1
|
Ricciardi G, Martinez O, Cabrera J, Matta J, Davila V, Jimenez JM, Vilchis H, Tejerina V, Perez J, Cabrera JP, Yurac R. Spinal gunshot wounds: A retrospective, multicenter, cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:328-335. [PMID: 37423382 DOI: 10.1016/j.recot.2023.07.001] [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: 04/12/2023] [Revised: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.
Collapse
Affiliation(s)
| | - O Martinez
- Hospital Universitario Dr. José E. González, Mexico
| | - J Cabrera
- Hospital de Traumatología "Dr. Victorio de la Fuente Narvaez" IMSS, Mexico
| | - J Matta
- Hospital Militar Central, Colombia
| | - V Davila
- Hospital Universitario Dr. Manuel Nuñez Tovar, Venezuela
| | - J M Jimenez
- Instituto Mexicano del Seguro Social, Mexico
| | - H Vilchis
- Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Lomas Verdes IMSS, Mexico
| | - V Tejerina
- Hospital Traumatología y Ortopedia Magdalena de las Salinas, Mexico
| | - J Perez
- Clínica de columna "Dr. Manuel Dufoo Olvera", Mexico
| | - J P Cabrera
- Hospital Clínico Regional de Concepción, Chile
| | - R Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Spine Unit, Department of Traumatology, Clinica Alemana, Santiago, Chile
| |
Collapse
|
2
|
Wang P, Zhou S, Li B, Wang Y, Xu W. Investigating Research Hotspots of Combat-related Spinal Injuries: A 30-year Bibliometric Analysis Study. Mil Med 2024:usae178. [PMID: 38771111 DOI: 10.1093/milmed/usae178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/15/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Spinal cord injuries often lead to significant motor and sensory deficits, as well as autonomic dysfunction. Compared with normal spinal injuries, combat-related spinal injuries (CRSIs) are usually more complex and challenging to treat because of multiple traumas, firing-line treatments, and arduous initial treatments on a battlefield. Yet numerous issues remain unresolved about clinical treatment and scientific research. The enhancement of CRSI diagnosis and treatment quality by military surgeons and nurses is imperative. The objective of this study is to identify the frontiers, hotspots, and trends among recent research, summarize the development process of clinical trials, and visualize them systematically. MATERIALS AND METHODS We collected publications from CRSI based on the Core Collection of Web of Science for 30 years from January 1, 1993 to May 1, 2023.Visualizations of the knowledge maps were produced using VOSviewer and CiteSpace software. We examined annual trends of publications and distribution patterns, the number of publications, as well as the research hotspots. RESULTS Among 201 documents, it was found that there was a stable upward trend in publications. There were 2 rapid growth stages during the 30 years. Among all countries, the USA contributed the most publications, along with the highest influence and the most international cooperation. Military Medicine was the journal of the maximum publications, whereas the Spine journal was the most influential one. Keyword co-occurrence analysis and trend topics analysis revealed that these articles focused 5 distinct categories for CRSI. CONCLUSIONS As the first bibliometric study focused on CRSI, we demonstrated the evolution of the field and provided future research directions. We summarized the hotspots and 5 clusters published. This would serve as a useful guide for clinicians and scientists regarding CRSI global impacts.
