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Bhushan A, Beland A, Poelstra C, Butterfield J, Angel M, Cheung T, Plater E, Guha D, Pahuta M, Macedo LG. Immobilization protocols for the treatment of cervical spine fracture: a scoping review. Spine J 2024:S1529-9430(24)00264-X. [PMID: 38908439 DOI: 10.1016/j.spinee.2024.05.012] [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: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Current protocols on cervical immobilization postcervical spine fracture are widely accepted in the acute rehabilitation of older adults, however consensus on its overall effectiveness remains lacking. PURPOSE Summarize information from original studies on available cervical immobilization protocols following a cervical fracture and to answer the questions; Which types of study designs have been used to assess the effectiveness of these protocols? What are the currently reported cervical immobilization protocols following cervical fracture in adults? What is the effectiveness of these protocols? What adverse events are associated with these protocols? STUDY DESIGN Scoping review was performed. PATIENT SAMPLE Searches were performed on the following online databases from inception to February 23, 2023: EMBASE, MEDLINE, CINAHL, and CENTRAL. Databases were searched for articles pertaining to collar use post cervical spine fracture. OUTCOME MEASURES Effectiveness of the cervical fracture immobilization protocols was the primary outcome, examined by various measures including union rates and disability indexes. METHODS 4 databases were searched; EMBASE, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) beginning on February 23, 2023, where 5,127 studies were yielded and 32 were extracted based on studies of adults (≥18 years) with a diagnosis of a cervical fracture (C0-C7) managed with a rigid external orthosis to prevent instability and surgery (collar, or cervicothoracic orthosis). Risk of bias was assessed using the guidelines set out by the Joanna Briggs Institute. RESULTS This scoping review yielded low-level prospective (18%) and retrospective (69%) cohort studies, case-control studies (3%), and case series (6%) from 1987 to 2022, patient age ranged from 14 to 104 years. Findings were difficult to summarize based on the lack of randomized controlled trials, leading to no clear conclusions drawn on the presence of standardized cervical immobilization protocols with no information on the duration of treatment or transition in care. Most included articles were retrospective cohort studies of poor to moderate quality, which have significant risk of bias for intervention questions. The effectiveness of these protocols remains unclear as most studies evaluated heterogeneous outcomes and did not present between-group differences. Mortality, musculoskeletal (MSK) complications, and delayed surgery were common adverse events associated with cervical collar use. CONCLUSION This scoping review highlights the need for higher levels of evidence as there is currently no standardized immobilization protocol for cervical spine fractures as a primary treatment, the effectiveness of cervical immobilization protocols is unclear, and mortality, MSK complications, and delayed surgery are common adverse events. No sources of funding were used for this scoping review.
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Affiliation(s)
- Akhilesh Bhushan
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Alexa Beland
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Chantelle Poelstra
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Butterfield
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Marina Angel
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Tiffany Cheung
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Emma Plater
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Daipayan Guha
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Markian Pahuta
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada.
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Kitov B, Gicheva M, Davarski AN, Angelova P, Kehayov I. Epidemiology of Cervical Spine Injuries Requiring Surgical Treatment in Plovdiv and Plovdiv Region, Bulgaria. Korean J Neurotrauma 2024; 20:27-34. [PMID: 38576509 PMCID: PMC10990694 DOI: 10.13004/kjnt.2024.20.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 04/06/2024] Open
Abstract
Objective Cervical spine injuries (CSI) are associated with high rates of permanent disability and mortality, which increase the socioeconomic burden on healthcare systems worldwide. We aimed to investigate the epidemiology of CSI, frequency of operative treatment, and incidence of associated neurological deficits at regional level. Methods We performed a retrospective monocentric study of patients with sustained CSI from January 2017 to December 2021, carried out only in a first-level trauma center in the Plovdiv metro region. Demographic, clinical, and imaging data from the medical records were thoroughly analyzed. Based on the assumption that all patients with CSI were hospitalized in single trauma center, the percentage of cases indicated for surgical treatment was calculated based on the population of the entire Plovdiv metro area. Results One hundred forty-nine patients permanently residing in the Plovdiv metro region were included in this study. Of the 149 patients, 97 (65.1%) were surgically treated and 61 (62.9%) were over 60 years of age. The frequency of operative interventions for CSI was 2.9/100,000 patients. Annually, 10.6 people from the Plovdiv metro region suffer from neurological deficits as a result of neck injuries (1.6/100,000 residents). The number of patients with complete spinal cord injury in the surgically treated group was 11 (11.3%); that is, the regional frequency was 2.2 people per year. Conclusion In the Plovdiv metro region, a significant annual frequency of neurological deficits requiring surgical intervention for CSI has been established, especially in patients aged >60 years.
