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Choi JW, DeSimone KE, Dacumos VM, Hoshide RR, Qiao Y, Hui FK. Scalpellum occulta: A rare case of dorsal spinal arachnoid web without the scalpel sign. Radiol Case Rep 2024; 19:1552-1555. [PMID: 38317702 PMCID: PMC10839584 DOI: 10.1016/j.radcr.2024.01.036] [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] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Spinal arachnoid web is a rare condition characterized by extramedullary bands of arachnoid tissue at the level of the dorsal thoracic spinal cord that may lead to progressive, permanent neurological deficits. To date, this condition has been radiographically characterized by a scalpel sign, which has been pathognomonic in all reported cases of spinal arachnoid webs. In this case, we report the first known patient with confirmed spinal arachnoid web without radiographic evidence of the scalpel sign. In reporting our finding, we encourage a higher clinical suspicion for spinal arachnoid web in patients presenting with progressive thoracic myelopathy following trauma, and radiographic evidence of ventrally displaced spinal cord and turbulent cerebrospinal fluid flow, even in the absence of a scalpel sign.
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Affiliation(s)
- Joo Won Choi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Kulani E. DeSimone
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Vianca Mae Dacumos
- College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, 3050 Maile Way, Honolulu, HI 96822, USA
| | - Reid R. Hoshide
- Department of Neurosurgery, The Queen's Medical Center, 550 South Beretania Street, Honolulu, HI 96813, USA
| | - Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin Street Suite #1200, Houston, TX 77030, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Ferdinand K. Hui
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Department of Neurointerventional Surgery, The Queen's Medical Center, 550 South Beretania Street, Honolulu, HI 96813, USA
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van Tiel J, Tan T, Tee J, Marion T, Öner F, Rutges J. Outcome of traumatic thoracolumbar spine fractures in elderly: A systematic review. Brain Spine 2024; 4:102775. [PMID: 38510601 PMCID: PMC10951749 DOI: 10.1016/j.bas.2024.102775] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
Introduction Adequate guidelines for treatment of people over 65 years, suffering traumatic thoracolumbar spine fractures without neurologic deficit, are currently lacking. Research question The aim of this study was to systematically review the available literature regarding the outcome of conservative and surgical treatment of thoracolumbar spinal trauma in elderly patients. Material and methods A systematic review according the PRISMA guidelines was performed. Pubmed, Web of Science, EMBASE and the Cochrane Central register were searched until June 2021. Risk of bias of the included studies was evaluated. Clinical and radiological results, as well as complications of conservative or surgical treatment were reviewed. Results Six articles were included (one prospective randomized trial, two prospective and three retrospective cohort studies). In these studies conflicting results were observed with regard to pain, radiological results and complications following both conservative and surgical treatment strategies for thoracolumbar spine fractures in elderly. Discussion and conclusion Treatment of thoracolumbar fractures in elderly should focus on early mobilization to reduce complications and hospital stay. This may improve functional outcome and prevent worsening of frailty in this vulnerable group of patients. To elucidate the optimal treatment for elderly patient with thoracolumbar fractures, future research should focus on patient specific treatment rather than the mere difference between outcome of surgical and conservative treatment.
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Affiliation(s)
- J. van Tiel
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T. Tan
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - J. Tee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - T.E. Marion
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - F.C. Öner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J.P.H.J. Rutges
- Department of Orthopedic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Karabacak M, Margetis K. Precision medicine for traumatic cervical spinal cord injuries: accessible and interpretable machine learning models to predict individualized in-hospital outcomes. Spine J 2023; 23:1750-1763. [PMID: 37619871 DOI: 10.1016/j.spinee.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND CONTEXT A traumatic spinal cord injury (SCI) can cause temporary or permanent motor and sensory impairment, leading to serious short and long-term consequences that can result in significant morbidity and mortality. The cervical spine is the most commonly affected area, accounting for about 60% of all traumatic SCI cases. PURPOSE This study aims to employ machine learning (ML) algorithms to predict various outcomes, such as in-hospital mortality, nonhome discharges, extended length of stay (LOS), extended length of intensive care unit stay (ICU-LOS), and major complications in patients diagnosed with cervical SCI (cSCI). STUDY DESIGN Our study was a retrospective machine learning classification study aiming to predict the outcomes of interest, which were binary categorical variables, in patients diagnosed with cSCI. PATIENT SAMPLE The data for this study were obtained from the American College of Surgeons (ACS) Trauma Quality Program (TQP) database, which was queried to identify patients who suffered from cSCI between 2019 and 2021. OUTCOME MEASURES The outcomes of interest of our study were in-hospital mortality, nonhome discharges, prolonged LOS, prolonged ICU-LOS, and major complications. The study evaluated the models' performance using both graphical and numerical methods. The receiver operating characteristic (ROC) and precision-recall curves (PRC) were used to assess model performance graphically. Numerical evaluation metrics included AUROC, balanced accuracy, weighted area under PRC (AUPRC), weighted precision, and weighted recall. METHODS The study employed data from the American College of Surgeons (ACS) Trauma Quality Program (TQP) database to identify patients with cSCI. Four ML algorithms, namely XGBoost, LightGBM, CatBoost, and Random Forest, were utilized to develop predictive models. The most effective models were then incorporated into a publicly available web application designed to forecast the outcomes of interest. RESULTS There were 71,661 patients included in the analysis for the outcome mortality, 67,331 for the outcome nonhome discharges, 76,782 for the outcome prolonged LOS, 26,615 for the outcome prolonged ICU-LOS, and 72,132 for the outcome major complications. The algorithms exhibited an AUROC value range of 0.78 to 0.839 for in-hospital mortality, 0.806 to 0.815 for nonhome discharges, 0.679 to 0.742 for prolonged LOS, 0.666 to 0.682 for prolonged ICU-LOS, and 0.637 to 0.704 for major complications. An open access web application was developed as part of the study, which can generate predictions for individual patients based on their characteristics. CONCLUSIONS Our study suggests that ML models can be valuable in assessing risk for patients with cervical cSCI and may have considerable potential for predicting outcomes during hospitalization. ML models demonstrated good predictive ability for in-hospital mortality and nonhome discharges, fair predictive ability for prolonged LOS, but poor predictive ability for prolonged ICU-LOS and major complications. Along with these promising results, the development of a user-friendly web application that facilitates the integration of these models into clinical practice is a significant contribution of this study. The product of this study may have significant implications in clinical settings to personalize care, anticipate outcomes, facilitate shared decision making and informed consent processes for cSCI patients.
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Affiliation(s)
- Mert Karabacak
- Department of Neurosurgery, Mount Sinai Health System, 1468 Madison (Ave), New York, 10029 NY, USA
| | - Konstantinos Margetis
- Department of Neurosurgery, Mount Sinai Health System, 1468 Madison (Ave), New York, 10029 NY, USA
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Heye T, Thind T, Jenkins A, Reif R, Jensen HK, Sexton K, Kalkwarf K, Bhavaraju A. Weight-Based Dosing for Venous Thromboembolism Prophylaxis in Spinal Trauma Patients Appears Safe. J Surg Res 2023; 290:209-214. [PMID: 37285702 DOI: 10.1016/j.jss.2023.04.019] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a substantial cause of morbidity and mortality in trauma patients. VTE prophylaxis (VTEP) initiation is often delayed in certain patients due to the perceived risk of bleeding complications. Our VTEP guideline was changed from fixed-dosing to a weight-based dosing strategy using enoxaparin in June 2019. We investigated the rate of postoperative bleeding complications with a weight-based and a standard dosing protocol in traumatic spine injury patients requiring surgical stabilization. METHODS A retrospective pre-post cohort study using an institutional trauma database was conducted, comparing bleeding complications between fixed and weight-based VTEP protocols. Patients undergoing surgical stabilization of a spine injury were included. The preintervention cohort received fixed-dose thromboprophylaxis (30 mg twice daily or 40 mg daily); the postcohort received weight-based thromboprophylaxis (0.5 mg/kg q12 h with anti-factor Xa monitoring). All patients received VTEP 24-48 h after surgery. International Classification of Diseases codes were used to identify bleeding complications. RESULTS There were 68 patients in the pregroup and 68 in the postgroup with comparable demographics. Incidence of bleeding complications in the pre- and postgroups were 2.94% and 0% respectively. CONCLUSIONS VTEP initiated 24-48 h after surgical stabilization of a spine fracture using a weight-based dosing strategy and has a similar rate of bleeding complications as a standard dose protocol. Our study is limited by the low overall incidence of bleeding complications and small sample size. These findings could be validated by a larger multicenter trial.
