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ObjectivesMethodsResultsConclusionGrain storage facility entrapments continue to be of concern in the agricultural industry, with nearly 1,500 documented incidents recorded over the last 45 years. Previous research studies have shown that attempting to extricate a full-size pulling test dummy from a grain mass requires a substantial amount of tensile or pull force – e.g. up to 1.32 kN if “buried” at waist depth, 2.77 kN at chest depth, and 4.01 kN at head depth. There is, however, a paucity of studies on the amount of distraction the human lumbar spine region can endure. The objective of this research study was to test the maximum tensile force that could be exerted on a sheep’s spine (comparable to the human spine) before the intervertebral discs and surrounding ligament would show signs of failure.Eight lumbar-region sheep spine segments were axially distracted using an MTS Criterion tensile testing machine, and the maximum forces were recorded.The average maximum force that the spinal discs and ligament withstood before showing signs of failure was 2.14 kN (standard deviation of 0.31 kN). This is comparable to the force required to extricate an individual entrapped in a grain mass at chest depth.The authors recommend that grain entrapment victims should not be forcefully pulled out if buried to waist level or above due to two primary reasons: (1) the large variation in failure load observed in our experiment with sheep spines and (2) the lack of knowledge regarding the victim’s pre-existing medical condition. The extractive forces required to remove a victim of entrapment in grain overlaps with the force needed to cause potential damage to the sheep spine, as the 1.7–3.0 kN range is comparable to the 1.65–2.48 kN force range that causes axial failure in the spine. [ABSTRACT FROM AUTHOR]

Traumatic penetrating spinal injuries with wooden objects are rare. A 6-year-old boy presented with history of fall from tree 1 month back. It resulted in a penetrating injury at the lumbosacral area, followed by a discharging sinus without any neurological deficit. Radiological imaging showed a foreign body at the spinous process level traversing L4-5 and is lodged in L3-4 intervertebral body causing listhesis of L3 over L4. The wooden stick was retrieved with a meticulous surgical procedure. Proper imaging and early surgery are necessary to prevent any complications and early recovery. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia.Retrospective case record review of all children with concerns of head or neck trauma and/or documented cervical spine collar use presenting to the statewide Ambulance Victoria (AV) EMS service, Victoria, Australia, between 1 July 2019 and 30 June 2020. Demographic, clinical features, mechanism of injury and spinal immobilisation practices were extracted.2100 children were included; 61% were male and the median age was 13 years (interquartile range: 9–15). Over half of the children were transported to suburban (32.2%) and rural/regional (22.9%) EDs, with 37.5% taken to designated trauma centres. The most common mechanisms of injury were sports/activity, motor vehicle accidents and falls in 35.4%, 27.9% and 26.3%, respectively. Spinal precaution use was recorded in 93.7% of cases; cervical collar use was the most common procedure recorded (87.1%). Younger age groups were less likely to have spinal precautions initiated; 51% of children aged 0–3 years, compared to 96.3% of children aged 12 and older (odds ratio = 23.8; 95% confidence interval = 14.5–37; P < 0.001).Prehospital spinal precautions were initiated commonly in children, with use increasing with age, and most were transported to suburban, regional and rural hospitals, not trauma centres. These data will inform the integration of emerging paediatric‐specific evidence into prehospital guidelines to risk stratify children. [ABSTRACT FROM AUTHOR]

Thoracolumbar fractures are common injuries that usually result from high energy trauma. They can lead to significant morbidity due to neurologic impair - or mortality - if not managed according to strict and rapid intervention rules in terms of decompression of the spinal cord, and rigid fixation of the fracture. This manuscript reviews emergency treatment protocols, imaging modalities, and classification systems used for thoracolumbar fractures. The emergency treatment is discussed, specific classifications are compared and indications for surgeries are compared. [ABSTRACT FROM AUTHOR]

Objective: To determine the impacts to research the impacts of pain's Specialized Pain Management Nursing Care in the perioperative period on pain symptoms and life quality of patients experiencing minimally invasive surgery for spinal injury. Method: Eighty patients with a spinal injury who underwent minimally invasive surgery in the Department of Orthopedics of Baoding No.1 Hospital from January 2018 to December 2021 were retrospectively analyzed. They were split into two groups following different nursing methods (n=40 each group). Specialized Pain Management Nursing Care were given to patients in the observation group. Those in the control group were given treated with routine care. Their pain score and nursing effect were compared, after which their quality of life, daily living ability and complication rate compared and analyzed. Results: The pain degree in the control group was considerably more than that in the observation group in the 1st postoperative period. The pain degree, which decreased in both groups, slumped more significantly in the observation group on the 2nd and 3rd postoperative days. The postoperative hospital stays and pain duration in the observation group were shorter than those in the control group (P<0.05), and the nursing effect was significantly better than that in the control group (P<0.05). After postoperative nursing intervention. Conclusion: Minimally invasive surgery integrated with the Specialized Pain Management Nursing Care can remarkably ameliorate pain after spinal injury surgery, reducing complications' incidence, and improving the life quality for patients. [ABSTRACT FROM AUTHOR]

Incidence of spinal injury is high in the Middle East and North African region (MENA) due to the high incidence of road traffic crashes. A spinal injury may trigger mental health issues. Compared to the general population, people with spinal injury are at higher risk for developing major depression, anxiety, posttraumatic stress disorders, substance abuse, and suicide. Objectives: The objectives of the study were to determine depression prevalence; identify relationships between depression and cause and site of spinal injury, sociodemographic factors, and social support; and explore the lived experiences of depression in people with spinal injury in Qatar. Methods: A sequential cross-sectional mixed methods study was conducted. In the quantitative component, the universal sample consisted of 106 consenting individuals presenting with spinal injury at Hamad General Hospital, Doha, Qatar between January and December 2020. The Patient Health Questionnaire-9 was used to assess levels of depression and the Medical Outcomes Study Social Support Survey was used to assess perceived social support. The cause and site of injury were obtained from patient records. In the qualitative component, semistructured in-depth interviews were conducted with 12 purposively selected participants from the quantitative component. Results: Spinal injury had a negative impact on participants physical, mental, social, and spiritual wellbeing. In total, 69% of participants had some level of depression: 28% mild, 25.5% minimal, and 15% moderate to severe. Depression was not associated with socio-demographic factors, or the cause or site of spinal injury. Higher levels of emotional/informational support and positive social interaction were associated with milder depression. Social support and religious faith were critical in assisting participants to cope with their new situation. Conclusions: Depression is prevalent among people with spinal injury attending health services. Early detection, referral, and treatment of depression are recommended. Strategies to enhance emotional/informational support and positive social interaction should be developed and tested with people with spinal injury. [ABSTRACT FROM AUTHOR]

