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McDonald CL, Daniels AH, Anderson GA, Alsoof D, Kuris EO. Traumatic Cervical Facet Fractures and Dislocations. JBJS Rev 2022; 10:01874474-202205000-00005. [PMID: 35536995 DOI: 10.2106/jbjs.rvw.22.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Flexion-distraction, axial loading, and rotational forces can cause various degrees of osseoligamentous disruption of the cervical spine, leading to traumatic cervical facet fractures and dislocations. » Low-energy forces lead to minimally displaced facet fractures that often can be treated with immobilization only. High-energy forces are more likely to cause unstable injuries with or without neurologic compromise, which may require surgical intervention. » The initial treatment of cervical facet injuries requires patient evaluation and management through the Advanced Trauma Life Support (ATLS) protocols, while definitive management varies based on the biomechanical components of the injury, the neurologic status of the patient, and additional patient factors. » Cervical facet injuries often require a multidisciplinary approach to optimize long-term functional outcomes and minimize serious complications.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Wang H, Fan T, Tang ZR, Li W, Liu L, Lin Q. Development and validation of a nomogram for prediction of the risk of positive hidden blood loss in the perioperative period of single-level thoracolumbar burst fracture. J Orthop Surg Res 2021; 16:560. [PMID: 34526070 PMCID: PMC8442389 DOI: 10.1186/s13018-021-02699-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study aimed to develop and validate an individualized nomogram to predict the risk of positive hidden blood loss (HBL) in patients with single-level thoracolumbar burst fracture (TBF) during the perioperative period. METHODS We conducted a retrospective investigation including 150 consecutive patients with TBL, and the corresponding patient data was extracted from March 2013 to March 2019. The independent risk factors for positive HBL were screened using univariate and multivariate logistic regression analyses. According to published literature and clinical experience, a series of variables were selected to develop a nomogram prediction model for positive HBL. The area under the receiver operating characteristic curves (AUC), C-index, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance of the prediction model. Bootstrapping validation was performed to evaluate the performance of the model. RESULTS Among the 150 consecutive patients, 62 patients were positive for HBL (38.0%). The multivariate logistic regression analysis showed that the six risk factors of age, length of surgical incision, duration of operation, percentage of vertebral height restoration (P1%), preoperative total cholesterol, and preoperative fibrinogen were independent risk factors of positive HBL. The C-index was 0.831 (95% CI 0.740-0.889) and 0.845 in bootstrapping validation, respectively. The calibration curve showed that the predicted probability of the model was consistent with the actual probability. Decision curve analysis (DCA) showed that the nomogram had clinical utility. CONCLUSION Overall, we explored the relationship between the positive HBL requirement and predictors. The individualized prediction model for patients with single-level TBF can accurately assess the risk of positive HBL and facilitate clinical decision making. However, external validation will be needed in the future.
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Affiliation(s)
- Haosheng Wang
- Department of Orthopedics, Baoji City Hospital of Traditional Chinese Medicine, 43 Baofu Road, Baoji, 721000, Shaanxi Province, People's Republic of China
| | - Tingting Fan
- Department of Endocrinology, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi Province, People's Republic of China
| | - Zhi-Ri Tang
- Department of Computer Science, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, People's Republic of China
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, People's Republic of China
| | - Linjing Liu
- Department of Computer Science, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Qiang Lin
- Department of Orthopedics, Baoji City Hospital of Traditional Chinese Medicine, 43 Baofu Road, Baoji, 721000, Shaanxi Province, People's Republic of China.
