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Purpose To determine the specificity of sagittal compensatory mechanisms in patients with post-traumatic deformities of the thoracic and lumbar spine, and also to study their correlation with pain and the life quality of patients. Materials and methods Using X-ray analysis of growth profile spondylograms of 103 patients we studied the effect of segmental post-traumatic deformity (SD) and anatomic shape of the spine (Roussouly type) on regional (TK, LL), pelvic (SS, PT) and global (SVA) parameters of sagittal balance. In addition, the analysis of dependence of pain (VAS) and the life quality of patients (ODI, SF-36) on the above parameters was done. Results SD of the thoracic spine (Th1–Th10) increased TK, which led to hyperextension of LL and a decrease in SS. These compensatory mechanisms were reflected in significant correlations SD-TK, TK-LL, TK-SS, and LL‑SS. In the thoracolumbar spine (Th11–L2) SD at the level of Th11 and Th12 increased TK (SD-TK r = 0.553), and at the level of L1 and L2 they caused reactive hypokyphosis (SD-TK r = –0.687). A compensatory increase in LL was typical for injuries of Th11–Th12 (TK-LL r = 0.831) and L1 (TK-LL r = –0.629). Deformities at the L2 level led to hypolordosis (SD-LL r = –0.710), the magnitude of which, in turn, significantly influenced the TK, SS, and PT (LL-TK r = 0.690; LL-SS r = 0.832; SS-PT r = 0.597). The effectiveness of sagittal alignment in thoracic and thoracolumbar SD was confirmed by normal SVA values, as well as their lack of correlation with TK, LL and SS. In the lumbar spine (L3–L5), SD in 75 % of cases led to a critical decrease in LL and sagittal imbalance, which was reflected in significant correlations SD-LL, SD-PT, and SD-SVA. Compensatory correction of regional (TK, LL) and pelvic sagittal parameters (SS, PT) depended on the anatomical features of the spine (PI, Roussouly type) at all levels of the spinal column. However, a significant effect of PI on global sagittal alignment was noted only in lumbar SD (SVA-PI r = –0.617). Correlation of sagittal modifiers with pain intensity and quality of life was also typical only for patients with SD of the lumbar spine (PT-VAS r = 0.777; PT-ODI r = 0.752; PT-SF36 (PH) r = 0.651; SVA-VAS r = 0.775; SVA-ODI r = 0.762; SVA-SF36 (PH) r = 0.703). Conclusion Sagittal balance in fixed thoracic and thoracolumbar kyphosis is satisfactorily supported by changes in the curvature of adjacent parts of the spine, in contrast to lumbar deformities, in which in 75 % of cases, decompensation of the spine profile alignment occurs.

Objective. To conduct a morphometric analysis of the soleus muscle of rats after moderate spinal cord contusion injury. Material and Methods. Experiments were performed on female Wistar rats aged 8–12 months, weighing 270–320 g. Animals of the experimental group (n = 25) underwent laminectomy at the T9 level under general anesthesia and modeling of spinal contusion injury of moderate severity. Intact rats constituted the control group (n = 10). Euthanasia was performed on the 5th, 15th, 30th, 60th, 90th, and 180th days of the experiment. Paraffin sections were stained with hematoxylin-eosin and Masson, the diameters of muscle fibers were determined by computer morphometry, and histograms of their distribution were obtained. Results. In the soleus muscle, the signs of reversible reparative processes prevailed in response to neurotrophic damage. It was evidenced by a local increase in the diversity of myocyte diameters and the loss of polygonality of their profiles, focal destruction of muscle fibers, ac- tivation of the connective tissue component, disorganization of some intramuscular nerve conductors, and vascular fibrosis of perimysium. Nevertheless, the histostructure of an intact muscle prevailed in the course of the experiment, which was confirmed by the data of morphometric analysis. All histograms of the distribution of the muscle fiber diameters are unimodal with a mode in the range of 30–41 μm. On the 180th day, the maximum myocyte diameters in the histogram of the left limb muscle belonged to the range of 21–30 μm, which was typical for histograms in the intact group. Conclusion. The nature of the plastic reorganization of the soleus muscle when neurotrophic control is impaired indicates compensatory regeneration of muscle tissue by the type of restitution, which opens up the possibility of predicting the rehabilitation period. It is advisable to take this into account when developing medical and social programs and therapeutic measures, where the most important role is played by superficial neuromuscular and functional electrical stimulation.