Background: Traumatic spinal injury (TSI) encompasses a wide range of injuries affecting the spinal cord, nerve roots, bones, and soft tissues that result in pain, impaired mobility, paralysis, and death. There is some evidence suggesting that women may have different physiological responses to traumatic injury compared to men; therefore, this study aimed to investigate if there are any associations between sex and adverse outcomes following surgically managed isolated TSI. Methods: Using the 2013–2019 TQIP database, all adult patients with isolated TSI, defined as a spine AIS ≥ 2 with an AIS ≤ 1 in all other body regions, resulting from blunt force trauma requiring spinal surgery, were eligible for inclusion in the study. The association between the sex and in-hospital mortality as well as cardiopulmonary and venothromboembolic complications was determined by calculating the risk ratio (RR) after adjusting for potential confounding using inverse probability weighting. Results: A total of 43,756 patients were included. After adjusting for potential confounders, female sex was associated with a 37% lower risk of in-hospital mortality [adjusted RR (95% CI): 0.63 (0.57–0.69), p < 0.001], a 27% lower risk of myocardial infarction [adjusted RR (95% CI): 0.73 (0.56–0.95), p = 0.021], a 37% lower risk of cardiac arrest [adjusted RR (95% CI): 0.63 (0.55–0.72), p < 0.001], a 34% lower risk of deep vein thrombosis [adjusted RR (95% CI): 0.66 (0.59–0.74), p < 0.001], a 45% lower risk of pulmonary embolism [adjusted RR (95% CI): 0.55 (0.46–0.65), p < 0.001], a 36% lower risk of acute respiratory distress syndrome [adjusted RR (95% CI): 0.64 (0.54–0.76), p < 0.001], a 34% lower risk of pneumonia [adjusted RR (95% CI): 0.66 (0.60–0.72), p < 0.001], and a 22% lower risk of surgical site infection [adjusted RR (95% CI): 0.78 (0.62–0.98), p < 0.032], compared to male sex. Conclusion: Female sex is associated with a significantly decreased risk of in-hospital mortality as well as cardiopulmonary and venothromboembolic complications following surgical management of traumatic spinal injuries. Further studies are needed to elucidate the cause of these differences. [ABSTRACT FROM AUTHOR]

Background: Trauma to the spine can lead to vertebral fracture, luxation or subluxation. Spinal injuries can cause partial or total loss of neurological functions. Neurologic signs of cervical spine injuries can range from mild pain to tetraplegia, and in cases of subluxation and instability, surgical treatment is usually indicated to stabilize the vertebrae. The aim of this study is to report the case of a dog with traumatic subluxation of the cervical spine that underwent surgical treatment to stabilize the cervical vertebrae. Case: A 7-year-old Shih-Tzu male dog, weighing 5.9 kg, was evaluated at a Veterinary Clinic with neurological signs suggestive of spinal injury. In the anamnesis, the owner reported that about 7 months ago the animal had suffered a domestic trauma, most likely due to a fall from a child's lap. It was reported that the animal stopped walking after the fall, and initially the dog was taken to a Veterinary Clinic, where the 1st care was performed. At that time, radiographic examinations of the spine in the lumbar region and of the hip joints were performed, where no alteration was observed. Seven months after the trauma, the neurological signs still persisted, and the owner raised funds to continue the treatment. The neurological examination revealed plegia in the pelvic limbs and paresis in the forelimbs, partially preserved nociception and signs compatible with spinal injury in the cervical region. Radiographic examinations of the cervicothoracic region of the spine demonstrated possible disc protrusion between cervical vertebrae C5-C6. A computed tomography scan of the same region was performed, which showed instability and subluxation of the spine, more pronounced between the C5-C6 cervical vertebrae, promoting extradural compressive myelopathy in this medullary segment, indicating the need for surgical stabilization. The technique of ventral vertebral application of screws fixed with polymethylmethacrylate (PMMA) was performed for vertebral stabilization. Access to the ventral surface of the bodies of the C5-C6 cervical vertebrae was performed, and 6 cortical screws (1.5 mm in diameter) were implanted, with 3 screws being fixed in each cervical vertebra. Subsequently, PMMA bone cement was applied on the screws and affected vertebrae. The dog started the rehabilitation in the 2nd week after the surgical procedure. In the physiatric evaluation the patient presented with ataxia and proprioceptive deficit, absence of superficial pain and presence of deep pain in all limbs. The physiotherapy treatment protocol instituted included photobiomodulation (laser therapy), pulsatile magnetic field and kinesiotherapy. The exercises performed initially were passive, evolving to assisted, free and isometric active. Discussion: This was a lesion in the cervical region of the spine, with large vertebral bodies and with the possibility of surgical access through a ventral approach, and therefore the technique of ventral application of screws fixed with polymethylmethacrylate (PMMA) was chosen. The surgical method was chosen because of its ability to stabilize the cervical vertebrae effectively and relatively simply. The PMMA was fixed to the screws and to the vertebral bone, forming a rigid and well-shaped structure, allowing the stability of the affected cervical region. After the physiotherapy sessions, the patient showed good outcome with fast and progressive recovery of ambulation, and adequate recovery of neurological and motor function after 40 days of surgery. In conclusion, the surgical technique used, associated with physiotherapy, proved to be effective in stabilizing the cervical spine and in recovering the neurological function of the dog. [ABSTRACT FROM AUTHOR]

