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Magogo J, Lazaro A, Mango M, Zuckerman SL, Leidinger A, Msuya S, Rutabasibwa N, Shabani HK, Härtl R. Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery. Global Spine J 2021; 11:89-98. [PMID: 32875835 PMCID: PMC7734258 DOI: 10.1177/2192568219894956] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Little is known about operative management of traumatic spinal injuries (TSI) in low- and middle-income countries (LMIC). In patients undergoing surgery for TSI in Tanzania, we sought to (1) determine factors involved in the operative decision-making process, specifically implant availability and surgical judgment; (2) report neurologic outcomes; and (3) evaluate time to surgery. METHODS All patients from October 2016 to June 2019 who presented with TSI and underwent surgical stabilization. Fracture type, operation, neurologic status, and time-to-care was collected. RESULTS Ninety-seven patients underwent operative stabilization, 23 (24%) cervical and 74 (77%) thoracic/lumbar. Cervical operations included 4 (17%) anterior cervical discectomy and fusion with plate, 7 (30%) anterior cervical corpectomy with tricortical iliac crest graft and plate, and 12 (52%) posterior cervical laminectomy and fusion with lateral mass screws. All 74 (100%) of thoracic/lumbar fractures were treated with posterolateral pedicle screws. Short-segment fixation was used in 86%, and constructs often ended at an injured (61%) or junctional (62%) level. Sixteen (17%) patients improved at least 1 ASIA grade. The sole predictor of neurologic improvement was faster time from admission to surgery (odds ratio = 1.04, P = .011, 95%CI = 1.01-1.07). Median (range) time in days included: injury to admission 2 (0-29), admission to operating room 23 (0-81), and operating room to discharge 8 (2-31). CONCLUSIONS In a cohort of LMIC patients with TSI undergoing stabilization, the principle driver of operative decision making was cost of implants. Faster time from admission to surgery was associated with neurologic improvement, yet significant delays to surgery were seen due to patients' inability to pay for implants. Several themes for improvement emerged: early surgery, implant availability, prehospital transfer, and long-term follow-up.
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Affiliation(s)
- Juma Magogo
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Albert Lazaro
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Mechris Mango
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Scott L. Zuckerman
- New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA,Vanderbilt University Medical Center, Nashville, TN, USA,Roger Härtl, Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York–Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 99, New York, NY 10065, USA. Scott L. Zuckerman
| | - Andreas Leidinger
- New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Salim Msuya
- Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | | | | | - Roger Härtl
- New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA,Roger Härtl, Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York–Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 99, New York, NY 10065, USA. Scott L. Zuckerman
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Wang TY, Mehta VA, Dalton T, Sankey EW, Rory Goodwin C, Karikari IO, Shaffrey CI, Than KD, Abd-El-Barr MM. Biomechanics, evaluation, and management of subaxial cervical spine injuries: A comprehensive review of the literature. J Clin Neurosci 2020; 83:131-139. [PMID: 33281051 DOI: 10.1016/j.jocn.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Literature review. OBJECTIVES It has been reported that 2.4-3.7% of all blunt trauma victims suffer some element of cervical spine fracture, with the majority of these patients suffering from C3-7 (subaxial) involvement. With the improvement of first-response to trauma in the community, there are an increasing number of patients who survive their initial trauma and thus arrive at the hospital in need of further evaluation, stabilization, and management of these injuries. METHODS A comprehensive literature review compiled all relevant data on the biomechanics, imaging, evaluation, and medical and surgical management strategies for subaxial cervical spine fractures. RESULTS After review of the current literature on subaxial cervical spine biomechanics, imaging characteristics, evaluation strategies and surgical and orthopedic management techniques, the authors created a comprehensive review and protocol for management of subaxial cervical spine fractures. CONCLUSIONS The subaxial cervical spine is biomechanically and anatomically unique from the remainder of the spinal axis. Evaluation of subaxial cervical spine injuries is nuanced, and improper management of these injuries can lead to significant patient morbidity and even death. This provides a comprehensive review combining anatomy, imaging characteristics, evaluation strategies, and surgical and orthopedic management principles for subaxial cervical spine fractures.
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Affiliation(s)
- Timothy Y Wang
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Vikram A Mehta
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Tara Dalton
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Eric W Sankey
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - C Rory Goodwin
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Isaac O Karikari
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | - Khoi D Than
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Zou P, Yang JS, Wang XF, Wei JM, Liu P, Chen H, Hao DJ, Li QD, Wei D, Gong HL, Wu XC, Liu BY, Zhang YT, Zhang XF, Zhao YT. Comparison of Clinical and Radiologic Outcome Between Mini-Open Wiltse Approach and Fluoroscopic-Guided Percutaneous Pedicle Screw Placement: A Randomized Controlled Trial. World Neurosurg 2020; 144:e368-e375. [DOI: 10.1016/j.wneu.2020.08.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
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Shen J, Yang Z, Fu M, Hao J, Jiang W. The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fracture: a randomized double-blinded controlled study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:3074-3080. [PMID: 33231778 PMCID: PMC7684563 DOI: 10.1007/s00586-020-06626-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 12/02/2022]
Abstract
Purpose To investigate the safety and efficacy of topical use of tranexamic acid (TXA) on early operation for thoracolumbar burst fracture (TBF). Methods Patients with acute TBF requiring early decompression were prospectively collected. The enrolled patients were randomly assigned to TXA and control group, in which wound surface was soaked with TXA or the same volume of normal saline for 5 min after wound incision, respectively. The total blood loss (TBL), intraoperative blood loss (IBL), postoperative blood loss (PBL), hemoglobin (HGB) levels on preoperatively (pre-op) and postoperatively, and amount of allogenic blood transfusion were recorded. Furthermore, the general information was also compared between groups. Results There were 39 and 37 patients enrolled in TXA and control group for final analysis. The demographics data showed no significant difference between groups (P > 0.05), but operation time and IBL were significantly decreased in TXA group (P < 0.05). Further analysis showed that HGB level was significantly higher in the TXA group at POD1, while the TBL and PBL were significantly less than those in the control group (P < 0.05), but similar to HBL (P > 0.05). The postoperative ambulation time, removal time of drainage tube, length of hospital stay, and blood transfusion rate were also significantly less in TXA group (P < 0.05). At the final follow-up, no neurological deteriorations and no TXA-related complications were observed in both groups. Conclusion This RCT first demonstrated that topical TXA usage after wound incision could effectively reduce IBL without increasing risk of complications, beneficial to enhanced recovery after early operation for TBF. Electronic supplementary material The online version of this article (10.1007/s00586-020-06626-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jieliang Shen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 40042, China
| | - Zhengyang Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 40042, China
| | - Mengyu Fu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 40042, China
| | - Jie Hao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 40042, China
| | - Wei Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 40042, China.
