a complete return to normal values during SP2 while a notable increase in cyclist-related referrals was witnessed (+ 63%) when compared with corresponding dates of previous years. Conclusion Spinal injury continues to occur across almost all categories, albeit at considerably reduced numbers. RTAs and falls remained the most common MOI. Awareness needs to be drawn to the reduction of malignancy-related referrals to dissuade people with such symptoms from avoiding presentation to hospital over periods of social restrictions.

The presence of red blood cells (RBCs) in urine is hematuria, even in microscopic amounts alarms the patient and parents of the patient, and often prompts physician for many laboratory investigations. Hematuria can be red, dark or cola-colored, or brown known as macroscopic hematuria, and when it is not visible to the unaided eye, it is known as microscopic hematuria. RBCs in urine is one of the most important signs of genitourinary tract disease; however, it is almost never a cause of anemia, since few drops (1 mL) of blood can turn 1 L of urine into red-colored urine. Overall the physician should be alert enough not to overlook serious conditions like neoplasms and underlying bleeding disorder, to avoid unnecessary and often expensive laboratory studies. This article provides an approach to the evaluation and management of hematuria in children, and the detection of preventable and treatable conditions at the earliest to limit the disease progression, and an overall reduction in cost, energy, and anxiety. The patients are spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of postvoid residual urine, uroflowmetry, and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy, and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life. Keywords: Children; Kidneys, bladder, neurogenic, injuries, spinal cord, spinal cord disorders, ; RBC cast; Red blood cells; Urine, ASIA (American Spinal Injury Association)

A growing body of evidence links abusive head trauma (AHT) to patterns of direct and indirect spinal injuries, such as spinal subdural hemorrhage (SDH). Identification of evidence of spinal injury such as spinal SDH plays a crucial role in the diagnosis and subsequent management of the index child with AHT and his or her siblings. In a value-based practice of medicine, it can be argued that adding spine imaging to identify spinal SDH in the workup of AHT adds value to both the short- and long-term management of the patient. This pictorial review describes the normal appearance of spinal SDH and challenges of identifying spinal SDH, and it explores the mechanism of spinal SDH development in AHT.

Background Most trauma systems and traumatic spinal injury guidelines mandate spinal stabilization from the site of injury to a radiological confirmation or refutal of spinal injury. Vacuum mattresses have been advocated for patients in need of prehospital spinal stabilization. Purpose To investigate the effect of different vacuum mattresses on standard resuscitation bay conventional radiography of chest and pelvis, especially regarding artefacts. Material and Methods We used a mobile X-ray machine to perform chest and pelvic conventional radiography on an anthropomorphic whole-body phantom with a trauma transfer board, three different vacuum mattresses, and without any stabilization device. The vacuum mattresses were investigated in activated, deactivated, and stretched after deactivated states. Two radiologists assessed the artefacts independently. Agreement was measured using kappa coefficient. Results All radiographs were of good technical quality and fully diagnostic. With the exception of one disagreed occurrence, artefacts were seen to hamper clinical judgment exclusively with activated vacuum mattresses. There was substantial agreement on artefact assessment. The observed agreement was 0.82 with a kappa coefficient of 0.71. The first vacuum mattress caused no artefacts hampering with clinical judgment. Conclusion Our study concludes that it is feasible to maintain some vacuum mattresses through resuscitation bay conventional radiography of chest and pelvis. They do not result in artefacts hampering with clinical judgment. Our vacuum mattress No. 1 is recommendable for this purpose. Together with our previous findings our present results indicate that some vacuum mattresses may be used throughout the initial resuscitation bay assessment and CT examination.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, in which involvement of the cervical spine (CS) can lead to clinically significant and irreversible functional impairment. Objective of the study: to provide a comparative characteristic of patients with JIA, depending on the presence of joint arthritis in cervical spine (CS). Materials and methods of the study: the retrospective uncontrolled continuous nonrandomized comparative study included data on patients with JIA (n=753) who were treated at the Clinic from 2007 to 2016. The diagnosis of JIA was diagnosed using ILAR criteria and all children were assessed for articular status. Disorders of the CS were diagnosed on the basis of clinical manifestations, as well as radiation studies. Results: clinical signs of CS injury were detected in 101 patients (13,4%) and were more common in patients with polyarticular (48%, OR=1,8 (1,2; 2,7), p

Experiencing a spinal cord injury (SCI) is extremely distressing, both physically and psychologically, and throws people into a complex, unfamiliar world of medical procedures, terminology, and decision making. You may have already had surgery to stabilize the spinal column and reduce the possibility of further damage. You are understandably distressed about the functions you may have lost below the level of spinal injury. You wish to recover any lost abilities as soon as possible. You, your family, or friends may have searched the Internet for treatments and cures.