Spinal injuries are a concern for automotive applications, requiring large parametric studies to understand spinal injury mechanisms under complex loading conditions. Finite element computational human body models (e.g. Global Human Body Models Consortium (GHBMC) models) can be used to identify spinal injury mechanisms. However, the existing GHBMC detailed models (with high computational time) or GHBMC simplified models (lacking vertebral fracture prediction capabilities) are not ideal for studying spinal injury mechanisms in large parametric studies. To overcome these limitations, a modular 50th percentile male simplified occupant model combining advantages of both the simplified and detailed models, M50-OS + DeformSpine, was developed by incorporating the deformable spine and 3D neck musculature from the detailed GHBMC model M50-O (v6.0) into the simplified GHBMC model M50-OS (v2.3). This new modular model was validated against post-mortem human subject test data in four rigid hub impactor tests and two frontal impact sled tests. The M50-OS + DeformSpine model showed good agreement with experimental test data with an average CORrelation and Analysis (CORA) score of 0.82 for the hub impact tests and 0.75 for the sled impact tests. CORA scores were statistically similar overall between the M50-OS + DeformSpine (0.79 ± 0.11), M50-OS (0.79 ± 0.11), and M50-O (0.82 ± 0.11) models (p > 0.05). This new model is computationally 6 times faster than the detailed M50-O model, with added spinal injury prediction capabilities over the simplified M50-OS model. [ABSTRACT FROM AUTHOR]

The management of spinal trauma in the pre-hospital setting is based on techniques of immobilization for prevention of secondary neurological damage in high-risk patients during transportation.1 Since the ’70s, the traditional form of Preventive Spinal Immobilization (PSI) has been carried out using a long spinal board, head blocks, and immobilization straps often associated with the placement of a cervical collar.2 The first documentation of this practice comes from the early 19th century, when pre-hospital trauma care was introduced on the battlefields of the Napoleonic Wars.3 This strategy is still adopted by many pre-hospital medical services worldwide and taught as the gold standard on many trauma courses. The traditional form of PSI is indeed based more on pragmatism than on high-quality studies supporting its efficacy.3 [...]

Compared to multiaxial computed tomography, the cone beam computed tomography has its benefits in terms of higher resolution imaging, including the construction of a 3D image, and in terms of several fold lower radiation exposure. The duration of scanning of less than 1 minute and the possibility to place a patient in the sitting position allow for the use of this method in various fields of stomatology, maxillofacial surgery, as well as in traumatology for the assessment of limb injuries. The paper presents our experience with the cone beam computed tomography as a single method for radiation diagnostics in children with cervical spine injuries. The first case is an example of the use of this method for primary diagnosis and subsequent follow-up of the restoration of the atlantoaxial position in a 9-year old child with rotatory subluxation of the atlant. To clarify the type of the injury, we combined and compared the axial planes of the 1st and 2nd cervical vertebrae. In the second case, we explored the possibility to assess the restoration of the bone structure and mutual position of the upper cervical vertebrae with the images obtained by cone beam computed tomography in a 9-year old girl with the Down's syndrome, who had been operated due to a cervical spine injury. The analysis of the cone beam computed tomography images from the first clinical case delineates the prospects of the method in the diagnostics of the atlant rotation subluxation in school-age children. Evaluation of the images obtained during the examination of the second clinical case has identified some disadvantages of the cone beam computed tomography, namely: 1) there is no way to control the fixed patient position, 2) limitations of the software to suppress artifacts arising from the metal construction, which leads to advanced image blurring and flatness, significantly hindering the identification of abnormalities.

RELEVANCE A special place in the development of enteral insufficiency is given to dysproteinemia, which is one of the leading causes of the development of decubital ulcers in patients with spinal cord injury. Early enteral nutrition partially solved this problem, but the incidence of bedsores still remains high and reaches 68%. The risk of metabolic disorders in the acute period of spinal injury is largely determined by non-occlusive intestinal ischemia against the background of spinal shock, neurohumoral dysregulation; intra-intestinal and intra-abdominal hypertension; change in intestinal microflora. Pathological changes in the intestinal wall occur during the first 20 days after injury and further exacerbate chronic maldigestion, malabsorption, intestinal dyskinesia in patients with traumatic spinal cord disease. New knowledge about the features of early enteral nutrition in patients in the acute period of traumatic spinal cord disease will reduce the risk of decubitus ulcerative defects.AIM OF THE STUDY To study the dynamics of metabolic processes in the tissues of the small intestine in the acute period of spinal injury.MATERIAL AND METHODS Wistar rats (n=22). Spinal injury was simulated by acute complete transection of the spinal cord at the level of Th5–Th6 vertebrae. The assessment of metabolic changes in the cells of the serous membrane of the intestine was performed immediately, 3 and 24 hours after injury. The metabolism was assessed in vivo using fluorescence time-resolved macroimaging technology FLIM by autofluorescence in the spectral channel of the metabolic cofactor nicotinamide adenine dinucleotide (phosphate).RESULTS The acute period of spinal cord injury is accompanied by a change in the endogenous autofluorescence of the serous membrane of the small intestine: a statistically significant decrease in the mean fluorescence lifetime (τm), the lifetime of the long component (τ2), and the relative contribution of the long component (а2) in 24 h after injury was recorded. The changes observed using FLIM confirm the catabolic type of metabolism in the tissues of the small intestine after spinal cord injury.CONCLUSION For the first time in the experiment in vivo it has been shown that the acute period of spinal injury is accompanied by a violation of metabolic processes in the tissues of the small intestine. This fact requires a more balanced approach in calculating the calorie content of nutrients used for early enteral nutrition in patients with spinal cord injury.