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Efficacy of a Novel Vertebral Body Augmentation System in the Treatment of Patients with Symptomatic Vertebral Body Fractures. Cardiovasc Intervent Radiol 2020; 44:289-299. [PMID: 33099702 PMCID: PMC7806563 DOI: 10.1007/s00270-020-02658-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate the safety and efficacy of a novel augmentation implant in the treatment of patients with symptomatic vertebral body fractures. Materials and Methods Thirty consecutive patients (seven males and 23 females), mean age of 70 years (range 56 to 89) with osteoporotic fractures and/or low-energy trauma fractures (osteoporosis confirmed by CT), were enrolled in an IRB-approved prospective study. The type of fracture was classified according to the Magerl classification. The patients were treated with the Tektona® dedicated vertebral body augmentation system. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were obtained after 1, 6 and 12 months. Quality of life was assessed with the SF36 score. Results A total of 37 vertebral bodies, mostly from T6 to L5, were treated in the 30 enrolled patients. In 67.6% of the cases (n = 25), lumbar fractures were treated. Most of the fractures (43%; n = 16) were A1.1 according to the Magerl classification. A significant pain reduction evaluated by VAS scores (p < 0.0001) was observed on average 7.6 (before the procedure) to 2.8 (immediately post-treatment), 2.1 and 2.7 (after 6 and 12 months later, respectively). The mean ODI score was 55.5% before treatment, and this was statistically significant reduced to 22.3% and 26.9%, respectively, at 6 and 12 months after treatment (p < 0.0001). The SF36 scores, both physical and mental components, showed statistically significant variations (p < 0.0001) whose direction was subpopulation dependent. Conclusion Patients with confirmed osteoporosis, suffering from symptomatic vertebral body fractures (osteoporotic and/or low-energy traumatic), were treated safely and effectively using this novel implant.
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Helfen T. [65/f-falling down the stairs with sequelae : Preparation for the medical specialist examination-Part 24]. Unfallchirurg 2020; 124:59-63. [PMID: 33006634 DOI: 10.1007/s00113-020-00880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Tobias Helfen
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU Klinikum, Nußbaumstr. 20, 80336, München, Deutschland.
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Huang Z, Tong Y, Fan Z, Hu C, Zhao C. Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture. J Orthop Surg Res 2020; 15:415. [PMID: 32933576 PMCID: PMC7493152 DOI: 10.1186/s13018-020-01946-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to evaluate the feasibility, safety, efficacy, and indications of percutaneous pedicle screw fixation (PPSF) combined with selective transforaminal endoscopic decompression (TED) in the treatment of thoracolumbar burst fracture (TBLF). Methods From August 2015 to October 2018, a total of 41 patients with single-segment TLBF (28 men and 13 women) were enrolled in this study. X-ray and computed tomography were obtained before surgery, 1 week after surgery, and 1 year after surgery to evaluate spinal recovery. In addition, we used the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association score (JOA), and the Frankel classification of neurological deficits to evaluate the effectiveness of the treatments. Results The average follow-up time was 22.02 ± 8.28 months. The postoperative Cobb angle, vertebral body compression ratio, vertebral wedge angle, mid-sagittal canal diameter compression ratio, and Frankel grade were significantly improved. There were also significant improvements in the VAS (7.61 ± 1.41 vs. 1.17 ± 0.80, P < 0.001), ODI (89.82 ± 7.44 vs. 15.71 ± 13.50, P < 0.001), and JOA (6.90 ± 2.91 vs. 24.90 ± 3.03, P < 0.001). Conclusions Our results showed that PPSF combined with selective TED in the treatment of TLBF had excellent efficacy, high safety, less secondary injury than other treatments, and a wide range of indications and that it could accurately distinguish patients who did not need spinal canal decompression after posterior fixation. PPSF combined with selective TED is therefore a good choice for the treatment of TLBF.
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Affiliation(s)
- Zhangheng Huang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China
| | - Yuexin Tong
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China
| | - Zhiyi Fan
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China
| | - Chuan Hu
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chengliang Zhao
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China.
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Hu X, Ma W, Chen J, Wang Y, Jiang W. Posterior short segment fixation including the fractured vertebra combined with kyphoplasty for unstable thoracolumbar osteoporotic burst fracture. BMC Musculoskelet Disord 2020; 21:566. [PMID: 32825812 PMCID: PMC7442982 DOI: 10.1186/s12891-020-03576-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Various studies have described the efficacy and safety of the treatment for unstable thoracolumbar osteoporotic burst fracture, however, there is still no consensus on the optimal treatment regimen. The aim of this study was to evaluate the clinical and radiographic results of posterior short segment fixation including the fractured vertebra (PSFFV) combined with kyphoplasty (KP) for unstable thoracolumbar osteoporotic burst fracture. METHODS Forty-three patients with unstable thoracolumbar osteoporotic burst fracture underwent PSFFV combined with KP from January 2015 to December 2017 were analyzed retrospectively. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) was used to evaluate the clinical outcome, radiological parametres including local kyphotic Cobb angle, percentage of the anterior, middle and posterior height of the fractured vertebra were measured and compared pre-operation, post-operation and at final follow-up. RESULTS All patients underwent surgery successfully and with an average follow-up of 19.2 ± 6.7 months (rang 15-32). The VAS decreased from 7.1 ± 2.3 pre-operation to 1.6 ± 0.4 at the final follow-up (p < 0.05). The ODI decreased from 83.1 ± 10.5 pre-operation to 19.2 ± 7.3 (P < 0.05) at the final follow-up. The correction of local kyphotic angle was 16.9° ± 5.3° (p < 0.05), and the loss of correction was 3.3° ± 2.6° (p > 0.05), the correction of anterior vertebral height was 30.8% ± 8.6% (p < 0.05), and the loss of correction was 4.5% ± 3.9% (p > 0.05), the correction of middle vertebral height was 26.4% ± 5.8% (p < 0.05), and the loss of correction was 2.0% ± 1.6% (p > 0.05), the correction of posterior vertebral height was 9.4% ± 6.9% (p < 0.05), and the loss of correction was 1.6% ± 1.3% (p > 0.05). Two cases of screw pullout and 8 cases of cement leakage were observed, but without clinical consequence. CONCLUSIONS PSFFV combined with KP is a reliable and safe procedure with satisfactory clinical and radiological results for the treatment of unstable thoracolumbar osteoporotic burst fracture.
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Affiliation(s)
- Xudong Hu
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhongshan East Road 1059#, Ningbo, 315040, Zhejiang Province, China
| | - Weihu Ma
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhongshan East Road 1059#, Ningbo, 315040, Zhejiang Province, China
| | - Jianming Chen
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhongshan East Road 1059#, Ningbo, 315040, Zhejiang Province, China
| | - Yang Wang
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhongshan East Road 1059#, Ningbo, 315040, Zhejiang Province, China
| | - Weiyu Jiang
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhongshan East Road 1059#, Ningbo, 315040, Zhejiang Province, China.