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.

Introduction and purpose: Falling from a tree is a common cause of injury in and around the Karabük province. Such injuries can impair the quality of life by causing permanent damage and can increase morbidity and mortality. This study aimed to reveal the patterns of spinal and cranial injuries in patients admitted to the hospital. Methods: Patients who were admitted to the emergency department after falling from a tree in the Karabük province over a 2-year period and were diagnosed with injuries caused by falling from a tree were included. The parameters of age, sex, type of tree which the patient fell from, spinal and cranial fracture patterns and pain scores during follow-up were evaluated. Results: We studied 98 patients over a 2-year period. Of these, 5 (5.10%) patients were aged

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Introduction: Despite nearly a decade of conflict, little is known about trauma and injuries resulting from the Syrian war.Methods: Secondary analysis was conducted of an administrative dataset of patient presentations to a network of 95 war-affected hospitals in Syria from July 2013-July 2015. Logistic regression was performed to identify factors associated with mortality of neurotrauma patients.Results: Of 193,618 overall trauma presentations, 41,143 were for neurotrauma (37,410 head trauma, 1407 spinal trauma, and 3133 peripheral nervous system). There were 31,359 males (76.2%) and 9784 females (23.8%). Males aged 19-30 years (10,113; 24.6%) were the largest single demographic group. Presumed non-combatants including females, elders, and children under 13 years (16,214; 39.4%) were the largest group of patients overall. There were 16,881 (41.0%) presentations with blunt injuries (blunt/crush injuries) and 21,307 (51.8%) patients with penetrating injuries (shrapnel, cut, gunshot). A total of 36,589 patients (89.6%) were treated and discharged from the hospital, 2100 (5.1%) were transferred to another facility, 2050 patients (5.0%) died in-hospital, 26 remained in the hospital (0.1%), and 108 (0.3%) had unknown disposition. The median length of hospital stay was 1 day. There were 4034 (9.7%) neurosurgical procedures documented. Patients with combined neurotrauma and general trauma suffered 30 times higher mortality than neurotrauma alone (aOR: 30.4; 95% CI: 20.8-44.2, p < 0.0001).Conclusion: The Syrian War resulted in large volumes of neurotrauma patients. Presumed non-combatants comprised 39.4% of patients who survived to treatment at a facility. Further study is needed on long-term needs of neurotrauma victims of the Syrian war. [ABSTRACT FROM AUTHOR]

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, 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 (−39%), falls > 2 m (−17%), malignancy (−33%), sporting injuries (−100%), and miscellaneous (−58%). Four of 8 categories (RTAs, falls < 2 m, malignancy, miscellaneous) showed a trend towards return of pre-lockdown values during SP2. Two categories (disc disease, 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

While the role of the London Hospital in delineating diseases of the nervous system is widely accepted, its role in developing the speciality of spinal injuries in the United Kingdom has not been acknowledged. The pioneering efforts of Henry Head and George Riddoch provided the foundation for the successful treatment of patients with spinal injuries. Julian Holland-Hibbert, a trustee of the London Hospital and himself a paraplegic, by his magnificent unselfish effort made sure that patients with a spinal injury could live independent, fulfilled lives in society. [ABSTRACT FROM AUTHOR]