Incidence of spinal injury is high in the Middle East and North African region (MENA) due to the high incidence of road traffic crashes. A spinal injury may trigger mental health issues. Compared to the general population, people with spinal injury are at higher risk for developing major depression, anxiety, post-traumatic stress disorders, substance abuse, and suicide.ObjectivesThe objectives of the study were to determine depression prevalence; identify relationships between depression and cause and site of spinal injury, sociodemographic factors, and social support; and explore the lived experiences of depression in people with spinal injury in Qatar.MethodsA sequential cross-sectional mixed methods study was conducted. In the quantitative component, the universal sample consisted of 106 consenting individuals presenting with spinal injury at Hamad General Hospital, Doha, Qatar between January and December 2020. The Patient Health Questionnaire-9 was used to assess levels of depression and the Medical Outcomes Study Social Support Survey was used to assess perceived social support. The cause and site of injury were obtained from patient records. In the qualitative component, semi-structured in-depth interviews were conducted with 12 purposively selected participants from the quantitative component.ResultsSpinal injury had a negative impact on participants physical, mental, social, and spiritual wellbeing. In total, 69% of participants had some level of depression: 28% mild, 25.5% minimal, and 15% moderate to severe. Depression was not associated with socio-demographic factors, or the cause or site of spinal injury. Higher levels of emotional/informational support and positive social interaction were associated with milder depression. Social support and religious faith were critical in assisting participants to cope with their new situation.ConclusionsDepression is prevalent among people with spinal injury attending health services. Early detection, referral, and treatment of depression are recommended. Strategies to enhance emotional/informational support and positive social interaction should be developed and tested with people with spinal injury.

Introduction: Vertebral fractures in postictal patients with no prior acute or chronic trauma history are rare but can lead to severe neurological complications if missed during the initial evaluation. Research question: What are the prevalence and risk factors associated with vertebral fractures? What are the characteristics of these fractures in terms of their location, severity, and clinical outcome? Materials and methods: A comprehensive literature search using MeSH terms was conducted. Data from previously published studies and three new cases from the authors' institution were collected. The variables included demographic information, seizure history, medical comorbidities, fracture characteristics, and treatment details. Descriptive statistics summarize the data. Inferential statistics (t-test, Mann-Whitney U test, chi-squared test, Fisher's exact test, and logistic regression) were used to identify the risk factors for vertebral fractures. Results: The review included nine studies with a total of 19 patients, and three additional unpublished cases from the authors' institution. The median patient age was 50 years, with male predominance. No significant differences were found between the groups in osteoporosis, seizure history, antiepileptic drug use, or alcohol or drug abuse. The most common sites of fracture were the midthoracic spine for compression fractures and thoracolumbar junction for burst fractures. Risk factors for fractures include greater muscle mass, lower bone mineral density, longer convulsions, and recurrent convulsions. Discussion: The mechanism of injury involved violent muscle contractions during seizures. Conclusion: This review summarizes the current knowledge and provides evidence for best practices in the management of seizure-induced vertebral fractures.

Background: Persons with tetraplegia rank improved upper extremity (UE) function as the most important rehabilitation outcome because it allows them greater independence in activities of daily living (ADL). The aim of this study was to describe UE status in patients with tetraplegia using the International Spinal Cord Injury Upper Extremity Basic Data Set version 1.1 (ISCI-UE 1.1) and to determine differences in UE status between tetraplegic individuals with traumatic and non-traumatic SCIs. Methods: This cross-sectional study was conducted among patients with tetraplegia who attended the SCI rehabilitation clinic of a tertiary hospital from September 2021 to August 2022. Both upper limbs were assessed using ISCI-UE 1.1. Results: One hundred patients were included in this study, of whom 80 were men. The mean (SD) age of the patients was 54.30 (16.95) years old. In these patients, most SCIs (62%) were of traumatic origin. Two hundred UEs were evaluated, of which 109 showed good hand function (level 5) and 10 had the poorest hand function (level 1). Meanwhile, 130 UEs showed good shoulder function (level D) and 10 had the poorest shoulder function (level A). A statistically significant association with UE status (reach-and-grasp ability and shoulder function) was found in both the non-traumatic and traumatic SCI groups, with better hand and shoulder functions in the non-traumatic SCI group (right-hand, P = 0.004 and left hand, P = 0.001; right shoulder, P < 0.001 and left shoulder, P = 0.002). Conclusion: ISCI-UE 1.1 is a feasible tool for documenting UE function in patients with tetraplegia. Compared with the individuals with traumatic SCI in this study, those with non-traumatic SCI demonstrated better upper extremity functionality. [ABSTRACT FROM AUTHOR]

Study Design: Bibliometric analysis. Objectives: This study aimed to highlight the 200 most influential articles related to traumatic spinal cord and spinal column injuries and provide an insight of past and current global trends in spinal trauma research. Methods: The Web of Science database was used to identify the top 200 most cited articles on the topic of traumatic spinal cord injury (SCI) and spinal column injuries between using a prespecified algorithm. The articles were manually reviewed; bibliometrics were collected on title, first and corresponding authors' country, institution, journal, publication year, and citation data. Results: The search string yielded 30,551 articles during 1977–2019. The average time from the publication was 19.5 years. A total of 1356 authors contributed to 67 different journals, the top 200 most cited articles amassing a total of 88,115 citations and an average 440.6 citations. The United States of America (USA) contributed the most with 110 articles; the top institution was the University of Toronto with 34 publications. Most studies focused on basic science research on SCI. Keyword analysis revealed the most commonly used keywords: SCI, inflammation, apoptosis, incidence/prevalence, and regeneration; four word-clusters were identified. Institutions from the USA and Canada collaborated the most and two major and two minor institutional collaboration subnetworks were identified. Co-citation analysis detected three main clusters of authors. Conclusion: This overview of the most cited articles on traumatic spinal cord and spinal column injuries provides insight into the international spinal trauma community and the terrain in this field, potentially acting as a springboard for further collaboration development. [ABSTRACT FROM AUTHOR]

To improve the ecological and economic sustainability in the Dutch beam trawl fishery, tickler chains were replaced by electrical pulse stimulation to drive common sole (Solea solea) out of the seabed. Because electrical stimulation may cause internal injuries, we quantified this risk by sampling fish species from commercial beam trawlers and recording spinal injuries and haemorrhages from X-radiographs and autopsy. To distinguish mechanically-induced and electrical-pulse-induced injuries, we compared injuries in ten species sampled from pulse (PUL) and tickler-chain (TCK) trawlers and four species sampled from PUL trawlers with the stimulus switched on or off. Co-occurrence of a major spinal injury and major haemorrhage at the same location was only observed in PUL samples, and were frequently (40%) observed in Atlantic cod (Gadus morhua) and in low numbers (0–2%) in whiting (Merlangius merlangus), grey gurnard (Eutrigla gurnardus), and greater sandeel (Hyperoplus lanceolatus), but not in flatfishes and other species. In cod, injury occurrence correlated with fish length, with lower probabilities for small fish. Major spinal injury or major haemorrhage occurrence in PUL (range: <1–16%) was lower than in TCK (range: <1–42%) in eight of the ten species studied. Population level consequences of pulse-induced injuries are considered negligible. [ABSTRACT FROM AUTHOR]

