Spinal cord injury and its association with blunt head trauma

Football (soccer)-related spinal cord injury-reported cases from 1976 to 2020

STUDY DESIGN

An analysis of reported cases.

OBJECTIVES

To analyze the existing data on soccer (international football)-related spinal cord injury (SCI).

SETTING

Cases of soccer (international football)-related SCI that were reported globally.

METHODS

PubMed/MEDLINE, EMBASE, and online news publication databases were searched.

RESULTS

Fourteen cases of football-related SCI that occurred between 1976 and 2020 were found. Average age at the time of injury was 19 and 86% of individuals were males. Eight of 14 individuals had vertebral fracture/dislocation, whereas two individuals had concomitant traumatic brain injury. Neurologically, 54% had tetraplegia, 39% had paraplegia, and 8% each suffered from hemiplegia and sensory deficit. Two cases could regain ability to walk with orthosis and four had full mobility with "Return to Play" (RTP). The mortality was 14%.

CONCLUSIONS

Younger males were most commonly affected. The most common etiology, vertebral level of injury, and neurological manifestation was fall, cervical spine, and tetraplegia respectively. More than 50% of the individuals with football-related SCI were able to walk or RTP after rehabilitation. Further studies are required to establish universal RTP criteria and formulate preventive measures.

Semirigid cervical spine collar and risk of missing significant soft tissue injuries

We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.

Analysis of Associated Spinal Fractures in Cases of Traumatic Intracranial Hemorrhage or Skull Fracture

Introduction: Patients with traumatic intracranial hemorrhage (ICH) or skull fracture are typically admitted to the Department of Neurosurgery for fear of delayed neurological deterioration. Neurosurgeons, therefore, must be careful not to overlook a spinal fracture in these patients. In this study, we investigated the occurrence and risk factor of spinal fracture in patients with traumatic ICH or skull fracture.

Patients and methods: We retrospectively analyzed the hospital records of 134 patients admitted to the Department of Neurosurgery at Kagawa Rosai Hospital for traumatic ICH or skull fracture. The etiology of trauma, level of consciousness, presence or absence of ICH, skull fracture, craniotomy and spinal surgery were investigated. Furthermore, in cases of spinal fracture, its type, neurological symptoms, treatment were investigated.

Results: In an analysis of 134 patients, Ground level fall and traffic accident were the most frequent etiologies of trauma (47.0% and 23.9% respectively). Glasgow coma scale on admission was 15-13 for 106 patients (79.1%). spinal fracture was identified in 10 of 134 patients (7.5%). Two patients had cervical, 8 had thoracolumbar fractures. In the analysis of risk factors, an accidental fall and skull fracture was observed significantly more in the spinal fracture cases.

Conclusion: The majority of traumatic ICH or skull fracture cases treated in the Department of Neurosurgery were caused by minor head impacts. When treating these patients, it is necessary to investigate not only the cervical, but also the thoracolumbar spine, especially when the cause of injury is an accidental fall and a skull fracture is identified.

Radiation dose reduction using a neck detection algorithm for single spiral brain and cervical spine CT acquisition in the trauma setting

Cervical spine injuries occur in 4-8 % of adults with head trauma. Dual acquisition technique has been traditionally used for the CT scanning of brain and cervical spine. The purpose of this study was to determine the efficacy of radiation dose reduction by using a single acquisition technique that incorporated both anatomical regions with a dedicated neck detection algorithm. Thirty trauma patients for brain and cervical spine CT were included and were scanned with the single acquisition technique. The radiation doses from the single CT acquisition technique with the neck detection algorithm, which allowed appropriate independent dose administration relevant to brain and cervical spine regions, were recorded. Comparison was made both to the doses calculated from the simulation of the traditional dual acquisitions with matching parameters, and to the doses of retrospective dual acquisition legacy technique with the same sample size. The mean simulated dose for the traditional dual acquisition technique was 3.99 mSv, comparable to the average dose of 4.2 mSv from 30 previous patients who had CT of brain and cervical spine as dual acquisitions. The mean dose from the single acquisition technique was 3.35 mSv, resulting in a 16 % overall dose reduction. The images from the single acquisition technique were of excellent diagnostic quality. The new single acquisition CT technique incorporating the neck detection algorithm for brain and cervical spine significantly reduces the overall radiation dose by eliminating the unavoidable overlapping range between 2 anatomical regions which occurs with the traditional dual acquisition technique.