We studied the risk of associated spinal and nonspinal injuries (NSIs) in the setting of observed thoracolumbar transverse process fracture (TPF) and examined the clinical management of TPF.Patients treated at a Level I trauma center over a 5-year period were screened for thoracolumbar TPF. Prevalence of associated spinal fractures and NSIs as well as relationship to level of TPF was explored. Clinical management and follow-up outcomes were reviewed.A total of 252 patients with thoracolumbar TPFs were identified. NSIs were commonly observed (70.6%, n = 178); however, associated spinal fractures were more rarely seen (24.6%, n = 62, P0.0001). No patients had neurological deficits attributable to TPFs, and only 3 patients with isolated TPFs were treated with orthosis. Among patients with outpatient follow-up (70.6%, n = 178), none developed delayed-onset neurological deficits or spinal instability. Thoracic TPFs (odds ratio = 3.56, 95% confidence interval = 1.20-10.56) and L1 TPFs (odds ratio = 2.48, 95% confidence interval = 1.41-4.36) were predictive of associated thoracic NSIs. L5 TPF was associated with pelvic fractures (odds ratio = 6.30, 95% confidence interval = 3.26-12.17). There was no difference in rate of NSIs between isolated TPF (70.0%) and TPF with associated clinically relevant spinal fracture (72.6%, P = 0.70).NSIs are nearly 3 times more common in patients with thoracolumbar TPFs than associated clinically relevant spinal fractures. Spine service consultation for TPF may be unnecessary unless fracture is associated with a clinically relevant spinal injury, which represents a minority of cases. However, detection of TPF should raise suspicion for high likelihood of associated NSIs.

Background To investigate the impact of COVID-19 on trauma referrals to a National Neurosurgical Centre during the first wave of COVID-19 in Ireland. Methods Retrospective analysis of a prospectively maintained database of all trauma referrals to the National Neurosurgical Centre at Beaumont Hospital, Dublin, during the period March 1–May 31, 2019 and 2020. Patient characteristics including age, sex, alcohol use, anticoagulant/antiplatelet use and initial Glasgow Coma Scale (GCS) were recorded. Patients were grouped based on trauma aetiology and diagnosis. Results There were 527 and 437 trauma referrals in 2019 and 2020 respectively. Overall, there was a 17.1% reduction in trauma referrals between 2019 and 2020. Traumatic brain injury, spinal injury and cranial fractures referrals reduced 25% (375 vs 283), 59% (32 vs 13) and 18% (39 vs 32) respectively from 2019 to 2020. Low-energy falls below 2 m was the most common mechanism of injury and accounted for 60 and 61% of referrals in 2019 and 2020. No reduction in road traffic collision (33 vs 34) and assault (40 vs 40) referrals were observed between years. Conclusions COVID-19 has had a significant impact on both the volume and mechanism of trauma referrals to the National Neurosurgical Centre in Ireland, with falls below 2 m the most common mechanism of trauma referral across both years. The workload remains substantial and a fully resourced neurosurgical department is essential in any future COVID-19 waves.

Objective: The clinical outcome following multilevel stabilization in patients who suffered cervical spinal injury and developed severe neurological deficits and then gradually partially recovered is evaluated. The basis of the surgical concept was that cervical spinal degeneration is a result of single or multilevel spinal instability and that spinal trauma exaggerates the instability. Materials and Methods: During the period 2015–2020, 14 patients who suffered severe cervical spinal injury and could be included in the classification of spinal cord injury without computed tomography evidence of trauma were surgically treated. There were 11 males and 3 females. The ages ranged from 45 to 67 years, average being 53 years. Cervical canal stenoses related to degenerative spinal changes were observed in all patients. All patients suffered severe neurological deficits and within few days or weeks had shown significant but incomplete neurological recovery. The identification of the levels of unstable spinal segments was done on the basis of radiological and clinical parameters and direct observation of spinal instability in adjoining spinal segments. Transarticular fixation was done by Camille's transarticular fixation technique. Using ASIA score, modified JOA score, and Goel Clinical Grading Scale, the clinical course of the patients was monitored. Results: All patients showed recovery in the neurological status. Recovery started in the immediate postoperative period and the improvement progressed during the period of follow-up. Conclusions: Surgery for spinal stabilization can be indicated even in cases that improve in the neurological function.

Background: Secondary spinal injury induced in trauma patients during transfer is of major concern. The logroll technique is used to transfer immobilize patients in many trauma centers. Healthcare trainees require a reliable objective tool for ensuring high competency and safety when handling trauma patients. This study aimed to develop and validate a novel method for assessing and evaluating the log-roll technique. Methods: This experimental validation study was conducted at the clinical skill lab of the Faculty of Medicine of Umm Al-Qura University from March 2018 to July 2019. A log-roll technique assessment sheet was developed using revised input from 20 content experts, current guidelines, and relevant literature. Simulated trials were filmed and reviewed by 10 content experts using the index and reference tests. Content validity, concurrent validity, internal consistency, and reliability were tested against the modified Global Rating Scale (GRS). Results: The current sheet was valid, reliable, and internally consistent compared to the GRS. The concurrent validity coefficient between the two scales was 0.75 (p 0.64 (p 0.75 (p < 0.01). Conclusion: The log-roll technique assessment sheet is a valid and reliable tool for testing trainee competency at performing the log-roll technique. This tool might be helpful for training healthcare professionals to handle trauma patients.

US was a 37-year old man who presented with generalized skin rashes of two years duration. He had a history of cervicothoracic (C6/T1) spine injury seven years earlier and for which he was managed conservatively at a secondary level hospital. He had Baclofen Pump inserted intrathecally in India four years following the spinal injury resulting in persistent spastic paralysis of both lower limbs. He was scheduled for intermittent Baclofen refill at India. Three months after the second drug refill, he developed generalized skin rashes. His vital signs were stable on presentation. He had wide-spread skin rashes. There was a bulge on the anterior abdominal wall on the right hypochondrial region due to the presence of the metallic implant. The dermatological review suggested foreign body reaction to exclude Acquired Ichthyosis was made. The patient had an explantation done and thereafter, showed remarkable improvement three months after the removal of the Intrathecal Baclofen Pump with healing and disappearance of the skin rash.