The paper presents a clinical case report and non-systematic review of the literature on the problem of the manubriotomy use in the treatment of complicated injury of the cervicothoracic spine. Approach to surgical treatment of complicated compression-comminuted fracture- dislocation of the cervicothoracic spine was based on preoperative calculation of angulometric characteristics of the injury and individual characteristics of the patient’s anatomy, including the Teng criterion. A partial resection of the manubrium of sternum in the area of the jugular notch was performed to ensure safe and stable placement of the cervical fixation plate. Complete restoration of the axis and stability of the spine, and regression of neurological deficit were achieved. The preoperative determination of the Teng criterion in planning cervicothoracic intervention allows, taking into account the anatomical features of the patients, to assess a zone of optimal visualization, as well as to plan caudal expansion of the approach, including by limited U-shaped manubriotomy.

Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient’s spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians’ understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes.

This paper presents the clinical outcome of an 82-year-old female who experienced sudden back pain combined with lower limb paresthesia and weakness after epidural steroid injection. The magnetic resonance imaging of the thoracolumbar spine showed a spinal epidural hematoma (SEH) extending from T8 to L4. She was treated non-operatively in the traditional Korean medicine (TKM) hospital. The patient’s progress was assessed using the Numerical Rating Scale (NRS), American Spinal Injury Association (ASIS), Spinal Cord Independence Measure version III (SCIM III), and self-reported symptoms. During the 22-day hospitalization period, the NRS score decreased from 7 to 2 points, the motor score on the ASIS scale increased from 65 to 95 points. The subjective sense of lower extremities was felt by 1 increased to 8. The SCIM III score increased from 32 to 69 points. These results suggest that TKM could effectively reduce pain and aid the rehabilitation of patients with SEH.

Study Design: Bibliometric analysis. Objectives: This study aimed to highlight the 200 most influential articles related to traumatic spinal cord and spinal column injuries and provide an insight of past and current global trends in spinal trauma research. Methods: The Web of Science database was used to identify the top 200 most cited articles on the topic of traumatic spinal cord injury (SCI) and spinal column injuries between using a prespecified algorithm. The articles were manually reviewed; bibliometrics were collected on title, first and corresponding authors' country, institution, journal, publication year, and citation data. Results: The search string yielded 30,551 articles during 1977–2019. The average time from the publication was 19.5 years. A total of 1356 authors contributed to 67 different journals, the top 200 most cited articles amassing a total of 88,115 citations and an average 440.6 citations. The United States of America (USA) contributed the most with 110 articles; the top institution was the University of Toronto with 34 publications. Most studies focused on basic science research on SCI. Keyword analysis revealed the most commonly used keywords: SCI, inflammation, apoptosis, incidence/prevalence, and regeneration; four word-clusters were identified. Institutions from the USA and Canada collaborated the most and two major and two minor institutional collaboration subnetworks were identified. Co-citation analysis detected three main clusters of authors. Conclusion: This overview of the most cited articles on traumatic spinal cord and spinal column injuries provides insight into the international spinal trauma community and the terrain in this field, potentially acting as a springboard for further collaboration development.

• Biomechanical simulation of axial force induction testing C1/2 Harms Construct. • Lateral Mass screws construct resulted from 142.04 µm/m to 188.54 µm/m. • Pedicle screws construct resulted from 165.98 µm/m to 195.95 µm/m. • Pedicle screws in a C1/2 Harms Construct were not superior compared to lateral mass screws. The use of the posterior arch of C1 as pedicle has shown beneficial stability regarding screw loosening, however, the C1 pedicle screw placement is challenging. Therefore, the study aimed to analyse the bending forces of the Harms construct used in fixation of C1/C2 when using pedicle screws compared to lateral mass screws. Five cadaveric specimens with a mean age of 72 years at death and bone mineral density measuring for 512.4 Hounsfield Units (HU) on average were used. A custom-made biomechanical setup was used to test the specimens with a C1/C2 Harms construct each with the use of lateral mass screws and pedicle screws in sequence. Strain gauges were used to analyse the bending forces from C1 to C2 in cyclic axial compression (μm/m). All underwent cyclic biomechanical testing using 50, 75 and 100 N. In all specimens, placement of lateral mass screws and pedicle screws was feasible. All underwent cyclic biomechanical testing. For the lateral mass screw, a bending of 142.04 µm/m at 50 N, 166.56 µm/m at 75 N and 188.54 µm/m at 100 N was measured. For the pedicle screws, bending force was slightly elevated with 165.98 µm/m at 50 N, 190.58 µm/m at 75 N and 195.95 µm/m at 100 N. However, bending forces did not vary significantly. In all measurements, no statistical significance was found when comparing pedicle screws and lateral mass screws. The lateral mass screw used in the Harms Construct to stabilize C1/2 showed less bending forces, therefore the construct with lateral mass screws appears more stable in axial compression compared to the one with pedicle screws. However, bending forces did not vary significantly. [ABSTRACT FROM AUTHOR]

The purpose of this review was to compare all intervention modalities aimed at increasing skeletal muscle mass (SMM) in the paralysed limbs of persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI). A systematic review of EMBASE, MEDLINE, Scopus, and SPORTDiscus databases was conducted from inception until December 2021. Published intervention studies aimed to increase SMM (measured by magnetic resonance imaging, computed tomography, ultrasound, muscle biopsy, or lean soft tissue mass by dual X-ray absorptiometry) in the paralysed limbs of adults (>18 years) with SCI were included. Fifty articles were included that, overall, demonstrated a high risk of bias. Studies were categorised into six groups: neuromuscular electrical stimulation (NMES) with and without external resistance, functional electrical stimulation cycling, walking- and standing-based interventions, pharmacological treatments, and studies that compared or combined intervention modalities. Resistance training (RT) using NMES on the quadriceps produced the largest and most consistent increases in SMM of all intervention modalities. Current evidence suggests that clinical practise aiming to increase SMM in the paralysed limbs of persons with motor complete SCI should perform NMES-RT. However, more high-quality randomised control trials are needed to determine how training variables, such as exercise volume and intensity, can be optimised for increasing SMM. Persons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease. Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury. The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population. [ABSTRACT FROM AUTHOR]