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Vaccaro AR, Schroeder GD, Divi SN, Kepler CK, Kleweno CP, Krieg JC, Wilson JR, Holstein JH, Kurd MF, Firoozabadi R, Vialle LR, Oner FC, Kandziora F, Chapman JR, Schnake KJ, Benneker LM, Dvorak MF, Rajasekaran S, Vialle EN, Joaquim AF, El-Sharkawi MM, Dhakal GR, Popescu EC, Kanna RM, Muijs S, Tee JW, Bellabarba C. Description and Reliability of the AOSpine Sacral Classification System. J Bone Joint Surg Am 2020; 102:1454-1463. [PMID: 32816418 PMCID: PMC7508295 DOI: 10.2106/jbjs.19.01153] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons. METHODS A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (κ) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3). RESULTS Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (κ = 0.83) for fracture severity and substantial (κ = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (κ = 0.75), with the highest agreement for type-A fractures (κ = 0.95) and the lowest for type-C fractures (κ = 0.70). Overall interrater agreement was moderate (κ = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (κ = 0.81) and the lowest for A1 subtypes (κ = 0.20). CONCLUSIONS To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment.
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Affiliation(s)
- Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Srikanth N. Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,Email address for S.N. Divi:
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Conor P. Kleweno
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - James C. Krieg
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jörg H. Holstein
- Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Reza Firoozabadi
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Luiz R. Vialle
- Department of Orthopaedics, Catholic University of Parana, Curitiba, Brazil
| | | | - Frank Kandziora
- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Jens R. Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Klaus J. Schnake
- Center for Spine and Scoliosis Surgery, Schön Klinik Nürnberg Fürth, Fürth, Germany
| | - Lorin M. Benneker
- Spine Unit, Department of Orthopaedic Surgery and Traumatology, Insel Hospital and Bern University Hospital, Bern, Switzerland
| | - Marcel F. Dvorak
- Department of Orthopaedics, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Emiliano N. Vialle
- Department of Orthopaedics, Catholic University of Parana, Curitiba, Brazil
| | - Andrei F. Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | | | | | | | - Rishi M. Kanna
- Department of Orthopaedics, Trauma, and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - S.P.J. Muijs
- University Medical Center, Utrecht, the Netherlands
| | - Jin W. Tee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Carlo Bellabarba
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
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Abstract
Rib fractures due to blunt trauma are a common chest injury seen at the emergency department; however, injuries to the costovertebral joints are very rare. We present a case of a 24-year-old man who was admitted after a high-speed car collision and was assessed in a level 1 trauma centre in Amsterdam. He had multiple injuries, including dislocation of the costovertebral joint of ribs 7–10. After performing a literature search we concluded that patients with traumatic costovertebral joint dislocations have a high incidence of vertebral fractures, neurological deficits and additional fractures. We believe that isolated dislocation of one or multiple costovertebral joint(s) can safely be treated conservatively. Close monitoring of the patients is advisable as these injuries are caused by high impact and are associated with other injuries.
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Piccone L, Cipolloni V, Nasto LA, Pripp C, Tamburrelli FC, Maccauro G, Pola E. Reprint of: Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: Is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury 2020; 51 Suppl 3:S45-S49. [PMID: 32800314 DOI: 10.1016/j.injury.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical management of thoracolumbar burst fractures is controversial. While the goals of surgical treatment are well accepted (i.e., fracture reduction and stabilization, neural elements decompression, and segmental angular deformity correction), the choice of the best surgical approach (i.e., posterior vs. anterior vs. combined approach) remains controversial. Several studies have debated the advantages of each surgical approach but there is no definitive evidence available to date, particularly in young adult patients. The aim of this study was to assess whether posterior approach alone can be a valid surgical treatment for patient under the age of 40 affected by thoracolumbar burst fractures and incomplete neurological deficits. MATERIAL AND METHODS A total of 10 consecutive patients affected by thoracolumbar burst fractures associated with incomplete neurological deficits treated at our institution from January 2015 to February 2017 were included in our study. All patients were under the age of 40 at the time of injury and underwent decompression and stabilization using the posterior surgical approach alone. Demographics, clinical, and radiographic parameters were recorded preoperatively, postoperatively and at the latest available follow-up. The minimum follow-up was set at 2 years post-operatively. RESULTS The mean operative time was 303.6 min (range, 138-486). Average blood loss was 756 mL (range, 440-2100). Nine out of ten patients returned to a normal neurological status after surgery while 1 patient showed some improvement but did not recover completely. Segmental kyphotic deformity improved from a mean of 21.8° before surgery to 14.8° at the time of the last follow-up. The anterior and posterior wall height of the fractured vertebra was restored with an average of 4 mm. The Visual Analogue Scale score reported an improvement from the mean preoperative value of 7.92 to 1.24 at the last follow-up; 8 out of 10 patients resumed physical activity while all of them returned to work. CONCLUSIONS A single posterior surgical approach is an acceptable option in terms of clinical, radiological and functional outcomes at 2 years follow-up in patients under the age of 40 presenting with a thoracolumbar burst fracture and neurological deficit.
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Affiliation(s)
- L Piccone
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - V Cipolloni
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - L A Nasto
- Department of Pediatric Orthopaedics, IRCCS Istituto "G Gaslini", Genova, Italy
| | - C Pripp
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - F C Tamburrelli
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Maccauro
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - E Pola
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
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Pressure ulcers after traumatic spinal injury in East Africa: risk factors, illustrative case, and low-cost protocol for prevention and treatment. Spinal Cord Ser Cases 2020; 6:48. [PMID: 32541848 DOI: 10.1038/s41394-020-0294-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective, case-control study. OBJECTIVES In a traumatic spinal injury (TSI) cohort from Tanzania, we sought to: (1) describe potential risk factors for pressure ulcer development, (2) present an illustrative case, and (3) propose a low-cost outpatient protocol for prevention and treatment. SETTING Tertiary referral hospital. METHODS All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, time to hospital, injury characteristics, operative management, length of hospitalization, and mortality. Pressure ulcer development was the primary outcome. Regressions were used to report potential predictors, and international guidelines were referenced to construct a low-cost outpatient protocol. RESULTS Of 267 patients that met the inclusion criteria, 51 developed a pressure ulcer. Length of stay was greater for patients with pressure ulcers compared with those without (45 vs. 30 days, p < 0.001). Potential predictors for developing pressure ulcers were: increased days from injury to hospital admission (p = 0.036), American Spinal Injury Association Impairment Scale grade A upon admission (p < 0.001), and thoracic spine injury (p = 0.037). The illustrative case described a young male presenting ~2 months after complete thoracic spinal cord injury with a grade IV sacral pressure ulcer that lead to septic shock and death. Considering the dramatic consequences of pressure ulcers in lower- and middle-income countries (LMICs), we proposed a low-cost protocol for prevention and treatment targeting support surfaces, repositioning, skin care, nutrition, follow-up, and dressing. CONCLUSIONS Pressure ulcers after TSI in LMICs can lead to increased hospital stays and major adverse events. High-risk patients were those with delayed presentation, complete neurologic injuries, and thoracic injuries. We recommended aggressive prevention and treatment strategies suitable for resource-constrained settings.