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Affiliation(s)
- Thomas Heye
- University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Tarendeep Thind
- University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Allison Jenkins
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rebecca Reif
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin Sexton
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biomedical Informatics, UAMS College of Medicine, Little Rock, Arkansas; Department of Health Policy and Management, UAMS Fay. W. Boozman College of Public Health, Little Rock, Arkansas; Division of Pharmaceutical Evaluation & Policy, Department of Pharmacy Practice, UAMS College of Pharmacy, Little Rock, Arkansas
| | - Kyle Kalkwarf
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Avi Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Kumar AA, Wong JYH, Pillay R, Nolan CP, Ling JM. Treatment of acute traumatic central cord syndrome: a score-based approach based on the literature. Eur Spine J 2023; 32:1575-1583. [PMID: 36912986 DOI: 10.1007/s00586-023-07626-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/06/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Acute traumatic central cord syndrome (ATCCS) accounts for up to 70% of incomplete spinal cord injuries, and modern improvements in surgical and anaesthetic techniques have given surgeons more treatment options for the ATCCS patient. We present a literature review of ATCCS, with the aim of elucidating the best treatment option for the varying ATCCS patient characteristics and profiles. We aim to synthesise the available literature into a simple-to-use format to aid in the decision-making process. METHODS The MEDLINE, EMBASE, CENTRAL, Web of Science and CINAHL databases were searched for relevant studies and improvement in functional outcomes were calculated. To allow for direct comparison of functional outcomes, we chose to focus solely on studies which utilised the ASIA motor score and improvements in ASIA motor score. RESULTS A total of 16 studies were included for review. There were a total of 749 patients, of which 564 were treated surgically and 185 were treated conservatively. There was a significantly higher average motor recovery percentage amongst surgically-treated patients as compared to conservatively treated patients (76.1% vs. 66.1%, p value = 0.04). There was no significant difference between the ASIA motor recovery percentage of patients treated with early surgery and delayed surgery (69.9 vs. 77.2, p value = 0.31). Delayed surgery after a trial of conservative management is also an appropriate treatment strategy for certain patients, and the presence of multiple comorbidities portend poor outcomes. We propose a score-based approach to decision making in ATCCS, by allocating a numerical score for the patient's clinical neurological condition, imaging findings on CT or MRI, history of cervical spondylosis and comorbidity profile. CONCLUSIONS An individualised approach to each ATCCS patient, considering their unique characteristics will lead to the best outcomes, and the use of a simple scoring system, can aid clinicians in choosing the best treatment for ATCCS patients.
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Affiliation(s)
- A Aravin Kumar
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.
| | - Joey Ying Hao Wong
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Robin Pillay
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Colum Patrick Nolan
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ji Min Ling
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
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Dobran M, Aiudi D, Liverotti V, Fasinella MR, Lattanzi S, Melchiorri C, Iacoangeli A, Campa S, Polonara G. Prognostic MRI parameters in acute traumatic cervical spinal cord injury. Eur Spine J 2023; 32:1584-1590. [PMID: 36882580 DOI: 10.1007/s00586-023-07560-4] [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: 10/03/2022] [Revised: 12/09/2022] [Accepted: 01/22/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE The aim of this study is to estimate the prognostic value of some features documented on preoperative MRI study in patients with acute cervical spinal cord injury. METHODS The study was conducted in patients operated for cervical spinal cord injury (cSCI) from April 2014 to October 2020. The quantitative analysis on preoperative MRI scans included: length of the spinal cord intramedullary lesion (IMLL the canal diameter at the level of maximal spinal cord compression (MSCC) and the presence of intramedullary hemorrhage. The canal diameter at the MSCC was measured on the middle sagittal FSE-T2W images at the maximum level of injury. The America Spinal Injury Association (ASIA) motor score was used for neurological assessment at hospital admission. At 12-month follow-up all patients were examined with the SCIM questionnaire. RESULTS At linear regression analysis, the length of the spinal cord lesion [β coefficient -10.35, 95% confidence interval (CI)-13.71 to-6.99; p < 0.001], the diameter of the canal at the level of the MSCC (β coefficient 6.99, 95% CI 0.65 to 13.33; p = 0.032), and the intramedullary hemorrhage (β coefficient - 20.76, 95% CI - 38.70 to - 2.82; p = 0.025), were significantly associated with the score at the SCIM questionnaire at one year follow-up: shorter spinal cord lesion, greater diameter of the canal at the level of the MSCC, and absence of intramedullary hemorrhage were predictors of better outcome. CONCLUSION According to the findings of our study, the spinal length lesion, canal diameter at the level of spinal cord compression and intramedullary hematoma documented by the preoperative MRI study were associated with the prognosis of patients with cSCI.
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Affiliation(s)
- M Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
| | - D Aiudi
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - V Liverotti
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - M R Fasinella
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - S Lattanzi
- Department of Neurology, Università Politecnica delle Marche, Ancona, Italy
| | - C Melchiorri
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - A Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - S Campa
- Department of Neuroradiology, Università Politecnica delle Marche, Ancona, Italy
| | - G Polonara
- Department of Neuroradiology, Università Politecnica delle Marche, Ancona, Italy
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Ossaba Vélez S, Sanz Canalejas L, Martínez-Checa Guiote J, Díez Tascón A, Martí de Gracia M. Cervical spine trauma. Radiologia (Engl Ed) 2023; 65 Suppl 1:S21-S31. [PMID: 37024227 DOI: 10.1016/j.rxeng.2022.10.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/22/2022] [Indexed: 04/08/2023]
Abstract
Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular involvement. The Canadian C-Spine Rule and the NEXUS criteria aim to identify individuals with a low risk of cervical spine trauma who can safely forgo imaging tests. In high-risk patients, an imaging test is indicated. In adult patients the imaging test of choice is multidetector computed tomography. Complementary imaging tests such as CT angiography of the supra-aortic vessels and/or magnetic resonance imaging are occasionally necessary. It can be challenging for radiologists to diagnose and classify these lesions, because some of them can be subtle and difficult to detect. This paper aims to describe the most important imaging findings and the most widely used classification systems.
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Affiliation(s)
- S Ossaba Vélez
- Sección de Radiología de Urgencias, Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain.
| | - L Sanz Canalejas
- Sección de Radiología de Urgencias, Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - J Martínez-Checa Guiote
- Sección de Radiología de Urgencias, Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - A Díez Tascón
- Sección de Radiología de Urgencias, Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - M Martí de Gracia
- Sección de Radiología de Urgencias, Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
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Conlon M, Thommen R, Kazim SF, Dicpinigaitis AJ, Schmidt MH, McKee RG, Bowers CA. Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury. Neurospine 2022; 19:1039-1048. [PMID: 36597640 PMCID: PMC9816576 DOI: 10.14245/ns.2244326.163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/01/2022] [Accepted: 10/14/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs). METHODS The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015-2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes. RESULTS Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001). CONCLUSION Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAI-based frailty indices can be used in preoperative risk assessment of spinal trauma patients.
