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Takaoka H, Eguchi Y, Shibahashi K, Ozone E, Teramura S, Takeda T, Kitagawa K, Sai K, Setojima Y, Masaki Y, Mizutani M, Hamabe Y, Sugiyama K, Orita S, Inage K, Shiga Y, Shiko Y, Kawasaki Y, Ohtori S. Characteristics and comparative study of thoracolumbar spine injury and dislocation fracture due to tertiary trauma. Eur Spine J 2023; 32:68-74. [PMID: 36469132 DOI: 10.1007/s00586-022-07478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/09/2022]
Abstract
PURPOSE Thoracolumbar spine injury is frequently seen with high-energy trauma but dislocation fractures are relatively rare in spinal trauma, which is often neurologically severe and requires urgent treatment. Therefore, it is essential to understand other concomitant injuries when treating dislocation fractures. The purpose of this study is to determine the differences in clinical features between thoracolumbar spine injury without dislocation and thoracolumbar dislocation fracture. METHODS We conducted an observational study using the Japan Trauma Data Bank (2004-2019). A total of 734 dislocation fractures (Type C) and 32,382 thoracolumbar spine injuries without dislocation (Non-type C) were included in the study. The patient background, injury mechanism, and major complications in both groups were compared. In addition, multivariate analysis of predictors of the diagnosis of dislocation fracture using logistic regression analysis were performed. RESULTS Items significantly more frequent in Type C than in Non-type C were males, hypotension, bradycardia, percentage of complete paralysis, falling objects, pincer pressure, accidents during sports, and thoracic artery injury (P < 0.001); items significantly more frequent in Non-type C than in Type C were falls and traffic accidents, head injury, and pelvic trauma (P < 0.001). Logistic regression analysis showed that younger age, male, complete paralysis, bradycardia, and hypotension were associated with dislocation fracture. CONCLUSION Five associated factors were identified in the development of thoracolumbar dislocation fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hiromitsu Takaoka
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan
| | - Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Ei Ozone
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Shin Teramura
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takuto Takeda
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kyota Kitagawa
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Koichi Sai
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yusuke Setojima
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yuta Masaki
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Masaya Mizutani
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan.,Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan
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Endo T, Suda K, Fukui T, Matsumoto S, Komatsu M, Ota M, Ushiku C, Yamane J, Minami A, Takahata M, Iwasaki N. Rare case of real-time observation of paralytic deterioration after cervical dislocation in the hyperacute phase. BMC Musculoskelet Disord 2022; 23:412. [PMID: 35501753 PMCID: PMC9059409 DOI: 10.1186/s12891-022-05345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background There have been no prior reports of real-time detailed records leading to complete quadriplegia immediately after fracture dislocation in high-energy trauma. Here, we report a case of cervical dislocation in which the deterioration to complete motor paralysis (modified Frankel B1) and complete recovery (Frankel E) could be monitored in real time after reduction in the hyperacute phase. Case presentation A 65-year-old man was involved in a car accident and sustained a dislocation at the C5/6 level (Allen–Ferguson classification: distractive flexion injury stage IV). His paralysis gradually deteriorated from Frankel D to C 2 hours after the injury and from Frankl C to B 5 hours after the injury. His final neurological status immediately before reduction was Frankel B1 (complete motor paralysis with sensation only in the perianal region). Reduction was completed within 6 h and 5 min after injury, and spinal fusion was subsequently performed. The patient exhibited rapid motor recovery immediately after surgery, and was able to walk independently on postoperative day 14. Conclusions This case suggests that there is a mixture of cases in which the spinal cord has not been catastrophically damaged, even if the patient has complete motor paralysis. Prompt reduction has the potential to improve neurological function in such cases.
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Affiliation(s)
- Tsutomu Endo
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
| | - Kota Suda
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan.
| | - Takafumi Fukui
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoko Matsumoto
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Miki Komatsu
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Masahiro Ota
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Chikara Ushiku
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Junichi Yamane
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Akio Minami
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
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