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Abstract Background This study aimed to assess the outcomes of conservative management in patients with thoracolumbar fractures classified with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4 or 5, and to analyze initial imaging findings and clinical risk factors associated with treatment failure. Methods In this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed. Results The conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22–85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001–0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001–0.045 or

Background: This study aimed to assess the outcomes of conservative management in patients with thoracolumbar fractures classified with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4 or 5, and to analyze initial imaging findings and clinical risk factors associated with treatment failure. Methods: In this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed. Results: The conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22–85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001–0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001–0.045 or < 0.001; with cutoff values of 18.2, 12.8, and 7.8%, respectively), and lower anterior wall height (p = 0.001), demonstrating good to excellent interobserver agreement (0.72–0.99, p < 0.001). Furthermore, osteoporosis was identified as a significant risk factor (odds ratio = 5.64, p = 0.008). Conclusion: Among patients with TLICS scores of 4 or 5, those experiencing conservative treatment failure exhibited unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis. Additionally, osteoporosis emerged as a significant risk factor for treatment failure. [ABSTRACT FROM AUTHOR]

Background/Objectives: Osteoporotic vertebral fractures (OVFs) significantly impair quality of life. This study evaluates the impact of STIR sequence MR imaging on clinical decision-making for treating OVFs, mainly focusing on how MRI findings influence treatment modifications compared to those based solely on CT scans. Methods: This retrospective analysis reviewed cases from the Manninger Jenő National Traumatology Institute over ten years, where patients with suspected OVFs underwent CT and STIR sequence MR imaging. The study examined changes in treatment plans initiated by MRI findings. The diagnostic effectiveness of MRI was compared against CT in terms of sensitivity, specificity, and the ability to influence clinical treatment paths. Results: MRI detected 1.65 times more fractures than CT scans. MRI influenced treatment adjustments in 67% of cases, leading to significant changes from conservative–conservative, conservative–surgery, and surgery–surgery based on fracture characterizations provided by MRI. Conclusions: This study demonstrates that integrating STIR sequence MR imaging into the diagnostic pathway for OVFs significantly enhances the accuracy of fracture detection and profoundly impacts treatment decisions. The ability of MRI to reveal specific fracture features that are not detectable by CT scans supports its importance in the clinical evaluation of OVFs, suggesting that MRI should be incorporated more into diagnostic protocols to improve patient management and outcomes. The findings advocate for further research to establish STIR MRI as a standard osteoporosis management tool and explore its long-term benefits in preventing secondary fractures. [ABSTRACT FROM AUTHOR]

AbstractAutomatic type identification of sub-axial spine fractures is of prime importance for orthopaedicians to reduce image interpretation time and increase patient care time. But identifying fracture types is challenging due to imbalanced datasets. In this work, CT scan images of fractured spine has been collected from a Tertiary Care hospital and extended Deep Convolutional Generative Adversarial Network (DCGAN) architecture is developed for generating spine fracture images that overcomes the imbalanced dataset problem. These enhanced dataset are clinically evaluated with Two Visual Turing Tests (VTTs): the first test to “identify real and generated images” and second test to determine “type of fractures in the generated images.” The first VTT demonstrates that generated images of fractures are realistic and that even spine surgeons have difficulty in distinguishing them from real. The second VTT demonstrates that fracture lines are clearly visible in the generated images. The VTT results are analyzed using Fleiss Kappa statistical techniques to determine the inter-observer reliability of spine surgeons’ clinical evaluation. The results showed high interobserver agreement for “type identification” in the generated images. The clinically evaluated generated images are provided to the proposed ensemble based type identification model, which outperformed other models in type identification.

In large-scale naval battles during World War II, sailors sometimes sustained serious lower limb injuries when explosion blast of sea mines was transmitted from underneath through the metal deck of the ships. Some of these sailors were thrown in the air due to the blast and sustained axial trauma of the spine when they landed on the hard deck, which was thus called a deck slap by Captain Joseph Barr in 1946, among others. Nowadays, this peculiar mechanism has shifted to the civilian setting. Tourists unaware of the danger may sustain spine compression fractures when they sit at the bow of speed boats while underway on a calm sea. When the craft unexpectedly crosses the wake of another ship, tourists are thrown a few feet in the air before suffering a hard landing on their buttocks. This historical vignette is presented as a preventive message to help to reduce this poorly known yet avoidable "summer wave of vertebral fractures." [ABSTRACT FROM AUTHOR]

An active straight leg raise (SLR) is a weight bearing test which assesses pain upon movement and a patient's ability to load their pelvis, lumbar, and thoracic spine. Since many stable patients undergo computed tomography (CT) scanning solely for spinal tenderness, our hypothesis is that performing active straight leg raising could effectively rule out lumbar and thoracic vertebral fractures. Blunt trauma patients ≥18 years of age with Glasgow Coma Scale 15 presenting in hemodynamically stable condition were screened. Patients remaining in the supine position were asked to perform SLR at 12, 18, and 24 inches above the bed. The patient's ability to raise the leg, baseline pain, and pain at each level were assessed. Patients also underwent standard CT scanning of the chest, abdomen and pelvis. The clinical examination results were then matched post hoc with the official radiology reports. 99 patients were screened, 65 males and 34 females. Spinal fractures were present in 15/99 patients (16%). Mechanisms of injury included motor vehicle collision 51%, pedestrian struck 25%, fall1 9%, and other 4%. The median pain score of patients with and without significant spinal fractures at 12, 18, 24 inches was 7.5, 7, 6 and 5, 5, 4, respectively. At 24 inches, active SLR had sensitivity of 0.47, a specificity of 0.59, a positive predictive value of 0.17, and an negative predictive value of 0.86. Although SLR has been discussed as a useful adjunct to secondary survey and physical exam following blunt trauma, its positive and more importantly negative predictive value are insufficient to rule out spinal column fractures. Liberal indications for CT based upon mechanism and especially pain and tenderness are necessary to identify all thoraco-lumbar spine fractures. • Blunt trauma patients were asked to perform active straight leg raise (SLR). • Active SLR did not produce significant sensitivity or specificity for fracture. • Active SLR did not produce significant positive predictive value or NPV for fracture. • Spinal tenderness was elicited in 42% of nonfracture patients. • In thoracolumbar fracture computed tomography imaging remains the standard test for ruling out injury. [ABSTRACT FROM AUTHOR]

Objective: Basilar artery occlusion (BAO) secondary to traumatic vertebral artery (VA) dissection caused by vertebral fracture is a rare cause of acute ischemic stroke, and optimal management, such as antithrombotic agents, surgical fixation, and parent artery occlusion (PAO), has been controversial. We report a case in which mechanical thrombectomy and PAO were performed for a BAO due to right VA dissection caused by a transverse foramen fracture of the axis vertebra. Case Presentation: A patient in her 80s suffered from a backward fall, and a neck CT revealed a fracture and dislocation of the right lateral mass of the axis and a compressed transverse foramen. The patient was instructed to admit and to remain in bed rest; however, she suddenly lost consciousness the following day. The CTA revealed right VA occlusion and BAO; therefore, the patient underwent mechanical thrombectomy and the BAO was successfully reperfused but the VA stenotic dissection remained. PAO of the right VA was performed on the fifth day after the accident to prevent BAO recurrence. Conclusion: Mechanical thrombectomy is an effective treatment for BAO caused by VA dissection, and PAO may contribute to the prevention of stroke recurrence. [ABSTRACT FROM AUTHOR]

