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Norisyam Y, Lim HS, Bahrin Z, Foo CH. Bilateral Cervical Facet Dislocation Due to Catastrophic Shallow Water Diving: A Case Report. Cureus 2023; 15:e48846. [PMID: 38106714 PMCID: PMC10722344 DOI: 10.7759/cureus.48846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Bilateral cervical facet dislocation is a rare injury resulting from headfirst shallow water diving accidents. Accurate diagnosis, prompt management, precise intervention, and aggressive rehabilitation can lead to a favourable neurologic and functional outcome for cervical spine injuries. In this case, we present a young adolescent patient who experienced bilateral facet dislocation of C4/C5, resulting in incomplete central cord syndrome neurological deficits (American Spinal Injury Association (ASIA) Impairment Scale C) due to a dangerous shallow water diving accident. The patient subsequently underwent emergency posterior instrumentation and decompression for stabilization and rehabilitation. Immediately following the surgery, he exhibited substantial neurologic recovery and was able to walk independently after six months. This case is unique not only for its rarity but also because it involved a young adolescent, highlighting the need for increased awareness and preventive measures to reduce the risk of dangerous shallow water diving accidents.
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Affiliation(s)
| | - Han Sim Lim
- Spine Surgery, Hospital Pulau Pinang, George Town, MYS
| | - Zairul Bahrin
- Spine Surgery, Hospital Pulau Pinang, George Town, MYS
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Stuhr M, Kowald B, Schulz AP, Meyer M, Hirschfeld S, Böthig R, Thietje R. Demographics and functional outcome of shallow water diving spinal injuries in northern Germany - A retrospective analysis of 160 consecutive cases. Injury 2023:S0020-1383(23)00198-5. [PMID: 36990902 DOI: 10.1016/j.injury.2023.03.002] [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: 01/12/2023] [Revised: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/31/2023]
Abstract
AIM To describe demographic findings, typical injuries and functional neurological outcomes in patients with cervical trauma and tetraplegia sustained after diving into shallow water. PATIENTS AND METHODS A retrospective study was performed including all patients treated in BG Klinikum Hamburg suffering from tetraplegia after jumping into shallow water between 1st June 1980 and 31st July 2018. RESULTS One hundred and sixty patients with cervical spinal injuries and tetraplegia following a dive into shallow water were evaluated. Of these, 156 patients (97.5%) were male. The mean age was 24.3 years ± 8.1 and the accidents occurred most often in inland waters (56.2%) and mostly between May and August (90.6%). In all cases there was one vertebra fractured, whereas in 48.1% of cases, two vertebrae were severed. In the majority of cases (n = 146), a surgical procedure was performed. Overall, the mean hospital stay was 202 days (±72, range: 31-403) and one patient died. On admission, 106 patients (66.2%) showed a complete lesion according to AIS A, with incomplete lesions in the remaining 54 patients (AIS B: n = 25 [15.6%], AIS C: n = 26 [16.3%], AIS D: n = 3 [1.9%]). In two thirds of the patients, the level of paralysis on admission was at the level of segments C4 (31.9%) or C5 (33.7%). Seventeen patients (10.6%) needed prehospital resuscitation. In 55 patients (34.4%), the neurological findings improved during the course of inpatient treatment and rehabilitation. Sixty-eight patients (42.5%) developed pneumonia, of which 52 patients (76.5%) were ventilated. In addition, 56.5% of patients with paralysis levels C0-C3 required ventilation, whereas only 6.3% of patients with paralysis levels C6-C7 were affected. Three patients (1.9%) were discharged from hospital with continuous ventilation. Overall, 27.4% of all AIS A patients, 56% of all AIS B patients and 46.2% of all AIS C patients improved neurologically, with 17% of all patients being able to walk. CONCLUSIONS The consequences of a cervical spine injury after diving into shallow water are severe and lifelong. Functionally, patients may benefit from care in a specialised centre, both in the acute phase and during rehabilitation. The more incomplete the primary paralysis, the greater the possibility of neurological recovery.