Traumatic thoracic spondyloptosis represents a rare but potentially catastrophic spinal injury pattern. We present a unique case of a 37-year-old male who suffered a high-thoracic retroloptosis with resultant complete spinal cord injury following a motor vehicle accident. We describe a novel and effective method of open reduction utilising horizontally oriented temporary rods facilitating controlled, sequential sagittal distraction and unlocking, reversal of anteroposterior shear and restoration of alignment. Using our technique, successful reduction and realignment was achieved.

This study aimed to design a neural interface that extracts motor commands from the cerebral cortex and generates fuzzy-based intraspinal stimulations to restore the hindlimb movements. The study consisted of four steps: (i) recording of electrocorticographic (ECoG) signals and of the corresponding leg movements in healthy rabbits, (ii) partial laminectomy to induce spinal cord injury (SCI) and to detect motor modules in the spinal cord, (iii) delivering appropriate intraspinal stimulation to the motor modules for restoration of the movements to those recorded before SCI by a fuzzy controller, and (iv) developing a neural interface developed by a sparse linear regression (SLiR) model to decode intraspinal stimulation from the ECoG signals. Based on the results of module detection by stimulating the detected spinal cord modules, joint angles evaluated before spinal injury did not significantly differ from those induced by fuzzy controllers (P > 0.05). As was shown, the neural interface could correlate the ECoG signals and intraspinal stimulation signals and restore the leg movement under the above ECoG signals. This resulted in the appropriate leg movements based on the offline ECoG signals (achieved previously from the non-injured rabbit) and also on the online-ECoG signals from the same rabbit after SCI. The overall correlation coefficient (CC) and normalized root mean square (NRMS) values of the online prediction were 0.61 ± 0.14 and 0.36 ± 0.11, respectively. Overall, it seems that the ECoG data may contain information capable of controlling intraspinal electric stimulations. The neural interface could decode intraspinal stimulation from the ECoG signals and restore a significant portion of the natural leg movements.

Purulent meningitis in children can be both primary and secondary. The latter are the result of various surgical interventions, ENT pathology, immunosuppressive therapy, as well as craniocerebral and spinal trauma, which justifies the need for an integrated approach to differential diagnosis to select the appropriate therapy tactics. The article presents a clinical observation of a child in whom purulent meningitis developed on the background of epiduritis, which was the result of a spinal injury. The diagnostic search algorithm is described. The authors concluded that if the patient has laboratory confirmed purulent meningitis and adequate therapy with clinical improvement in the patient’s condition, but persistent febrile fever, an increase in inflammatory changes in the blood amid a decrease in the level of acute phase inflammation proteins (C-reactive protein) and negative procalcitonin the test requires a search for a local inflammatory focus using additional examination methods, such as MRI or CT, as well as consultations with a neurosurgeon That allows you to specify the diagnosis and to determine the conduct of tactics, thus providing a favorable outcome.

The aim of this study was to determine the effect of contextual interference on learning of adapted sailing for people with spinal cord injury. Seven participants with traumatic spinal injury were selected to undergo learning in an adapted boat equipped with wind-measuring instrument. A learning program, defined by two conditions, (1) blocked practice and (2) random practice, was applied. In blocked schedule, fixed sequence of two maneuvers consist of tacking on a close-hauled course (45°–55°) and gybing on a broad reaching course (135°–145°). In random schedule, the same maneuvers were carried out randomly. Eight 30-min practice sessions were carried out over a period of 2 weeks, in 3 days per week. Velocity Made Good was analyzed in the familiarization test, pre-test, post-test, and retention test. The learning program was effective in both random and blocked practice conditions on all participants. However, there is an evident variability in the results. This study demonstrates the suitability of applying contextual interference to facilitate the learning of adapted sailing. The variability of the results could be related to the heterogeneity of the participants and suggests the need for further research that can provide information about how restricted mobility affects the learning process.

Context/objective: Swallowing difficulties (dysphagia) are well recognized after spinal injury. There are no published rehabilitation efficacy studies to date. This study explored viability and outcomes of swallowing rehabilitation programs for four patients with persisting dysphagia. Design: Prospective, quantitative experimental longitudinal case series. Setting: Spinal rehabilitation unit or patients’ homes. Interventions: Four patients engaged in a 6-week (3×weekly) individualized progressive rehabilitation program. Outcome measures: Objective videofluoroscopic measures of timing and displacement and a validated self-reported questionnaire – the Eating Assessment Tool (EAT-10) were taken pre-therapy, immediately post-therapy and EAT-10 was repeated at 3 months. Feeling and fatigue scale scores were taken before and after each therapy session. Results: Patients (63, 67 yr, 67 yr, 76 yr; 3 male) had varying spinal diagnoses (2 traumatic, all involving the C-spine) and length of dysphagia (6 weeks, 6 weeks, 12 weeks, 10 yr). Common physiological impairments across all patients were: reduced maximum hyoid displacement, reduced pharyngeal constriction and reduced pharyngoesophageal segment maximum opening. Therapy programs were well received with 100% compliance. Participants made quantitative improvements in their videofluoroscopic measures of timing and displacement. Three out of four participants were able to have their percutaneous endoscopic gastrostomies (PEG) removed. EAT-10 scores significantly improved for all patients (P