Context: Vertebral fractures (VFs) make up an important but challenging group of fractures often caused by osteoporosis. Osteoporotic fractures pose unique diagnostic challenges in generally requiring imaging for diagnosis. The objective of this narrative mini-review is to provide an overview of these recent advances in our knowledge of VF pathophysiology and epidemiology with particular focus on endocrine diseases, prevention, and treatment. Evidence Acquisition: We searched PubMed on May 23, 2022, for studies of VFs in humans. Results were limited to papers available as full-text publications in English, published from 2020 and onward. This yielded 3457 citations. This was supplemented by earlier publications selected to add context to the recent findings. Evidence Synthesis: Studies addressed VF risk in hyperthyreosis, hyperparathyroidism, acromegaly, Cushing syndrome, primary aldosteronism, and diabetes. For pharmaceutical treatment, new studies or analyses were identified for romosozumab and for weekly teriparatide. Several studies, including studies in the immediate pipeline, were intervention studies with vertebroplasty or kyphoplasty, including combination with stem cells or pharmaceuticals. Conclusions: Endocrinologists should be aware of the high likelihood of osteoporotic VFs in patients with endocrine diseases. Though licensed treatments are able to substantially reduce the occurrence of VFs in patients with osteoporosis, the vast majority of recent or ongoing randomized controlled trials in the VF area focus on advanced invasive therapy of the fracture itself. [ABSTRACT FROM AUTHOR]

Dens fractures are an increasingly common injury, yet their epidemiology and its implications remain underexamined. We retrospectively analyzed all traumatic dens fracture patients managed at our institution over a 10-year period, examining demographic, clinical, and outcomes data. Patient subsets were compared across these parameters. Among 303 traumatic dens fracture patients, we observed a bimodal age distribution with a strong goodness of fit centered at age 22.3 ± 5.7 (R = 0.8781) and at 77.7 ± 13.9 (R = 0.9686). A population pyramid demonstrated a bimodal distribution among male patients, but not female patients, which was confirmed with a strong goodness of fit for male patient subpopulations age <35 (R = 0.9791) and age ≥35 (R = 0.8843), but a weaker fit for a second female subpopulation age <35. Both age groups were equally likely to undergo surgery. Patients younger than age 35 were more likely to be male (82.4% vs. 46.9%, odds ratio [OR] = 5.29 [1.54, 17.57], P = 0.0052), have motor vehicle collision as their mechanism of injury (64.7% vs. 14.1%, OR = 11.18 [3.77, 31.77], P < 0.0001), and to have a severe trauma injury severity score (17.6% vs. 2.9%, OR = 7.23 [1.88, 28.88], P = 0.0198). Nevertheless, patients age <35 were less likely to have fracture nonunion at follow (18.2% vs. 53.7%, OR = 0.19 [0.041, 0.76], P = 0.0288). The dens fracture patient population comprises 2 subpopulations, distinguished by differences in age, sex, injury mechanism and severity, and outcome, with male dens fracture patients demonstrating a bimodal age distribution. Young, male patients were more likely to have high-energy injury mechanisms leading to severe trauma, yet were less likely to have fracture nonunion at follow-up. [ABSTRACT FROM AUTHOR]

Background: Patients with simultaneous fractures of the atlas and dens have traditionally been managed according to the dens fracture's morphology, but data supporting this practice are limited. Methods: We retrospectively examined all patients with traumatic atlas fractures at our institution between 2008 and 2016. We used multivariable regression and propensity score matching to compare the presentation, management, and outcomes of patients with isolated atlas fractures to patients with simultaneous atlas-dens fractures. Results: Ninety-nine patients were identified. Patients with isolated atlas fractures were younger (61 ± 22 vs. 77 ± 14, P = 0.0003), had lower median Charlson Comorbidity Index (3 vs. 5, P = 0.0005), had better presenting Nurick myelopathy scores (0 vs. 3, P < 0.0001), and had different mechanisms of injury (P = 0.0011). Multivariable regression showed that having a simultaneous atlas-dens fracture was independently associated with older age (odds ratio [OR] =1.59 [1.22, 2.07], P = 0.001), worse presenting myelopathy (OR = 3.10 [2.04, 4.16], P < 0.001), and selection for surgery (OR = 4.91 [1.10, 21.97], P = 0.037). Propensity score matching yielded balanced populations (Rubin's B = 23.3, Rubin's R = 1.96) and showed that the risk of atlas fracture nonunion was no different among isolated atlas fractures compared to simultaneous atlas-dens fractures (P = 0.304). Age was the only variable independently associated with atlas fracture nonunion (OR = 2.39 [1.15, 5.00], P = 0.020), having a simultaneous atlas-dens fracture was not significant (P = 0.2829). Conclusions: Among patients with atlas fractures, simultaneous fractures of the dens occur in older patients and confer an increased risk of myelopathy and requiring surgical stabilization. Controlling for confounders, the risk of atlas fracture nonunion is equivalent for isolated atlas fractures versus simultaneous atlas-dens fractures. [ABSTRACT FROM AUTHOR]

Abstract Background Methods Results Conclusion \nHighlights The increased popularity of cycling is leading to an anticipated increase in cycling-related traffic accidents and a need to better understand the demographics and epidemiology of craniospinal injuries in this vulnerable road user group. This study aims to systematically investigate and characterise cycling-related head and spine injuries seen in the Major Trauma Centre for the Eastern region, which has the highest cycling rates in the UK.We performed a retrospective cohort study comparing the incidence, patterns, and severity of head and spine injuries in pedal cyclists presenting to the Major Trauma Centre in Cambridge between January 2012 and December 2020. Comparisons of injury patterns, characteristics, and associations were made according to mechanism of injury, helmet use, patient age and gender.A total of 851 patients were admitted after being involved in cycling-related collisions over the study period, with 454 (53%) sustaining head or spine injuries. The majority of victims (80%) were male and in mid-adulthood (median age 46 years). Head injuries were more common than spine injuries, with the most common head injuries being intracranial bleeds (29%), followed by skull fractures (12%), and cerebral contusions (10%). The most common spine injuries were cervical segment fractures, particularly C6 (9%), C7 (9%), and C2 (8%). Motorised collisions had a higher prevalence of spine fractures at each segment (p < 0.001) and were associated with a higher proportion of multi-vertebral fractures (p < 0.001). These collisions were also associated with impaired consciousness at the scene and more severe systemic injuries, including a lower Glasgow coma scale (R = −0.23, p < 0.001), higher injury severity score (R = 0.24, p < 0.001), and longer length of stay (R = 0.21, p < 0.001). Helmet use data showed that lack of head protection was associated with more severe injuries and poorer outcomes.As cycling rates continue to increase, healthcare providers may expect to see an increase in bicycle-related injuries in their practice. The insights gained from this study can inform the treatment of these injuries while highlighting the need for future initiatives aimed at increasing road safety and accident prevention. Study of 851 cycling-related trauma patients in Cambridge, UK, shows high rates of head & spine injuries. Motorised collisions were associated with more severe injuries and impaired consciousness at the scene. The lack of helmet use was linked to more severe head injuries and impaired consciousness, but not to a longer hospital stay. Rising cycling rates may lead to increased incidence of these injuries in clinical practice. Our findings may be relevant for clinicians treating cycling-related traumatic injuries to head and spine. Study of 851 cycling-related trauma patients in Cambridge, UK, shows high rates of head & spine injuries.Motorised collisions were associated with more severe injuries and impaired consciousness at the scene.The lack of helmet use was linked to more severe head injuries and impaired consciousness, but not to a longer hospital stay.Rising cycling rates may lead to increased incidence of these injuries in clinical practice.Our findings may be relevant for clinicians treating cycling-related traumatic injuries to head and spine. [ABSTRACT FROM AUTHOR]