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Affiliation(s)
- Markus Stuhr
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Medicine, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany.
| | - Birgitt Kowald
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Arndt P Schulz
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany; University of Luebeck, Medical Faculty, Luebeck, Germany
| | - Matthias Meyer
- University of Luebeck, Medical Faculty, Luebeck, Germany
| | - Sven Hirschfeld
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Ralf Böthig
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Roland Thietje
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
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Rehabilitation outcome in people with spinal cord injuries resulting from diving in South Korea. Spinal Cord Ser Cases 2022; 8:40. [PMID: 35397619 PMCID: PMC8994773 DOI: 10.1038/s41394-022-00509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective electronic medical record review combined with a telephone interview. OBJECTIVES The purpose of this study was to describe the neurological and socio-professional outcomes of patients with diving injuries of the cervical spine. SETTING A tertiary hospital and its affiliated rehabilitation hospital in South Korea. METHODS Electronic medical records were reviewed for medical and neurological information. Telephone interviews were then conducted with questionnaire regarding specific circumstances at the time of injury and social status. RESULTS A total of 33 patients with spinal cord injury (SCI) due to diving accidents were analyzed, of which 27 responded to telephone interviews. Thirty-two (97%) participants were men and 27 (81.8%) were younger than 40 years at the time of injury. The American Spinal Injury Association grade A was the most common of all grades in 16 participants (48.5%), whereas C4 was the most common neurologic level of the injury (n = 13, 39.4%). SCI due to diving accidents most commonly occurred in swimming pools in holiday lodges (n = 12, 36.4%). Five out of 13 married couples with motor complete SCI were divorced or separated after injury. Eight persons resumed work or studies after the injury, with a mean return time of 33 (24.4) months. CONCLUSIONS SCI resulting from a diving accident not only causes severe functional impairment but can also result in changes in marital and employment status. This study may be used as a basic source of education and awareness to prevent further SCI due to diving accidents.
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Griepp DW, de la Garza Ramos R, Lee J, Miller A, Prasad M, Gelfand Y, Cardozo-Stolberg S, Murthy SG. Beach Breaking Waves and Related Cervical Spine Injuries: A Level One Trauma Center Experience and Systematic Review. World Neurosurg 2022; 160:e471-e480. [PMID: 35074543 DOI: 10.1016/j.wneu.2022.01.055] [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: 11/28/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze cervical spine injuries resulting from recreational activity in shallow ocean water amidst high energy breaking waves. METHODS Single-center 10-year review of patients who sustained cervical injuries at the beach in Long Island, New York. A systematic review following the PRISMA guidelines was also performed. RESULTS Nineteen patients (age 17-79 years) sustained cervical injury from high energy breaking waves while in shallow beach water. Six patients dove into a wave; 6 patients were struck by a large wave while standing upright; and 7 tumbled in the waves while engaged in non-specified recreational activity. All 7 patients with Subaxial Cervical AO Spine Injury Score (AO-SIS) scores higher than 10 had cervical spine injury with cord signal change and required operative management. Diving mechanism, AO-SIS score > 10, and cord signal change all predicted significant disability or death at 12 months (p<0.01). The present study and 7 additional studies reporting on 534 patients (mean age: 45.4 years) were analyzed. Within reported literature, most patients (94.2%) sustained a spinal cord injury. On long-term follow up, an estimated 64.8% of patients had permanent neurological injury and 12.5% had permanent quadriplegia. CONCLUSIONS We offer the first description of cervical injuries sustained in water-related recreational activity using the AOSpine scoring system. The morphology of injuries varied significantly and appeared to depend upon body position and wave kinetic energy. Patients presenting with cervical injury in this setting and yielding AO-SIS scores higher than 10 are likely to have poor functional recovery.