The loss of descending serotonin (5-HT) to the spinal cord contributes to muscle spasms in chronic spinal cord injury (SCI). Hyperexcitable motoneurons receive long-lasting excitatory postsynaptic potentials (EPSPs), which activate their persistent inward currents to drive muscle spasms. Deep dorsal horn (DDH) neurons with bursting behavior could be involved in triggering the EPSPs due to loss of inhibition in the chronically 5-HT-deprived spinal cord. Previously, in an acutely transected preparation, we found that bursting DDH neurons were affected by administration of the 5-HT(1B/1D) receptor agonist zolmitriptan, which suppressed their bursts, and by N-methyl-d-aspartate (NMDA), which enhanced their bursting behavior. Nonbursting DDH neurons were not influenced by these agents. In the present study, we investigate the firing characteristics of bursting DDH neurons following chronic spinal transection at T10 level in adult mice and examine the effects of replacing lost endogenous 5-HT with zolmitriptan. Terminal experiments using our in vitro preparation of the sacral cord were carried out ~10 wk postransection. Compared with the acute spinal stage of our previous study, DDH neurons in the chronic stage became more responsive to dorsal root stimulation, with burst duration doubling with chronic injury. The suppressive effects of zolmitriptan were stronger overall, but the facilitative effects of NMDA were weaker. In addition, the onset of DDH neuron activity preceded ventral root output and the firing rates of DDH interneurons correlated with the integrated long-lasting ventral root output. These results support a contribution of the bursting DDH neurons to muscle spasms following SCI and inhibition by 5-HT. NEW & NOTEWORTHY We investigate the firing characteristics of bursting deep dorsal horn (DDH) neurons following chronic spinal transection. DDH neurons in the chronic stage are different from those in the acute stage as noted by their increase in excitability overall and their differing responses serotonin (5-HT) and N-methyl-d-aspartate (NMDA) receptor agonists. Also, there is a strong relationship between DDH neuron activity and ventral root output. These results support a contribution of the bursting DDH neurons to muscle spasms following chronic spinal cord injury (SCI).

Introducción: La acrobacia en tela es una práctica circense con muchos adeptos en la población urbana. Consiste en sostenerse en altura tomado por dos extremos de tela, para realizar posturas fijas y cambiar entre ellas mediante deslizamiento y caídas. La práctica profesional no está libre de lesiones. Objetivo: Conocer la naturaleza de la lesión, reconocer los factores predisponentes de lesión y las medidas de prevención utilizadas, evaluar la cinemática, clasificar la lesión y analizar el tratamiento. Materiales y Métodos: Se incluyeron seis pacientes. Se evaluaron la estructura física personal, la cinemática de la caída, los sistemas de protección, la clasificación de las fracturas según la nueva clasificación AO, el cuadro neurológico, el tratamiento y las complicaciones. Resultados: La muestra incluyó a 6 mujeres, con un promedio de edad de 24 años y un índice de masa corporal de 19,29. Caída de 3,08 m de altura, cuatro con colchoneta, Introduction: Aerial silk is a circus practice that has become very popular in urban populations. It involves hanging from two pieces of fabric in order to make fixed positions and change between them by sliding and dropping from different heights. The professional practice is not free of injuries. Objective: To learn the nature of the injury, to recognize the injury predisposing factors and the safety measures used, to study the kinematics, to classify the injury, and to analyze the treatment. Materials and Methods: Six patients were included. The evaluation included individual body structure, drop kinematics, safety measures, classification of fractures according to the new AO classification, neurological symptoms, treatment, and complications. Results: The study included six female patients, averaging 24 years, a body mass index of 19.29 and a fall from 3.08m, 4 of which included mattress, Facultad de Ciencias Médicas

Les enjeux de la prise en charge du traumatisme vertébromédullaire (TVM) cervical sont fondamentaux. Le pronostic vital peut être engagé dans l’immédiat. Cette prise en charge découle des conséquences de l’atteinte médullaire sur ses différents contingents moteur, sensitif et autonome et des objectifs de limiter les lésions secondaires. L’évaluation neurologique initiale repose sur le score ASIA (American Spinal Injury Association score). Le scanner ou l’imagerie par résonance magnétique à l’admission sont indispensables. L’optimisation hémodynamique repose sur un remplissage vasculaire minutieux et l’emploi adapté des amines vasopressives chez ces patients qui ont une défaillance des systèmes adaptatifs cardiaques. La prise en charge respiratoire repose sur une stratégie globale comportant une évaluation respiratoire et, si possible, une extubation précoce avec relai par ventilation non invasive et kinésithérapie intensive. Cette stratégie permet la diminution du recours à la trachéotomie et une réduction de la durée de ventilation mécanique. La prévention et le traitement des autres complications liées à la pathologie et à l’immobilisation ne doivent pas être négligés.