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Wipplinger C, Griessenauer CJ. Commentary: George Chance and Frank Holdsworth: Understanding Spinal Instability and the Evolution of Modern Spine Injury Classification Systems. Neurosurgery 2020; 86:E519-E520. [PMID: 32297636 DOI: 10.1093/neuros/nyaa084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Starlinger J, Lorenz G, Fochtmann-Frana A, Sarahrudi K. Bisegmental posterior stabilisation of thoracolumbar fractures with polyaxial pedicle screws: Does additional balloon kyphoplasty retain vertebral height? PLoS One 2020; 15:e0233240. [PMID: 32421734 PMCID: PMC7233542 DOI: 10.1371/journal.pone.0233240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/30/2020] [Indexed: 11/18/2022] Open
Abstract
We retrospectively evaluated single-level compression fractures (T12-L3) scheduled for a short-segment POS (posterior-only stabilization) using polyaxial screws. Patients averaged 55.7 years (range, 19–65). Patients received either POS or, concomitantly, BK (balloon kyphoplasty) of the fractured vertebrae as well. Primary endpoint was the radiological outcome at the last radiographic follow-up prior to implant removal. POS together with BK of the fractured vertebrae resulted in a significant improvement of the local kyphosis angle and vertebral body compression rates immediately post-OP. During the further course of FU, a considerable loss of correction was observed post-OP in both groups. (Local KA: pre-OP/ post-OP/ FU: 12.6±4.8/ 3.35±4.8/ 11.6±6.0; anterior vertebral body compression%: pre-OP/post-OP/ FU: 71.94±12.3/ 94.78±19.95/ 78.17±14.74). VAS was significantly improved from 7.2±1.3 pre-OP to 2.7±1.3 (P<0.001) at FU. We found a significant restoration of the vertebral body height by BK. Nevertheless, follow-up revealed a noticeable loss of reduction. Given the fact that BK used together with polyaxial screws did not maintain intra-operative reduction, our data do not support this additional maneuver when used together with bi-segmental polyaxial pedicle screw fixation.
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Affiliation(s)
- Julia Starlinger
- Department for Orthopedics, Mayo Clinic, Rochester, MN, United States of America
- Department for Orthopedics and Trauma Surgery, Medical University Vienna, Vienna, Austria
- * E-mail:
| | | | | | - Kambiz Sarahrudi
- Department for Trauma Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
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Safety of vertebral augmentation with cranio-caudal expansion implants in vertebral compression fractures with posterior wall protrusion. Eur Radiol 2020; 30:5641-5649. [PMID: 32367420 DOI: 10.1007/s00330-020-06889-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Vertebral augmentation (VA) has become routinely used in vertebral compression fractures (VCFs). VCFs are often associated with posterior wall protrusions (PWPs), which theoretically contraindicates vertebroplasty due to a higher risk of neurological complications. The latest generation of VA devices uses intravertebral cranio-caudal expandable implants to improve the correction of structural deformities but could also be used to prevent further PWP during cement injection. The aim of this study was to evaluate the safety of VA with expandable implant for VCFs with PWP. METHODS All consecutive patients treated with expandable implants were considered eligible for inclusion if they met the following criteria: (1) non-neurological VCF, (2) considered unstable (A3-A4 in AOSpine classification), (3) significant PWP (> 2 mm), (4) back pain with a visual analogue scale (VAS) ≥ 4. PWPs were independently measured by two investigators; Pearson's statistics were used for interobserver reproducibility. RESULTS Fifty-one consecutive patients, with a mean age of 75 ± 8.3 years (range, 50-92), were included. There was a slight decrease between mean preoperative (6.7 mm ± 2.2 mm) and postoperative (6.5 mm ± 2.2 mm) PWP (p = 0.02), with an excellent interobserver reproducibility (Pearson correlation coefficient = 0.92). A mean kyphosis reduction of 34.9% (± 28.4) was observed (p < 0.001). Forty-two patients (82.4%) had significant pain improvements (mean preoperative VAS = 6.9 [± 1.7] versus 3.1 [± 2.0] postoperatively [p < 0.001]). Secondary adjacent level fractures were noted in 16 patients (31.4%), with a reduction of that risk down to 18.8% if a preventive adjacent vertebroplasty was performed, without reaching the significance threshold (p = 0.14). CONCLUSIONS VA with expandable implants appeared safe for non-neurological VCFs with PWP, while allowing satisfactory pain relief. KEY POINTS • Vertebral augmentation with cranio-caudal expandable implants is safe for non-neurological vertebral compression fractures with posterior wall protrusions. • Vertebral augmentation with cranio-caudal expandable implants might increase the occurrence of secondary adjacent level fractures. • Adjacent level vertebroplasty might be helpful to prevent secondary adjacent level fractures.
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Nonoperative treatment of traumatic spinal injuries in Tanzania: who is not undergoing surgery and why? Spinal Cord 2020; 58:1197-1205. [PMID: 32350408 PMCID: PMC7222864 DOI: 10.1038/s41393-020-0474-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective, cohort study of a prospectively collected database. OBJECTIVES In a cohort of patients with traumatic spine injury (TSI) in Tanzania who did not undergo surgery, we sought to: (1) describe this nonoperative population, (2) compare outcomes to operative patients, and (3) determine predictors of nonoperative treatment. SETTING Tertiary referral hospital. METHODS All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, fracture morphology, neurologic exam, indication for surgery, length of hospitalization, and mortality. Regression analyses were used to report outcomes and predictors of nonoperative treatment. RESULTS 270 patients met inclusion criteria, of which 145 were managed nonoperatively. Demographics between groups were similar. The nonoperative group was young (mean = 35.5 years) and primarily male (n = 125, 86%). Nonoperative patients had 7.39 times the odds of death (p = 0.003). Patients with AO type A0/1/2/3 fractures (p < 0.001), ASIA E exams (p = 0.016), cervical spine injuries (p = 0.005), and central cord syndrome (p = 0.016) were more commonly managed nonoperatively. One hundred and twenty-four patients (86%) had indications for but did not undergo surgery. After multivariate analysis, the only predictor of nonoperative management was sustaining a cervical injury (p < 0.001). CONCLUSIONS Eighty-six percent of nonoperative TSI patients had an indication for surgery. Nonoperative management was associated with an increased risk of mortality. Cervical injury was the single independent risk factor for not undergoing surgery. The principle reason for nonoperative management was cost of implants. While a causal relationship between nonoperative management and inferior outcomes cannot be made, efforts should be made to provide surgery when indicated, regardless of a patient's ability to pay.