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Affiliation(s)
- Daniel W Griepp
- Division of Neurological Surgery, Nassau University Medical Center, Nassau County, NY, USA; Department of Surgery, Nassau University Medical Center, Nassau County, NY, USA; New York Institute of Technology, Old Westbury, NY USA
| | - Rafael de la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY USA
| | - Jason Lee
- Department of Surgery, Nassau University Medical Center, Nassau County, NY, USA; New York Institute of Technology, Old Westbury, NY USA
| | - Aaron Miller
- Division of Neurological Surgery, Nassau University Medical Center, Nassau County, NY, USA; New York Institute of Technology, Old Westbury, NY USA
| | - Meenu Prasad
- Department of Surgery, Nassau University Medical Center, Nassau County, NY, USA; New York Institute of Technology, Old Westbury, NY USA
| | - Yaroslav Gelfand
- Department of Neurological Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Saikiran G Murthy
- Division of Neurological Surgery, Nassau University Medical Center, Nassau County, NY, USA; Department of Neurological Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY USA.
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Verhofste BP, Hedequist DJ, Birch CM, Rademacher ES, Glotzbecker MP, Proctor MR, Yen YM. Operative Treatment of Cervical Spine Injuries Sustained in Youth Sports. J Pediatr Orthop 2021; 41:617-624. [PMID: 34469395 DOI: 10.1097/bpo.0000000000001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little data exists on surgical outcomes of sports-related cervical spine injuries (CSI) sustained in children and adolescent athletes. This study reviewed demographics, injury characteristics, management, and operative outcomes of severe CSI encountered in youth sports. METHODS Children below 18 years with operative sports-related CSI at a Level 1 pediatric trauma center were reviewed (2004 to 2019). All patients underwent morden cervical spine instrumentation and fusion. Clinical, radiographic, and surgical characteristics were analyzed. RESULTS A total of 3231 patients (mean, 11.3±4.6 y) with neck pain were evaluated for CSI. Sports/recreational activities were the most common etiology in 1358 cases (42.0%). Twenty-nine patients (2.1%) with sports-related CSI (mean age, 14.5 y; range, 6.4 to 17.8 y) required surgical intervention. Twenty-five were males (86%). Operative CSI occurred in football (n=8), wrestling (n=7), gymnastics (n=5), diving (n=4), trampoline (n=2), hockey (n=1), snowboarding (n=1), and biking (n=1). Mechanisms were 27 hyperflexion/axial loading (93%) and 2 hyperextension injuries (7%). Most were cervical fractures (79%) and subaxial injuries (79%). Seven patients (24%) sustained spinal cord injury (SCI) and 3 patients (10%) cord contusion or myelomalacia without neurological deficits. The risk of SCI increased with age (P=0.03). Postoperatively, 2 SCI patients (29%) improved 1 American Spinal Injury Association Impairment Scale Grade and 1 (14%) improved 2 American Spinal Injury Association Impairment Scale Grades. Increased complications developed in SCI than non-SCI cases (mean, 2.0 vs. 0.1 complications; P=0.02). Bony fusion occurred in 26/28 patients (93%) after a median of 7.2 months (interquartile range, 6 to 15 mo). Ten patients (34%) returned to their baseline sport and 9 (31%) to lower-level activities. CONCLUSIONS The incidence of sports-related CSI requiring surgery is low with differences in age/sex, sport, and injury patterns. Older males with hyperflexion/axial loading injuries in contact sports were at greatest risk of SCI, complications, and permanent disability. Prevention campaigns, education on proper tackling techniques, and neck strength training are required in sports at high risk of hyperflexion/axial loading injury. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
| | | | | | | | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Mark R Proctor
- Neurosurgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA
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Ull C, Yilmaz E, Jansen O, Lotzien S, Schildhauer TA, Aach M, Königshausen M. Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years? Global Spine J 2021; 11:1238-1247. [PMID: 32909818 PMCID: PMC8453686 DOI: 10.1177/2192568220944124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective, monocentric, observational study in a tertiary health care center. OBJECTIVES To analyze prehospital and clinical findings, complications, neurological improvement and follow-up in a young person cohort with spinal cord injury (SCI) and tetraplegia according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) A to D after diving into shallow water. METHODS Included were all persons younger than 50 years with SCI after head-first diving into shallow water between June 2001 and June 2019. All persons with SCI were divided into complete tetraplegia (AIS A) and incomplete tetraplegia (AIS B, C, and D) to test differences. RESULTS A total of 59 males (98.7%) and 1 female with a mean age of 27.7 years suffered an SCI. Alcohol use was documented in 25 cases (41.7%). At the time of admission, 33 people (55%) showed a complete tetraplegia (AIS A) and 27 showed an incomplete tetraplegia with 8 AIS B (13.3%), 15 AIS C (25%), and 4 AIS D (6.7%). At the time of discharge, people with initially complete tetraplegia showed a significant improvement from admission to discharge (P ≤ .004). Persons with incomplete tetraplegia were more likely to improve their neurological status compared with complete tetraplegia patients (P ≤ .001). Especially persons with complete tetraplegia suffered from typical SCI-related problems and complications. CONCLUSIONS People with SCI and tetraplegia at the time admission show neurological improvement in 50% of the cases with an overall better outcome in persons with incomplete tetraplegia. The surgical treatment of SCI within 24 hours seems to be associated with a better neurological outcome and a lower level of tetraplegia. The incidence of SCI caused by diving into shallow water remains stable without a significant change, especially in high-risk groups. More education and prevention programs are necessary to avoid these injuries.
