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Herren C, Jarvers JS, Jung MK, Blume C, Meinig H, Ruf M, Weiß T, Rüther H, Welk T, Badke A, Gonschorek O, Heyde CE, Kandziora F, Knop C, Kobbe P, Scholz M, Siekmann H, Spiegl U, Strohm P, Strüwind C, Matschke S, Disch AC, Kreinest M. Paediatric spine injuries in the thoracic and lumbar spine-results of the German multicentre CHILDSPINE study. Eur Spine J 2024; 33:1574-1584. [PMID: 37466720 DOI: 10.1007/s00586-023-07822-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Paediatric thoracolumbar spine injuries are rare, and meaningful epidemiological data are lacking. OBJECTIVES The aim of this study was to provide epidemiological data for paediatric patients with thoracolumbar spinal trauma in Germany with a view to enhancing future decision-making in relation to the diagnostics and treatment of these patients. MATERIALS AND METHODS A retrospective multicentre study includes patients up to 16 years of age who were suffering from thoracolumbar spine injuries who had been treated in six German spine centres between 01/2010 and 12/2016. The clinical database was analysed for patient-specific data, trauma mechanisms, level of injury, and any accompanying injuries. Diagnostic imaging and subsequent treatment were investigated. Patients were divided into three age groups for further evaluation: age group I (0-6 years), age group II (7-9 years) and age group III (10-16 years). RESULTS A total of 153 children with 345 thoracolumbar spine injuries met the inclusion criteria. The mean age at the time of hospitalization due to the injury was 12.9 (± 3.1) years. Boys were likelier to be affected (1:1.3). In all age groups, falls and traffic accidents were the most common causes of thoracolumbar spine injuries. A total of 95 patients (62.1%) were treated conservatively, while 58 (37.9%) of the children underwent surgical treatment. Minimally invasive procedures were the most chosen procedures. Older children and adolescents were likelier to suffer from higher-grade injuries according to the AOSpine classification. The thoracolumbar junction (T11 to L2) was the most affected level along the thoracolumbar spine (n = 90). Neurological deficits were rarely seen in all age groups. Besides extremity injuries (n = 52, 30.2%), head injuries represented the most common accompanying injuries (n = 53, 30.8%). Regarding spinal injuries, most of the patients showed no evidence of complications during their hospital stay (96.7%). CONCLUSIONS The thoracolumbar junction was more frequently affected in older children and adolescents. The majority of thoracolumbar spinal column injuries were treated conservatively. Nevertheless, 37.9% of hospitalized children had to be treated surgically, and there was an acceptable complication rate for the surgeries that were performed.
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Affiliation(s)
- Christian Herren
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jan-Sven Jarvers
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Matthias K Jung
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
| | - Christian Blume
- Uniklinik RWTH Aachen, Klinik für Neurochirurgie, Aachen, Germany
| | - Holger Meinig
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Michael Ruf
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Thomas Weiß
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Hauke Rüther
- Universitätsmedizin Göttingen, Zentrum für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Göttingen, Germany
| | - Thomas Welk
- SRH Klinikum Karlsbad-Langensteinbach, Abteilung für Radiologie und Neuroradiologie, Karlsbad, Germany
| | - Andreas Badke
- BG Klinik Tübingen, Abteilung für Wirbelsäulenchirurgie, Tübingen, Germany
| | - Oliver Gonschorek
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Christoph E Heyde
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Christian Knop
- Klinikum Stuttgart, Klinik für Unfallchirurgie und Orthopädie, Stuttgart, Germany
| | - Philipp Kobbe
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matti Scholz
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Holger Siekmann
- Ameos Klinik Halberstadt, Klinik für Unfall, Hand- und Wiederherstellungschirurgie, Halberstadt, Germany
| | - Ulrich Spiegl
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Peter Strohm
- Klinikum Bamberg, Klinik für Orthopädie und Unfallchirurgie, Bamberg, Germany
| | - Christoph Strüwind
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Stefan Matschke
- ATOS Klinik Heidelberg, Praxis für Wirbelsäulenchirurgie, Heidelberg, Germany
| | - Alexander C Disch
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, UniversitätsWirbelsäulenzentrum (UCSC), UniversitätsCentrum für Orthopädie, Unfall- and Plastische Chirurgie, Dresden, Germany
| | - Michael Kreinest
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
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Abstract
Thoracolumbar spine trauma can result in potentially life-threatening consequences and requires careful management to ensure good outcomes. The purpose of this chapter is to discuss the anatomy, diagnostic tools, non-operative, and operative treatments important when addressing thoracolumbar trauma.
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Affiliation(s)
- William Hunter Waddell
- Department of Orthopedics, Vanderbilt University Medical Center, Suite 4200, 1215 21st Avenue South, Nashville, TN 37212, USA
| | - Rishabh Gupta
- Department of Orthopedics, Vanderbilt University Medical Center, Suite 4200, 1215 21st Avenue South, Nashville, TN 37212, USA
| | - Byron Fitzgerald Stephens
- Department of Orthopedics, Vanderbilt University Medical Center, Suite 4200, 1215 21st Avenue South, Nashville, TN 37212, USA.