We review the spatial organization of corticospinal outputs from different cortical areas and how this reflects the varied functions mediated by the corticospinal tract. A long-standing question is whether the primate corticospinal tract shows somatotopical organization. Although this has been clearly demonstrated for corticofugal outputs passing through the internal capsule and cerebral peduncle, there is accumulating evidence against somatotopy in the pyramidal tract in the lower brainstem and in the spinal course of the corticospinal tract. Answering the question on somatotopy has important consequences for understanding the effects of incomplete spinal cord injury. Our recent study in the macaque monkey, using high-resolution dextran tracers, demonstrated a great deal of intermingling of fibres originating from primary motor cortex arm/hand, shoulder and leg areas. We quantified the distribution of fibres belonging to these different projections and found no significant difference in their distribution across different subsectors of the pyramidal tract or lateral corticospinal tract, arguing against somatotopy. We further demonstrated intermingling with corticospinal outputs derived from premotor and supplementary motor arm areas. We present new evidence against somatotopy for corticospinal projections from rostral and caudal cingulate motor areas and from somatosensory areas of the parietal cortex. In the pyramidal tract and lateral corticospinal tract, fibres from the cingulate motor areas overlap with each other. Fibres from the primary somatosensory cortex arm area completely overlap those from the leg area. There is also substantial overlap of both these outputs with those from posterior parietal sensorimotor areas. We argue that the extensive intermingling of corticospinal outputs from so many different cortical regions must represent an organizational principle, closely related to its mediation of many different functions and its large range of fibre diameters. The motor sequelae of incomplete spinal injury, such as central cord syndrome and 'cruciate paralysis', include much greater deficits in upper than in lower limb movement. Current teaching and text book explanations of these symptoms are still based on a supposed corticospinal somatotopy or 'lamination', with greater vulnerability of arm and hand versus leg fibres. We suggest that such explanations should now be finally abandoned. Instead, the clinical and neurobiological implications of the complex organization of the corticospinal tract need now to be taken into consideration. This leads us to consider the evidence for a greater relative influence of the corticospinal tract on upper versus lower limb movements, the former best characterized by skilled hand and digit movements. [ABSTRACT FROM AUTHOR]

• In Italy, spinal injuries are most frequently caused by road accidents (59.9%, mainly cervico-thoracic) than by falls (35.1%, mainly lumbar). • Most patients with spinal injuries (70.7%) have a high injury severity score patients, i.e. ISS≥16. • Trauma patients have more severe spinal injuries in fall cases (40.1%) compared to RA (21.9% to 26.3%). • A spinal cord injury (SCI) complicated 13.7% fractures. SCI decreased with aging and extremities associated injuries but increased at higher ISS. • Among upper cervical injuries, the probability of a severe fracture increased by 5.95 times in the presence of facial associated injuries. Traumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management. Retrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures. Patients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died. In Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury. [ABSTRACT FROM AUTHOR]

Objectives Understanding the occupational characteristics of patients is not only related to patients' life and health, but also conducive to improving their happiness. However, there were no studies that had been conducted on the relationship between occupation characteristic and postoperative recovery in patients with spinal fractures. The purpose of this study was to explore the relationship between the occupation characteristics of patients with thoracolumbar fracture and the characteristics of disease injury, treatment, and recovery so as to reduce the incidence and improve postoperative rehabilitation. Methods Patients (n = 719) with thoracolumbar fractures were recruited. Patients were grouped according to the characteristic of occupations: unemployed group (n = 299), white‐collar worker group (n = 20), and blue‐collar worker group (n = 400). Data were collected, including the characteristics, injury and treatment information, and the recovery records for 1 year after operation. One‐way ANOVA analysis, χ2 test, and binary logistic regression analysis was used to explore the relationship among these factors. Results Male, high‐falling injuries and single segment injury (mainly T 11, T 12 and L2) were common in patients with thoracolumbar fractures, especially in the blue‐collar worker group (70.8%, 78.3%, and 85.4%). Compared with the unemployed group, the patients in the white‐collar worker group and blue‐collar worker group had a higher proportion of young patients, a higher height and weight, a lesser rate of hypertension or diabetes. One week after injury, 73.4% of patients underwent surgery, with the blue‐collar worker group accounted for the largest proportion. One month after surgery, 77.1% of patients were able to get out of bed, with the white‐collar worker group accounted for the largest proportion. In the postoperative recovery information, patients in the blue‐collar worker group were more likely to have severe low back pain (OR = 2.023, 95% CI: 1.440‐2.284) and pain‐disturbed sleep (OR = 2.287, 95% CI: 1.585‐3.299) than those who in the unemployed group. Conclusions Blue‐collar workers, with a high risk of thoracolumbar fracture, have a higher incidence of low back leg pain and pain‐disturbed sleep in the recovery after thoracolumbar fracture surgery, and this requires more attention.

Although acute spinal injury is rarely reported to complicate total hip arthroplasty (THA), its consequences can be devastating. We present a case of L5-S1 discoligamentous dissociation following single-stage bilateral THA performed sequentially through an anterior approach with a traction hemi-table applied on the operated leg. Internal fixation L5-S1 was required, resulting in prolonged recovery, but without relevant long-term sequelae. Pre-operative assessment of the spine is recommended when considering these procedures to evaluate the risk for this potentially severe complication. Particularly, lateral position may be favoured to avoid extension stresses of the spine. An anterior approach may have to be avoided, as it requires hyperextending the hip. A staged procedure may also be preferred to a single-anaesthesia bilateral procedure, limiting duration of potentially harmful positioning.