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Affiliation(s)
- Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | | | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Rohini G. McKee
- Department of Surgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA,Corresponding Author Christian A. Bowers Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM 81731, USA
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Adamski S, Węclewicz MM, Rocławski M, Pankowski R, Kloc W. Minimally invasive lateral occipitocervical fixation: case series and technique description. Eur Spine J 2022. [PMID: 35771267 DOI: 10.1007/s00586-022-07278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Occipitocervical junction (OCJ) instability is commonly treated with fixation via open posterior approach. The use of intraoperative navigation allows us to perform occipitocervical fixation via minimally invasive approach. We report a series of patients treated with percutaneous occipitocervical fixation, describing the surgical procedure in detail and discussing the technique. METHODS We prospectively enrolled 8 patients affected by OCJ instability secondary to trauma and rheumatoid arthritis. Traumatic patients were preoperatively evaluated with CT scan and MRI scan if needed. Rheumatoid arthritis group was evaluated with both CT and MR. Patients underwent percutaneous occipitocervical fixation with the assist of intraoperative 3D imaging and navigation. All patients were functionally and radiologically evaluated pre-, at 6 weeks, and at 1 year postoperatively. RESULTS Percutaneous occipitocervical fixation was successfully performed in all of the patients. 33 screws were placed. 29 (87.88%) were placed without any pedicle breach. In 3 (9.09%) screws we observed a minor; and in 1 (3.03%) screw we observed a major pedicle breach. We did not have any postoperative complications. CONCLUSIONS Described method of occipitocervical fixation is a minimally invasive method that has a similar outcome to the open technique. It requires the experience in open techniques and the assist of intraoperative 3D imaging and navigation to be performed efficiently.
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Tu PH, Liu ZH, Yeap MC, Liu YT, Li YC, Huang YC, Lin TM, Chen CC. Spinal cord injury and spinal fracture in patients with ankylosing spondylitis. BMC Emerg Med 2022; 22:73. [PMID: 35501709 PMCID: PMC9063196 DOI: 10.1186/s12873-022-00635-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Spinal cord injury (SCI) and spinal fracture are major complications in patients with ankylosing spondylitis (AS) who sustain spinal trauma. The purpose of this study was to investigate the incidence, predictors, and sequelae of spinal trauma in patients with AS. Methods This retrospective study included patients with AS who were admitted for spinal trauma between January 1, 2006, and June 30, 2016. The study compared clinical outcomes of patients between group 1: SCI alone, group 2: spinal fracture alone (no SCI), and group 3: both SCI and spinal fracture. Results Of the 6285 patients with AS admitted during the retrospective study period, only 105 suffered from spinal trauma and were enrolled in the study. Case number in group 1, 2, and 3 was 11(10.48%), 45(42.85%), and 49(46.67%), respectively. Among the patients with spinal fractures, 52.1% had SCI. Bamboo spine was significantly more prevalent in the fracture group than in the nonfracture group (78.7% vs. 36.4%; P = 0.006). Patients with SCI had more instances of subluxation or dislocation (48.3% vs. 8.9%; P < 0.001) and more cases of spinal epidural hematoma (SEH; 21.7% vs. 2.2%; P = 0.003) than patients without SCI. The rate of delayed diagnosis for spinal fracture was 31.4%, with one-third of patients developing delayed SCI. Among the patients with incomplete SCI, 58.3% achieved neurological improvement after treatment (P = 0.004). Conclusions Patients with AS and bamboo spine at radiograph had a higher rate of spinal fracture, which may be an important factor in SCI in patients with AS. Spinal fractures involving the C3–C7 region, subluxation or dislocation, severe spinal fracture, and SEH were found to be predictive of SCI, and SCI in patients with AS resulted in higher mortality and complication rates.
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Affiliation(s)
- Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Ying-Ching Li
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Tzu-Min Lin
- Department of Internal Medicine, Division of Rheumatology, Immunology and Allergy, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Internal Medicine, Division of Allergy, Immunology and Rheumatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan.
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11
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Gader G, Badri M, Rkhami M, Zammel I. Transdural spinal cord herniation: A rare cause of neurologic impairment: Report of two cases and review of the literature. Int J Surg Case Rep 2022; 93:106951. [PMID: 35313186 PMCID: PMC8935513 DOI: 10.1016/j.ijscr.2022.106951] [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] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Herniation of the thoracic spinal cord is a rare pathology related to the genesis of a breach in the anterior dura. Adding to the previously published cases, we report our department's experience with 2 cases of young adults who presented with transdural spinal cord herniation following spinal trauma. Presentation of the cases We report the cases of 2 men aged 27 and 57, with history of spinal trauma, who presented diverse clinical complaints (motor impairment, genito-sphincteric disorders, etc.). Spinal cord MRI showed an anterior displacement of the spinal cord. Both patients were operated. Peroperative findings and radiological features were concordant with transdural spinal cord herniation. Discussion Spinal cord herniation is a rare condition which is usually related to a misdiagnosed spinal trauma. Pathogenesis is still being debated. This condition may lead to a myelopathy potentially responsible for severe neurologic impairment, mainly presenting as a Brown-Sequard syndrome. Diagnosis is based on clinical and radiologic features on MRI. Surgical treatment is proposed when neurological signs are found. Long-term clinical and radiological monitoring is necessary for paucisymptomatic, non-operated patients. Conclusions Based on the described cases, we tried to review the main clinical, radiological and therapeutic features related to this condition. Herniation of the thoracic spinal cord is due to a breach in the anterior dura of an uncertain pathogenesis Transdural spinal cord herniation is a little known cause for myelopathy potentially responsible for severe neurologic impairment Main clinical features are related to a Brown-Sequard syndrome In symptomatic cases, surgical treatment may stabilize or even improve neurologic impairment
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Affiliation(s)
- Ghassen Gader
- Faculty of medicine of Tunis, University Tunis-El Manar, Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Mohamed Badri
- Faculty of medicine of Tunis, University Tunis-El Manar, Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Mouna Rkhami
- Faculty of medicine of Tunis, University Tunis-El Manar, Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Ihsèn Zammel
- Faculty of medicine of Tunis, University Tunis-El Manar, Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
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Nagassima Rodrigues Dos Reis K, McDonnell JM, Ahern DP, Evans S, Gibbons D, Butler JS. Changing Demographic Trends in spine trauma: The presentation and outcome of Major Spine Trauma in the elderly. Surgeon 2021; 20:e410-e415. [PMID: 34600828 DOI: 10.1016/j.surge.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/21/2020] [Revised: 11/30/2020] [Accepted: 08/19/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Major trauma has seen a demographic shift in recent years and it is expected that the elderly population will comprise a greater burden on the major trauma service in the near future. However, whether a similar trend exists in those undergoing operative intervention for spinal trauma remains to be elucidated. AIMS To compare the presentation and outcomes of patients ≥65 years of age sustaining spine trauma to those <65 years at a national tertiary referral spine centre. METHODS The local Trauma Audit Research Network (TARN) database was analysed to identify spinal patients referred to our institution, a national tertiary referral centre, between 01/2016 and 05/2019. Patients were divided into a young cohort (16-64 years old) and an elderly cohort (> 64 years old). No explicit distinction was made between major and minor spine trauma cases. Variables analysed included patient demographics, injury severity, mortality, interventions, mechanism of injury and length of hospital stay. RESULTS A total of 669 patients were admitted of which 480 patients underwent operative intervention for spinal trauma. Within the elderly cohort, this represented 75.3% of cases. Among the younger population, road traffic collisions were the most common mechanism of injury (37.1%), while low falls (<2 m) (57.4%) were the most common mechanism among the older population. Patients ≥65 years old had significantly longer length of stay (21 days [1-194] v 14 days [1-183]) and suffered higher 30-day mortality rates (4.6% [0-12] v 0.97% [0-4]). CONCLUSION Orthopaedic spinal trauma in older people is associated with a significantly higher mortality rate as well as a longer duration of hospitalization. Even though severity of injury is similar for both young and old patients, the mechanism of injury for the older population is of typically much lower energy compared to the high energy trauma affecting younger patients.