Collapse
Affiliation(s)
- Pengru Wang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
| | - Shangbin Zhou
- Department of Orthopedic Oncology, Naval Medical Center, Naval Military Medical University, Shanghai 200030, China
| | - Bo Li
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
| | - Yingtian Wang
- Medical Administration Division, Chinese PLA General Hospital, Beijing 100141, China
| | - Wei Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
| |
Collapse
|
3
|
Santangelo G, Wathen C, Pieters T, George DD, Worley L, Macaluso D, Dagli MM, Catanzaro S, Gu B, Welch WC, Petrov D, Vates GE, Ozturk AK, Schuster J, Stone JJ. Multi-institutional review of characteristics and management of gunshot wounds to the spine. Spine J 2024:S1529-9430(24)00216-X. [PMID: 38740190 DOI: 10.1016/j.spinee.2024.04.032] [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: 05/24/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND CONTEXT Gunshot wounds (GSWs) to the vertebral column represent an important cause of morbidity and mortality in the United States, constituting approximately 20% of all spinal injuries. The management of these injuries is an understudied and controversial topic, given its heterogeneity and lack of follow-up data. PURPOSE To characterize the management and follow-up of GSWs to the spine. STUDY DESIGN/SETTING A multi-institutional retrospective review of the experience of two urban Level 1 trauma centers. PATIENT SAMPLE Patients with GSWs to the spine between 2010-2021. OUTCOME MEASURES Measures included work status, follow-up healthcare utilization, and pain management were collected. METHODS Charts were reviewed for demographics, injury characteristics, surgery and medical management, and follow-up. Statistical analysis included T-tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables. All statistics were performed on SPSS v24 (IBM, Armonk, NY). RESULTS A total of 271 patients were included for analysis. The average age was 28 years old, 82.7% of patients were black, 90% were male, and 76.4% had Medicare/Medicaid. The thoracic spine (35%) was most commonly injured followed by lumbar (33.9%) and cervical (25.6%). Cervical GSW was associated with higher mortality (p<.001); 8.7% of patients developed subsequent osteomyelitis/discitis, 71.3% received prophylactic antibiotics, and 56.1% of cervical GSW had a confirmed vertebral or carotid artery injury. ASIA scores at presentation were most commonly A (26.9%), D (20.7%), or E (19.6%), followed by C (7.4%) and B (6.6%). 18.8% of patients were unable to be assessed at presentation. ASIA score declined in only 2 patients, while 15.5% improved over their hospital stay. Those who improved were more likely to have ASIA B injury (p<.001). Overall, 9.2% of patients underwent spinal surgery. Of these, 33% presented as ASIA A, 21% as ASIA B, 29% as ASIA C, and 13% as ASIA D. Surgery was not associated with an improvement in ASIA score. CONCLUSIONS Given the ubiquitous and heterogeneous experience with GSWs to the spine, rigorous attempts should be made to define this population and its clinical and surgical outcomes. Here, we present an analysis of 11 years of patients presenting to two large trauma centers to elucidate patterns in presentation, management, and follow-up. We highlight that GSWs to the cervical spine are most often seen in young black male patients. They were associated with high mortality and high rates of injury to vertebral arteries and that surgical intervention did not alter rates of discitis/osteomyelitis or propensity for neurologic recovery; moreover, there was no incidence of delayed spinal instability in the study population.
Collapse
Affiliation(s)
- Gabrielle Santangelo
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA.
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas Pieters
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Derek D George
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Logan Worley
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Dominick Macaluso
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mert Marcel Dagli
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Catanzaro
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Ben Gu
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dmitry Petrov
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - G Edward Vates
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Schuster
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan J Stone
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| |
Collapse
|
4
|
Johnson CT, Batbold A, Benson D, Herman M, Lee MJ, Ramos E, El Dafrawy M. Civilian Ballistic Injuries to the Atlantoaxial Spine: A Single Institution Case Series. Clin Spine Surg 2024:01933606-990000000-00291. [PMID: 38637934 DOI: 10.1097/bsd.0000000000001627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Describe the injury characteristics of ballistic fractures involving the atlantoaxial spine. SUMMARY OF BACKGROUND DATA Civilian gunshot wounds to the spine are an increasingly common injury in the United States. Civilian studies have focused on ballistic injuries to the entire spine as opposed to a region-specific fashion. Only a single 10-patient case series investigating ballistic fractures to the upper cervical spine (C1 and C2) exists, leaving a large gap in the understanding of this injury complex. METHODS A retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries. RESULTS Thirty-six patients were identified, with 86% being male with an average patient age of 30.0 ± 10.36 years (mean ± SD). Fracture morphology was characterized using proportional analysis. Initial neurological exams were either ASIA A or ASIA E, without any incomplete injuries noted. Patients who sustained a transcanal injury did not show any neurological improvement. The initial in-hospital mortality rate was 5.6%, with a 1-year mortality rate of 8.3%. There is a high incidence of associated vascular injury (66%) and mandible fracture (33%). CONCLUSIONS Ballistic penetrating trauma to the atlantoaxial spine often results in complex injury patterns necessitating multidisciplinary care with high rates of morbidity and mortality. If neurological deficits are present initially, they are often complete. Two thirds of patients sustained an associated vascular injury, which should be screened for with CT angiography.