Abstract Background This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome. Surgical technique and post-operative management is discussed. Case presentation A 34-year-old fit and well healthy man was admitted with a history of stab injury to the thoracic spine at thoracic T2/3 level with ASIA impairment score (AIS) score D with an incomplete spinal cord affecting his left lower limb with complete paralysis and right lower limb paresis with impaired sensation below T6 level to L5. Neuroimaging confirmed a penetrating knife injury traversing the T2/3 level causing hemi-section of the spinal cord confirmed intraoperatively. He underwent an urgent exploratory surgery of his spine and a T2/3 laminectomy was performed to aid removal of the knife. The dura was noted to be contused and severed spinal cord was noted to be severed with associated cord oedema. A microsurgical repair of the severed cord was performed with duroplasty followed by intense neuro-rehabilitation. On a 3 month follow up his AIS score is E with lower limb power is 5/5 bilaterally and he is able to mobilise independently up to 8–10 steps without any supportive aid and with crutches he is independently functional and mobile. Conclusion This is the first documented case of microsurgical repair of severed thoracic spinal cord secondary to traumatic knife injury. In the management of such scenario, apart from the removal of foreign body, repair of the cord with duroplasty should be carefully considered. The role of spinal neuroplasticity in healing following timely repair of the spinal cord along with intense rehabilitation remains the key. This had resulted in a good clinical and functional outcome with in a 18-month follow up.

Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient's spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians' understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: For ages, humankind and horses have been closely related to occupational and recreational activities. The dangers of engaging with horses have been previously reported. Among sporting activities, horse riding is well-known for its risks. Despite multiple recommendations to wear protective gear, horse-related activities still comprise the risk of severe injuries. This study aimed to examine: (1) if specific mechanisms are correlated to particular injury patterns and (2) if injury types are related to patient demographics. Methods: From one level I trauma center, between July 2019 and July 2022 (3 years) all emergency reports and discharge letters were retrospectively reviewed by full-text search regarding horse-related injuries. Patient demographics, body mass index, trauma mechanism, injury types, and initiated treatment were extracted from medical records and analyzed. Results: During the study period, 95 patients with 99 horse-related injuries were included. The overwhelming majority of the patients was female (93.7%). Age averaged 35.3 years (range 6 to 71). BMI was 23.6 kg/m2. Inpatient treatment was required in 60.6%. Length of hospital stay averaged 10 days. Surgical treatment was performed in 55 patients (55.6%). Open reduction and internal fixation was the most common procedure (74.5%). Trauma mechanism was fall from a horse followed by being hit by a horse (60.6% and 23.2%, respectively). Injured upper extremities counted up for 52.5% followed by spinal and pelvic injuries (23.2%). Spinal and pelvic injuries were related to fall from a horse (p < 0.001). Injuries to the lower extremities were predominantly caused by a kick of the horse when the rider was unmounted (p = 0.001) and negatively related to a fall from a horse (p = 0.002). Ten patients got their fingers tangled while holding the reins and suffered from injuries to the upper extremity (p < 0.001). Three of them required an amputation (30%). Conclusion: Despite the fact that patients are young and healthy, horse related injuries must not be underestimated. In our study, almost two-thirds of the patients required inpatient treatment and 50% underwent surgery. We could show that patient age was related to injury severity according to the Abbreviated Injury Scale (AIS). Spinal and pelvic injuries were significantly related to a fall from a horse with a significantly greater trauma impact according to the AIS. Therefore, these severe entities need to be ruled out in such events. Accidents caused by holding the reins, may result in serious injuries to the hand with 30% requiring an amputation. Doctors need to be aware of possible horse-related injury patterns to reduce morbidity. [ABSTRACT FROM AUTHOR]

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Esophageal carcinoma (EC) is recognized as the 6th most frequent carcinoma in China, with esophageal squamous cell carcinoma (ESCC) being the predominant histologic type. Currently, chemotherapy is one among the most important therapy modalities for patients with ESCC. However, resistance to chemotherapeutic drugs leads to limited treatment options and poor prognosis. In our study, the analysis of small RNA sequencing and digital gene expression (DGE) profiling was done to recognize the microRNAs (miRNAs) and key genes related with drug resistance in ESCC. It was noticed that the hsa-miRNA-140-3p (miR-140-3p) expression was considerably higher in drug-resistant cells than in sensitive cells. In addition, DGE identified target genes of miR-140-3p might perform key roles in ESCC. Furthermore, this work exhibited that miR-140-3p represents the nuclear transcription factor Y subunit alpha (NFYA) gene by targeting its 3′-untranslated regions. Such an interaction might influence the formation of the transcription factor NFY trimer, which in turn may inhibit the transcription of the multidrug resistance 1 gene and, ultimately, to multidrug resistance in ESCC. The inhibition of miR-140-3p decreased resistance to oxaliplatin in EC. Therefore, miR-140-3p may serve as a molecular marker for treatment response, efficacy, and prognosis of chemotherapy in ESCC patients. [ABSTRACT FROM AUTHOR]

Abstract Background Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects. The aim of this study is to describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups. Methods This is a retrospective study using the Trauma Audit and Research Network (TARN) database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2019. Patients were excluded when their outcomes were not known or if they were secondary transfers. Simple descriptive analysis was used across the age groups: 16–59, 60–69, 70–79 and 80+ years. Logistic regression was performed to develop a model with known confounders, considering the odds of death by age group, and examining any interaction between age and trapped status with mortality. Results 70,027 patients met the inclusion criteria. Older patients were more likely to be trapped and to die following an MVC (p

Background: Immobilization of the neck in cervical spine injury patients can lead to misalignment of the oral, pharyngeal, and laryngeal axis, thereby making intubation more difficult. The principal aim of our study was to compare the efficacy of King Vision, Truview Evo2, and McCoy with Macintosh laryngoscope in patients getting intubated with cervical spine immobilized using manual inline stabilization. Materials and Methods: This was a randomized, controlled trial of 160 patients who were randomized to undergo surgery under general anesthesia with endotracheal intubation. We equally divided the subjects into using either Macintosh, McCoy, Truview Evo2, and King Vision laryngoscopes to facilitate intubation. We evaluated the intubation difficulty using the Intubation Difficulty Score (IDS) and Cormack–Lehane grading. Results: King Vision, Truview Evo2, and McCoy reduced the IDS as compared to Macintosh (P < 0.001). King Vision showed a first-attempt success rate of 100%. Cormack and Lehane’s glottic views were best with King Vision followed by Truview Evo2 and there was much less need for external manipulation as compared to McCoy and Macintosh. Time taken for intubation was least with McCoy blade (22.9 ± 7.2 s, P < 0.001). Conclusion: The use of both King Vision and Truview Evo2 significantly resulted in a decreased the IDS and improved Cormack–Lehane grading as compared to Macintosh and McCoy.