Objective: This study aims to discuss the appropriate treatment of esophageal fistula following anterior surgery for cervical spine fracture. Methods: Clinical data of patients with cervical spine fracture treated at our research center from January 2000 to December 2019 were screened. Data of patients with esophageal fistula were included, and the causes of injury, diagnosis, and treatment were retrospectively analyzed. Results: A total of 3578 patients with cervical spine fracture were screened, among whom there were 10 cases (0.28 %) of esophageal fistula. 60 % of the cases were early-onset and all were caused by intraoperative electric knife injury. The positive rate of early endoscopy was only 25 %, while routine radiography showed a positive rate of 33.3 % after three attempts. Among the six patients with early-onset esophageal fistula, three underwent sternocleidomastoid flap transfer and two underwent primary suture, all achieving successful healing. In the four cases of late-onset esophageal fistula, two patients received implant removal, debridement, incision lavage, and sternocleidomastoid muscle flap transfer three weeks later. One patient received implant removal, debridement, vacuum sealing drainage, followed by sternocleidomastoid muscle pedicle transfer muscle flap plus lavage two weeks later and achieved complete recovery. All patients gargled alternately with metronidazole and chlorhexidine gargle after surgery. Conclusion: The occurrence of esophageal fistula is associated with surgical procedures, esophageal injury, and implant compression. Esophagography and endoscopy are the primary diagnostic methods, while incision exploration after ingestion of food mixed with methylene serves as a supplementary approach. Recommended treatments include alternating metronidazole and chlorhexidine gargles, esophageal rest, repair of the fistula, muscle flap packing, lavage and drainage, nutritional support, and removal of internal fixation if necessary. Post-surgery administration of antibiotics should continue until three consecutive lavage cultures yield negative results.

Background: Patients with simultaneous fractures of the atlas and dens have traditionally been managed according to the dens fracture's morphology, but data supporting this practice are limited. Methods: We retrospectively examined all patients with traumatic atlas fractures at our institution between 2008 and 2016. We used multivariable regression and propensity score matching to compare the presentation, management, and outcomes of patients with isolated atlas fractures to patients with simultaneous atlas-dens fractures. Results: Ninety-nine patients were identified. Patients with isolated atlas fractures were younger (61 ± 22 vs. 77 ± 14, P = 0.0003), had lower median Charlson Comorbidity Index (3 vs. 5, P = 0.0005), had better presenting Nurick myelopathy scores (0 vs. 3, P < 0.0001), and had different mechanisms of injury (P = 0.0011). Multivariable regression showed that having a simultaneous atlas-dens fracture was independently associated with older age (odds ratio [OR] =1.59 [1.22, 2.07], P = 0.001), worse presenting myelopathy (OR = 3.10 [2.04, 4.16], P < 0.001), and selection for surgery (OR = 4.91 [1.10, 21.97], P = 0.037). Propensity score matching yielded balanced populations (Rubin's B = 23.3, Rubin's R = 1.96) and showed that the risk of atlas fracture nonunion was no different among isolated atlas fractures compared to simultaneous atlas-dens fractures (P = 0.304). Age was the only variable independently associated with atlas fracture nonunion (OR = 2.39 [1.15, 5.00], P = 0.020), having a simultaneous atlas-dens fracture was not significant (P = 0.2829). Conclusions: Among patients with atlas fractures, simultaneous fractures of the dens occur in older patients and confer an increased risk of myelopathy and requiring surgical stabilization. Controlling for confounders, the risk of atlas fracture nonunion is equivalent for isolated atlas fractures versus simultaneous atlas-dens fractures.

Background: We retrospectively reviewed traumatic spinal fractures (TSFs), including their mechanisms of injury and associated injuries in patients aged ≤50 years admitted to our center over a period of 11 years. Our secondary objective was to investigate whether spine injuries have decreased since the introduction of new transportation-related legislation applications. Methods: Between 2005 and 2016, all patients admitted to the hospital due to TSFs, including cervical, thoracic, and lumbar spinal fractures, who were aged ≤50 years were included in this study. Patient demographics, mechanism of injury, associated injuries, hospital stay duration, treatment, complications, and mortalities were reviewed and analyzed. Results: Altogether, 373 patients (81% male; 19% female; median age, 28 years) were included in the study, and 579 spinal fractures were identified. The lumbar spine was the most affected part. The most common injury mechanism was motor vehicle accidents (MVA) (69.7%), followed by falls (26.8%). Neurological injuries were detected in 9.4% of patients. Associated injuries were observed in 45.3% of patients, and 33.6% of patients were surgically treated. Thoracic injuries and lower limb fractures were the most common injuries, and the postoperative complication rate was 3.9%. Conclusions: Although there was a significant decrease in TSFs after the speed control legislation over the study period, MVA and falls remained the most common causes of spinal injuries. Associated injuries, operated patients, and female sex were all associated with a prolonged hospital stay.

Objective: This study aimed to investigate the effect of sarcopenia, osteoporosis, and osteosarcopenia on spine fracture in patients with prediabetes. Methods: We collected and analyzed the data from the U.S. National Health and Nutrition Examination Surveys during the period from 2009 to 2018. Bone mineral density and the skeletal muscle mass index (SMI) were measured with dual-energy X-ray absorptiometry (DXA). The diagnosis of spine fracture was based on DXA and history. Results: People with prediabetes were more likely to develop sarcopenia than normal glucose tolerance subjects (OR 1.33, 95% CI 1.07-1.66), while there was no significant increase of osteoporosis in prediabetes (OR 0.91, 95% CI 0.78-1.05). The SMI was independently associated with osteoporosis in prediabetes adults (OR 0.65, 95% CI 0.50-0.85). Both sarcopenia and osteoporosis were positively associated with spine fracture in prediabetes (OR 4.44, 95% CI 1.76-11.21, and OR 2.90, 95% CI 1.85-4.56, respectively). The risk of spine fracture was substantially higher in the presence of osteosarcopenia (OR 6.63; 95% CI, 1.34-32.94) than in the presence of sarcopenia or osteoporosis alone in prediabetes. Conclusion: In adults with prediabetes, both sarcopenia and osteoporosis are risk factors for spine fracture, and the combination of sarcopenia and osteoporosis further increases the prevalence of spine fracture. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to validate the use of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a spine fracture. Methods: Cross-sectional cohort of individuals that had sustained a spine fracture (C1-L5) one year earlier. Patients were asked to fill out SMFA, Oswestry Disability Index (ODI), EQ-5D-3L and EQ-VAS. Spearman's rank correlation coefficient (rho) was used to assess convergent validity for each patient-reported outcome measure (PROM). Bland–Altman plots were used to assess PROM agreement. Results: 82 patients completed all questionnaires. The correlations between SMFA Dysfunction and Bother indices and ODI were 0.89 and 0.86, with EQ-5D-3L index 0.89 and 0.80, and with EQ-VAS 0.80 and 0.73, respectively. The correlation for separate categories of the SMFA dysfunction index (daily activities, emotional status, arm and hand function, mobility) ranged between 0.71–0.87 for ODI, 0.72–0.84 for EQ-5D-3L index, and 0.67–0.77 for EQ-VAS. A selection of the ten items of SMFA that had the highest correlations with ODI resulted in a correlation of 0.91. The agreements between SMFA indices and ODI in Bland–Altman plots were good with small differential biases and minimal proportional biases, but worse for SMFA and EQ-5D-3L index and EQ-VAS. Conclusion: The SMFA indices are highly correlated with ODI in patients with a spine fracture. The Dysfunction index and Bother index, or selected SMFA items, may be used to assess outcome in patients with spine fractures as an alternative to ODI. [ABSTRACT FROM AUTHOR]