Collapse
Affiliation(s)
| | | | - Dillon Benson
- Departments of Orthopaedic Surgery and Rehabilitation
| | - Martin Herman
- Neurological Surgery, University of Chicago, Chicago, IL
| | - Michael J Lee
- Departments of Orthopaedic Surgery and Rehabilitation
| | - Edwin Ramos
- Departments of Orthopaedic Surgery and Rehabilitation
| | | |
Collapse
|
5
|
Johnson C, Batbold A, Ahmadpour A, Benson D, Das P, Herman M, Lee M, Ramos E, Dafrawy ME. A predictive model of motor deficit in civilian ballistic lumbosacral spine injuries. Spine J 2024; 24:446-453. [PMID: 37980958 DOI: 10.1016/j.spinee.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/04/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND CONTEXT Civilian gunshot wounds to the spine are an increasingly common injury in the USA. A majority of the available research is focused on a military population suffering high energy missile injury. Minimal research has focused on civilian ballistic injuries to the lumbosacral spine as the available studies focus on the entire spine due to limited numbers. PURPOSE Characterize ballistic injuries to the lumbosacral spine and develop a model to predict the presence of neurological deficit based upon a patients presenting fracture morphology. STUDY DESIGN Retrospective chart review. PATIENT SAMPLE One hundred forty-eight consecutive patients that were presented to an urban level 1 trauma center with ballistic injures to the spine involving the levels L1-S2. OUTCOMES MEASURES Neurological status at presentation and final follow up using the American Spinal Injury Association (ASIA) Impairment Scale. METHODS IRB approval was obtained, and retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation and final follow-up, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries. Chi-square testing was done to identify fracture characteristics associated with neurologic injury. A multiple logistical regression was performed using fracture characteristics highly associated with neurological deficit to develop a model to predict neurologic deficit. The model was then validated with a receiver operator curve. RESULTS Of the 148 patients, 14 patients underwent spinal surgery with the most common indication being decompression and foreign body removal. There was a high incidence of intra-abdominal injury (73.6%). Fractures were characterized by level, affected vertebral component, and spinal canal involvement. Neurological injury was classified using the ASIA scale at presentation and final follow up. Odds-ratios of vertebral fracture characteristics showed neurologic deficit was highly associated with pedicle fractures (OR=9.07 [4.14-21.54] - 95% CI), lamina fractures (OR=6.42 [3.16-13.62] - 95% CI), facet fractures (OR=5.95 [2.90-12.79] - 95% CI), intra-canal bone (OR=12.79 [5.98-29.05] - 95% CI), and an intra-canal trajectory (OR=1078 [4.48-28.98]) - 95% CI. Multiple logistic regression was performed to construct a predictive model of neurologic deficit which showed that intra-canal trajectory, pedicle fracture and facet fracture are associated with neurologic deficit. An ROC curve was made with an area of 0.849 ([0.7853 to 0.9128 - 95% CI], p<.0001) demonstrating a good model fit. CONCLUSIONS Ballistic injuries to the lumbosacral spine involve complex injury patterns in an often polytraumatized patient. Fractures involving the pedicle, lamina, and facet are highly associated with neurologic injury, as is a trans-canal trajectory. A patients fracture morphology can be used to predict if a neurologic deficit is present.
Collapse
Affiliation(s)
- Christopher Johnson
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, 5841 S. Maryland Ave. Room E302/P211, Chicago, IL 60637, USA.
| | - Anudariya Batbold
- Department of Neurological Surgery, University of Chicago, 5841 S. Maryland Ave. MC 3026, Chicago, IL 60637, USA
| | - Arjang Ahmadpour
- Department of Neurological Surgery, University of Chicago, 5841 S. Maryland Ave. MC 3026, Chicago, IL 60637, USA
| | - Dillon Benson
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, 5841 S. Maryland Ave. Room E302/P211, Chicago, IL 60637, USA
| | - Paramita Das
- Department of Neurological Surgery, University of Chicago, 5841 S. Maryland Ave. MC 3026, Chicago, IL 60637, USA
| | - Martin Herman
- Department of Neurological Surgery, University of Chicago, 5841 S. Maryland Ave. MC 3026, Chicago, IL 60637, USA
| | - Michael Lee
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, 5841 S. Maryland Ave. Room E302/P211, Chicago, IL 60637, USA
| | - Edwin Ramos
- Department of Neurological Surgery, University of Chicago, 5841 S. Maryland Ave. MC 3026, Chicago, IL 60637, USA
| | - Mostafa El Dafrawy
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, 5841 S. Maryland Ave. Room E302/P211, Chicago, IL 60637, USA
| |
Collapse
|
6
|
Ricciardi GA, Cabrera JP, Martínez O, Matta J, Vilchis H, Perez Ríos JJ, Carazzo CA, Dittmar M, Yurac R. Predicting early complications in patients with spinal gunshot wounds: A multicenter study. BRAIN & SPINE 2024; 4:102766. [PMID: 38510628 PMCID: PMC10951780 DOI: 10.1016/j.bas.2024.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
Introduction There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research question we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methods This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. Results Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68-7.30), dirty wound (3.32, 1.50-7.34), GCS ≤8 (3.56, 1.17-10.79), hemodynamic instability (2.29, 1.07-4.88), and multiple bullets (1.97, 1.05-3.67). Discussion and conclusion Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.