Background: In the UK, around 500–600 people a year sustain traumatic injuries to the spinal cord, half of which involve the cervical spine. UK ambulance guidelines stipulate that if immobilisation is indicated, the entire spine should be immobilised using an orthopaedic scoop stretcher, head restraints and a rigid cervical collar. However, the use of cervical collars is being debated in the paramedic profession. Although they were originally considered harmless and used as a precautionary measure, an increasing amount of evidence suggests otherwise and it is argued that they can do more harm than good. Therefore, it is debatable whether using them is consistent with the principles of patient safety and evidence-based practice. Aim: A literature review was carried out to comprehensively examine research surrounding the adverse effects of cervical collars and the range of movement they allow to gain a comprehensive understanding of their efficacy. Methods: The EBSCOhost Health Science Research database was searched. Seven articles were found and chosen for inclusion in the literature review. Results: Two themes were identified regarding cervical collars: adverse effects and range of movement. Conclusion: Evidence suggests that cervical collars can cause more harm than good, and UK ambulance guidelines for spinal immobilisation should be reconsidered.

Introduction: Although childhood trauma is a major cause of morbidity and mortality, the incidence of spinal trauma is significantly lower in children than in adults. Existing studies on pediatric spinal trauma (PST) largely concern cervical trauma because of its frequency of incidence. We aimed to obtain more information by examining all types of spinal trauma, and evaluating factors such as age, trauma type, injury type, and American Spinal Injury Association score and comparing them with data from the literature. Methods: We retrospectively reviewed 30 pediatric trauma patients with spinal pathology confirmed by spinal imaging. Results: The mean age was 166.4 months. Mean age for each mechanism of injury was: 142.7 months for a simple fall, 149.0 months for injury involving a foreign object, 163.5 months for a fall from a height, and 181.6 months for traffic accidents. There was no statistically significant difference in mean age for different mechanisms of injury (p = 0.372). The levels of the spinal injuries were: lumbar 53.3% (16), thoracic 26.6% (8), and cervical 20.0% (6). Mean age for each level of spinal injury was 113.3 months for the cervical area, 172.2 months for the thoracic area, and 183.3 months for the lumbar area. Mean age was found to be statistically significant (p = 0.000). Discussion: PST is uncommon and the type of trauma and the spinal level affected varies with age. Cervical trauma predominates at younger ages, but adult-like traumas begin to occur with increasing age. It should be considered that the risk of developing neurological deficits is higher in pediatric patients than in adults, and the risk of multisystem injury is also high.

Purpose The Work Rehabilitation Questionnaire (WORQ) is a self-report vocational rehabilitation assessment. A comprehensive (WORQ-FULL) and a brief version (WORQ-BRIEF) are available. The purpose of this study was to investigate measurement properties of both versions in persons with physical disabilities. Methods Cross sectional and test–retest design. Adults with physical disabilities in vocational rehabilitation were included. Internal consistency (Cronbach’s alpha), test–retest reliability (intra-class correlation; ICC), agreement between sessions (Bland–Altman Plots), criterion validity (ICC and agreement with Bland–Altman Plots between WORQ-FULL and WORQ-BRIEF) and convergent validity with the Work Ability Index -Single item (WAS) and the EuroQOL 5D-5L were analyzed. Results Out of the 91 individuals who agreed to participate, 74 (81%) returned questionnaire T1 and 49 (54%) participants returned questionnaire T2 within the maximum time interval (= 27 days). At T2, 28 (57%) participants reported no medical changes compared to T1. Median age was 49 (IQR 40–60), 57% were male, 47% had experienced a stroke and 27% a spinal cord injury (n = 49). Internal consistency was good: 0.95/0.95/0.94 for the WORQ-FULL and 0.88/0.89/0.85 for the WORQ-BRIEF (n = 74/n = 48/n = 28, respectively). Test–retest reliabilitywas good: ICC = 0.86/0.85 for the WORQ-FULL and ICC = 0.87/0.86 for the WORQ-BRIEF (n = 49/ n = 28). Bland Altman plots suggested a higher score at T1. As for criterion validity of the WORQ-FULL versus the WORQ-BRIEF, ICC was good (ICC = 0.84; n = 74), however Bland Altman plots indicated potential bias. Correlations with the WAS/EuroQOL 5D-5L were variable: r = -0.24/r = -0.57 (WORQ-FULL) and r = -0.28/-0.65 (WORQ-BRIEF). Conclusions The WORQ showed good internal consistency and test–retest reliability. Agreement demonstrated large score differences are needed to indicate change beyond random chance at individual level, whereas small changes are sufficient at group level. Criterion validity of the WORQ-FULL versus the WORQ-BRIEF was supported, however, agreement demonstrated moderate to large score differences are needed to indicate change beyond random chance at individual level, whereas small changes are sufficient at group level. This indicates the WORQ-FULL and WORQ-BRIEF are better not used interchangeably. Correlation analyses provided better insight in the validity of the WORQ. Convergent validity was supported for the WORQ-BRIEF with the EuroQoL 5D-5L (r = -0.65).

This study investigated the nanohydroxyapatite (nHA) prosthesis application effect based on CT-scanning data in spinal injury. This study chose 26 spinal injury patients treated in our hospital from September 2017 to September 2018, who were randomly divided into two groups. nHA prosthesis based on CT-scanning data was implanted in the nHA group, whereas titanium mesh was implanted in the titanium mesh group. Consequently, osteoblasts were cultured to test the biological activity of nHA and titanium alloy. In cell tests, we found osteoblasts could better adhere to nHA, and proliferation and activity were higher when planted on nHA material. After surgical treatment, all patients’ spinal symptoms (VAS score, JOA score, and Cobb angle) had improved and did not cause obvious inflammatory foreign body reactions. During a two-year follow-up, the fusion time and support settlement in the nHA group was lower, and the vertebral fusion rate and ASIA score were higher than those in the titanium mesh group. Thus, CT-scanning data could further improve the vertebral fusion rate in the nHA group. Consequentially, nHA prosthesis based on CT-scanning data is a better choice for spinal injury therapy.