Contiguous spinous process fractures are an extremely rare event with only a few cases described in the literature. They are usually stable lesions treated with analgesic medication, immobilization, physical activity restriction for 4 to 6 weeks and close surveillance. These fractures appear to have a significant risk of nonunion, despite the good reported results. We report a case of a 61 years-old male patient who suffered eight contiguous spinous process fractures following a tractor accident.

BACKGROUND: At present, there is considerable controversy in the treatment of osteoporotic patients with posterior wall rupture. Some scholars believe that it is a contraindication to bone cement augmentation and is suitable for open reduction and internal fixation; however, some scholars believed that osteoporosis can easily lead to failure of internal fixation, and minimally invasive bone cement augmentation can be performed under appropriate conditions. OBJECTIVE: To investigate the clinical effect of bone cement injection for incomplete posterior wall osteoporotic fractures without neurological symptoms. METHODS: Data of 31 patients (12 males and 19 females; age range: 57 to 82 years old) with osteoporotic vertebral compression fracture with imcomplete posterior wall, which admitted to the First Affiliated Hospital of Soochow University from January 2011 to June 2013, were retrospectively analyzed. All patients were treated with balloon kyphoplasty, and the leakage of bone cement was evaluated. X-ray examination was carried out preoperatively, at 1 day, 3 months postoperatively and the last follow-up to measure the height of vertebral body and Cobb angle. The curative effect was evaluated by visual analogue scale score and Oswestry dysfunction index. RESULTS AND CONCLUSION: (1) Three out of 31 patients affected sidewall bone cement leakage and the patients had no remarkable neurological symptoms. (2) All 31 patients were followed up for a mean time of (47.2±24.3) months. At 1 day and 3 months and the last follow-up after treatment, the mean height of the vertebral body was higher than that before treatment (P < 0.05) and Cobb angle was smaller than that before treatment (P < 0.05). Visual analogue scale score and Oswestry dysfunction index were lower at 1 day and 3 months and the last follow-up after treatment than those before treatment (P < 0.05). (3) It is concluded that kyphoplasty is safe and effective in the treatment of osteoporotic vertebral compression fracture with incomplete posterior wall. It can dramatically relieve pain, increase the height of the vertebral body, and reduce kyphosis. BACKGROUND: At present, there is considerable controversy in the treatment of osteoporotic patients with posterior wall rupture. Some scholars believe that it is a contraindication to bone cement augmentation and is suitable for open reduction and internal fixation; however, some scholars believed that osteoporosis can easily lead to failure of internal fixation, and minimally invasive bone cement augmentation can be performed under appropriate conditions. OBJECTIVE: To investigate the clinical effect of bone cement injection for incomplete posterior wall osteoporotic fractures without neurological symptoms. METHODS: Data of 31 patients (12 males and 19 females; age range: 57 to 82 years old) with osteoporotic vertebral compression fracture with imcomplete posterior wall, which admitted to the First Affiliated Hospital of Soochow University from January 2011 to June 2013, were retrospectively analyzed. All patients were treated with balloon kyphoplasty, and the leakage of bone cement was evaluated. X-ray examination was carried out preoperatively, at 1 day, 3 months postoperatively and the last follow-up to measure the height of vertebral body and Cobb angle. The curative effect was evaluated by visual analogue scale score and Oswestry dysfunction index. RESULTS AND CONCLUSION: (1) Three out of 31 patients affected sidewall bone cement leakage and the patients had no remarkable neurological symptoms. (2) All 31 patients were followed up for a mean time of (47.2±24.3) months. At 1 day and 3 months and the last follow-up after treatment, the mean height of the vertebral body was higher than that before treatment (P < 0.05) and Cobb angle was smaller than that before treatment (P < 0.05). Visual analogue scale score and Oswestry dysfunction index were lower at 1 day and 3 months and the last follow-up after treatment than those before treatment (P < 0.05). (3) It is concluded that kyphoplasty is safe and effective in the treatment of osteoporotic vertebral compression fracture with incomplete posterior wall. It can dramatically relieve pain, increase the height of the vertebral body, and reduce kyphosis. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective Objective: To evaluate functional outcomes and characteristics associated with gunshot wound (GSW) to the spine. Methods: Patients with GSW to the spine managed at a Level 1 Trauma Center from January 2003 to December 2017 were enrolled. Patient demographics, diagnoses, level of injury, American Spinal Injury Association (ASIA) score, ambulatory status at follow-up, bowel and bladder function, clinical improvement, and mortality were evaluated. Clinical improvement was defined as a progression in ambulatory status category at latest follow up. Results: 51 patients with GSW of the spine were identified. 48 (94.1%) were male and 3 (5.9%) were female, with a mean age of 27 years-old (range 15-56). 38 (74.5%) were Caucasian, 7 (13.7%) were African American, 1 (2.0%) Asian-American, and 5 (9.8%) were Other/Unknown. 46 (90.2%) patients had GSW related spinal fractures and 44 (86.3%) had neurological deficits. Among patients with neurologic deficits, 5 (9.8%) had Cauda Equina Syndrome, 1 (2%) had Brown-Sequard Syndrome, and 38 (74.5%) spinal cord injuries: ASIA A 26 (68.4%); ASIA B 3 (7.9%); ASIA C 7 (18.4%); ASIA D 2 (5.3%). At mean follow-up time of 4.2 years (SD 3.9), 27 (52.9%) patients were wheelchair bound, 11 (21.6%) were ambulating with assistance, and 13 (25.5%) had normal ambulation. ASIA grade (A or B) was significantly, P < 0.00001, associated with being wheelchair bound and having neurogenic bowel or bladder at follow-up. Conclusions: Most spinal GSW patients (70.6%) did not have any clinical improvement in ambulatory status and most injuries were ASIA A. [ABSTRACT FROM AUTHOR]