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Affiliation(s)
| | - Jake M McDonnell
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland.
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Ireland
| | - Shane Evans
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Denys Gibbons
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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Delumpa A, Wu G, So J, Lincoln C. Intraspinal pseudomeningoceles: A rare complication of spinal trauma and surgery. Clin Imaging 2021; 79:323-325. [PMID: 34392073 DOI: 10.1016/j.clinimag.2021.07.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
We present two cases of acute and delayed presentations of intraspinal pseudomeningoceles, which is a rare complication of spinal trauma or surgery. Our goal is to discuss the pathophysiology, clinical presentation, imaging findings, and treatment of this rare entity. This diagnosis should be considered in patients with unexplained neurologic symptoms in the setting of prior cervical spine injury or surgery.
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Affiliation(s)
- Alfred Delumpa
- Department of Radiology, Baylor College of Medicine, One Baylor Plaza BCM 360, Houston, TX 77030, United States.
| | - George Wu
- Department of Radiology, Baylor College of Medicine, One Baylor Plaza BCM 360, Houston, TX 77030, United States
| | - Jerry So
- Department of Radiology, Baylor College of Medicine, One Baylor Plaza BCM 360, Houston, TX 77030, United States
| | - Christie Lincoln
- Department of Radiology, Baylor College of Medicine, One Baylor Plaza BCM 360, Houston, TX 77030, United States
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14
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Abstract
BACKGROUND Injuries of the cervical spine are quite common with an incidence of more than 3% in trauma patients. The incidence is even higher in elderly patients. Cervical spine injuries might induce severe neurological deficits. Therefore, they must be quickly and adequately diagnosed and treated. Depending on the pattern of injury, conservative or surgical treatment is indicated. OBJECTIVE The authors describe the different surgical strategies and treatment options based on the pattern of injury. Typical surgical methods are illustrated by case presentations. CONCLUSION Cervical spine injuries should be treated in a trauma centre with extensive expertise in spine surgery. The immobilisation and gentle transportation is important already at the scene of the accident. Nowadays, there are excellent surgical options and strategies available as well as excellent intensive care therapy. These possibilities lead to rapid and good stabilisation of cervical spine injuries and the posttraumatic morbidity and mortality can be reduced significantly especially in elderly patients.
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15
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Abstract
Background We report a patient who fractured the seventh cervical vertebra while playing a virtual reality (VR) game, without any other trauma. This case report aims to describe the spinal trauma incurred during the use of a VR headset in a video game. Case presentation The Caucasian patient presented with pain and swelling in the lower cervical spine at our clinic after playing a video game involving a combination of shoulder, arm and head movements while wearing a VR headset. Preexisting comorbidities were not present in the 31-year-old male. No history of regular medication use or drug abuse was recorded. After performing a clinical examination and radiological diagnostics, we found a dislocated traumatic fracture of the spinous process of the seventh cervical vertebra. After a soft tissue defect was excluded through magnetic resonance imaging (MRI) diagnostics, a conservative therapy regimen with pain therapy and immobilization was started. After hospitalization, outpatient controls were conducted at 4, 6 and 12 weeks. At 6 weeks after hospitalization, the patient had recovered from the injury without complications. Conclusions Rapid movements during VR gaming can lead to injuries of the cervical spine. In addition to rapid movements, the additional weight of the VR headset as well as the decoupling of audiovisual stimuli from the perceived proprioceptive information should be considered. Determining whether this is an isolated incident induced by unknown preexisting factors or whether the trauma mechanism alone can lead to severe spinal trauma needs to be studied further with additional cases.
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Affiliation(s)
- D Baur
- University hospital, 04103, Leipzig, Germany.
| | - C Pfeifle
- University hospital, 04103, Leipzig, Germany
| | - C E Heyde
- University hospital, 04103, Leipzig, Germany
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Abstract
In the evaluation of spinal trauma, diagnostic imaging is of paramount importance. Computed tomography (CT), flexion/extension radiographs, and MRI are complementary modalities. CT is typically obtained in the initial setting of spinal trauma and provides detailed information about osseous structures. MRI provides detailed information about structural injury to the spinal cord. Diffusion tensor imaging provides microstructural information about the integrity of the axons and myelin sheaths, but its clinical use is limited. Novel imaging techniques may be better suited for the acute clinical setting and are under development for potential future clinical use.
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Kim W, Ahn N, Ata A, Adamo MA, Entezami P, Edwards M. Pediatric cervical spine injury in the United States: Defining the burden of injury, need for operative intervention, and disparities in imaging across trauma centers. J Pediatr Surg 2021; 56:293-296. [PMID: 32561174 DOI: 10.1016/j.jpedsurg.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pediatric cervical spine injury (PCSI) in children is rare. Incidence of PCSI requiring intervention is not known, and imaging practices for screening in United States trauma centers are not well described. METHODS The 2016 NTDB was queried for patients younger than 15 years with PCSI. Incidence of PCSI, operative interventions, and imaging rates were analyzed by age and ACS accreditation status. RESULTS Of 84,554 children, 873 (1.03%) had PCSI. Patients <4 years were less likely to have PCSI (0.68% vs. 1.1%, RR 0.59, p < 0.001). 165 children (0.20%) required an intervention for PCSI. 12.8% of all children were screened for PCSI with imaging, 9.3% with CT, and 3.2% with plain X-rays. In spite of similar injury and intervention rates, stand-alone pediatric trauma centers were less likely than others to image patients without PCSI (11% vs. 13% p < 0.001), less likely to utilize CT scan (5.8% vs. 10.6% p < 0.001) and more likely to utilize plain films (5.2% vs. 2.4% p < 0.001). CONCLUSION Despite exceedingly low rates of PSCI requiring intervention (0.2%), imaging rates for screening are significant. Stand-alone pediatric trauma centers outperform others in limiting unnecessary imaging. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Woihwan Kim
- Department of Surgery, Albany Medical Center, Albany, NY
| | - Nicholas Ahn
- Department of Surgery, Albany Medical Center, Albany, NY
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, NY
| | - Matthew A Adamo
- Department of Surgery, Division of Neurosurgery, Albany Medical Center, Albany, NY
| | - Pouya Entezami
- Department of Surgery, Division of Neurosurgery, Albany Medical Center, Albany, NY
| | - Mary Edwards
- Department of Surgery, Division of Pediatric Surgery, Albany Medical Center, Albany, NY.
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18
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Sajid MI, Ahmad B, Mahmood SD, Darbar A. Gunshot injury to spine: An institutional experience of management and complications from a developing country. Chin J Traumatol 2020; 23:324-328. [PMID: 32891484 PMCID: PMC7718504 DOI: 10.1016/j.cjtee.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/06/2020] [Revised: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Gunshot wounds are the second leading cause of spinal cord injuries. Surgical intervention for gunshot injury to the spine carries a high rate of complications. There is a scarcity of data on civilian gunshot injuries to the spine in Pakistan. Approximately 60 cases over the last 10 years have been recoded, with unusual presentation and neurological recovery. Thus it is imperative to fill this gap in data, by reviewing cases of civilian gunshot injuries to spine presenting at a tertiary care hospital (Aga Khan University Hospital, Karachi). METHODS This is a retrospective cohort study. Patients of all ages who presented to the emergency department of Aga Khan University Hospital, with gunshot injuries to spine between January 2005 and December 2016 were included in the study. Data were collected on neurological status (American Spinal Injury Association score was used for the initial and follow-up neurological assessment), extent of cord transection, motor and sensory deficits. The patients were further grouped into those with cord transection, and those with fractures of the bony spine but an intact spinal cord. These patients were then followed and the outcomes were recorded. RESULTS A total of 40 patients were identified. The mean ± SD of patients age was (30.9 ± 9.5) years. Of the 40 patients with gunshot wounds, 31 had the medical imaging performed at the facility, and hence they were included in this categorization. The remaining 9 patients were excluded from this additional grouping. Thirteen patients were managed surgically and 27 patients underwent the conservative management. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, the thoracic spine was the most commonly injured region in gunshot injuries. Of the 31 patients with medical imaging performed at our institute, 17 (54.8%) had cord transection, of whom 8 (47%) ultimately developed paraplegia. CONCLUSION The prognosis of gunshot injuries to the spine can be varied depending on whether the spinal cord is intact or transected. This will help healthcare providers to plan the further management of the patient and counsel them accordingly.
