Cervical spinal cord injury after blunt assault: Just a pain in the neck?

Discrimination between falls and blows from the localization and the number of fractures on computed tomography scans of the skull and the trunk

The distinction between falls and blows is a common and difficult task in forensic sciences. One of the most often used criteria to address this issue is the hat brim line (HBL) rule, which states that fall-related injuries do not lie above the HBL. Some studies, however, have found that the use of HBL rule is not so relevant. This study assesses the aetiologies, the number of fractures, and their location on the skull and the trunk in a sample of 400 individuals aged 20-49 years, which were CT scanned after traumas. This may facilitate the interpretation of such injuries in skeletonized or heavily decomposed bodies in which soft tissues are no longer available. Our aim is to improve the distinction rate between falls and blows by combining several criteria and assessing their predictability. Skeletal lesions were analysed using retrospective CT scans. Cases selected comprise 235 falls and 165 blows. We registered the presence and the number of fractures in 14 skeletal anatomical regions related to the two different aetiologies. We showed that the HBL rule should be used with caution, but there is nevertheless a possibility of discussing the aetiology of blunt fractures. Possibly, parameters like the anatomical location and the number of fractures by region can be used to distinguish falls and blows.

The Efficacy of Anterior Cervical Corpectomy and Fusion and Posterior Total Laminectomy on Cervical Spinal Cord Injury and Quality of Life

This study is aimed at investigating the efficacy of anterior cervical corpectomy and fusion and posterior total laminectomy in the treatment of cervical spinal cord injury and assessing the impact of the two approaches on cervical spine function and patient quality of life. Retrospectively analyze the clinical data from 180 patients with cervical spinal cord injury who were admitted to the First Affiliated Hospital of Hebei North University from June 2019 to June 2021. The patients were divided into an anterior approach group (n = 89, treated with anterior cervical corpectomy and fusion) and a posterior approach group (n = 91, treated with posterior total laminectomy). The amount of blood loss in the posterior approach group was larger compared to the anterior approach group. Patients in the posterior approach group had higher wound diameters and operation times compared to the anterior approach group, as well as the operation cost. The visual analogue scale (VAS) scores of patients in the posterior approach group were significantly higher than in the anterior approach group one month after operation. The Japanese Orthopaedic Association (JOA), neck disability index (NDI), and American Spinal Injury Association (ASIA) scores of patients in both groups at 1, 6, and 9 months after surgery were higher compared to those before surgery, yet no significant differences were observed between the two groups. Also, no significant difference was observed in the incidence of complication and the quality of life between the two groups before and after treatment. Anterior cervical corpectomy and fusion and posterior total laminectomy can effectively restore the cervical nerve function in the treatment of cervical spinal cord injury. However, anterior subtotal vertebral resection is associated with improved perioperative indicators compared to posterior total laminectomy. Clinically, surgical methods can be selected according to imaging findings, the general condition of patients, and individual economic status.

Incidence and characteristics of spinal injuries in the victims of intimate partner violence (IPV)

PURPOSE

To describe the incidence and patterns of the spinal injuries in the victims of physical IPV.

MATERIALS AND METHODS

With institutional review board (IRB) approval, we retrospectively reviewed patients referred to our institution's domestic violence intervention and prevention program with a diagnosis directly related to physical abuse between January 2013 and June 2018. Electronic health records and radiology reports were reviewed for all patients.

RESULTS

A total of 21/688 (3%) IPV patients with 41 vertebral injuries were identified. The study population comprised of 19/21 (90%) females. Median age of the included patients was 43 years with a range of 21-72 years. All vertebral injuries were AO type A spinal injuries. Upper lumbar spine (L1 and L2) was the most common level of injury followed by upper to mid-thoracic spine. The reported mechanism of the injury was IPV in 8/21 (38.0%), fall in 8/21(38.0%), and incidental in 5/21 (24.0%). Ten out of 21 (48%) patients had concomitant injuries, most commonly to the craniofacial region 5/21 (23%). Psychiatry history was positive in 17/21 (81%), and substance abuse was positive in 15/21 (71%) of the patients.

CONCLUSION

Incidence of spinal injuries is relatively low in IPV with morphologic AO type A injury being the most common type of injury and the upper lumbar spine being the most common level of injury.