Wakeboarding is a sport associated with various types of injuries, primarily affecting the upper and lower limbs. In this case, a 44-year-old man fell from a ramp while wakeboarding and barely managed to reach the shore before dying shortly afterward. An autopsy revealed a complete rupture of the thoracic aorta along with a fracture of the fourth thoracic vertebra. It is likely that several mechanisms contributed to these injuries, either individually or in combination: concussive, rotational, and tensile forces. Additionally, it is plausible that the rupture occurred in two stages, with an initial partial injury worsening during subsequent movements or attempts at rescue and resuscitation. This is the first reported case of death resulting from a ruptured aorta due to wakeboarding, highlighting a potential consequence of this sport., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Spinal cord injury (SCI) is a debilitating neurologic disorder that can result in significant morbidity and mortality, as well as long term disability. Pediatric spinal cord injuries account for only 5% of all spinal cord injuries. Understanding differences in anatomic and epidemiologic characteristics between pediatric and adult SCI is paramount to the accurate evaluation, diagnosis, and treatment of this potentially debilitating pathology. Standardized neurological examination and dedicated spine imaging guide optimal management. For both adult and pediatric populations, medical optimization and surgical decompression, stabilization, and/or fusion in select patient groups comprise the foundation of high-quality SCI care. Research into novel therapeutics, however, may afford improved functional outcomes. In the present review, we discuss differences between pediatric and adult patients with spinal cord injury as they pertain to patient anatomy, evaluation, management, and medical complications.

Purpose: Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. Methods: In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. Results: Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. Conclusion: OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment. [ABSTRACT FROM AUTHOR]

UNLABELLED: Spine fracture prevalence is similar in men and women, increasing from 90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.

Context: Vertebral fracture (VF) prevalence up to 24% has been reported among young people with type 1 diabetes (T1D). If this high prevalence is confirmed, individuals with T1D could benefit from preventative VF screening. Objective: We compared the prevalence of VFs between adults with T1D and nondiabetic controls. Methods: This cross-sectional study included 127 adults with T1D, and 65 controls with a similar age, sex, and BMI distribution, from outpatient clinics of 2 tertiary care centers. Vertebral fracture assessment (VFA) by dual-energy x-ray absorptiometry (DXA) was used for prevalent VFs. The modified algorithm-based qualitative (mABQ) method was applied. Bone mineral density (BMD) and trabecular bone score (TBS) were assessed by DXA. Serum bone turnover markers and sclerostin were measured in a subgroup of participants. Results: Participants with T1D (70 women, 57 men) had a mean age of 42.8 ± 14.8 years, median diabetes duration of 25.8 (15.8-34.4) years, mean BMI of 26.6 ± 5.4 kg/m2 and mean HbA1c over the past 3 years of 7.5 ± 0.9%. Controls (35 women, 30 men) had mean age of 42.2 ± 15.9 years and mean BMI of 26.1 ± 5.1 kg/m². VF prevalence was comparable between groups (2.4% vs 3.1%, P = 0.99). TBS, BMD at the total hip and femoral neck, and bone formation and resorption markers were lower while sclerostin levels were similar in participants with T1D vs controls. Conclusion: Our VFA results using the mABQ method do not confirm increased prevalence of VFs in men and women with relatively well-controlled T1D. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis.Objective: This study aimed to identify the prevalence of concomitant thoracic spinal and sternal fractures and factors associated with concomitant fractures.Summary Of Background Data: The sternum has been implicated in stability of the upper thoracic spine, and both bony structures are included in the stable upper thoracic cage. High force trauma to the thorax can cause multiple fractures to different upper thoracic cage components.Methods: This is a retrospective analysis of electronic medical record data of patients treated at a Level 1 Trauma Center who underwent surgery for thoracic spinal fracture between 2008-2020. We recorded presence of concomitant sternal fracture, injury characteristics, hospital course data, and demographic information.Results: 107 patients with thoracic spinal fractures had a sternal fracture prevalence of 18.7%. The average age was 53.2 [15-90]. 72 (67.3%) were male and 35 (32.7%) were female, 92 (85.9%) were White, 10 (9.3%) were African American, 3 (2.8%) were Hispanic, and 2 (1.9%) were Asian. The average age of patients with sternal fractures was 48.7 years, compared to those without sternal fractures, 54.3 years (P = 0.251). Patients with T1-T7 fractures [14 of 48 (29.2%)] had a significantly higher rate of sternal fractures compared to patients with T8-T12 fractures [6 of 59 (10.2%)] (P = 0.012). Patients with additional rib (P < 0.001), scapula (P = 0.01), clavicle fractures (P = 0.01), and those with multiple other thoracic fractures (P = 0.01) had significantly higher rates of sternal fractures compared to patients without these. Patients with concomitant sternal fractures [10 of 20 (50.0%)] had a significantly higher rate of respiratory complication during their hospital course than patients without concomitant sternal fracture [40 of 87 (46.0%)] (P < 0.001). Sex, age, mechanism of injury, fracture morphology, estimated blood loss during surgery, intraoperative complications, post-surgical intubation status, and post-surgical intubation duration were not associated with sternal fractures.Conclusions: The prevalence of concomitant thoracic spinal fracture and sternal fracture in our series is 18.7%. T1-T7 fractures and presence of rib, scapula, and clavicle fractures were significantly associated with the presence of sternal fractures. Presence of concomitant sternal fracture was significantly associated with respiratory complication during hospital course. [ABSTRACT FROM AUTHOR]

Background: Multiple myeloma (MM) presents with spinal lesions in 60% of cases. The combination of osteolytic lesions with multifactorial osteopenia raises specific surgical treatment challenges. Minimally invasive spine surgery (MISS) could be a potential option for MM spinal lesions treatment. Objective: The objective of this study is to evaluate MISS techniques to treat patients presenting with spine fractures due to MM Methods: Retrospective analysis of consecutive patients with histology-proven pathological fractures caused by MM treated with MISS between 2009 and 2018. We collected the data from the clinical records on epidemiology, topography of spine lesions, surgical techniques, blood loss, operation time, complications, mean in-hospital time, and clinical evolution. Results: Twenty-one patients were studied – 13 males and 8 females, with a mean age of 64 years (range 43–83). Mean preoperative spinal instability neoplastic score was 9.8 ± 6 (range 5–16). All cases had a thoracolumbar location – 15 patients underwent kyphoplasty (KP) or vertebroplasty (VP) and 6 were treated with other more complex procedures. All patients had a reduction of pain and/or analgesic load. Vertebral body height increased by a mean of 2.9 mm after VP/KP. Mean hospital stay was 1.3 days for KP/VP and 5.0 days for other MISS procedures. Three patients had complications. Conclusions: The heterogeneity of techniques used reflected the variety of spine involvement by MM. KP and VP led to shorter hospital stays and less complications, being adequate for lesions without major instability. More complex MISS techniques offer an effective treatment with short delay for starting MM adjuvant treatment.