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Affiliation(s)
- Mir Ibrahim Sajid
- Medical College, Aga Khan University, Karachi, 74880, Pakistan,Corresponding author.
| | - Bushra Ahmad
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, 74880, Pakistan
| | | | - Aneela Darbar
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, 74880, Pakistan
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Compagnon R, Ferrero E, Leroux J, Lefevre Y, Journeau P, Vialle R, Glorion C, Violas P, Chalopin A, Odent T, Haddad E, Nallet J, Garin C, Choufani E, Langlais T, Sales de Gauzy J; French Society of Spinal Surgery (SFCR), French Society of Pediatric Orthopedics (SOFOP). Epidemiology of spinal fractures in children: Cross-sectional study. Orthop Traumatol Surg Res 2020; 106:1245-9. [PMID: 33060015 DOI: 10.1016/j.otsr.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Epidemiological studies of fractures of the spine in children are all old, mostly single-centre, with series spanning periods of 5 to 20 years. HYPOTHESIS As lifestyle is constantly changing, notably with an increase in sports activities and improvements in the prevention of road and household accidents, epidemiology has likely changed. OBJECTIVE To update the description of spinal trauma in children and adolescents compared to the existing literature. MATERIAL AND METHOD A multicentre cross-sectional study of spinal fracture, dislocation and spinal cord injury without radiological abnormality (SCIWORA) in children was carried out in 15 French university hospital centres, for a period of one year (2016). RESULTS One hundred and sixty-five children were identified: 85 girls, 80 boys; mean age 11 years (range, 10 months-17 years); median, 12 years 6 months. One hundred and fifty-two children (92%) had fracture, 8 (5%) dislocation (including 7 C1-C2 rotary dislocations), and 5 (3%) SCIWORA. Fractures were multiple in 80 cases (49%), contiguous in 73 cases (91%) and non-contiguous in 7 (9%). Locations were cervical in 25 cases (15%), thoracic in 85 (52%), lumbar in 75 and sacral in 4 (2%). Fracture types comprised 234 vertebral compactions (78%), 25 burst fractures (8%), 5 chance fractures (2%), 2 odontoid fractures, and 33 other lesions. Causes comprised fall in 77 cases (47%), sports accidents in 56 (34%), road accidents in 29 (18%), and others in 3. In 52 cases (32%), there was ≥1 associated lesion: appendicular in 35 cases (67%), thoracic or abdominal in 31 (60%), and head in 16 (31%). Twenty-one cases had multiple lesions (40%). Eighteen cases showed neurological involvement (11%) including 5 SCIWORAs. Neurological complications were more frequent before 9 years of age. CONCLUSION The epidemiology of spine fractures in children has slightly changed. There are now fewer cervical lesions. Causes are less often road accidents and more often sports accidents. Multi-level lesions remain frequent and the rate of neurological complications is around 10%. Compaction fracture is the most common type.
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20
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Izzo R, Popolizio T, Balzano RF, Simeone A, Gasparotti R, Scarabino T, Muto M. Imaging of cranio-cervical junction traumas. Eur J Radiol 2020; 127:108960. [PMID: 32298957 DOI: 10.1016/j.ejrad.2020.108960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022]
Abstract
The craniocervical junction (CCJ) or upper cervical spine (UCS) has anatomic features and a biomechanics completely different from the other spinal segment of the spine. Several ligaments and muscles control its motion and function and ensure the maximum mobility and the visual and auditory spatial exploration. UCS traumas represent approximately one-third of all cervical spine injuries. Most of UCS traumas results from blows to the head and sudden deceleration of the body. Thanks to the improvement of the Advanced Trauma Life Support protocols dissociative injuries of CCJ have become less lethal onsite. In other less severe but unstable injuries, patients are neurologically intact at presentation, but they may deteriorate during the stay in hospital, with important clinical and medico-legal consequences. Knowing the peculiarities of UCS is fundamental for the early detection of imaging findings that influences the patient management and outcome. The classification of UCS traumas is mechanistic. More than in any other spinal segment, fractures of CCJ bones can occur without generating instability; on the contrary highly unstable injuries may not be associated with bone fractures. An early and correct diagnosis of occipito-cervical instability may prevent secondary neurological injury. The goal of imaging is to identify which patients can benefit of surgical stabilization and prevent secondary neurologic damage. Actual helical multidetector-CT (MDCT) offers high sensitivity and specificity for bone lesions and displacements in cervical spine traumas, but magnetic resonance imaging (MRI) is increasingly being used to evaluate soft tissues and ligaments, and mainly to identify possible spinal cord injury.
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Affiliation(s)
- Roberto Izzo
- Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.
| | - Teresa Popolizio
- Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.
| | | | - Anna Simeone
- Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Mario Muto
- Neuroradiology Department, A. Cardarelli Hospital, Napoli, Italy
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21
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Kaushal M, Shabani S, Soliman HM, Nguyen HS, Aarabi B, Fehlings MG, Kotter MR, Kwon BK, Harrop JS, Kurpad SN. The Use of Magnetic Resonance Imaging by Spine Surgeons in Management of Spinal Trauma Across AO Regions-Results of AO Spine Survey. World Neurosurg 2020; 137:e389-94. [PMID: 32032784 DOI: 10.1016/j.wneu.2020.01.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine use of magnetic resonance imaging (MRI) for management of spinal trauma as a function of the availability of an MRI scanner across AO regions. METHODS A survey regarding MRI availability and/or accessibility was conducted across 6 global AO regions. Questions were formulated to 1) evaluate availability of an MRI scanner and 2) whether the availability of an MRI scanner influenced time taken to image patients with spinal trauma. Pairwise comparison of responses among AO regions was performed. RESULTS The survey was sent to 5.813 AO Spine members and 561 completed surveys were obtained (Africa, 3%; Asia Pacific, 22.1%; Europe, 30.8%; Latin America, 25.7%; Middle East, 9.4%; and North America, 8.9%). On availability of MRI for spinal trauma, 31.9% reported that MRI was readily available at all times, 51.3% noted 24-hour availability, but more difficult to obtain during nighttime, and 8.7% reported not having an MRI at their hospital. On time taken to obtain scans if MRI is readily available, 32.4% responded that imaging was obtained within 1 hour, whereas 39.9% stated between 1 and 4 hours. On time taken to obtain scans when MRI is least available, 7% responded that imaging was completed within 1 hour whereas 31.4% stated between 1 and 4 hours. Responses from Latin America significantly differed (P < 0.05) from all other AO regions except Africa. CONCLUSIONS MRI use varies across AO regions, with clinical decision making on obtaining MRI in spinal trauma being influenced heavily by the availability of an MRI scanner.