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Affiliation(s)
- Borislav Kitov
- Clinic of Neurosurgery, Sv. Georgi University Hospital, Plovdiv, Bulgaria
| | - Maria Gicheva
- Clinic of Neurosurgery, Sv. Georgi University Hospital, Plovdiv, Bulgaria
| | - Atanas N. Davarski
- Clinic of Neurosurgery, Sv. Georgi University Hospital, Plovdiv, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Polina Angelova
- Clinic of Neurosurgery, Sv. Georgi University Hospital, Plovdiv, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ivo Kehayov
- Clinic of Neurosurgery, Sv. Georgi University Hospital, Plovdiv, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
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Kerschbaum M, Klute L, Henssler L, Rupp M, Alt V, Lang S. Risk factors for in-hospital mortality in geriatric patients aged 80 and older with axis fractures: a nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 10,077 cases. 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 2024; 33:185-197. [PMID: 37714928 DOI: 10.1007/s00586-023-07919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/05/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To investigate the association between treatment, comorbidities, concomitant injuries, and procedures with in-hospital mortality in patients aged 80 years or older with axis fractures. METHODS Data were extracted from the German InEK (Institut für das Entgeltsystem im Krankenhaus) GmbH database (2019-2021) for patients aged 80 years or older with axis fractures and the in-hospital mortality rate was calculated. Differences in comorbidities and concomitant diseases and injuries were analyzed using the Chi-square test. In surgically treated patients, odds ratios (OR) with 95% confidence intervals (95% CI) were used to analyze potential risk factors for in-hospital mortality. RESULTS Among 10,077 patients, the in-hospital mortality rate was 8.4%, with no significant difference between surgically (9.4%) and non-surgically treated patients (7.9%; p = 0.103). The most common comorbidities were essential hypertension (67.3%), atrial fibrillation (28.2%), and chronic kidney disease (23.3%), while the most common concomitant injuries were head and face wounds (25.9%), concussions (12.8%), and atlas fractures (11.6%). In surgically treated patients, spinal cord injury (OR = 4.62, 95% CI: 2.23-9.58), acute renal failure (OR = 3.20, 95% CI: 2.26-4.53), and acute bleeding anemia (OR = 2.06, 95% CI: 1.64-2.59) were associated with increased in-hospital mortality (all p < 0.01). Screw-rod-system fixation of one segment (OR = 0.74, 95% CI: 0.56-0.97) and intraoperative navigation (OR = 0.45, 95% CI: 0.16-0.71) were identified as potential protective factors (both p < 0.05). CONCLUSION Comprehensive geriatric assessment and optimization of comorbidities during treatment are crucial. The indication for surgical treatment must be carefully individualized. Future studies should focus on the choice of surgical technique, perioperative blood management, and intraoperative navigation as potential protective factors.
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Affiliation(s)
- Maximilian Kerschbaum
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lisa Klute
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Leopold Henssler
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Somogyi R, Smith S, Kark J, Ryu WHA, Yoo J. Age-Based Incidence of Dens Fracture Has Unimodal Distribution Rather Than Commonly Claimed Bimodal Distribution. JB JS Open Access 2024; 9:e23.00059. [PMID: 38214006 PMCID: PMC10773694 DOI: 10.2106/jbjs.oa.23.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Background Type-II dens fractures have long been described in the literature as occurring in a bimodal distribution, peaking in young adulthood as well as in older adulthood; however, the origin of this claim is unclear. The primary goal of this study was to examine the incidence of type-II dens fractures and assess for bimodality. Methods This is a retrospective cross-sectional review of the National Trauma Data Bank (NTDB) records on traumatic type-II dens fractures between October 2015 and December 2016. Rates were obtained from the NTDB, and the incidence per 100,000 was ascertained by utilizing U.S. Census data from 2016. Subgroupings by gender and Black or White race were also examined. Results Dens fractures occur unimodally, peaking around 89 years of age overall, skewed left by high rates in older White adults. The Black subgroup demonstrated trimodality, with the fracture incidence peaking at 25, 62, and 82 years of age. Rates among Black and White patients were similar until age 65, after which dens fractures occurred disproportionately in White patients. Fractures prior to age 75 occurred predominantly in men. Conclusions The evidence derived in this study challenges the common belief that type-II dens fractures occur bimodally across the entire population. However, there remains utility in considering younger and older patients as distinct groups for the purposes of management.
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Affiliation(s)
- Rita Somogyi
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Jonathan Kark
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Won Hyung A. Ryu
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Osterhoff G, Scholz M, Disch AC, Katscher S, Spiegl UJA, Schnake KJ, Scheyerer MJ. Geriatric Odontoid Fractures: Treatment Algorithms of the German Society for Orthopaedics and Trauma Based on Expert Consensus and a Systematic Review. Global Spine J 2023; 13:13S-21S. [PMID: 37084350 PMCID: PMC10177304 DOI: 10.1177/21925682231157316] [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] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Systematic review/expert consensus. OBJECTIVES Fractures of the axis represent the most frequent injury of the spine in elderly patients. Both, operative and non-operative treatment are associated with a high rate of complications and mortality. The aim of this article was to summarize the current literature on the management of odontoid fractures in geriatric patients and to weigh it based on an expert consensus process. METHODS In a joint consensus process, members of the Spine Section of the German Orthopaedic and Trauma Society (DGOU) aimed to formulate recommendations for the diagnostic workup and treatment of odontoid fractures in geriatric patients. Based on the previously published recommendations, this article is an updated version with incorporating a systematic review of the recent literature. RESULTS Based on the new data available, the recommendations established in the initial consensus process were adapted. CONCLUSIONS Computed tomography represents the diagnostic standard for patients with suspected injuries of the upper cervical spine. Anderson/D'Alonzo odontoid fractures type 1, non-displaced type 2, and type 3 can be treated conservatively. Even non-unions do not necessarily result in poor clinical outcome. In Anderson/D'Alonzo type 2 fractures, surgical therapy offers the advantage of relatively safe osseous healing with no increased complication rate even in elderly patients and can thus be recommended. In very high aged patients, however, a case-by-case decision should be made. When surgical stabilization of osteoporotic odontoid fractures is indicated, posterior techniques are biomechanically advantageous and can be considered the standard.
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Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Matti Scholz
- ATOS Orthopaedic Clinic Braunfels, Braunfels, Germany
| | - Alexander C Disch
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics, Traumatology & Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Germany
| | - Sebastian Katscher
- Interdisciplinary Center for Spine and Neurotrauma, Sana Klinikum Borna, Borna, Germany
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Max J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Koln, Germany
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