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Affiliation(s)
- Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany,Christopher Ull, Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Thomas A. Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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An Overview of Spinal Injuries due to Dive or Fall into Shallow Water: Our Long-Term, Double-Center Experience from the Aegean Coast. Emerg Med Int 2021; 2021:9937730. [PMID: 34188959 PMCID: PMC8192199 DOI: 10.1155/2021/9937730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/06/2021] [Accepted: 05/29/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose We aimed to evaluate the demographic and clinical features of patients with cervical spinal injuries secondary to shallow-water diving and share our therapeutic outcomes. Methods A retrospective study was carried out using data extracted from the medical files of 39 patients (3 females and 36 males) who were treated surgically (n = 29) or conservatively (n = 10). Demographics, clinical features, operative data, American Spine Injury Association (ASIA) impairment scales, and Karnofsky Performance Status (KPS) results were noted. Results The average age of our series (n = 39) was 31.59 ± 14.80 (range, 14 to 92) years. The vast majority of patients (n = 34, 87.2%) presented with isolated cervical trauma. At initial admission, neurological deficits were diagnosed in 22 (56.4%) patients. A single-level cervical involvement was noted in 18 (46.2%) patients, while 21 cases (53.8%) displayed injury involving multiple levels. The levels of cervical injury were C5 (n = 16, 41%), C6 (n = 11, 28.2%), C7 (n = 6, 15.4%), C1 (n = 5, 12.8%), and C4 (n = 1, 2.6%). A total of 22 patients had neurological deficits at admission. Surgery was performed using anterior (n = 21, 72.4%), posterior (n = 7, 24.1%), and combined anterior and posterior (n = 1, 3.4%) routes. Nine patients (23.1%) exhibited improvement in their neurological deficits. There were significant improvements in both the ASIA impairment scale and KPS results after treatment. Conclusion Our data indicated that dive- or fall-related cervical spinal injuries are associated with profound morbidity. Reinforcement of primary prevention, identification of target population, and increased awareness on this topic are the key steps to minimize the frequency and severity of complications and to optimize therapeutic outcomes.
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Ryan KM, Dugas J, Pina T, Maksimenko Y, Liu J. Drowning injuries in the United States: Patient characteristics, mortality risk, and associated primary diagnoses. Injury 2020; 51:2560-2564. [PMID: 32798037 DOI: 10.1016/j.injury.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine patient demographics, associated primary diagnoses, mortality risk, and inpatient mortality of admitted drowning patients in the U.S. METHODS Retrospective cross-sectional study using 2016 National Inpatient Sample Healthcare Cost and Utilization Project Agency for Healthcare Research and Quality dataset. External cause codes were used to identify drowning records, excluding self-inflicted/suicides. ICD-10 diagnosis and procedure codes, patient demographics, and admission-related data were collected. RESULTS Of the 4,355 admissions in 2016, 68.3% were male (95% CI 65.3-71.3%) and 70.3% were white (95% CI 66.9-73.6%) with mean length of stay of 5.5 days (95% CI 4.9-6.2) and mean total charge of $81,624 (95% CI $70926-$92321). 8.2% of admissions resulted in inpatient death. Those that died were significantly younger than those that did not die (χ2=5.9, p=0.02). There was a statistically significant association between primary payer and inpatient mortality (χ2=10.5, p=0.02). CONCLUSION Younger, male, and white patients accounted for the majority of drowning admissions and deaths. A significantly larger proportion of Medicaid patients died compared to inpatient mortality of those with other insurance. Recognizing those most impacted by drowning could help better tailor prevention efforts.