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Yang J, Wang Y, Kong Q. [The application of classification of lateral region of lumbar spinal canal for treatment of lumbar spinal stenosis in geriatric patients using full endoscopic transforaminal decompression surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:415-421. [PMID: 32291974 DOI: 10.7507/1002-1892.201911001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To assess the reliability, effectiveness, and the safety of full endoscopic transforaminal decompression (FETD) under local anesthesia guided by the classification of lateral region of the lumbar spinal canal (CLLSC) in treating lumbar spinal stenosis (LSS) in geriatric patients. Methods The clinical data of 63 geriatric patients with LSS met the inclusion criteria underwent FETD surgery between June 2015 and July 2017 were retrospectively analyzed. There were 37 males and 26 females, with a median age of 76 years [interquartile range (IQR), 73-80 years], and a median symptomatic duration of 55 months (IQR, 16-120 months). There were 17 cases of grade B and 46 cases of grade C based on the Schizas morphological grading system. CLLSC was used for imaging evaluation for the stenotic condition, and intra-class correlation coefficients (ICC) were used to test intra-observer and inter-observer reliability of CLLSC. The stenotic condition of patients was re-evaluated by the surgeon after operation, and the results were compared with the findings of preoperative CLLSC. The visual analogue scale (VAS) score for low back pain and leg pain recorded before operation, and at 1 day, 3 months, and 6 months after operation, and last follow-up were used to assess the pain relieving; the functional improvement was evaluate by Oswestry disability index (ODI); the modified Macnab criteria were used to self-evaluate the surgical satisfaction. Results The operation were successfully performed for all patients, with a median operation time of 75 minutes (IQR, 65-85 minutes), postoperative hospitalization stay of 48 hours (IQR, 48-72 hours), and the time to ambulation after operation of 24 hours (IQR, 24-24 hours). Sixty-three patients were followed-up and with a median follow-up time of 18 months (IQR, 13-20 months). Based on preoperative CLLSC classification, there were 72 stenotic zones, distributed 16 in zone 1, 6 in zone 2, 3 in zone 3, 2 in zone 4, 7 in zone 5, 34 in zones 1+2, 2 in zones 3+4, and 2 in zones 4+5. Perioperative complications occurred in 4 cases (6.3%), including 2 cases of intraoperative dural sac tear, 1 of preoperative numbness symptom aggravation, and 1 of postoperative urinary retention. VAS score of leg pain and ODI score at each time point after operation were significantly improved compared with those before operation ( P<0.05). VAS scores of low back pain showed no significant difference between pre- and post-operation ( P>0.05). At last follow-up, based on the modified Macnab criteria, 19 cases were excellent, 37 were good, 6 were fair, and 1 was poor, and the excellent and good rate was 88.9%. The reliability analysis showed that CLLSC had substantial intra-observer reliability in the geriatric population, with an average ICC of 0.78. There was also a substantial inter-observer reliability, with an average ICC of 0.73. While comparing the preoperative CLLSC results with the postoperative CLLSC results, 53 patients (73.6%) were in full agreement, 15 patients (20.8%) were in partial agreement, and 4 patients (5.6%) were not. Conclusion CLLSC has high reliability in the diagnosis of LSS in the geriatric patients. Combined FETD with CLLSC, accurate diagnosis, and minimal invasion can be performed to achieve safe and effective result.
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Affiliation(s)
- Jin Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Yu Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Qingquan Kong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Piccone L, Cipolloni V, Nasto LA, Pripp C, Tamburrelli FC, Maccauro G, Pola E. Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: Is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury 2020; 51:312-316. [PMID: 31917009 DOI: 10.1016/j.injury.2019.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical management of thoracolumbar burst fractures is controversial. While the goals of surgical treatment are well accepted (i.e., fracture reduction and stabilization, neural elements decompression, and segmental angular deformity correction), the choice of the best surgical approach (i.e., posterior vs. anterior vs. combined approach) remains controversial. Several studies have debated the advantages of each surgical approach but there is no definitive evidence available to date, particularly in young adult patients. The aim of this study was to assess whether posterior approach alone can be a valid surgical treatment for patient under the age of 40 affected by thoracolumbar burst fractures and incomplete neurological deficits. MATERIAL AND METHODS A total of 10 consecutive patients affected by thoracolumbar burst fractures associated with incomplete neurological deficits treated at our institution from January 2015 to February 2017 were included in our study. All patients were under the age of 40 at the time of injury and underwent decompression and stabilization using the posterior surgical approach alone. Demographics, clinical, and radiographic parameters were recorded preoperatively, postoperatively and at the latest available follow-up. The minimum follow-up was set at 2 years post-operatively. RESULTS The mean operative time was 303.6 min (range, 138-486). Average blood loss was 756 mL (range, 440-2100). Nine out of ten patients returned to a normal neurological status after surgery while 1 patient showed some improvement but did not recover completely. Segmental kyphotic deformity improved from a mean of 21.8° before surgery to 14.8° at the time of the last follow-up. The anterior and posterior wall height of the fractured vertebra was restored with an average of 4 mm. The Visual Analogue Scale score reported an improvement from the mean preoperative value of 7.92 to 1.24 at the last follow-up; 8 out of 10 patients resumed physical activity while all of them returned to work. CONCLUSIONS A single posterior surgical approach is an acceptable option in terms of clinical, radiological and functional outcomes at 2 years follow-up in patients under the age of 40 presenting with a thoracolumbar burst fracture and neurological deficit.
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Affiliation(s)
- L Piccone
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - V Cipolloni
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - L A Nasto
- Department of Pediatric Orthopaedics, IRCCS Istituto "G Gaslini", Genova, Italy
| | - C Pripp
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - F C Tamburrelli
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Maccauro
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - E Pola
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
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Grabel ZJ, Lunati MP, Segal DN, Kukowski NR, Yoon ST, Jain A. Thoracolumbar spinal fractures associated with ground level falls in the elderly: An analysis of 254,486 emergency department visits. J Clin Orthop Trauma 2020; 11:916-920. [PMID: 32879581 PMCID: PMC7452325 DOI: 10.1016/j.jcot.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022] Open
Abstract
STUDY DESIGN retrospective. OBJECTIVES To investigate the epidemiology of elderly (age ≥65 years) patients who presented to the emergency department (ED) in the United States with thoracolumbar (TL) fractures after ground level falls. METHODS Using the National Emergency Department Sample database, we queried all ED visits in the United States from 2009 through 2012 of elderly patients who presented after ground level falls. We identified patients who sustained TL fractures with and without neurological injury. Resulting data was used to analyze the fracture prevalence, ED and patient characteristics, associated injuries, treatment patterns, inpatient mortality, and hospital charges. RESULTS Of the 6,654,526 ED visits in the elderly for ground level falls, 254,486 (3.8%) were associated with a diagnosis of TL fracture. 39% patients had multiple injuries, and upper extremity fractures were the most common associated injuries. Overall, 55.6% were admitted to the hospital. Of those, 77.7% were treated non-operatively, 20.4% were treated with cement augmentation alone, 1.5% were treated with spinal fusion surgery, and 0.4% were treated with spinal decompression alone. The overall rate of inpatient mortality was 2.14%. CONCLUSIONS This investigation evaluated the epidemiology of elderly patients who presented to the ED in the United States with TL fractures after ground level falls. The study demonstrated a rather high incidence of TL fractures in this patient cohort. As a result, it is important for ED physicians and orthopaedic surgeons to be highly suspicious of TL fractures in elderly patients who sustain low energy trauma. With the continued aging of the population and rising health care costs, future effort ought to focus on fall prevention and increased surveillance for TL injuries in the elderly.