There is no doubt that COVID-19 has had a profound impact on every medical and surgical speciality. In the height of the pandemic many non-emergency services were shut down, including dental services, with unexpected consequences. We present a case which highlights the unexpected and indirect consequences of a national lockdown on a Urology patient and discuss learning points. A 54-year-old male, previously fit and well suffered with a small dental abscess, media outlets were reporting that dental surgeries were closed, and he therefore attempted to drain the abscess himself. The infection spread to his epidural space, causing compression via a collection at L2 and consequently spinal cord injury. This was managed with urgent lumbar decompression and antibiotics. A specialist functional urology team were involved after his transfer to the tertiary spinal unit 3 months after his first presentation. He was catheterised but suffered with recurrent catheter blockages. Video urodynamics demonstrated a stable bladder with a low-pressure leak point, managed with urethral catheterisation. A repeat video urodynamics demonstrated a loss of compliance and stress incontinence. Unclear as to whether he would regain function rehabilitation techniques are currently being attempted prior for definitive operative management with an artificial sphincter. This case highlights the indirect impact of COVID-19 on UK urology services, and this has not been widely reported.

Since 2013, neurosurgeons have been guided by the RUANS recommendation protocol for surgical management of patients with acute cervical spine fractures in Russia. However, there are no studies devoted to interobserver agreement between specialists with different experience.To evaluate the role of the RUANS recommendation protocol for decision-making in patients with acute traumatic cervical spine injuries.Twenty-one neurosurgeons from 5 hospitals estimated data of 64 patients with cervical spine fractures. The study implied choosing an option for patient treatment (conservative therapy; anterior, posterior and circular fusion surgery). Two evaluations of CT and MR scans with an interval of 1.5 months were conducted. In the main group (9/21), neurosurgeons strictly followed the RUANS recommendation protocol during re-evaluation. In the control group (12/21), neurosurgeons analysed data considering their own knowledge and experience. Interobserver agreement was evaluated using a Fleiss' or Cohen's Kappa (K).Among the junior neurosurgeons (up to 5 years of experience), change in consent level during re-evaluation was greater in the main group (∆The RUANS recommendation protocol can significantly improve interobserver agreement between specialists with various levels of experience regarding management of acute cervical spine injury.С 2013 г. в России при выборе тактики лечения пострадавших с острыми переломами шейного отдела позвоночника нейрохирург может руководствоваться соответствующим рекомендательным протоколом. Исследований, посвященных уровню согласованности решений, принимаемых на основе рекомендательного протокола специалистами с разным уровнем опыта, нет.Оценить влияние рекомендательного протокола лечения острой осложненной и неосложненной травмы позвоночника у взрослых, предложенного Общероссийской общественной организацией «Ассоциация нейрохирургов России» (Рекомендательный протокол АНР), на уровень согласия специалистов разной квалификации при принятии решения о тактике лечения пострадавших с острой травмой шейного отдела позвоночника.Клинические и радиологические данные 64 пациентов с переломами шейного отдела позвоночника оценены 21 нейрохирургом из 5 стационаров. Следовало выбрать оптимальный вариант лечения (консервативная терапия, передний, задний и циркулярный спондилодез). Все участники оценивали данные 2 раза с интервалом в 1,5 мес. Первую оценку все участники проводили на основании личного опыта. При повторной оценке нейрохирурги основной группы (9 человек) строго следовали Рекомендательному протоколу АНР, участники контрольной группы (12), как и прежде, основывались на собственных знаниях и опыте. Уровень согласия наблюдателей в зависимости от числа участников оценивали при помощи каппы (К) Флейса или Коэна.У хирургов основной группы с опытом работы до 5 лет изменение уровня согласия при повторной оценке было большим (∆Применение рекомендательного протокола лечения острой осложненной и неосложненной травмы позвоночника у взрослых, предложенного Общероссийской общественной организацией «Ассоциация нейрохирургов России», позволяет существенно повысить уровень согласия специалистов разной квалификации при принятии решения о тактике лечения пострадавших с острой травмой шейного отдела позвоночника.