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Affiliation(s)
- Kevin M Ryan
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States.
| | - Julianne Dugas
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - Tyler Pina
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - Yevgeniy Maksimenko
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - James Liu
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
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McGrath R, Hall O, Peterson M, DeVivo M, Heinemann A, Kalpakjian C. The association between the etiology of a spinal cord injury and time to mortality in the United States: A 44-year investigation. J Spinal Cord Med 2019; 42:444-452. [PMID: 30124389 PMCID: PMC6718184 DOI: 10.1080/10790268.2018.1505311] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: To determine the association between spinal cord injury (SCI) etiology categories and mortality, and examine the association between etiology sub-categories and mortality. Design: Prospective cohort study. Setting: Model Systems and Shriners Hospital SCI units. Participants: Data were analyzed from 42,627 cases in the SCI Model System Collaborative Survival Study Database from 1973 to 2017. Those with SCI etiologies categorized as vehicular, violent, sports, falls, pedestrian, and medical were included. Interventions: Not applicable. Outcome Measure: Time to mortality after SCI. Results: Relative to the sports related etiology category, those with medical, pedestrian, violence, falls, and vehicular related SCIs had a 2.00 (95% confidence intervals (CIs): 1.79-2.24), 1.57 (CIs: 1.34-1.83), 1.54 (CIs: 1.41-1.68), 1.35 (CIs: 1.25-1.45), and 1.26 (CIs: 1.17-1.35) higher hazard for mortality, respectfully. Persons with SCIs from automobile crashes had a 1.38 (CIs: 1.23-1.56) higher hazard for mortality, whereas those with SCIs from motorcycle crashes had a 1.21 (CIs: 1.04-1.39) higher hazard for mortality, relative to other etiologies within the vehicular category. Those with SCIs from diving had a 1.37 (CIs: 1.18-1.59) higher hazard for mortality relative to other etiologies within the sports category. Conclusions: Injury etiology categories and certain sub-categories were associated with a higher risk for early mortality. Understanding how additional factors such as socioeconomic status, co-occurring injuries, medical co-morbidities, and environmental aspects interact with SCI etiologies may provide insights for how etiology of injury impacts survival. These findings may serve as a development for extending long-term life expectancy by informing SCI prevention programs and care post-injury.
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Affiliation(s)
- Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota, USA,Department of Physical Medicine and Rehabilitation, Medical School, University of Michigan, Ann Arbor, Michigan, USA,Correspondence to: Ryan McGrath, Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept. 2620, PO Box 6050, Fargo, ND 58108, USA.