While the anatomical properties of regenerated axons across spinal cord lesion sites have been studied extensively, little is known of how the functional properties of regenerated synapses compared to those in unlesioned animals. This study aims to compare the properties of synapses made by regenerated axons with unlesioned axons using the lamprey, a model system for spinal injury research, in which functional locomotor recovery after spinal cord lesions is associated with axonal regeneration across the lesion site. Regenerated synapses below the lesion site did not differ from synapses from unlesioned axons with respect to the amplitude and duration of single excitatory postsynaptic potentials. They also showed the same activity-dependent depression over spike trains. However, regenerated synapses did differ from unlesioned synapses as the estimated number of synaptic vesicles was greater and there was evidence for increased postsynaptic quantal amplitude. For axons above the lesion site, the amplitude and duration of single synaptic inputs also did not differ significantly from unlesioned animals. However, in this case, there was evidence of a reduction in release probability and inputs facilitated rather than depressed over spike trains. Synaptic inputs from single regenerated axons below the lesion site thus do not increase in amplitude to compensate for the reduced number of descending axons after functional recovery. However, the postsynaptic input was maintained at the unlesioned level using different synaptic properties. Conversely, the facilitation from the same initial amplitude above the lesion site made the synaptic input over spike trains functionally stronger. This may help to increase propriospinal activity across the lesion site to compensate for the lesion-induced reduction in supraspinal inputs. The animal experiments were approved by the Animal Ethics Committee of Cambridge University.

Background: The recent San Diego-Mexico border wall height extension has resulted in an increased injury risk for unauthorized immigrants falling from greater heights. However, the effects of the border wall extension on frequency and morbidity of spinal injuries and related economic costs have yet to be highlighted.Methods: We retrospectively compared two cohorts who presented to the UC San Diego Health Trauma Center for border wall falls: pre-height extension (12 patients; January 2016-May 2018), and post-height extension (102 patients; January 2020-December 2021). Patients presented during border wall construction (June 2018-December 2019) were excluded. Demographics, clinical data and hospital costs were collected. Spinal injuries were normalized using Customs and Border Protection apprehensions. Costs were adjusted for inflation using the 2021 medical care price index.Results: The increase in spine injuries per month (0.8-4.25) and operative spine injuries per month (0.3- 1.7) was statistically significant (P < 0.001). Increase in median length of stay from 6 [interquartile range (IQR) 2-7] to 9 days (IQR 6-13) was statistically significant (P = 0.006). Median total hospital charges increased from $174 660 to $294 421 and was also significant (P < 0.001).Conclusion: The data support that the recent San Diego-Mexico border wall extension is correlated with more frequent, severe and costly spinal injuries. This current infrastructure should be re-evaluated as border-related injuries represent a humanitarian and public health crisis. [ABSTRACT FROM AUTHOR]

Objective: The most common causes of spinal injuries are traffic accidents and falls. The third most common cause is spinal gunshot wounds (spinal GSWs). Moreover, the treatment of spinal GSWs remains controversial. The aim of this study was to evaluate the results of treatment options and determine the best treatment for spinal GSWs. Materials and Methods: A total of 33 spinal GSW patients treated at our institution between January 2014 and December 2019 were retrospectively assessed. Epidemiological and medical information, including age, sex, sign, the form of operation, initial examination, followup evaluation, and imaging data, was gathered in individuals who had neurological deficits. Results: There were 24 males and 9 females (mean age, 31.5 years at the time of injury). The mean hospital length of stay was 14.3 days (range, 1-85 days). The mean follow-up time was 8.2 months (range, 0-13 months). Of these injuries, 27 caused neurological deficits. A total of 17 (51.5%) patients underwent spinal operations, and 16 (48.5%) had conservative management. Six (18%) patients needed intervention for spinal instability. The neurological conditions of 10 patients worsened during the follow-up period. Five patients did not show improvement in their recent neurological condition (p>0.05). Two patients had better outcomes during the follow-up. The surgical intervention did not significantly improve outcomes relative to those of conservative management (p>0.05). Conclusion: There is an ongoing need for more extensively studied protocols specific to spinal GSWs to further improve treatment decisions and the standard of care. [ABSTRACT FROM AUTHOR]

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 LEVEL OF EVIDENCE: 2., Competing Interests: Declaration of Conflicting Interests : The authors report no conflicts of interest in this work., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Introduction: Vertebral fractures in postictal patients with no prior acute or chronic trauma history are rare but can lead to severe neurological complications if missed during the initial evaluation., Research Question: What are the prevalence and risk factors associated with vertebral fractures? What are the characteristics of these fractures in terms of their location, severity, and clinical outcome?, Materials and Methods: A comprehensive literature search using MeSH terms was conducted. Data from previously published studies and three new cases from the authors' institution were collected. The variables included demographic information, seizure history, medical comorbidities, fracture characteristics, and treatment details. Descriptive statistics summarize the data. Inferential statistics ( t -test, Mann-Whitney U test, chi-squared test, Fisher's exact test, and logistic regression) were used to identify the risk factors for vertebral fractures., Results: The review included nine studies with a total of 19 patients, and three additional unpublished cases from the authors' institution. The median patient age was 50 years, with male predominance. No significant differences were found between the groups in osteoporosis, seizure history, antiepileptic drug use, or alcohol or drug abuse. The most common sites of fracture were the midthoracic spine for compression fractures and thoracolumbar junction for burst fractures. Risk factors for fractures include greater muscle mass, lower bone mineral density, longer convulsions, and recurrent convulsions., Discussion: The mechanism of injury involved violent muscle contractions during seizures., Conclusion: This review summarizes the current knowledge and provides evidence for best practices in the management of seizure-induced vertebral fractures., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)