A 28-year-old man presented to the emergency department after a witnessed GTC seizure. The patient had a history of systemic lupus erythematosus, previous subarachnoid hemorrhage, and pulmonary embolism. He was on regular methylprednisolone 16 mg, enoxaparin 60 mg once daily, and levetiracetam (LEV) 500 mg twice daily. The patient had recently stopped taking LEV. There was no trauma in the history. Neurological examination was normal. He had severe lower back pain that failed to subside despite treatment with analgesics and opioids; therefore, this patient had an indication for radiological imaging. Urgent non-contrast computerized tomography (CT) scan of the lumbar spine revealed a burst fracture of L1. Non-contrast lumbar magnetic resonance imaging (MRI) revealed a bursal fracture in the L1 vertebral corpus that caused approximately 50% height loss, and there was compression of the posterior corpus of the vertebra on the thecal sac; however, no stenosis of the spinal canal was detected. At this level, there was bone marrow edema in the vertebral corpus (Figure 1,2). He was transferred to the neurosurgery department. Written informed consent was obtained from the patient for the publication of this case. A 28-year-old man presented to the emergency department after a witnessed GTC seizure. The patient had a history of systemic lupus erythematosus, previous subarachnoid hemorrhage, and pulmonary embolism. He was on regular methylprednisolone 16 mg, enoxaparin 60 mg once daily, and levetiracetam (LEV) 500 mg twice daily. The patient had recently stopped taking LEV. There was no trauma in the history. Neurological examination was normal. He had severe lower back pain that failed to subside despite treatment with analgesics and opioids; therefore, this patient had an indication for radiological imaging. Urgent non-contrast computerized tomography (CT) scan of the lumbar spine revealed a burst fracture of L1. Non-contrast lumbar magnetic resonance imaging (MRI) revealed a bursal fracture in the L1 vertebral corpus that caused approximately 50% height loss, and there was compression of the posterior corpus of the vertebra on the thecal sac; however, no stenosis of the spinal canal was detected. At this level, there was bone marrow edema in the vertebral corpus (Figure 1,2). He was transferred to the neurosurgery department. Written informed consent was obtained from the patient for the publication of this case. [ABSTRACT FROM AUTHOR]

Study designA retrospective, propensity score, multivariate analysis of the National Trauma Data Bank (NTDB) between 2008 and 2011.ObjectiveThe aim of this study was to determine the relationship between insurance status and rates of surgery for acute spinal fractures with and without spinal cord injury (SCI).Summary of background dataThe decision for surgery in patients with spinal fractures is often based on fracture pattern and stability, associated SCI, and the presence of ligamentous and other associated injuries. It is poorly understood how nonclinical factors, such as insurance status, influence the decision for surgical intervention in patients sustaining spinal trauma.MethodsUsing NTDB admission years 2008 to 2011, we included patients 18 to 64 years old who sustained a fracture of the cervical or thoracolumbar spine. Patients were excluded if they sustained polytrauma (Injury Severity Score ≥27) or a major injury (Abbreviated Injury Scale severity ≥3) to the head, thorax, or abdomen. Our main outcome measure was surgical versus nonsurgical treatment for spinal injury; our main predictor was insurance status. Hierarchical multivariate regression analysis and propensity scores were used to determine the relationship between insurance status and surgical treatment, controlling for other factors. We calculated adjusted odds ratios (ORs) for rates of surgery.ResultsOur propensity score multivariate analysis demonstrated significantly higher rates of surgery in patients with SCI (OR = 11.76, P

Background: A Chance fracture is a traumatic fracture of the thoracic or lumbar spine that occurs secondary to a flexion-distraction injury. Although patients with chance fractures rarely present with neurologic deficits, a subset may become symptomatic from spinal epidural hematomas (SEH) warranting emergent decompressive surgery. Case Description: An 87-year-old female on anticoagulation presented with a T1 Chance fracture after a fall. She was originally neurologically intact, but became paraplegic over the next 10 h. When the cervical/thoracic magnetic resonance revealed a SEH markedly compressing the cord between the C7-T1 levels, she underwent an emergent decompression; she also had a C5-T4 instrumented fusion. Postoperatively, she regained lower limb function, but expired on postoperative day 5 due to respiratory complications likely attributed to the prolonged surgery for the spinal instrumentation. Conclusion: Delayed SEH rarely occur following spinal Chance fractures. Here, an 87-year-old female on anticoagulation developed the 10-h delayed onset of a SEH with paraplegia attributed to a T1 Chance fracture at the C7-T1 level. Although she regained neurological function following the emergent decompression, she expired 5 days later likely due to the extended operative time/blood loss from the C5-T4 fusion that could have been avoided. [ABSTRACT FROM AUTHOR]

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

Neglected stress related fracture of superior articular process fracture leading to disability is not commonly reported. Intravertebral foraminal ligament attachment to superior articular process is well described but its repetitive stress related avulsion injury was not reported. The presence of abundant sensory and nociceptive nerve endings around the facet joint can cause significant symptoms in this uncommon condition. We hereby present 2 cases of superior articular process tip fracture. First case is a 53 years old business who presented with intractable chronic back and right gluteal pain for many years worsened with golf games with the diagnosis of nonunion of right L2 superior articular facet and second case is a 74 years old lady who had intractable left buttock and left calf radicular pain with neglected left L5 superior articular facet tip fracture after vertebroplasty treatment on L4 compression fracture; both underwent uniportal endoscopic contralateral approach for decompression and resection of the Superior Articular Process, SAP tip fragment with its attached foraminal ligament with good symptoms relief on one year follow up. Consideration can be made for endoscopic decompression SAP tip fracture in comparison to open decompression or fusion surgery in these symptomatic patients.

Objective To evaluate the cases of osteoporotic compression fracture with kyphotic deformity treated with modified pedicle subtraction osteotomy and analyze the usefulness of this osteotomy. Methods Twenty patients (nine men, 11 women; mean age, 66.4 years; mean follow‐up duration, 39.6 months) who underwent modified pedicle subtraction osteotomy at our hospital between November 2003 and July 2012 with a minimum follow‐up period of 2 years were included. All cases were injuries induced by a fall incurred while standing or lifting heavy objects without high‐energy trauma. The mean bone mineral density‐dual energy x‐ray absorptiometry (BMD‐DEXA) was 0.673 g/cm2 (0.571–0.740 g/cm2), which was ‐2SD below normal, indicating severe osteoporosis. The indications for surgery included gait disturbance due to severe pain with pseudarthrosis, increased kyphotic angle, and progressive neurological symptoms. We evaluated Japanese Orthopaedic Association scores, Oswestry Disability Index scores, bone union, change in kyphotic angle, estimated blood loss, complications, and the patient's overall clinical satisfaction. Results The collapsed vertebrae were thoracic (T9, 11, 12) in 13 cases and lumbar (L1) in seven cases. The mean pre‐ and post‐operative kyphotic angles were 26.2 ± 9.9 degrees and 8.3 ± 8.1 degrees, showing an 18.3‐degree correction. Plain radiography at the last follow‐up showed a mean angle of 17.9 ± 12.6 degrees, indicating a 9.5‐degree correction loss. The overall correction was 8.2 degrees. Bony union was achieved at the last follow‐up in all cases. Clinical outcomes showed improvement in mean Japanese Orthopaedic Association score from 13.2 to 21.7 and mean Oswestry Disability Index score from 40.3 to 13.6. Overall clinical patient satisfaction showed 12 excellent results, five moderate results, and three poor results. Mean operation time was 4.2 h (range, 4–6 h). The overall mean estimated blood loss (EBL) was 1098 mL (range, 750–1370 mL). The mean hospital stay was 3.6 weeks (range, 2–6 weeks). There was one case of cauda equina syndrome at 2 days postoperatively, and two cases of screw loosening. There were no cases of distal junctional kyphosis, but there were two cases of proximal junctional kyphosis. Conclusions Despite limited correction of kyphotic angle, our modified pedicle subtraction osteotomy technique resulted in satisfactory outcomes in our patients, who had persistent severe back pain, increased kyphotic angle with pseudarthrosis, and progressive neurologic deficits. Nevertheless, this procedure requires careful follow‐up and strict surgical indications because of the risk of neurological damage and technical problems.