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Gorissen Z, Hakvoort K, van den Boogaart M, Klinkenberg S, Schijns O. Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury. Acta Neurochir (Wien) 2019; 161:361-5. [PMID: 30652201 DOI: 10.1007/s00701-018-03796-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/31/2018] [Indexed: 11/05/2022]
Abstract
Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery. When it leads to a pressure gradient, a so-called tension pneumocephalus, it may require emergency surgery. Clinical symptomatology, especially in young children, does not differentiate between a pneumocephalus and a tension pneumocephalus. An additional CT scan is therefore warranted. Here, we report on a rare case of pneumocephalus after penetrating lumbar injury. Additionally, the pathophysiology of pneumocephalus, as well as its recommendations for diagnosis and treatment, will be elucidated.
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Vicenty-Padilla JC, De Jesus O. Interval Recovery of Syringomyelia in Chiari I Malformation Patient with Acute Cervical Trauma After Anterior Decompression: Case Report and Review of Literature. World Neurosurg 2018; 118:240-2. [PMID: 29981915 DOI: 10.1016/j.wneu.2018.06.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Syringomyelia in the cervical spinal cord is a complex pathology that is commonly associated with Chiari I malformation or spinal cord trauma. In both cases the development of syringomyelia has been linked to multiple anatomic and molecular elements including epidural compression. Literature has mainly reported posterior cervical decompressive procedures or shunting of the cyst as options to address this pathology. Anterior decompression is rarely recommended. CASE DESCRIPTION We present the case of a 19-year-old female who suffered a motor vehicle accident causing a cervical subluxation with mild new-onset neurologic deficits. Preoperative workup showed a large incidental cervical syringomyelia associated with a Chiari I malformation. Anterior cervical decompression at the subluxated cervical segment with a concomitant anterior and posterior fusion was performed. Postoperative workup revealed a significant interval reduction in the size of the syrinx cavity with concomitant neurologic improvement. CONCLUSIONS Anterior decompression may be considered as an option in select cases of syringomyelia. The findings of this case support the theory of epidural compression as one of the inciting events for the development of syringomyelia.
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Richardson B, Paulzak A, Rusyniak WG, Martino A. Anterior Lumbar Corpectomy with Expandable Titanium Cage Reconstruction: A Case Series of 42 Patients. World Neurosurg 2017; 108:317-324. [PMID: 28887282 DOI: 10.1016/j.wneu.2017.08.179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/24/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Burst fractures involve the anterior and middle columns with an intact posterior column. Deforming forces are magnified at areas of transition, making the thoracolumbar junction highly susceptible to injury. METHODS This is a retrospective review of 42 consecutive patients who underwent single-level anterior lumbar corpectomy using an obelisc expandable titanium cage and lateral fixation for traumatic lumbar burst fractures. RESULTS Myelopathy and sensory dysfunction were the most frequent neurologic deficits initially, occurring in 16 (38%) and 15 (36%) patients, respectively, which both decreased to 5 (13%). At follow-up, 26 patients (68%) were able to ambulate independently. No patient had significant cage displacement or needed cage replacement. Subsidence was minimal in 32 of 39 patients (82%). There were no hardware infections or surgical site infections. Options for stabilization include posterior instrumentation and fusion, anterior corpectomy with interbody fusion, and combination procedures. We believe anterior stabilization is superior because the aim is structural restoration of anterior and middle columns. The aim of posterior fixation is to replace the posterior tension band, which is not affected. There are 3 major surgical components to consider. First is anterior versus posterior decompression of the spinal canal. Second is the choice of autograft or titanium graft. Third is whether to stabilize posteriorly or anterolateral. CONCLUSIONS Anterior corpectomy with an expandable titanium cage and lateral rod fixation is safe and effective with minimal complications. It is a viable alternative to posterior decompression and instrumentation.
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Affiliation(s)
- Bradford Richardson
- Department of Neurological Surgery, University of South Alabama, Mobile, Alabama, USA.
| | - Audrey Paulzak
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Walter G Rusyniak
- Department of Neurological Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Anthony Martino
- Department of Neurological Surgery, University of South Alabama, Mobile, Alabama, USA
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25
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Caranci F, Leone G, Ugga L, Cesarano E, Capasso R, Schipani S, Bianco A, Fonio P, Briganti F, Brunese L. Imaging of post-surgical treatment and of related complications in spinal trauma. Musculoskelet Surg 2017; 101:63-73. [PMID: 28168635 DOI: 10.1007/s12306-017-0457-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 11/26/2022]
Abstract
Spinal trauma is a devastating event with a high morbidity and mortality. The rationale of imaging is to diagnose the traumatic abnormalities and characterize the type of injury, to estimate the severity of the lesions, to evaluate the potential spinal instability. In case of spinal instability, the goals of operative treatment are decompression of the spinal cord canal and stabilization of the disrupted vertebral column. Particularly, diagnostic imaging, mainly by CT and MR, has a main role in the post-treatment evaluation. The neuroradiological evaluation of the postoperative spine requires a general knowledge of the surgical approach to each spinal region and of the normal temporal evolution of expected postoperative changes. The neuroradiologist should evaluate the devices implanted, their related complications and promptly alert the surgeon of acute complications, mainly vascular and infective. During the follow-up, it is mandatory to know and search chronic complications as pseudomeningocele, accelerated degenerative disease, arachnoiditis, peridural fibrosis. Knowledge of specific complications relating to each surgical approach will assist the neuroradiologist in interpretation of postoperative images.
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Affiliation(s)
- F Caranci
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy.
| | - G Leone
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Ugga
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - E Cesarano
- Radiology Section, Health Service, Navy Command of Brindisi, Brindisi, Italy
| | - R Capasso
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - S Schipani
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - A Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Briganti
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
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Landi A, Marotta N, Ambrosone A, Prizio E, Mancarella C, Gregori F, La Torre G, Santoro A, Delfini R. Correlation Between Timing of Surgery and Outcome in ThoracoLumbar Fractures: Does Early Surgery Influence Neurological Recovery and Functional Restoration? A Multivariate Analysis of Results in Our Experience. Acta Neurochir Suppl 2017; 124:231-238. [PMID: 28120079 DOI: 10.1007/978-3-319-39546-3_35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Treatment for spinal trauma is affected by both nonmodifiable and modifiable variables. The aim of this study was to compare early surgery with intermediate and late surgery to determine the benefits of spinal reconstruction in neurological recovery and functional restoration in patients with thoracolumbar fractures. METHODS In order to identify correlations between treatment timing, fracture site, neurological recovery, American Spinal Injury Association (ASIA) score restoration, and rehabilitation prognosis in patients with thoracic and lumbar fractures, we conducted a multivariate analysis of the results of surgery, at our institution, in 166 consecutive patients with unstable thoracolumbar fractures with or without neurological impairment. We conducted a literature review (1988-2012) and compared our results with those already published. RESULTS Regardless of the location and type of fracture, early surgery resulted in a reduction of median hospital and intensive care unit (ICU) length of stay, as well as a reduction of nosocomial complications. Regardless of the type of fracture and preoperative ASIA score, thoracic fractures had the worst outcome. Early treatment seemed to have better results, depending on the preoperative ASIA score. CONCLUSION Early surgery in patients with thoracolumbar fractures with incomplete neurological damage could positively affect neurological recovery, functional restoration, length of hospital and ICU stay, and associated comorbidity. Thoracic fractures had the worst outcome. Early surgery seemed to have better results if the initial ASIA score was good. The better the ASIA score on admission, the better was the outcome. Surgical timing did not affect the outcome when the ASIA score was A or E.