BACKGROUND: Some patients with cervical spondylotic myelopathy suffer from certain low-energy trauma or only a single hyperextension movement of the neck, and then their neurological symptoms deteriorate, showing typical symptoms of traumatic central cervical syndrome. Although the overall prognosis is good, many patients still have some sequelae. OBJECTIVE: To analyze the risk factors of traumatic central cervical syndrome in patients with cervical spondylotic myelopathy suffering from low-energy trauma, and the correlation with neurological dysfunction. METHODS: Between January 2012 and December 2016, the clinical data of 181 cervical spondylotic myelopathy patients, treated in the First Affiliated Hospital of Soochow University, with a history of low-energy trauma were retrospectively analyzed. According to whether traumatic central cervical syndrome occurred, patients were divided into appearing group (68 cases) and non-appearing group (113 cases). The potential risk factors and their correlations with the neurological function of traumatic central cervical syndrome were analyzed, including patients’ general condition, clinical manifestations and imaging findings. This study was approved by the Medical Ethics Committee of First Affiliated Hospital of Soochow University (approval No. (2021)053). RESULTS AND CONCLUSION: (1) Average age and gender were not statistically significant between the two groups (P > 0.05). However, the incidence of hyperextension injury in appearing group was more than in non-appearing group (P < 0.05). (2) Ratios of axial pain, weakness of proximal lower limb, proprioception dysfunction and hand sensory dysfunction were not statistically significant between the two groups (P > 0.05). Hand muscle weakness, hypermyotonia, tendon hyperreflexia and positive pathological signs in the appearing group were higher than those in the non-appearing group (P < 0.05). (3) The C2-7 Cobb angle of the appearing group was lower than that of the non-appearing group (P < 0.05), and the proportion of instability, rigid/mixed ratio and “anterior-posterior clamp type” in the appearing group were higher than those in the non-appearing group (P < 0.05). Both spinal stenosis and cervical spinal cord compression were higher in the appearing group than those in the non-appearing group (P < 0.05). With higher proportions of maximum canal compromise >50% and maximum spinal cord compression >25%, the maximum canal compromise and maximum spinal cord compression in the appearing group were both greater than those in the non-appearing group (P < 0.05). The ratio, length and grade 2 of intramedullary high signal intensity in appearing group were higher than those in the non-appearing group (P < 0.05). (4) Logistic regression analysis indicated that the possible risk factors for traumatic central cervical syndrome were hyperextension injury, intrinsic hand strength, hypermyotonia, positive pathological signs, poor cervical curvature, spine instability, compression type, compression source, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity. (5) The correlation analysis indicated that age, intrinsic hand muscle strength, lower limb muscle tone, pathological signs, cervical curvature, cervical stability, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity were significantly negatively correlated with neurological function scores (P < 0.05). [ABSTRACT FROM AUTHOR]

Abstract Background According to most of the commonly used classification systems for subaxial spine injuries, unilateral and minimally displaced facet fractures without any sign of a spinal cord injury would be directed to non-operative management. However, the failure rate of non-operative treatment varies from 20 to 80%, and no consensus exists with regard to predictors of failure after non-operative management. Case presentation Case 1 is a patient with a unilateral facet fracture. The patient had only numbness in the right C6 dermatome but failed non-operative treatment, which resulted in severe spinal cord injury. Case 2 is a patient who had a similar injury pattern as case 1 but presented with immediate instability and underwent fusion surgery. Both patients had a minimally displaced unilateral facet fracture accompanied by disc injury and blunt vertebral artery injury, which are possible signs indicating significant instability. Conclusions This is the first report of an isolated unilateral facet fracture that resulted in catastrophic spinal cord injury. These two cases illustrate that an isolated minimally displaced unilateral facet fracture with disc injury and vertebral artery injury were associated with significant instability that can lead to spinal cord injury.

Abstract Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p

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.

Spinal fractures, spinal cord injuries, and nerve root injuries are commonly encountered entities for spine surgeon. While many cases have well-researched presentations, outcomes, and standards of care there are many patients for which the appropriate clinical management is less clear. Other patients present with injuries with clear treatment preferences that are impossible to implement based on comorbidities or preference. The authors present a few recent cases of spinal injury where multiple treatment pathways could be considered and individual patient-related factors changed the course of treatment., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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 < 0.0001). Head, abdominal and limb injuries were more common in the young with thoracic and spinal injuries being more common in older patients (all p < 0.0001). No statistical difference was found between the age groups in relation to ability to self-extricate. After adjustment for confounders, the 80 + age group were more likely to die if they were trapped; adjusted OR trapped 30.2 (19.8–46), not trapped 24.2 (20.1–29.2). Conclusions: Patients over the age of 80 are more likely to die when trapped following an MVC. Self-extrication should be considered the primary route of egress for patients of all ages unless it is clearly impracticable or unachievable. For those patients who cannot self-extricate, a minimally invasive extrication approach should be employed to minimise entrapment time. [ABSTRACT FROM AUTHOR]