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Karamian BA, Schroeder GD, Holas M, Joaquim AF, Canseco JA, Rajasekaran S, Benneker LM, Kandziora F, Schnake KJ, Öner FC, Kepler CK, Vaccaro AR. Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures. 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 2021; 30:1635-1650. [PMID: 33797624 DOI: 10.1007/s00586-021-06818-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty. METHODS A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries. RESULTS A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment. CONCLUSION Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Andrei F Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | | | - Lorin M Benneker
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
| | - Frank Kandziora
- FK- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Klaus J Schnake
- Center for Spinal Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | | | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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Aarabi B, Albrecht JS, Simard JM, Chryssikos T, Schwartzbauer G, Sansur CA, Crandall K, Gertner M, Howie B, Wessell A, Cannarsa G, Caffes N, Oliver J, Shanmuganathan K, Olexa J, Lomangino CD, Scarboro M. Trends in Demographics and Markers of Injury Severity in Traumatic Cervical Spinal Cord Injury. J Neurotrauma 2021; 38:756-764. [PMID: 33353454 DOI: 10.1089/neu.2020.7415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Over the past four decades, there have been progressive changes in the epidemiology of traumatic spinal cord injury (tSCI). We assessed trends in demographic and injury-related variables in traumatic cervical spinal cord injury (tCSCI) patients over an 18-year period at a single Level I trauma center. We included all magnetic resonance imaging-confirmed tCSCI patients ≥15 years of age for years 2001-2018. Among 1420 patients, 78.3% were male with a mean age 51.5 years. Etiology included falls (46.9%), motor vehicle collisions (MVCs; 34.2%), and sports injuries (10.9%). Median American Spinal Injury Association (ASIA) Motor Score (AMS) was 44, complete tCSCI was noted in 29.6% of patients, fracture dislocations were noted in 44.7%, and median intramedullary lesion length (IMLL) was 30.8 mm (complete injuries 56.3 mm and incomplete injuries 27.4 mm). Over the study period, mean age and proportion of falls increased (p < 0.001) whereas proportion attributable to MVCs and sports injuries decreased (p < 0.001). Incomplete injuries, AMS, and the proportion of patients with no fracture dislocations increased whereas complete injuries decreased significantly. IMLL declined (p = 0.17) and proportion with hematomyelia did not change significantly. In adjusted regression models, increase in age and decreases in prevalence of MVC mechanism and complete injuries over time remained statistically significant. Changes in demographic and injury-related characteristics of tCSCI patients over time may help explain the observed improvement in outcomes. Further, improved clinical outcomes and drop in IMLL may reflect improvements in initial risk assessment and pre-hospital management, advances in healthcare delivery, and preventive measures including public education.
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Affiliation(s)
- Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gary Schwartzbauer
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Charles A Sansur
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kenneth Crandall
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melanie Gertner
- Maryland Institute for EMS Systems, Baltimore, Maryland, USA
| | | | - Aaron Wessell
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gregory Cannarsa
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nick Caffes
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey Oliver
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Joshua Olexa
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Cara Diaz Lomangino
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maureen Scarboro
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Sharif S, Ali MYJ, Sih IMY, Parthiban J, Alves ÓL. Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations. Neurospine 2021; 17:737-758. [PMID: 33401854 PMCID: PMC7788423 DOI: 10.14245/ns.2040368.184] [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] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
To formulate specific guidelines for the recommendation of subaxial cervical spine injuries concerning classification, management, posttraumatic locked facets and vertebral artery injury. Computerized literature was searched on PubMed and google scholar database from 2009 to 2020. For classification, keywords “Sub Axial Cervical Spine Classification,” resulting in 22 articles related to subaxial cervical spine injury classification system (SLICS) system and 11 articles related to AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) Spine system. The literature search yielded 210 and 78 articles on “management of subaxial cervical spine injuries” and the role of “SLICS” and “AO Spine” respectively. Keywords “management of traumatic facet locks” were searched and closed reduction, traction, approaches and techniques were studied. “Vertebral artery injury and cervical fracture” exhibited 2,328 references from the last 15 years. The objective was to identify the appropriate diagnostic tests and optimal treatment. Up-to-date information was reviewed, and statements were produced to reach a consensus in 2 separate consensus meetings of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Based on the most relevant literature, panelists in Moscow consensus meeting conducted in May 2019 drafted the statements, and after a preliminary voting session, the consensus was identified on various statements. Another meeting was conducted at Peshawar in November 2019, where in addition to previous statements, few other statements were discussed and voted. Specific recommendations were then formulated guiding classification, management, locked facets and vertebral artery injuries. This review summarizes the WFNS Spine Committee recommendations on subaxial cervical spine injuries.