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Affiliation(s)
- Alessandro Landi
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Nicola Marotta
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Angela Ambrosone
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Emiliano Prizio
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Cristina Mancarella
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabrizio Gregori
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberto Delfini
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Chu MW, Soleimani T, Evans TA, Fernandez SI, Spera L, Klene C, Zarzaur BL, Tholpady SS. C-spine injury and mandibular fractures: lifesaver broken in two spots. J Surg Res 2016; 206:386-390. [PMID: 27884333 DOI: 10.1016/j.jss.2016.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/06/2016] [Revised: 07/14/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trauma is a leading cause of injury and mortality and may involve mandibular fractures and cervical spine injuries. Manipulation of the spine during trauma protocols and operative treatment has the potential to cause serious spinal cord injuries. The purpose of this study was to identify risk factors associated with cervical spine injury (CSI) in patients with mandibular fractures. METHODS The National Trauma Databank (2007-2010) was used to identify patients with mandibular fractures. RESULTS A total of 59,028 patients were identified and separated into adult and pediatric cohorts. There were 50,711 adults (86%) and 8317 children (14%). There were statistically significant lower rates of associated CSI in pediatric patients than adults (3.5% versus 7.3%, P < 0.01). Predictors of associated CSI in mandible fractures for both adults and children were older age, lower Glasgow Coma Scale, thoracic injuries, firearm or motor vehicle accident mechanisms, and symphyseal fractures. In the pediatric cohort, body, ramus, and subcondylar fractures were significantly associated with CSI. In adults, female gender, and upper extremity, abdominopelvic, and head injuries were also significantly associated with CSI. CONCLUSIONS Multiple mandibular fractures were inversely correlated with CSI. One possibility is that energy dissipation in the mandible with multiple fractures is protective of the C-spine leading to fewer fractures. Children and adults had different associations in the pattern of mandible fractures concomitant with CSI. This has implications in management, imaging, and workup of trauma patients.
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Affiliation(s)
- Michael W Chu
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, R.L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Tahereh Soleimani
- Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Tyler A Evans
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah I Fernandez
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leigh Spera
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carrie Klene
- Department of Oromaxillofacial Surgery, Indiana School of Dentistry, Indianapolis, Indiana
| | - Ben L Zarzaur
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sunil S Tholpady
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, R.L. Roudebush VA Medical Center, Indianapolis, Indiana.
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Koehn LM, Noor NM, Dong Q, Er SY, Rash LD, King GF, Dziegielewska KM, Saunders NR, Habgood MD. Selective inhibition of ASIC1a confers functional and morphological neuroprotection following traumatic spinal cord injury. F1000Res 2016; 5:1822. [PMID: 28105306 PMCID: PMC5200949 DOI: 10.12688/f1000research.9094.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Accepted: 11/29/2016] [Indexed: 12/31/2022] Open
Abstract
Tissue loss after spinal trauma is biphasic, with initial mechanical/haemorrhagic damage at the time of impact being followed by gradual secondary expansion into adjacent, previously unaffected tissue. Limiting the extent of this secondary expansion of tissue damage has the potential to preserve greater residual spinal cord function in patients. The acute tissue hypoxia resulting from spinal cord injury (SCI) activates acid-sensing ion channel 1a (ASIC1a). We surmised that antagonism of this channel should provide neuroprotection and functional preservation after SCI. We show that systemic administration of the spider-venom peptide PcTx1, a selective inhibitor of ASIC1a, improves locomotor function in adult Sprague Dawley rats after thoracic SCI. The degree of functional improvement correlated with the degree of tissue preservation in descending white matter tracts involved in hind limb locomotor function. Transcriptomic analysis suggests that PcTx1-induced preservation of spinal cord tissue does not result from a reduction in apoptosis, with no evidence of down-regulation of key genes involved in either the intrinsic or extrinsic apoptotic pathways. We also demonstrate that trauma-induced disruption of blood-spinal cord barrier function persists for at least 4 days post-injury for compounds up to 10 kDa in size, whereas barrier function is restored for larger molecules within a few hours. This temporary loss of barrier function provides a “
treatment window” through which systemically administered drugs have unrestricted access to spinal tissue in and around the sites of trauma. Taken together, our data provide evidence to support the use of ASIC1a inhibitors as a therapeutic treatment for SCI. This study also emphasizes the importance of objectively grading the functional severity of initial injuries (even when using standardized impacts) and we describe a simple scoring system based on hind limb function that could be adopted in future studies.
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Affiliation(s)
- Liam M Koehn
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Natassya M Noor
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Qing Dong
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Sing-Yan Er
- Division of Chemistry and Structural Biology, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Australia
| | - Lachlan D Rash
- Division of Chemistry and Structural Biology, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Australia; School of Biomedical Sciences, The University of Queensland, St. Lucia, Australia
| | - Glenn F King
- Division of Chemistry and Structural Biology, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Australia
| | | | - Norman R Saunders
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Mark D Habgood
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
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Koehn LM, Noor NM, Dong Q, Er SY, Rash LD, King GF, Dziegielewska KM, Saunders NR, Habgood MD. Selective inhibition of ASIC1a confers functional and morphological neuroprotection following traumatic spinal cord injury. F1000Res 2016; 5:1822. [PMID: 28105306 PMCID: PMC5200949 DOI: 10.12688/f1000research.9094.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/10/2023] Open
Abstract
Tissue loss after spinal trauma is biphasic, with initial mechanical/haemorrhagic damage at the time of impact being followed by gradual secondary expansion into adjacent, previously unaffected tissue. Limiting the extent of this secondary expansion of tissue damage has the potential to preserve greater residual spinal cord function in patients. The acute tissue hypoxia resulting from spinal cord injury (SCI) activates acid-sensing ion channel 1a (ASIC1a). We surmised that antagonism of this channel should provide neuroprotection and functional preservation after SCI. We show that systemic administration of the spider-venom peptide PcTx1, a selective inhibitor of ASIC1a, improves locomotor function in adult Sprague Dawley rats after thoracic SCI. The degree of functional improvement correlated with the degree of tissue preservation in descending white matter tracts involved in hind limb locomotor function. Transcriptomic analysis suggests that PcTx1-induced preservation of spinal cord tissue does not result from a reduction in apoptosis, with no evidence of down-regulation of key genes involved in either the intrinsic or extrinsic apoptotic pathways. We also demonstrate that trauma-induced disruption of blood-spinal cord barrier function persists for at least 4 days post-injury for compounds up to 10 kDa in size, whereas barrier function is restored for larger molecules within a few hours. This temporary loss of barrier function provides a " treatment window" through which systemically administered drugs have unrestricted access to spinal tissue in and around the sites of trauma. Taken together, our data provide evidence to support the use of ASIC1a inhibitors as a therapeutic treatment for SCI. This study also emphasizes the importance of objectively grading the functional severity of initial injuries (even when using standardized impacts) and we describe a simple scoring system based on hind limb function that could be adopted in future studies.
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Affiliation(s)
- Liam M Koehn
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Natassya M Noor
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Qing Dong
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Sing-Yan Er
- Division of Chemistry and Structural Biology, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Australia
| | - Lachlan D Rash
- Division of Chemistry and Structural Biology, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Australia; School of Biomedical Sciences, The University of Queensland, St. Lucia, Australia
| | - Glenn F King
- Division of Chemistry and Structural Biology, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Australia
| | | | - Norman R Saunders
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Mark D Habgood
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
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Abstract
Magnetic resonance imaging (MRI) has been playing an increasingly important role in the spinal trauma patients due to high sensitivity for detection of acute soft tissue and cord injuries. More and more patients are undergoing MRI for spinal trauma in the emergency settings, thus necessitating the interpreting physicians to be familiar with MRI findings in spinal trauma. In this pictorial review, we will first describe the normal anatomy of various ligamentous structures. Indications of MRI in spinal trauma as well as the role of MRI in diagnosing spinal cord and soft tissue injuries will then be discussed. Illustrated cases are mainly of cervical spine trauma, but thoracolumbar spine injuries are also included where appropriate in our review.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Bridgeport Hospital, Yale New Haven Health System, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Daichi Hayashi
- Department of Radiology, Bridgeport Hospital, Yale New Haven Health System, 267 Grant Street, Bridgeport, CT, 06610, USA. .,Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
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Splendiani A, Bruno F, Patriarca L, Barile A, Di Cesare E, Masciocchi C, Gallucci M. Thoracic spine trauma: advanced imaging modality. Radiol Med 2016; 121:780-92. [PMID: 27307000 DOI: 10.1007/s11547-016-0657-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/29/2016] [Indexed: 01/02/2023]
Abstract
Technological advances in diagnostic imaging make the diagnosis of spinal trauma more accurate both in the acute and in the chronic settings. Improvements in medical care and in diagnostic imaging lead to an increasing prevalence of patients' surviving injuries. The management of these patients depends on early and appropriate radiological evaluation in the acute phase. The aim of this work was to review advanced imaging modalities employed to study thoracic spine and spinal cord in injured patients.