Experimental studies have demonstrated a relationship between spinal injury severity and vertebral kinematics, influenced by the initial spinal alignment of automotive occupants. Spinal alignment has been considered one of the possible causes of gender differences in the risk of sustaining spinal injuries. To predict vertebral kinematics and investigate spinal injury mechanisms, including gender-related mechanisms, under different seat back inclinations, it is needed to investigate the effect of the seat back inclination on initial spinal alignment in automotive seating postures for both men and women. The purpose of this study was to investigate the effect of the seat back inclination on spinal alignments, comparing spinal alignments of automotive seating postures in the 20° and 25° seat back angle and standing and supine postures. The spinal columns of 11 female and 12 male volunteers in automotive seating, standing, and supine postures were scanned in an upright open magnetic resonance imaging system. Patterns of their spinal alignments were analyzed using Multidimensional Scaling presented in a distribution map. Spinal segmental angles (cervical curvature, T1 slope, total thoracic kyphosis, upper thoracic kyphosis, lower thoracic kyphosis, lumbar lordosis, and sacral slope) were also measured using the imaging data. In the maximum individual variances in spinal alignment, a relationship between the cervical and thoracic spinal alignment was found in multidimensional scaling analyses. Subjects with a more lordotic cervical spine had a pronounced kyphotic thoracic spine, whereas subjects with a straighter to kyphotic cervical spine had a less kyphotic thoracic spine. When categorizing spinal alignments into two groups based on the spinal segmental angle of cervical curvature, spinal alignments with a lordotic cervical spine showed significantly greater absolute average values of T1 slope, total thoracic kyphosis, and lower thoracic kyphosis for both the 20° and 25° seat back angles. For automotive seating postures, the gender difference in spinal alignment was almost straight cervical and less-kyphotic thoracic spine for the female subjects and lordotic cervical and more pronounced kyphotic thoracic spine for the male subjects. The most prominent influence of seatback inclination appeared in Total thoracic kyphosis, with increased angles for 25° seat back, 8.0° greater in spinal alignments with a lordotic cervical spine, 3.2° greater in spinal alignments with a kyphotic cervical spine. The difference in total thoracic kyphosis between the two seatback angles and between the seating posture with the 20° seat back angle and the standing posture was greater for spinal alignments with a lordotic cervical spine than for spinal alignments with a kyphotic cervical spine. The female subjects in this study had a tendency toward the kyphotic cervical spine. Some of the differences between average gender-specific spinal alignments may be explained by the findings observed in the differences between spinal alignments with a lordotic and kyphotic cervical spine.

Prehospital spinal immobilization is a widely used procedure in the emergency medical service (EMS) system worldwide, while the incidence of patients with spinal injury (SI) is relatively low, and unnecessary prehospital spinal immobilization is associated with patient complications. This study aimed to determine the association between prehospital spine immobilization and favorable functional outcomes at hospital discharge among trauma patients with SI. We conducted a retrospective cohort study using the Pan-Asia Trauma Outcomes Study (PATOS) registry data from January 1, 2016, to November 30, 2018. A total of 759 patients with SI were enrolled from 43,752 trauma patients in the PATOS registry during the study period. The subjects had a median age of 58 years ( Q1−Q3,41−72), and 438 (57.7%) patients had prehospital spine immobilization. Overall, prehospital spinal immobilization was not associated with favorable functional outcomes at discharge in multivariable logistic regression (aOR, 1.06; 95%CI 0.62−1.81, p = 0.826). However, in the subgroup of cervical SI, prehospital spinal immobilization was associated with favorable functional outcomes at discharge (aOR, 3.14; 95%CI 1.04−9.50; p = 0.043). Therefore, we suggest that paramedics should be more careful when determining cervical SI and using prehospital immobilization.

The work analyzed the anesthesiology of 132 patients with a complicated spinal injury, who underwent surgical treatment for decibital ulcers of various localization. The basic principles of surgical treatment, approaches to the choice of type and method of anesthesiology, measures to prevent the development of vegetative hyperreflexion syndrome during surgery and in the early postoperative period.

Two three-dimensional geometric solid-state models of the Th7-L1 spinal segment (Model 1, Model 2) with metal construction were built. Models include the vertebrae Th7, Th8, Th9, Th10, Th11, Th12, L1, intervertebral discs, facet joints and ligaments, and metal construction elements. In Model 1, the cortical and spongy layers are constructed by three-dimensional solids, facet joints and intervertebral discs by three-dimensional bodies, ligaments by one-dimensional objects. In Model 2, the spongy layer of bone tissue is built with a three-dimensional solid body, the cortical layer with a shell 1 mm thick, the facet joints and intervertebral discs with three-dimensional bodies, and the ligaments with one-dimensional ones. Bodies are accepted linear, isotropic, homogeneous. The mechanical properties of all biological tissues and metal are set on the basis of published data. The problem of the statics of an elastic body is solved. The fields of complete displacements and Mises equivalent stresses are obtained for each point of the constructed models under characteristic loads. The analysis of the field of equivalent stresses makes it possible to identify areas of the spine that are most susceptible to destruction. The analysis of the field of full displacements makes it possible to evaluate the stability and reliability of fixation under standard physiological loads.

Background: Recurrent pressure sores and unstable scars over the bony prominences of the greater trochanter and ischium are a troublesome sequela of spinal injury. A reliable reconstruction is needed for patients with ‘dual-defect’ pressure sores in these locations. We modified the pedicled anterolateral thigh (ALT) flap to fit the reconstructive requirements of ‘dual-defect’ pressure sores.Methods: Eleven consecutive patients with concurrent pressure sores (> grade III) or unstable scar in one of the ‘dual-defect’ areas and an active pressure sore in the other were identified from the Victorian state tertiary referral centre for spinal injuries. We describe the technique and clinical experience of pedicled ALT flaps for reconstruction of ‘dual-defect’ pressure sores in this patient cohort. Preoperative status and minor and major postoperative complications were recorded. Results: Eleven consecutive pedicled myocutaneous ALT flaps were performed for reconstruction of ‘dual-defect’ pressure sores. Several key variations in the anatomical landmarks and the intra-operative flap raise technique that are integral to the use of the ALT flap for this application are described herein. The average dimensions of the cutaneous pressure sore defects were 6 x 4.9 cm (greater trochanter) and 8.2 x 6.7 cm (ischial). The average dimensions of the cutaneous paddle of the flaps raised were 27.3 x 8.4 cm. Two postoperative complications necessitated return to theatre but no incidences of flap loss were recorded. Conclusions: The modified pedicled myocutaneous ALT provides a robust reconstructive solution for resurfacing ‘dual-defect’ pressure sores in spinal patients. Further recommendations for future technical adaptations are made.