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Affiliation(s)
- Zachary J. Grabel
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, 30329, USA
| | - Matthew P. Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, 30329, USA,Corresponding author. Department of Orthopaedics, Emory University School of Medicine, 57 Executive Park South, Suite 120, Atlanta, GA, USA.
| | - Dale N. Segal
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, 30329, USA
| | - Nathan R. Kukowski
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, 30329, USA
| | - S. Tim Yoon
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, 30329, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 N. Caroline St, Baltimore, MD, 21287, USA
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Current status of short segment fixation in thoracolumbar spine injuries. J Clin Orthop Trauma 2020; 11:770-777. [PMID: 32879564 PMCID: PMC7452221 DOI: 10.1016/j.jcot.2020.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/20/2022] Open
Abstract
Short segment fixation aims to restore spinal stability and alignment in thoracolumbar spine injuries while preserving spinal motion by decreasing the levels of spine involved in fixation. In its simplest form it applies to fixation one level above and one level below the fractured vertebra. It has proven effective with good clinical, functional and radiological results in well selected cases. However not insignificant rates of sagittal collapse and recurrence of kyphosis with or without clinical implications have also been reported. Most of the failures were attributed to lack of anterior column integrity and relatively inferior robustness of earlier posterior short segment constructs. With better understanding of fracture biomechanics, better implant designs and evolution of strategies to increase the biomechanical strengths of posterior constructs, the rates of kyphosis recurrence and implant failure have been significantly reduced. Although there is lack of robust evidence to guide a surgeon to the best approach for a particular fracture, adhering to basic biomechanical principals increases the efficacy and reliability of short segment fixation. This narrative review highlights the status of short segment fixation in dorsolumbar spine injuries with emphasis on patient selection and strategies to increase effectiveness and reduce failures of short segment fixation.
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Nonmetallic posterior monosegmental cervical fusion of a dislocated C6/7 fracture in a 4-year-old girl : A case report. DER ORTHOPADE 2019; 48:433-439. [PMID: 30887057 DOI: 10.1007/s00132-019-03714-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pediatric cervical spine injuries constitute approximately 1-2% of all pediatric trauma cases. Usually pediatric vertebral injuries appear as stable A type fractures, whereas B and C type injuries are relatively uncommon. In contrast to adults, the appropriate treatment strategy in children is still controversial and places spine surgeons in complex situations. This article reports the case of a 4-year-old girl with an unstable B type injury at the C6/7 level (AOSpine C6-7: B2 [F4 BL, C7:A1]) with bilateral locked fractures of the facet joints after falling down a flight of stairs. PATIENT AND METHODS Magnetic resonance imaging (MRI) and computed tomography (CT) were initially performed. The 4‑year-old girl was treated under intraoperative neurophysiological monitoring via open reduction after partial resection of both C7 upper articular processes and nonmetallic monosegmental posterior interlaminar fusion (FiberWire®) at the C6/7 level with temporary immobilization in a halo brace. RESULTS Clinical and radiological follow-up was carried out after 9 months. The patient suffered no pain or neurological deficits. Plain radiographs revealed a correct cervical alignment with anatomical correction of the initial dislocation. CONCLUSION The treatment of highly unstable pediatric B type injuries of the lower cervical spine via open reduction and nonmetallic monosegmental posterior interlaminar fusion results in good clinical and radiological outcomes. A temporary immobilization in a halo brace provides stability until osseous fusion occurs.
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Vetter S. [Cervical spine injuries in the elderly patient]. Chirurg 2019; 90:782-790. [PMID: 31463657 DOI: 10.1007/s00104-019-01020-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Studies have shown that the numbers of injuries of the cervical spine increase in elderly patients. An early clinical examination and adequate diagnostics are necessary to initiate the appropriate treatment. A computed tomography (CT) scan is recommended to exclude injuries of the cervical spine. Dynamic fluoroscopy and magnetic resonance imaging (MRI) can additionally be helpful to detect instabilities. The treatment of the injury depends on the extent of the fracture and includes conservative treatment options with soft or rigid ortheses for cervical spine immobilization, retention with a halo fixator or open/closed reduction and fixation. In the selection of treatment it should be taken into consideration that the use of rigid immobilization or a halo fixator is associated with a significant reduction of the quality of life. In the region of the upper cervical spine only unstable fractures of the atlas and of the axis should be operatively treated. In the region of the subaxial cervical spine fractures are prone to be unstable due to the lack of flexibility of the cervical spine in elderly patients. Therefore, fractures of types B and C according to AO Spine, for which operative treatment is recommended, are regularely seen. In addition, a pre-existing stenosis of the spinal cord may lead to neurological symptoms which negatively influence the clinical outcome.
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Affiliation(s)
- S Vetter
- Klinik für Orthopädie und Unfallchirurgie, BG-Klinik Ludwigshafen, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Deutschland.
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Barreau X, Palussiere J, Fauche C. La radiologie interventionnelle en pathologie rachidienne. Presse Med 2019; 48:696-705. [DOI: 10.1016/j.lpm.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
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Divi SN, Schroeder GD, Oner FC, Kandziora F, Schnake KJ, Dvorak MF, Benneker LM, Chapman JR, Vaccaro AR. AOSpine-Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles. Global Spine J 2019; 9:77S-88S. [PMID: 31157149 PMCID: PMC6512201 DOI: 10.1177/2192568219827260] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To describe the current AOSpine Trauma Classification system for spinal trauma and highlight the value of patient-specific modifiers for facilitating communication and nuances in treatment. METHODS The classification for spine trauma previously developed by The AOSpine Knowledge Forum is reviewed and the importance of case modifiers in this system is discussed. RESULTS A successful classification system facilitates communication and agreement between physicians while also determining injury severity and provides guidance on prognosis and treatment. As each injury may be unique among different patients, the importance of considering patient-specific characteristics is highlighted in this review. In the current AOSpine Trauma Classification, the spinal column is divided into 4 regions: the upper cervical spine (C0-C2), subaxial cervical spine (C3-C7), thoracolumbar spine (T1-L5), and the sacral spine (S1-S5, including coccyx). Each region is classified according to a hierarchical system with increasing levels of injury or instability and represents the morphology of the injury, neurologic status, and clinical modifiers. Specifically, these clinical modifiers are denoted starting with M followed by a number. They describe unique conditions that may change treatment approach such as the presence of significant soft tissue damage, uncertainty about posterior tension band injury, or the presence of a critical disc herniation in a cervical bilateral facet dislocation. These characteristics are described in detail for each spinal region. CONCLUSIONS Patient-specific modifiers in the AOSpine Trauma Classification highlight unique clinical characteristics for each injury and facilitate communication and treatment between surgeons.