| | - Orman Hall
- Department of Physical Medicine and Rehabilitation, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark Peterson
- Department of Physical Medicine and Rehabilitation, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael DeVivo
- Department of Physical Medicine and Rehabilitation, Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allen Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Claire Kalpakjian
- Department of Physical Medicine and Rehabilitation, Medical School, University of Michigan, Ann Arbor, Michigan, USA
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Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Sánchez-Enríquez J, Sosa-Henríquez M. [Spinal cord injuries resulting from diving accidents in the Canary Islands]. Neurocirugia (Astur) 2017; 28:183-189. [PMID: 28343903 DOI: 10.1016/j.neucir.2017.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Diving accidents is one of the leading causes of spinal cord injury after falls and car accidents. The objective of this study was to determine the epidemiological and clinical characteristics of these patients in our setting to better prevent these injuries. MATERIAL AND METHODS We performed a retrospective, descriptive study of patients who have suffered from a traumatic spinal cord injury after a diving accident in the Canary Islands, Spain from 2000 to 2014. These patients were admitted to the Spinal Cord Unit of Hospital Universitario Insular de Gran Canaria. RESULTS Of the 264 patients admitted to our unit for acute traumatic spinal cord injury, 23 (8.7%) cases were due to diving. Grouping the patients into 5years periods, 56% of the injuries occurred in 2000-2005, 17% in 2006-2010 and 26% in 2011-2014. All patients were male, with a mean age of 29years. Approximately 65% were under 30years. A total of 22/23 patients had a fracture and injury most commonly occurred to the C5 vertebra. Burst fractures were the most common. A total of 86% of cases underwent surgery. All the spinal cord injuries were cervical, with C6 being the neurological level most often affected. A total of 65% of spinal cord injuries were complete injuries. CONCLUSIONS Spinal cord injury secondary to diving accidents is the third leading cause of traumatic spinal cord injury in our setting. It affects young males and the most common clinical presentation is a complete cervical spinal cord injury. Given the irreversible nature of the injury, prevention, aimed mainly at young people, is of great importance.
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Affiliation(s)
- Enrique Bárbara-Bataller
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - José Luis Méndez-Suárez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Carolina Alemán-Sánchez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Jesús Sánchez-Enríquez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Manuel Sosa-Henríquez
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Grupo de Investigación en Osteoporosis y Metabolismo Mineral, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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Sadiqi S, Lehr AM, Post MW, Jacobs WCH, Aarabi B, Chapman JR, Dunn RN, Dvorak MF, Fehlings MG, Rajasekaran S, Vialle LR, Vaccaro AR, Oner FC. The selection of core International Classification of Functioning, Disability, and Health (ICF) categories for patient-reported outcome measurement in spine trauma patients-results of an international consensus process. Spine J 2016; 16:962-70. [PMID: 27058286 DOI: 10.1016/j.spinee.2016.03.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/09/2016] [Accepted: 03/31/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There is no outcome instrument specifically designed and validated for spine trauma patients without complete paralysis, which makes it difficult to compare outcomes of different treatments of the spinal column injury within and between studies. PURPOSE The paper aimed to report on the evidence-based consensus process that resulted in the selection of core International Classification of Functioning, Disability, and Health (ICF) categories, as well as the response scale for use in a universal patient-reported outcome measure for patients with traumatic spinal column injury. STUDY DESIGN/SETTING The study used a formal decision-making and consensus process. PATIENT SAMPLE The sample includes patients with a primary diagnosis of traumatic spinal column injury, excluding completely paralyzed and polytrauma patients. OUTCOME MEASURES The wide array of function and health status of patients with traumatic spinal column injury was explored through the identification of all potentially meaningful ICF categories. METHODS A formal decision-making and consensus process integrated evidence from four preparatory studies. Three studies aimed to identify relevant ICF categories from three different perspectives. The research perspective was covered by a systematic literature review identifying outcome measures focusing on the functioning and health of spine trauma patients. The expert perspective was explored through an international web-based survey among spine surgeons from the five AOSpine International world regions. The patient perspective was investigated in an international empirical study. A fourth study investigated various response scales for their potential use in the future universal outcome instrument. This work was supported by AOSpine. AOSpine is a clinical division of the AO Foundation, an independent medically guided non-profit organization. The AOSpine Knowledge Forums are pathology-focused working groups acting on behalf of AOSpine in their domain of scientific expertise. RESULTS Combining the results of the preparatory studies, the list of ICF categories presented at the consensus conference included 159 different ICF categories. Based on voting and discussion, 11 experts from 6 countries selected a total of 25 ICF categories as core categories for patient-reported outcome measurement in adult traumatic spinal column injury patients (9 body functions, 14 activities and participation, and 2 environmental factors). The experts also agreed to use the Numeric Rating Scale 0-100 as response scale in the future universal outcome instrument. CONCLUSIONS A formal consensus process integrating evidence and expert opinion led to a set of 25 core ICF categories for patient-reported outcome measurement in adult traumatic spinal column injury patients, as well as the response scale for use in the future universal disease-specific outcome instrument. The adopted core ICF categories could also serve as a benchmark for assessing the content validity of existing and future outcome instruments used in this specific patient population.