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Yelamarthy PKK, Chhabra HS, Vaksha V, Agarwal Y, Agarwal A, Das K, Erli HJ, Bapat M, Singh R, Gautam D, Tandon R, Balamurali G, Rajan S. Radiological protocol in spinal trauma: literature review and Spinal Cord Society position statement. Eur Spine J 2020; 29:1197-211. [PMID: 31440893 DOI: 10.1007/s00586-019-06112-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 06/29/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The Spinal Cord Society constituted a panel tasked with reviewing the literature on the radiological evaluation of spinal trauma with or without spinal cord injury and recommend a protocol. This position statement provides recommendations for the use of each modality, i.e., radiographs (X-rays), computed tomography (CT), magnetic resonance imaging (MRI), as well as vascular imaging, and makes suggestions on identifying or clearing spinal injury in trauma patients. METHODS PubMed was searched for the corresponding keywords from January 1, 1980, to August 1, 2017. A MEDLINE search was subsequently undertaken after applying MeSH filters. Appropriate cross-references were retrieved. Out of the 545 articles retrieved, 105 relevant papers that address the present topic were studied and the extracted content was circulated for further discussions. A draft position statement was compiled and circulated among the panel members via e-mail. The draft was modified by incorporating relevant suggestions to reach a consensus. RESULTS AND CONCLUSION For imaging cervical and thoracolumbar spine trauma patients, CT without contrast is generally considered to be the initial line of imaging and radiographs are required if CT is unavailable or unaffordable. CT screening in polytrauma cases is best done with a multidetector CT by utilizing the reformatted images obtained when scanning the chest, abdomen, and pelvis (CT-CAP). MRI is indicated in cases with neurological involvement and advanced cervical degenerative changes and to determine the extent of soft tissue injury, i.e., disco-ligamentous injuries as well as epidural space compromise. MRI is also usually performed when X-rays and CT are unable to correlate with patient symptomatology. These slides can be retrieved under Electronic Supplementary Material.
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Garg M, Kumar A, Sawarkar DP, Singh PK, Agarwal D, Kale SS, Mahapatra AK. Traumatic Lateral Spondyloptosis: Case Series. World Neurosurg 2018; 113:e166-e171. [PMID: 29427815 DOI: 10.1016/j.wneu.2018.01.206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To apprise readers about this rare but severest form of traumatic spine injury and its surgical management. BACKGROUND Complete fracture dislocation and subluxation (>100%) of 1 vertebral body in the coronal or sagittal plane with respect to the adjacent vertebra is defined as spondyloptosis. In coronal spondyloptosis the subluxated vertebral bodies lie beside each other, and the condition is lateraloptosis. Patients with lateraloptosis present unique surgical challenges because reduction and achieving realignment of spinal column require meticulous planning and execution. METHODS A retrospective analysis of patients admitted with lateraloptosis over a 4-year period (2013-2016) was done. Lateraloptosis was defined on computed tomography as complete subluxation of the spinal column with more than 50% of adjacent vertebral bodies lying directly lateral to each other. RESULTS Five men, ranging from 18 to 50 years (mean, 35.2 years) old were included in the study. Three patients had thoracic spine lateraloptosis, and in 2 the injury was at the thoracolumbar junction. All patients underwent single-stage posterior surgical reduction and fixation. Intraoperatively, cord transection was seen in 3 patients, and dural tear with cerebrospinal fluid leak was seen in 1 patient. The mean follow-up period was 14 months (range, 1-36 months), during which 1 patient died of complications arising from bedsores. All patients remained at American Spinal Injury Association grade A neurologically. CONCLUSION Lateraloptosis is difficult to treat, and the aim of surgery is to stabilize the spine. Rehabilitation remains the most crucial factor, but the scarcity of proper rehabilitation centers results in high mortality and morbidity.
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Affiliation(s)
- Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepak Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Choi HJ, Kim HS, Nam KH, Cho WH, Choi BK, Han IH. Applicability of thoracolumbar injury classification and severity score to criteria of korean health insurance review and assessment service in treatment decision of thoracolumbar injury. J Korean Neurosurg Soc 2015; 57:174-7. [PMID: 25810856 PMCID: PMC4373045 DOI: 10.3340/jkns.2015.57.3.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/26/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022] Open
Abstract
Objective For improving the drawbacks of previous thoracolumbar spine trauma classification, the Spine Trauma Study Group was developed new classification, Thoracolumbar Injury Classification and Severity Score (TLICS). The simplicity of this scoring system makes it useful clinical application. However, considering criteria of Korean Health Insurance Review and Assessment Service (HIRA), the usefulness of TLICS system is still controversial in the treatment decision of thoracolumbar spine injury. Methods Total 100 patients, who admitted to our hospital due to acute traumatic thoracolumbar injury, were enrolled. In 45, surgical treatment was performed and surgical treatment was decided following the criteria of HIRA in all patients. With assessing of TLICS score and Denis's classification, the treatment guidelines of TLICS and Denis's classification were applied to the criteria of Korean HIRA. Results According to the Denis's three-column spine system, numbers of patients with 2 or 3 column injuries were 94. Only 45 of 94 patients (47.9%) with middle column injury fulfilled the criteria of HIRA. According to TLICS system, operation required fractures (score>4) were 31 and all patients except one fulfilled the criteria of HIRA. Conservative treatment required fractures (score<4) were 52 and borderline fracture (score=4) were 17. Conclusion The TLICS system is very useful system for decision of surgical indication in acute traumatic thoracolumbar injury. However, the decision of treatment in TLICS score 4 should be carefully considered. Furthermore, definite criteria of posterior ligamentous complex (PLC) injury may be necessary because the differentiation of PLC injury between TLICS score 2 and 3 is very difficult.
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Affiliation(s)
- Hyuk Jin Choi
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hwan Soo Kim
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kyoung Hyup Nam
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byung Kwan Choi
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Ho Han
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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