Collapse
Affiliation(s)
- Guillermo A. Ricciardi
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
| | - Juan P. Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
| | - Oscar Martínez
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
| | - Javier Matta
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
| | - Hugo Vilchis
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
| | - Jeasson Javier Perez Ríos
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
| | - Charles A. Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
| | - Michael Dittmar
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
| | - the AO Spine Latin America Trauma Study Group
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
| |
Collapse
|
7
|
Prasse T, Khaing ZZ, Cates LN, Dewees DM, Hyde JE, Bredow J, Hofstetter CP. A decrease in the neuroprotective effects of acute spinal cord decompression according to injury severity: introducing the concept of a ceiling effect. J Neurosurg Spine 2023; 38:299-306. [PMID: 36401546 DOI: 10.3171/2022.6.spine22383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/28/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Acute traumatic spinal cord injury (tSCI) is followed by a prolonged period of secondary neuroglial cell death. Neuroprotective interventions, such as surgical spinal cord decompression, aim to mitigate secondary injury. In this study, the authors explore whether the effect size of posttraumatic neuroprotective spinal cord decompression varies with injury severity. METHODS Seventy-one adult female Long Evans rats were subjected to a thoracic tSCI using a third-generation spinal contusion device. Moderate and severe tSCI were defined by recorded impact force delivered to the spinal cord. Immediately after injury (< 15 minutes), treatment cohorts underwent either a decompressive durotomy or myelotomy. Functional recovery was documented using the Basso, Beattie, and Bresnahan locomotor scale, and tissue sparing was documented using histological analysis. RESULTS Moderate and severe injuries were separated at a cutoff point of 231.8 kdyn peak impact force based on locomotor recovery at 8 weeks after injury. Durotomy improved hindlimb locomotor recovery 8 weeks after moderate trauma (p < 0.01), but not after severe trauma (p > 0.05). Myelotomy led to increased tissue sparing (p < 0.0001) and a significantly higher number of spared motor neurons (p < 0.05) in moderate trauma, but no such effect was noted in severely injured rats (p > 0.05). Within the moderate injury group, myelotomy also resulted in significantly more spared tissue when compared with durotomy-only animals (p < 0.01). CONCLUSIONS These results suggest that the neuroprotective effects of surgical spinal cord decompression decrease with increasing injury severity in a rodent tSCI model.
Collapse
Affiliation(s)
- Tobias Prasse
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
- 2Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne; and
| | - Zin Z Khaing
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Lindsay N Cates
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Dane M Dewees
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Jeffrey E Hyde
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Jan Bredow
- 3Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany
| | | |
Collapse
|
8
|
Cingoz ID, Kaya I, Sahin MC, Kilcarslan B, Yuceer N. Spine and spinal cord injuries in Syria war: treatment and outcome. Spinal Cord 2023; 61:169-174. [PMID: 36575225 DOI: 10.1038/s41393-022-00870-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
STUDY DESIGN This was a retrospective, comparative 6-year study. OBJECTIVES This study aimed to retrospectively analyze patients who were treated at Kilis State Hospital for spine and spinal cord injuries during the Syrian civil war and to compare the treatment results with the literature. SETTING Kilis State Hospital, Kilis, Turkey. METHODS In our study, 84 patients who were treated for spine and spinal cord injuries between December 2011 and May 2017 were examined. Patient age, sex, injury type, injury region, neurological status, time from injury to treatment, treatment methods, surgical methods applied, and complications were evaluated. RESULTS Of the patients, 72 were male, and 12 were female. The mean age of the patients was 23.2 ± 7.3 years. Fifty-two patients were treated surgically. Surgical treatment was applied to 44 patients with neurological deficits. At least 1-grade neurological improvement was observed in 77.3% (n = 34) of patients with neurological deficits who underwent surgical treatment. Surgical treatment was performed on 18 (34.6%) patients in the first 24 h, 27 (51.9%) patients within 24-72 h, and 7 patients (13.5%) between 72 h and 5 days. Neurological improvement was observed in all patients with neurological deficits who underwent surgical treatment in the first 24 h. CONCLUSIONS Early surgery (in the first 24 h) had a positive effect on the neurological recovery of the patients in our study. Thus, patients with spine and spinal cord injuries rendered a surgical-treatment decision should be operated on in a timely manner, particularly within the first 24 h.