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Affiliation(s)
- Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA Utrecht, The Netherlands.
| | - A Mechteld Lehr
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - Marcel W Post
- Rehabilitation Center "De Hoogstraat", Rembrandtkade 10, 3583TM Utrecht, The Netherlands; Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Hanzeplein 1, 9713 Groningen, The Netherlands
| | - Wilco C H Jacobs
- Department of Neurosurgery, Leiden University Medical Center, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, 22 S Greene St, Suite S-12-D, Baltimore, MD, USA
| | - Jens R Chapman
- Department of Neurosurgery, Swedish Neurosciences Institute, 500 17th Ave, Seattle, WA, USA
| | - Robert N Dunn
- Division of Orthopedic Surgery, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, 7935, Cape Town, South Africa
| | - Marcel F Dvorak
- Department of Orthopaedics, University of British Columbia, 818 10th Avenue West, Vancouver, British Columbia, V5Z 1M9 Canada
| | - Michael G Fehlings
- Division of Neurosurgery, 4W449, Toronto Western Hospital, 399 Bathurst St, Toronto, M5T 2S8, Ontario, Canada
| | - S Rajasekaran
- Department of Orthopaedic and Spine Surgery, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India
| | - Luiz R Vialle
- Department of Orthopaedics, Catholic University of Parana, Brigadeiro Franco 979 80.430-210, Curitiba, Brazil
| | - Alexander R Vaccaro
- Department of Orthopaedics, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| | - F Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA Utrecht, The Netherlands
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Abstract
Spinal cord injuries result after diving into shallow water, often after incautious jumps head first into water of unknown depth during recreational or sport activities. Mortality is generally due to upper cervical trauma. The authors present a case of a diving-related death in a young woman who underwent medicolegal investigations. The measured water depth at the supposed dive site was 1.40 m. Postmortem radiology and autopsy revealed fractures of the body and the posterior arch of the fifth cervical vertebra, a fracture of the right transverse process of the sixth cervical vertebra and hemorrhages involving the cervical paraspinal muscles. Neuropathology showed a posterior epidural hematoma involving the whole cervical region and a symmetric laceration of the spinal cord located at the fourth and fifth cervical vertebra level, surrounded by multiple petechial hemorrhages. Toxicology revealed the presence of ethanol in both blood and urine samples. The death was attributed to cervical spine fracture (C5-C6), spinal cord contusion, and subsequent drowning. This case highlights the usefulness of postmortem radiology, examination of the deep structures of the neck, toxicology, neuropathology, and a detailed research of signs of drowning to formulate appropriate hypotheses pertaining to the cause and mechanism of death.
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Abelairas-Gómez C, Barcala-Furelos R, Palacios-Aguilar J, Rodríguez-Núñez A. In-water secondary spinal cord injury prevention. Does out-of-water cervical immobilization save time? Am J Emerg Med 2016; 34:1172-4. [PMID: 27146457 DOI: 10.1016/j.ajem.2016.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Cristian Abelairas-Gómez
- CLINURSID Research Group, Nursing Department, University of Santiago de Compostela, Santiago de Compostela, Spain; Faculty of Health Sciences, European Atlantic University, Santander, Spain.
| | - Roberto Barcala-Furelos
- CLINURSID Research Group, Nursing Department, University of Santiago de Compostela, Santiago de Compostela, Spain; Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
| | - José Palacios-Aguilar
- Faculty of Sport Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Nursing Department, University of Santiago de Compostela, Santiago de Compostela, Spain; Pediatric Area, Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Tyrakowski M, Nandyala SV, Marquez-Lara A, Siemionow K. Congenital and Developmental Anomalies of the Cervical Spine in Athletes—Current Concepts. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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