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Affiliation(s)
- Srikanth N. Divi
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Frank Kandziora
- Berufsgenossenschaftliche Unfallklinik Frankfurt, Frankfurt am Main, Germany
| | | | | | | | | | - Alexander R. Vaccaro
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Acute Spinal Cord Injury: A Systematic Review Investigating miRNA Families Involved. Int J Mol Sci 2019; 20:ijms20081841. [PMID: 31013946 PMCID: PMC6515063 DOI: 10.3390/ijms20081841] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/06/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023] Open
Abstract
Acute traumatic spinal cord injury (SCI) involves primary and secondary injury mechanisms. The primary mechanism is related to the initial traumatic damage caused by the damaging impact and this damage is irreversible. Secondary mechanisms, which begin as early as a few minutes after the initial trauma, include processes such as spinal cord ischemia, cellular excitotoxicity, ionic dysregulation, and free radical-mediated peroxidation. SCI is featured by different forms of injury, investigating the pathology and degree of clinical diagnosis and treatment strategies, the animal models that have allowed us to better understand this entity and, finally, the role of new diagnostic and prognostic tools such as miRNA could improve our ability to manage this pathological entity. Autopsy could benefit from improvements in miRNA research: the specificity and sensitivity of miRNAs could help physicians in determining the cause of death, besides the time of death.
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Jenjitranant P, Beckmann NM, Cai C, Cheekatla SK, West OC. There has to be an easier way: facet fracture characteristics that reliably differentiate AOSpine F1 and F2 injuries. Emerg Radiol 2019; 26:391-399. [DOI: 10.1007/s10140-019-01684-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/08/2019] [Indexed: 11/29/2022]
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Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons. World Neurosurg 2019; 123:e125-e132. [DOI: 10.1016/j.wneu.2018.11.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/22/2022]
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Yu E, Choo S, Jain N, Malik A, Gennell T. The impact of body mass index on severity of cervical spine fracture: A retrospective cohort study. J Craniovertebr Junction Spine 2019; 10:224-228. [PMID: 32089615 PMCID: PMC7008661 DOI: 10.4103/jcvjs.jcvjs_95_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/06/2019] [Indexed: 11/19/2022] Open
Abstract
Background: No study has evaluated the relationship between increasing BMI and severity/type of cervical spine injuries. Aims and Objectives: The objective of our study was to study the impact of body mass index (BMI) on severity of cervical spine fracture. Methods: We performed a retrospective cohort study of patients with traumatic cervical spine fractures at a level I trauma center over a 74-year period. CT scans of the cervical spine were blindly graded according to the AO Spine sub-axial cervical spine classification. The association between BMI and severity of cervical spine fracture was studied by multiple-variable logistic regression. Results: A total of 291 patients with an average BMI of 26.1 ± 5.4 kg/m2 were studied. Higher BMI was not associated with more severe injury (OR 1.03, 95%, CI: 0.97–1.08). For rollover motor vehicle accident (MVA), the association was trending towards significance (OR 2.55, 95%, CI: 0.98-6.66, P = 0.06). Conclusions: Patients with higher BMI may be predisposed to more severe cervical spine fracture in rollover MVA, but not non-rollover MVA or falls.
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Abstract
Instability of the spine is a complex clinical entity that exists on a wide spectrum encompassing many aspects of spinal pathology including traumatic, neoplastic, infectious, and degenerative processes. The importance of determining stability is paramount in the decision-making process regarding the need for operative or nonoperative care. Defining clinical instability can be a challenging and requires careful attention to the pathology involved, findings of necessary imaging, and a thorough clinical exam. Several classification systems have been developed to aid in surgical decision making, but certain limitations exist. Various imaging modalities play a crucial role in the evaluation of suspected instability. Computed tomography is the initial imaging modality of choice in the traumatic setting. Magnetic resonance imaging is an important adjunct in the setting of suspected ligamentous injury and the modality of choice in suspected infectious and neoplastic processes. Upright radiographs can be particularly useful in the setting of acute or subacute instability to glean information about how the spine responds to gravity and weightbearing. The clinical exam is also of critical importance in the determination of stability. The presence of a neurologic deficit is highly suggestive of a potentially unstable spine and appropriate spinal precautions should be maintained until instability and injury has been ruled out. Certain clinical entities, such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, are at high risk for instability particularly in the traumatic setting. In these situations, the spine should be considered unstable until proven otherwise. Ultimately, the determination of spinal stability, and subsequent need for surgical treatment, should be based on the individual case. Combining information from the clinical exam and imaging findings, including upright radiographs when appropriate, allows for the appropriated determination of spinal stability.
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Affiliation(s)
- Scott A Vincent
- Department of Orthopedic Surgery & Rehabilitation, University of Nebraska Medical Center, Omaha, NE.
| | - Paul A Anderson
- Department of Orthopedic Surgery & Rehabilitation, University of Nebraska Medical Center, Omaha, NE
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Muñoz Montoya JE, Torres C, Ferrer ER, Muñoz Rodríguez EE. A Colombian experience involving SpineJack ®, a consecutive series of patients experiencing spinal fractures, percutaneous approach and anatomical restoration 2016-2017. JOURNAL OF SPINE SURGERY 2018; 4:624-629. [PMID: 30547128 DOI: 10.21037/jss.2018.07.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Spinal fractures are becoming more frequent and should be handled as a severe and endemic pathology that requires timely diagnosis and adequate treatment. The classification of the AOSpine is currently the classification used for this type of fractures, not only for its approach, but to predict surgical management. Methods These patients had spinal fracture reduction procedures done through percutaneous way with expander endovertebral implants, and intraosseous fixation using SpineJack® intravertebral implants plus Cohesion® cement. Within the follow-up scheme, subsequent measurements were taken after a week, a month after surgery, 3 months after the procedure and after 6 months of follow-up. STATA® (Statistical Analysis System, version 12.1, SAS Institute Inc., Cary, NC, USA) was used for all analyzes. The Wilcoxon or Student's t-test was used for comparisons in pairs depending on the normality of the distribution. Results A clinical follow-up is performed to 20 consecutive patients experiencing spinal compression fractures (SCF) who received percutaneous treatment involving SpineJack® and Cohesion® cement, resulting in a statistically significant decrease of both pain and pain-related disability. No complications arose from the procedure. Conclusions According to the observations, which reflect what is found in the world literature, this is an effective and safe way of handling SCF.