Background: Balloon-assisted kyphoplasty (BAK) is a minimally invasive procedure to treat vertebral compression fractures (VCF). BAK not only restores vertebral height and corrects kyphotic deformity by cement augmentation, but it also may alter spinal biomechanics, leading to subsequent adjacent level VCFs., Objectives: This study aims to investigate the timing, location, and incidence of new VCFs following BAK and identify the risk factors associated with their occurrence., Study Design: Single-institution observational study., Methods: A prospectively collected cohort of 1,318 patients who underwent BAK by a single-surgeon from 2001 through 2022 was analyzed. The patients had pain that was unresponsive to nonsurgical management and a VCF secondary to osteoporosis, trauma, or neoplasm. The time between the index and subsequent fracture, fracture level, number of initial fractures, age, body mass index (BMI), tobacco use, and chronic corticosteroid use were recorded., Results: Of 1,318 patients, 204 (15.5%) patients underwent a second BAK procedure an average of 373 days following BAK (range: 2-3,235 days). Third, fourth, and fifth procedures were less common (45, 12, and 6 patients, respectively). A total of 142 patients (69.6%) developed a subsequent fracture adjacent to the index level; adjacent and remote level fractures developed at different times (mean: 282 vs 581 days, P = 0.001). Patients treated for multiple VCFs in a single surgery were more likely to develop subsequent VCFs (P = 0.024) and at adjacent levels (P = 0.007). Subsequent VCFs were associated with older age (P < 0.001), women (P = 0.045), osteoporosis (P < 0.001), and chronic corticosteroid use (P < 0.001). A subgroup analysis of 812 (61.6%) patients who underwent BAK for degenerative indications revealed that osteoporosis (b = 0.09; 95% CI, 0.03-0.16; P = 0.005) and chronic corticosteroid use (b = 0.06; 95% CI, 0-0.11; P = 0.055) were associated with adjacent level fracture. For the entire cohort, almost every patient treated for both a thoracic and lumbar fracture (92.3%) developed an adjacent level second fracture (P = 0.005)., Limitations: The true incidence of post-BAK fractures may be underestimated as surveillance is not routine in asymptomatic or osteoporotic patients., Conclusions: Symptomatic post-BAK VCFs are infrequent and may occur long after the initial procedure. Nearly two-thirds of subsequent fractures in our study occurred adjacent to the initially treated level; almost every patient who suffered thoracic and lumbar fractures at the same time developed an adjacent level second fracture. Additionally, osteoporosis and chronic corticosteroid use were associated with adjacent level fractures in patients who underwent surgery for degenerative indications.

Literature and field data from CIREN database have shown that lumbar spine injuries occur during car crashes. There are multiple hypotheses regarding how they occur; however, there is no biomechanical explanation for these injuries during collisions with road safety barriers (RSBs). Therefore, the objective of this study was to investigate the mechanics of vertebral fractures during car collisions with concrete RSBs. The finite element method was used for the numerical simulations. The global model of the car collision with the concrete RSB was created. The lumbar spine kinematics were extracted from the global simulation and then applied as boundary conditions to the detailed lumbar spine model. The results showed that during the collision, the occupant was elevated, and then dropped during the vehicle landing. This resulted in axial compression forces 2.6 kN with flexion bending moments 34.7 and 37.8 Nm in the L2 and L3 vertebrae. It was shown that the bending moment is the result of the longitudinal force on the eccentricity. The lumbar spine index for the L1–L5 section was 2.80, thus indicating a lumbar spine fracture. The minimum principal strain criterion of 7.4% and damage variable indicated L2 and L3 vertebrae and the inferior part of L1, as those potentially prone to fracture. This study found that lumbar spine fractures could occur as a consequence of vehicle landing during a collision with a concrete RSB mostly affecting the L1–L3 lumbar spine section. The fracture was caused by a combination of axial forces and flexion bending moments.

Background: the demographics, mechanisms of injury, and concurrent injuries associated with cervical, thoracic and lumbar spinal fracture and/or spinal cord injury remain poorly characterized. Methods: Patients aged 18 and older with spinal injury between 2011 and 2015 in the National Trauma Data Bank (NTDB) were identified. Patient demographics, comorbidity burden, mechanism of injury, and associated injuries were analyzed. Results: in total, 520,183 patients with acute spinal injury were identified including 216,522 cervical, 191,218 thoracic, and 220,294 lumbar. The age distributions were trimodal with peaks in incidence at around 2155 and a lesser peak around 85 years of age. The number of comorbidities increased while injury severity decreased with advancing patient age. Motor vehicle accidents (MVAs) were the most common mechanism of injury. Associated bony and internal organ injuries were common and occurred in 63% of cervical spine injury patients, 79% of thoracic spine injury patients, and 71% of lumbar spine injury patients. In all three sub-populations, there was a predominance of injuries in the local area of the primary injury. For cervical, these were rib injuries (28%), thoracic spine injuries (22%), skull fractures (20%), intracranial injuries (26%) and lung injuries (21%). For thoracic, these were rib injuries (47%), lumbar spine injuries (26%), cervical spine injuries (25%), lung injuries (35%) and intracranial injuries (24%). For lumbar, these were rib injuries (38%), thoracic spine injuries (22%), pelvic fractures (20%), lung injuries (26%) and intracranial injuries (19%). Multivariate regression analysis demonstrated that increased injury severity was strongly correlated with increased mortality, with lesser contributions from increased age and comorbidity burden. Conclusions: the current study revealed spinal fractures and/or cord injuries had high incidences of associated injuries that had a predominance of local distribution. These findings, in combination with the mortality analysis, demonstrate the importance of local targeted evaluations for associated injuries.

Study Design: Meta-analysis.Objective: To compare the clinical, functional, and radiological outcomes of posterior-only versus combined anterior-posterior instrumentation in order to determine the optimal surgical intervention for thoracolumbar burst fractures.Summary Of Background Data: Unstable thoracolumbar burst fractures warrant surgical intervention to prevent neurological deterioration and progressive kyphosis, which can lead to significant pain and functional morbidity. The available literature remains largely inconclusive in determining the optimal instrumentation strategy.Methods: Electronic searches of MEDLINE (1948-May 2020), EMBASE (1947-May 2020), The Cochrane Library (1991-May 2020), and other databases were conducted. Cochrane Collaboration guidelines were used for data extraction and quality assessment. Outcomes of interest were divided into three categories: radiological (degree of postoperative kyphosis correction; loss of kyphosis correction at final follow-up), functional (visual analogue scale [VAS] pain score; Oswestry Disability Index [ODI] score), and clinical (intraoperative blood loss; length of stay [LOS]; operative time; the number and type of postoperative complications).Results: Four randomized control trials (RCTs) were retrieved, including 145 randomized participants. Seventy-three patients underwent posterior-only instrumentation and 72 underwent combined instrumentation. No significant difference was found in the degree of postoperative kyphosis correction (P = 0.39), VAS (centimeters) at final follow-up (P = 0.67), ODI at final follow-up (P = 0.89) or the number of postoperative complications between the two approaches (P = 0.49). Posterior-only instrumentation was associated with lower blood loss (P < 0.001), operative time (P < 0.001), and LOS (P = 0.01). Combined instrumentation had a lower degree of kyphosis loss at final follow-up (P = 0.001). There was heterogeneity in the duration of follow-up between the included studies (mean follow-up range 24-121 months).Conclusion: The available literature remains largely inconclusive. In order to reliably inform practice in this area, there is a need for large, high-quality, multicenter RCTs with standardized reporting of outcomes, with a particular focus on outcomes relating to patient function and severe complications causing long-term morbidity.Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