The study objectiveis to identify the features of diagnosis of patients with spinal cord injuries, resulting from falls from a height.Materials and methods.The data from 148 patients who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 01.01.2011 to 04.01.2016 were analyzed. Of these, 98 patients (the studied group) were injured in the spinal column as a result of a fall from a height of more than 2 m, 50 people (the comparison group) suffered in traffic accidents. We used clinical data, laboratory and radiological diagnostic methods. The severity of injuries in spinal injury was assessed according to the Injury Severity Score. When assessing the neurological status in spinal patients, the ASIA (American Spine Injury Assosiation) scale was used.Results.Significant differences in age (p = 0.57) and sex (p = 0.24) in the groups were not observed. More often at night: in the period from 00:00 to 6:00 in the morning – 44 (44.9 %) patients. There were significantly more patients with combined spinal injury in the studied group – 60 (61.2 %) than in the comparison group – 24 (48 %) (p Conclusion.Spinal cord injuries in catatrauma in 61.2 % of patients were accompanied by combined injuries of the internal organs and the musculoskeletal system. In 25.5 % of patients with catatrauma craniocerebral lesions were detected. On the ASIA scale, the proportion of victims with the most pronounced neurological disorders (ASIA A) was 30.6 %, and in the event of an accident – 6.0 %; to ASIA E – 36.8 % (in case of an accident – 64.0 %).

Introduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if...

Radiologists frequently interpret cross-sectional imaging of the spine in the setting of trauma. Mechanical stability of the traumatised spine is the single most important factor which guides further management. Several classification systems have been developed over the past to assist radiologists to judge the potentially unstable injuries. The radiologists are arguably most familiar with Denis system of classification which is based on injury morphology and mechanism. This system has been criticised for being too simple, not prognostically valuable and lack of consideration of patients' neurological status. AO (Arbeitsgemeinschaft für Osteosynthesefragen) and TLICS (Thoracolumbar Injury Classification and Severity Score ) classification systems are the next major evolutions which highlight the importance of the posterior ligamentous complex (PLC) and neurological status of the patients in predicting the potentially unstable fracture. The aim of this pictorial review is to familiarise radiologists with newer classification systems to improve their image interpretation skills and promote efficient communication with spinal surgeons. The pictorial examples are intended to illustrate the various injury types and how to classify them according to the aforementioned classification systems.

Background Seat belt marks are seen frequently on occupants after motor vehicle accidents. Over the years, the clinical significance of these marks has changed as restraint systems have evolved. With modern restraint systems, signs of a compromised occupant–restraint relationship are an important and easily identified bedside finding. Objectives We sought to learn to recognize seat belt marks that demonstrate an abnormal occupant–restraint system relationship and to cultivate an understanding of significant soft tissue biomechanical loading associated with marks caused by a compromised occupant–restraint relationship. Discussion A review of case studies from the literature combined with forensic work demonstrate a strong correlation between significant injury and improper seatbelt use. When evidence of a compromised occupant–restraint relationship exists, incorporating computed tomography angiography and observation may be clinically indicated. Conclusion The recognition of seat belt marks made by a compromised occupant–restraint relationship is an important finding that allows risk stratification of the patient at the bedside. Further investigation with a prospective trial at a trauma center is warranted.

BACKGROUND: Information on the performance of posterior fixation with cortical screw (CS) versus pedicle screw (PS) trajectories for stabilizing thoracolumbar burst fractures is limited. Therefore, we sought to analyze stability with CS versus PS in short- and long-segment fixations using a 3-column spinal injury model. METHODS: Nondestructive flexibility tests: (1) intact, (2) intact + short fixation, (3) intact + long fixation, (4) after burst fracture, (5) short fixation + burst fracture, and (6) long fixation + burst fracture using thoracic spine segments (7 CS, 7 PS). RESULTS: With CS, the range of motion (ROM) was significantly greater with short-segment than with long-segment fixation in all directions, with and without burst fracture (P ≤ .008). With PS and burst fracture, ROM was significantly greater with short fixation during lateral bending and axial rotation (P

A victim in a life-threatening situation is a big challenge for rescue services around the world. Especially in a situation where assistance is to be provided in conditions that also threaten rescuers. Such an event may occur, for example, in the conditions of the battlefield. In order to provide effective assistance, separate rescue systems had to be implemented, which on the one hand included effective assistance to the victim, and on the other, they adapted it to the battlefield. These systems allow limited exposure to the risk of health or life-threatening situations to the rescuers. The paramedic operating in the emergency medical system operates in the safe zone with the equipment in emergency backpacks, along with an ambulance and entities supporting the State Medical Rescue system. The victim is to receive full assistance according to current standards. The patient is to have all the tests done to confirm or rule out life-threatening inju- ries. Evacuation to the hospital takes place, if the situation requires, using equipment to fully immobilize the spine. Acting in combat conditions, a paramedic in a dangerous zone provides assistance to an injured person in the field of authorship or performs only simple activities to protect the basic life functions of the victim. It is only in a potentially safe zone that he uses emergency equipment stored in a rescue pack or a personal first aid kit. Evacuation of the victim takes place on a stretcher, which does not fully protect the victim with a spinal injury.