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Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | | | - Ibet Marie Y Sih
- Institute for the Neurosciences, St. Luke's Medical Center, University of the Philippines - Philippine General Hospital, Metro Manila, The Philippines
| | - Jutty Parthiban
- Department Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Coimbatore, India
| | - Óscar L Alves
- Department of Neurosurgery, Hospital Lusíadas, Porto, Portugal
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Mushlin H, Kole MJ, Chryssikos T, Cannarsa G, Schwartzbauer G, Aarabi B. AOSpine Subaxial Cervical Spine Injury Classification System: The Relationship Between Injury Morphology, Admission Injury Severity, and Long-Term Neurologic Outcome. World Neurosurg 2019; 130:e368-e374. [PMID: 31229750 DOI: 10.1016/j.wneu.2019.06.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The AOSpine Subaxial Cervical Spine Injury Classification System was introduced to improve communication, clinical management, and research. Here, the system was studied in relation to injury severity along with admission and long term neurologic follow-up. METHODS A retrospective study was performed in subaxial cervical spine injury patients. Morphology was classified using the AOSpine Subaxial Cervical Spine Injury Classification System. Six major morphology subtypes were selected for analysis. The American Spinal Injury Association (ASIA) motor and Abbreviated Injury Severity (AIS) scores were recorded at admission and at follow-up >6 months. Admission intramedullary lesion length (IMLL) on MRI was recorded. RESULTS In all, 82 patients met criteria for analysis. The mean follow-up time was 11 months (range, 6-33 months). The were 36 patients with morphology subtypes A0, 4 with A1/A2, 9 with A3/A4, 8 with B2, 11 with B3, and 14 with C. The A1/2 subtype had the least severe injuries on admission. The C and A3/A4 subtypes had the most severe injuries. The subtype C had the lowest ASIA Motor Score (AMS) and second highest percentage of complete injuries. A3/A4 patients had the highest percentage of complete injuries on admission. At follow-up, A3/A4 patients had the lowest AMS, and 33% of patients continued to have complete injuries. C subtype injuries all converted to AIS incomplete injuries on follow-up (P = 0.04). IMLL was found to be significantly different compared across multiple morphologic subtypes. Surgical management for each morphology subtype was reported. CONCLUSION The AOSpine Subaxial Cervical Spine Injury Classification System successfully associated injury morphology with IMLL along with admission and long-term neurologic function and recovery.
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Affiliation(s)
- Harry Mushlin
- Department of Neurosurgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA.
| | - Matthew J Kole
- Department of Neurosurgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Gregory Cannarsa
- Department of Neurosurgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Gary Schwartzbauer
- Department of Neurosurgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA; Department of Trauma Critical Care, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA; Department of Trauma Critical Care, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
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Bakhsheshian J, Sizdahkhani S, Ohiorhenuan I, Buchanan IA, Strickland B, Pham MH. Transpedicular lag screw placement in traumatic cervical spondylolisthesis: Case report and systematic review of the literature. J Clin Neurosci 2019; 63:256-262. [PMID: 30737091 DOI: 10.1016/j.jocn.2019.01.036] [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: 10/19/2018] [Revised: 12/30/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
Traumatic spondylolisthesis of C2-C3 is an unstable fracture. Posterior fixation techniques can be employed with intraoperative navigation, however this tool is not available to all spine surgeons. Furthermore, the evidence for posterior surgical stabilization of C2, while adhering to motion preservation principles is currently unknown. The authors describe a patient who had fractures of the pedicle and vertebral body of C2 and C3, which was successfully stabilized with freehand placement of C2 pedicle lag screws and subsequent C2-C5 fixation. Subsequently, a systematic review was performed to evaluate studies that utilized C2 lag screw placement in patients with traumatic spondylolisthesis of the axis (TSA). Eight retrospective case series were identified (N = 63 patients). Five studies evaluated an open posterior cervical approach and 3 investigated a percutaneous approach. Follow-up time ranged from 2 to 48 months and fusion was successful in most cases. No intra-operative complications were reported. On final follow-up, 2 patients had unintentional C2-C3 fusion, and 3 had C2-C3 instability. Three minor complications (urinary tract infection, surgical site hematoma, respiratory infection) were also reported, that resolved with medical management. Freehand placement of C2 pedicle lag screws may be a viable option in select cases. While posterior C2 lag-screw fixation demonstrated successful fusion in most patients with TSA, the supporting evidence is limited to level IV studies.
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Affiliation(s)
- Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Saman Sizdahkhani
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ifije Ohiorhenuan
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ian A Buchanan
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ben Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Martin H Pham
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
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