Evidence-based guidelines suggest computed tomography without magnetic resonance imaging (MRI) is sufficient to rule out clinically significant cervical spine injury in obtunded adult blunt trauma patients. This study evaluated MRI utilization over time to investigate the impact of the 2015 Eastern Association for the Surgery of Trauma guidelines suggesting cervical collar clearance with computed tomography alone in this population. We hypothesized that MRI utilization would decrease following the guidelines. We performed a retrospective cross-sectional study of the National Trauma Data Bank from 2007 to 2018 using multivariable logistic regression of the likelihood of spinal MRI utilization. Blunt trauma patients 18 y and older with a Glasgow Coma Scale (GCS) of 8 or less, Abbreviated Injury Score head of 4 or greater, intubated for at least 72 h were included. The sample consisted of 76,450 patients from 567 trauma centers. Controlling for age, gender, race/ethnicity, insurance status, injury mechanism, Injury Severity Score, GCS, GCS motor, hospital teaching status and trauma center level, patients seen after 2015 had a higher odds ratio (OR) of undergoing spinal MRI relative to those seen before 2015 (OR 1.77, 95% CI 1.49-2.09; P < 0.001). Each year was associated with a significantly increased OR of undergoing spinal MRI compared to the year prior (OR 1.10, 95% CI 1.05-1.15; P < 0.001). Spinal MRI use has been increasing in obtunded adult blunt trauma patients including after the release of the Eastern Association for the Surgery of Trauma guidelines in 2015. Future work should identify whether this is driven by improper MRI utilization and, if so, strategies to promote guideline adherence. [ABSTRACT FROM AUTHOR]

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.

The article presents the results of the study of the specifics of spiritual crisis experience and attitudes to Self in persons with spinal injury (N=65) and conventionally healthy respondents (N=63). The characteristics of spiritual crisis most typical of people with spinal injury were: dissatisfaction and loneliness attributed to the past, present, and future; and suffering attributed to the past. The categories of dissatisfaction, loneliness, and suffering were heterogeneous, as reflected in texts produced by people with spinal injuries and healthy people of different sex and age. Groups distinguished by time elapsed since injury did not differ on quantitative signs of spiritual crises but differed qualitatively in their experiences of dissatisfaction, loneliness, and suffering. People who had lived with the injury longer often experienced uselessness, and a lack of contacts, attention, and support; they were disposed to self-flagellation and guilt. Their attitude to Self reflected in the texts of fairy tales. Healthy controls wrote simple fairy tales describing the interaction of the Real Self and Ideal Self. By contrast, people with spinal injuries focused their stories on emotional experiences of their attitude to Self (complicated fairy tales) or finding meaning, accepting oneself and life in all its fullness and variety (complex fairy tale). Counseling people with a spinal injury, one should take into account both gender and age of the injured person and the potential of the fairy tale itself, which becomes a resource in the experiencing of spiritual crisis and in changing attitudes to Self.

Study Design: This was a prospective cohort study. Background: Despite being common injury, management of thoracolumbar burst fractures without neurological deficit remains an enigma. Proponents of surgery showed the debatable advantages of canal clearance, better kyphosis correction, and prevention of neurological deterioration. This study aims to review the outcome of conservative management in these injuries. Materials and Methods: Thirty adult patients of burst fractures of the thoracolumbar spine without neurological deficits, kyphosis angle of

Purpose of Review: Spinal cord stimulation (SCS) is a minimally invasive and reversible therapy for the treatment of severe neuropathic pain. There are several biologic complications that can arise during the implantation of SCS systems. This review aims to consolidate recent research on complications associated with SCS, specifically focusing on biologic complications., Recent Findings: Biologic complications are less frequently encountered compared to device-related complications but may have more severe consequences. Biologic complications covered in this review include infection, seromas, hematomas, dural puncture, nerve/spinal cord injury, and therapy habituation., Conclusion: The application of SCS remains a viable and effective choice for managing neuropathic pain conditions. It is crucial for physicians to carefully consider potential complications before proceeding with SCS trials and implantation. Familiarity with biologic complications is critical for patient safety and to optimize patient outcomes.