Background Context: The Allen and Ferguson classification of cervical spine injuries is widely used. They described compressive Extension (CE) injuries as having five progressive stages. Stage 4(CE4) and 5(CE5) have been described as having a posterior vertebral arch fracture involving two motion segments accompanied by displacement (dislocation) of the vertebral body at a single level. However, in their original work, CE4 was described only as a hypothetical stage, while CE5 was found in only three patients. Beyond this, little is understood about these injuries.Purpose: To identify characteristics of compression extension injuries with vertebral body displacement (CE4 and CE5) from a series of surgically treated subaxial cervical spine fractures. A secondary aim was to identify specific characteristics that may guide treatment or affect prognosis.Design: Retrospective case series.Patient Sample: Twenty-four patients who underwent surgical stabilization of CE4 and CE5 cervical spine fracture-dislocations in non-ankylosed spines over a 14-year period.Outcome Measures: Radiographic categorization of CE injury type, treatment rendered, postoperative spinal alignment, presence of nonunion, loss of fixation, hardware-related and neurologic complications.Methods: After IRB approval, patients with CE injuries were identified through billing data and radiology records at a level I trauma center between January 2005 and September 2018. Demographic data, ISS, ASA, motor score, and complications during the hospitalization were collected from the patient's EMR. CT scans were reviewed to assess fracture pattern, level, and location of the vertebral arch fracture, vertebral body displacement, spinal canal diameter and method of surgical stabilization. Injuries were classified according to the classification of Allen and Ferguson, and the AO subaxial cervical spine classification.Results: Of 221 patients identified with CE mechanism, 24 had CE4 or CE5 injuries. High-energy mechanism occurred in 92% of the patients, with motor vehicle accidents being the most common. The average ASIA motor score was 80 preoperatively and 84 at average 398 days follow-up. All CE4 and CE5 injuries occurred at C6-C7 or C7-T1. Average anterolisthesis was 6.26 mm (SD ± 2.3 mm) for CE4 and 16.8 mm (SD ± 1.8 mm) for CE5. Average spinal canal diameter at the level of dislocation was 20 mm (SD ± 0.4 mm) for CE4 and 30.5 mm (range 29.6 - 31.4 mm) for CE5. The surgical approach was anterior in 5 patients, posterior in 12 patients, and combined in 7 patients. Four patients had single-evel fixation, all of whom had CE4 injuries, and 20 patients had fixation across two or more levels. Thirty percent of patients had complications, none of which included postoperative spinal malalignment, nonunion or hardware-related complications, or worsening of neurologic exam. Three deaths occurred in the postoperative hospitalization period (7 to 15 days).Conclusion: CE4 and CE5 injuries represented 10% and 1% of all CE injuries in our series respectively occurring only at the C6-C7 and C7-T1 levels. Though by original description these are two-level injuries, in patients with milder posterior element injury, single level stabilization was used successfully. We have therefore proposed designating CE4 into less severe CE4a and more severe CE4b injuries. Because this fracture pattern typically results in widening of the spinal canal as the anterior displacement of the vertebral body occurs independent of the fractured posterior elements, spinal cord injuries are neither as severe nor as common as in fracture-dislocation from other mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: A classification system was recently developed by the international association AO Spine for assessing subaxial cervical spine fractures. Significant variability exists between users of the facet component, which consists of four morphological types (F1–F4). The primary aims of this study were to assess the diagnostic accuracy and reliability of this new system's facet injury morphological classifications. Methods: A survey consisting of 16 computed tomography (CT) scans of patients with cervical facet fractures was distributed to spine surgeon members of AO Spine Latin America. To provide a gold standard diagnosis for comparison, all 16 injuries had been classified previously by six co-authors and only were included after total consensus was achieved. Demographic and surgical practice characteristics of all respondents were analyzed, and diagnostic accuracy calculated. Inter- and intra-observer agreement rates were calculated across two survey rounds, conducted one month apart. Results: A total of 135 surgeons completed both surveys, among whom the mean age was 41.6 years (range 26–71), 130 (96.3%) were men, and 83 (61.5%) were orthopedic surgeons. The mean time in practice as a spine surgeon was 9.7 years (1–30). The overall diagnostic accuracy of all responses was 65.4%. Inter-observer and intra-observer agreement rates for F1/F2/F3/F4 were 55.4%/47.6%/64.0%/94.7% and 60.0%/49.1%/58.0%/93.0%, respectively. Conclusion: This study evaluates the AO Spine Classification System specifically for facet injuries involving the subaxial cervical spine in a large sample of spine surgeons. There was significant variability in diagnostic accuracy for F1 through F3-type fractures, whereas almost universal agreement was achieved for F4-type injuries. [ABSTRACT FROM AUTHOR]

Study Design: Bibliometric literature review.Objective: The aim of this study was to recognize and analyze the most frequently cited manuscripts published in the journal Spine.Summary Of Background Data: Although the journal Spine is considered a premiere location for distributing influential spine research, no previous study has evaluated which of their publications have had the most impact. Knowledge and appreciation of the most influential Spine publications can guide and inspire future research endeavors.Methods: Using the Scopus database, the 100 most cited articles published in Spine were accessed. The frequency of citations, year of publication, country of origin, level-of-evidence (LOE), article type, and contributing authors/institutions were recorded. The 10 most cited articles (per year) from the past decade were also determined.Results: "Guidelines For The Process Of Cross-Cultural Adaptation Of Self-Report Measures" by Beaton DE was the most cited article with 2960 citations. 2000 to 2009 (n = 46) was the most productive period. A LOE of III (n = 35) followed by II (n = 34) were the most common. Deyo RA (n = 8), Bombardier C (n = 6), and Waddell G (n = 6) produced the most articles. University of Washington (n = 8) and University of Toronto (n = 8) ranked first for institutional output. Clinical Outcome (n = 28) was the most recurring article topic. The United States (n = 51) ranked first for country of origin.Conclusion: Using citation analysis as an objective proxy for influence, certain publications can be distinguished from others due to their lasting impact and recognition from peers. Of the top cited Spine publications, many pertained to clinical outcomes (28%) and had a LOE of I, II, or III (60%). Although older publications have had longer time to accrue citations, those in the most recent decade comprise this list almost 2:1. Knowledge of these "classic" publications allows for a better overall understanding of the diagnosis, management, and future direction of spine health care.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]