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Affiliation(s)
| | | | - Esteban Ramírez Ferrer
- Department of Oncologic Neurosurgery, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Erik Edgardo Muñoz Rodríguez
- Department of Neurosurgery, Universidad Militar Nueva Granada, Bogotá, Colombia.,Department of Neurosurgery, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá, Colombia
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Vallier HA, Como JJ, Wagner KG, Moore TA. Team Approach: Timing of Operative Intervention in Multiply-Injured Patients. JBJS Rev 2018; 6:e2. [PMID: 30085943 DOI: 10.2106/jbjs.rvw.17.00171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Bernard F, Baucher G, Troude L, Fournier HD. The Surgeon in Action: Representations of Neurosurgery in Movies from the Frères Lumière to Today. World Neurosurg 2018; 119:66-76. [PMID: 30071331 DOI: 10.1016/j.wneu.2018.07.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 11/18/2022]
Abstract
In this review, we examine the portrayal of neurosurgery and neurosurgeons in 61 movies produced from the beginnings of cinema from the Lumière brothers (1895) to 2017, across 4 continents and covering 10 cinematic genres. We find that these movies tend to shape most beliefs and stereotypes about neurosurgery. However, we notice that there is a trend to describe neurosurgery and neurosurgical disorders with more accuracy as we progress in time. Although it is not for the medical profession to dictate or censor fictional content, a keen eye on these depictions will help us to understand, and perhaps combat, some of the stereotypes and myths that continue to surround neurosurgery in the twenty-first century.
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Affiliation(s)
- Florian Bernard
- Department of Neurosurgery, Teaching Hospital, Angers, Laboratory of Anatomy, Medical Faculty, Angers, France.
| | - Guillaume Baucher
- Department of Neurosurgery, Hopital Nord, APHM Marseille, Marseille, France
| | - Lucas Troude
- Department of Neurosurgery, Hopital Nord, APHM Marseille, Marseille, France
| | - Henri-Dominique Fournier
- Department of Neurosurgery, Teaching Hospital, Angers, Laboratory of Anatomy, Medical Faculty, Angers, France
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Pishnamaz M, Balosu S, Curfs I, Uhing D, Laubach M, Herren C, Weber C, Hildebrand F, Willems P, Kobbe P. Reliability and Agreement of Different Spine Fracture Classification Systems: An Independent Intraobserver and Interobserver Study. World Neurosurg 2018; 115:e695-e702. [PMID: 29709750 DOI: 10.1016/j.wneu.2018.04.138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Currently, no spinal classification system has achieved universal acceptance. Therefore, it is important to choose a reliable classification within clinical practice. The objective of this study was to determine and compare the intraobserver and interobserver agreement of the Load Sharing Classification (LSC), the Thoracolumbar Injury Classification System (TLICS), and the AOSpine Thoracolumbar Spine Injury Classification System. METHODS In this web-based intraobserver and interobserver study (www.spine.hostei.com), plain radiographs and computed tomographic scans of traumatic thoracolumbar fractures (T12-L2) were evaluated. By use of a questionnaire, fractures were classified according to the LSC, the TLICS, and the AOSpine classification. Data were analyzed with SPSS (Version 21, 76 Chicago, Illinois, USA). Intraobserver and interobserver agreement was determined by the Cohen κ. Statistical significance was defined as P < 0.05. RESULTS Data from 91 patients were classified twice by 7 board-certified spine surgeons. The intraobserver and interobserver reliability considering the LSC total score was noted as fair (intraobserver/interobserver reliability: κ = 0.26/0.22). Considering the resulting TLICS total score, a moderate intraobserver agreement (κ = 0.41) was noted, whereas the interobserver results presented only fair reliability (κ = 0.23). In contrast to the LSC and the TLICS, the AOSpine classification showed substantial agreement considering the fracture type (A;B;C) (intraobserver/interobserver reliability: κ = 0.71/0.61) and moderate agreement considering the fracture subtype (e.g., A0;A1;…;B1;…) (intraobserver/interobserver reliability: κ = 0.57/0.48). CONCLUSION In conclusion, the reliability of the AOSpine fracture classification is superior to the TLICS and the LSC. Therefore, this classification system could best be applied within clinical practice.
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Affiliation(s)
- Miguel Pishnamaz
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany.
| | - Stephan Balosu
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany
| | - Inez Curfs
- Department of Orthopaedic Surgery and Traumatology, Spine Centre, University of Maastricht Medical Center, Maastricht, The Netherlands
| | - Daniel Uhing
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany
| | - Markus Laubach
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany
| | - Christian Herren
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany
| | - Christian Weber
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany
| | - Paul Willems
- Department of Orthopaedic Surgery and Traumatology, Spine Centre, University of Maastricht Medical Center, Maastricht, The Netherlands
| | - Philipp Kobbe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany
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Three-material decomposition with dual-layer spectral CT compared to MRI for the detection of bone marrow edema in patients with acute vertebral fractures. Skeletal Radiol 2018; 47:1533-1540. [PMID: 29802531 PMCID: PMC6153646 DOI: 10.1007/s00256-018-2981-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/20/2018] [Accepted: 05/14/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess whether bone marrow edema in patients with acute vertebral fractures can be accurately diagnosed based on three-material decomposition with dual-layer spectral CT (DLCT). MATERIALS AND METHODS Acute (n = 41) and chronic (n = 18) osteoporotic thoracolumbar vertebral fractures as diagnosed by MRI (hyperintense signal in STIR sequences) in 27 subjects (72 ± 11 years; 17 women) were assessed with DLCT. Spectral data were decomposed into hydroxyapatite, edema-equivalent, and fat-equivalent density maps using an in-house-developed algorithm. Two radiologists, blinded to clinical and MR findings, assessed DLCT and conventional CT independently, using a Likert scale (1 = no edema; 2 = likely no edema; 3 = likely edema; 4 = edema). For DLCT and conventional CT, accuracy, sensitivity, and specificity for identifying acute fractures (Likert scale, 3 and 4) were analyzed separately using MRI as standard of reference. RESULTS For the identification of acute fractures, conventional CT showed a sensitivity of 0.73-0.76 and specificity of 0.78-0.83, whereas the sensitivity (0.93-0.95) and specificity (0.89) of decomposed DLCT images were substantially higher. Accuracy increased from 0.76 for conventional CT to 0.92-0.93 using DLCT. Interreader agreement for fracture assessment was high in conventional CT (weighted κ [95% confidence interval]; 0.81 [0.70; 0.92]) and DLCT (0.96 [0.92; 1.00]). CONCLUSIONS Material decomposition of DLCT data substantially improved accuracy for the diagnosis of acute vertebral fractures, with a high interreader agreement. This may spare patients additional examinations and facilitate the diagnosis of vertebral fractures.
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