Collapse
Affiliation(s)
- Ilker D Cingoz
- Department of Neurosurgery, Faculty of Medicine, Usak University, Usak, Turkey.
| | - Ismail Kaya
- Department of Neurosurgery, Faculty of Medicine, Usak University, Usak, Turkey
| | - Meryem C Sahin
- Department of Medical Services and Techniques, Vocational School of Health Services, Usak University, Usak, Turkey
| | - Bilal Kilcarslan
- Department of Neurosurgery, Denizli State Hospital, Denizli, Turkey
| | - Nurullah Yuceer
- Department of Neurosurgery, Faculty of Medicine, Izmir Katip Çelebi University, Izmir, Turkey
| |
Collapse
|
9
|
Lu VM, Pinilla Escobar VA, Saberi RA, Gilna GP, Burks JD, Niazi TN, Thorson CM, McCrea HJ. Clinical course of pediatric gunshot wounds involving the spine and spinal cord: the Miami experience. J Neurosurg Pediatr 2023; 31:24-31. [PMID: 36308473 DOI: 10.3171/2022.9.peds22375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Civilian gunshot wounds (GSWs) involving the skeletal spine and spinal cord in pediatric patients are fortunately rare. Nevertheless, their presentation mandates judicious evaluation, and their clinical outcomes remain poorly defined. Thus, the authors aimed to characterize the clinical course of this traumatic presentation in the pediatric population based on their institutional experience. METHODS A retrospective review of a level I trauma center database was performed for the period 2011-2021. Clinical data were included for patients aged ≤ 18 years who had presented with radiographic and clinical evidence of a GSW to the spine and had at least one documented follow-up at least 6 months after injury. The primary outcomes of the study were the categorization of gunshot injuries and the results of neurological and functional examinations. RESULTS A total of 13 patients satisfied the study selection criteria. The mean patient age was 15.7 ± 1.6 years, and all presentations were assault in nature. Most of the patients were male (n = 12, 92%) in gender, Black in race (n = 11, 85%), and from zip codes with a median household income below the local county average (n = 10, 77%). All patients presented with a minimum Glasgow Coma Scale score of 14. Examination at presentation revealed American Spinal Injury Association Impairment Scale (AIS) grade A in 3 cases (23%), grade B in 2 (15%), grade C in 1 (8%), grade D in 2 (15%), and grade E in 5 (38%). Gunshot injury involved all regions of the spine, most commonly the cervical and thoracic spine (n = 6 for each, 46%). In terms of skeletal injury, the most common injuries were to the facet (n = 10, 77%) and the pedicle (n = 8, 62%), with evidence of intracanal injury in 9 patients (69%). Neurosurgical intervention was pursued in 1 patient (8%). Overall, 7 patients (54%) experienced a complication during admission, and the median length of hospitalization was 12 days (range 1-88 days) without any mortality events. Within 90 days from discharge, 2 patients (15%) were readmitted to the hospital for further care. The mean follow-up was 28.9 months (range 6-74 months), by which only 1 patient (8%) had an improved AIS examination; all other patients remained at their initial AIS grade. CONCLUSIONS Pediatric GSWs involving the spine are typically nonfatal presentations, and their long-term functional outlook appears contingent on clinical examination findings at initial presentation. Although neurosurgical intervention is not necessary in most cases, judicious evaluation of radiographic and clinical examinations by a neurosurgical team is strongly recommended to optimize recovery.
Collapse
Affiliation(s)
- Victor M Lu
- 1Departments of Neurological Surgery and
- 2Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida
| | | | - Rebecca A Saberi
- 3Pediatric Surgery, University of Miami, Jackson Memorial Hospital, Miami; and
| | - Gareth P Gilna
- 3Pediatric Surgery, University of Miami, Jackson Memorial Hospital, Miami; and
| | | | - Toba N Niazi
- 1Departments of Neurological Surgery and
- 2Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida
| | - Chad M Thorson
- 3Pediatric Surgery, University of Miami, Jackson Memorial Hospital, Miami; and
| | - Heather J McCrea
- 1Departments of Neurological Surgery and
- 2Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida
| |
Collapse
|