Scheuermann disease, a structural deformity marked by kyphotic alterations in the thoracic or thoracolumbar spine, is frequently accompanied by back discomfort and spinal wedging. Scheuermann disease predominantly affects the thoracic and thoracolumbar parts of the spine; thus, there is an indirect link between the two conditions. This case report describes a rare form of Scheuermann illness in which lumbar canal stenosis caused bilateral lower limb radiculopathy. A 50-year-old male with a confirmed diagnosis of Scheuermann illness complained of severe back discomfort, developing bilateral lower limb weakness, and sensory impairments. Clinical and radiographic investigations indicated lumbar canal stenosis at multiple levels, resulting in nerve root compression and radiculopathy. MRI reports of the lumbosacral spine were suggestive of severe, multiple-level degenerative changes. Spinal canal stenosis was noted at lumbar levels. Following the investigation findings suggestive of Scheuermann disease, the patient underwent posterior decompression and spinal fixation of L3-L4 and L4-L5. The outcome led to the decompression of the lumbar canal and the stabilization of the affected spinal segments. A personalized postoperative rehabilitation plan was developed based on the patient's complaints of pain, stiffness, and the difficulties he faced associated with the disease. Overall physiotherapy rehabilitation plays an essential role in the overall care of Scheuermann's illness and postoperative lumbar spine disease, aiding in functional restoration, enhancing quality of life, and encouraging long-term spinal health. Although exercise therapy is intense, it shows promising results and is beneficial for these conditions. Physical therapy in the postoperative period plays a significant role in promoting the patient's functional independence., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kolhe et al.)

Introduction: This study evaluated the presence of neurologic sequelae among trauma patients after flexion-extension (F/E) radiographs., Methods: Authors of the study conducted a retrospective review of patients (age ≥ 14 years) with a Glasgow Coma Score of 15 who sustained a blunt traumatic injury and received F/E radiographs. Radiographic scans were defined as positive, negative, inconclusive, or incomplete. The neurologic status of each patient was assessed before and after the F/E radiographs, and at discharge and follow-up., Results: Of the 501 patients included in the analysis, 84.6% (n = 424) had negative F/E radiographs, and 3.2% (n = 16) had positive F/E radiographs. Ten percent (n = 51) of patients had incomplete F/E radiographs, and 2.0% (n = 10) were inconclusive due to the inability to rule out a ligamentous injury. Three patients (0.6%) had MRI-confirmed ligamentous injuries, all of which had initial incomplete F/E radiographs due to pain. No patient had a documented neurological deficit before or after the F/E exam. Three patients with an initial negative F/E radiograph returned to the clinic with symptoms of neurologic sequelae. Two of these patients had symptom resolution with no further issues at future follow-up appointments. The third patient was found to have chronic neurologic symptoms after further evaluation., Conclusions: The inclusion of F/E exams in cervical spine clearance protocols did not demonstrate any new long-term iatrogenic neurologic injuries. Consideration should be given to performing MRIs on patients with incomplete F/E radiographs that cannot rule out a ligamentous injury., (Copyright © 2024 Durler, et al.)

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., Competing Interests: Conflict of Interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

This study aimed to investigate the impact of race on hospital length of stay (LOS) and hospital complications among pediatric patients with cervical/thoracic injury. A retrospective cohort was performed using the 2017 admission year from 753 facilities utilizing the National Trauma Data Bank. All pediatric patients with cervical/thoracic spine injuries were identified using the ICD-10-CM diagnosis coding system. These patients were segregated by their race, non-Hispanic white (NHW), non-Hispanic black (NHB), non-Hispanic Asian (NHA), and Hispanic (H). Demographic, hospital variable, hospital complications, and LOS data were collected. A linear and logistic multivariate regression analysis was performed to determine the risk ratio for hospital LOS as well as complication rate, respectively. A total of 4,125 pediatric patients were identified. NHB cohort had a greater prevalence of cervical-only injuries (NHW: 37.39% vs. NHB: 49.93% vs. NHA: 34.29% vs. H: 38.71%, P < 0.001). While transport accident was most common injury etiology for both cohorts, NHB cohort had a greater prevalence of assault (NHW: 1.53% vs. NHB: 17.40% vs. NHA: 2.86% vs. H: 6.58%, P < 0.001) than the other cohorts. Overall complication rates were significantly higher among NHB patients (NHW: 9.39% vs. NHB: 15.12% vs. NHA: 14.29% vs. H: 13.60%, P < 0.001). Compared with the NHW cohort, NHB, NHA, and H had significantly longer hospital LOS (NHW: 6.15 ± 9.03 days vs. NHB: 9.24 ± 20.78 days vs. NHA: 9.09 ± 13.28 days vs. H: 8.05 ± 11.45 days, P < 0.001). NHB race was identified as a significant predictor of increased LOS on multivariate regression analysis (risk ratio: 1.14, 95% confidence interval: 0.46, 1.82; P = 0.001) but not hospital complications (P = 0.345). Race may significantly impact health care resource utilization following pediatric cervical/thoracic spinal trauma. [ABSTRACT FROM AUTHOR]

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

Purpose 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). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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

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