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Moghimi MH, Reitman CA. Perioperative complications associated with spine surgery in patients with established spinal cord injury. Spine J 2016; 16:552-7. [PMID: 24952256 DOI: 10.1016/j.spinee.2014.06.012] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 04/23/2014] [Accepted: 06/11/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Only a small percentage of patients with spinal cord injury (SCI) require consideration for reconstructive surgery after their initial injury. For those who do, perioperative complications can be frequent and significant. There has been very little published literature examining treatment of these patients and essentially nothing to guide the surgeon in perioperative decision making and management. PURPOSE To identify some of the common challenges associated with surgery in this patient population and review the literature to highlight the perioperative concerns in patients with chronic SCI. STUDY DESIGN Review article. METHODS A primary PubMed literature search was performed and reviewed for patients with chronic SCI with emphasis on the complications and difficulties encountered during surgical treatment of patients with chronic SCI. RESULTS For those who do proceed with surgery in this patient population, preoperative nutrition, bone density, and skin should be evaluated and optimized. Preoperative inferior vena cava filters should be considered. The integrity of the reconstruction will be extensively challenged. In addition, augmented fixation and bracing should be contemplated. CONCLUSIONS Patients with chronic SCI who require spinal reconstruction provide many unique challenges. Indications for surgery must be strong as perioperative complications can be frequent and long-term outcomes unpredictable. Close monitoring for postoperative complications is essential.
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Affiliation(s)
- Michael H Moghimi
- Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St, Ste 1325, Houston, TX 77030, USA
| | - Charles A Reitman
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge, Floor 10A, Houston, TX 77030, USA.
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Hernández-Fernández A, Massó A, Beristain M, G Esnal I, Pardo E, Carrillo I, Lersundi A. Spinal trauma. Radiologia 2016; 58 Suppl 1:60-7. [PMID: 26857304 DOI: 10.1016/j.rx.2015.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 11/28/2015] [Accepted: 11/29/2015] [Indexed: 11/20/2022]
Abstract
The treatment of a patient with a vertebral fracture requires an accurate diagnosis and categorization of the problem. Treatment decisions must be based on clinical data and information about the lesion itself, which is provided by imaging studies and their interpretation.
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Henke D, Gorgas D, Doherr MG, Howard J, Forterre F, Vandevelde M. Longitudinal extension of myelomalacia by intramedullary and subdural hemorrhage in a canine model of spinal cord injury. Spine J 2016; 16:82-90. [PMID: 26386168 DOI: 10.1016/j.spinee.2015.09.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 08/12/2015] [Accepted: 09/03/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In canine intervertebral disc (IVD) extrusion, a spontaneous animal model of spinal cord injury, hemorrhage is a consistent finding. In rodent models, hemorrhage might be involved in secondary tissue destruction by biochemical mechanisms. PURPOSE This study aimed to investigate a causal association between the extents of intramedullary, subdural and epidural hemorrhage and the severity of spinal cord damage following IVD extrusion in dogs. STUDY DESIGN/SETTING A retrospective study using histologic spinal cord sections from 83 dogs euthanized following IVD extrusion was carried out. METHODS The degree of hemorrhage (intramedullary, subdural, epidural), the degree of spinal cord damage in the epicenter (white and gray matter), and the longitudinal extent of myelomalacia were graded. Associations between the extent of hemorrhage and the degree of spinal cord damage were evaluated statistically. RESULTS Intramedullary and subdural hemorrhages were significantly associated with the degree of white (p<.001/ p=.004) and gray (both p<.001) matter damage, and with the longitudinal extension of myelomalacia (p<.001/p=.005). Intriguingly, accumulation of hemorrhagic cord debris inside or dorsal to a distended and ruptured central canal in segments distant to the epicenter of the lesion was observed exhibiting a wave-like pattern on longitudinal assessment. The occurrence of this debris accumulation was associated with high degrees of tissue destruction (all p<.001). CONCLUSIONS Tissue liquefaction and increased intramedullary pressure associated with hemorrhage are involved in the progression of spinal cord destruction in a canine model of spinal cord injury and ascending or descending myelomalacia. Functional and dynamic studies are needed to investigate this concept further.
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Ricciardi M. Usefulness of multidetector computed tomography in the evaluation of spinal neuro-musculoskeletal injuries. Vet Comp Orthop Traumatol 2016; 29:1-13. [PMID: 26640838 DOI: 10.3415/VCOT-15-05-0082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/06/2015] [Indexed: 11/17/2022]
Abstract
Spinal trauma is commonly diagnosed in small animal practice. Although the first approach to the patient with spinal trauma includes survey spinal radiographs, an accurate evaluation of the injury often requires advanced imaging. Multidetector computed tomography has revolutionized computed tomography technology, providing near-isotropic volumetric representation of the complete body with exquisite anatomical detail in a brief scan time. This review aims to discuss the technical background, indications, and limitations of multidetector computed tomography in the assessment of spinal trauma with particular reference to skeletal, muscular and nervous spinal components.
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Mobbs RJ, Park A, Maharaj M, Phan K. Outcomes of percutaneous pedicle screw fixation for spinal trauma and tumours. J Clin Neurosci 2015; 23:88-94. [PMID: 26422600 DOI: 10.1016/j.jocn.2015.05.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 02/14/2015] [Revised: 04/22/2015] [Accepted: 05/01/2015] [Indexed: 11/30/2022]
Abstract
We investigated the clinical and radiological results of percutaneous pedicle screw fixation in the management of spinal trauma and metastatic tumours. A retrospective analysis was performed on a series of 14 patients who were operated on from March 2009 to November 2011 by a single surgeon (RJM). Following a radiological review (CT scan/MRI), six patients underwent short segment fixation, while the remaining underwent long segment fixation. All patients had routine follow-ups at 4, 6, 12months, and annually thereafter. Clinical examinations were conducted preoperatively and postoperatively, and the length of operation, blood loss, and postoperative pain relief were recorded. There was a single patient with an incision site complication. The mean blood loss was 269mL. All of the parameters demonstrated no significant differences between the trauma and the tumour groups (p=0.10). The neurological power scores improved for all patients, with the largest increase being from a score of 2 to 4. At follow-up, the majority of patients had returned to their previous activities and had reduced pain scores. One patient suffered high pain levels from other medical conditions that were not related to the operation. Minimally invasive pedicle screw fixation is a suitable option for patients with spinal tumours and fractures, with acceptable safety and efficacy in this small retrospective patient series. We have seen favourable results in our patients, who have experienced an increased quality of life following their surgery.
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Affiliation(s)
- Ralph J Mobbs
- NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia.
| | - Ashley Park
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kevin Phan
- NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia
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Kanna RM, Gaike CV, Mahesh A, Shetty AP, Rajasekaran S. Multilevel non-contiguous spinal injuries: incidence and patterns based on whole spine MRI. Eur Spine J 2015; 25:1163-9. [PMID: 26329650 DOI: 10.1007/s00586-015-4209-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/22/2015] [Accepted: 08/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Multi-level non-contiguous spinal injuries are not uncommon and their incidence varies from 1.6 to 77% depending on the type of imaging modality used. Delayed diagnosis and missed spinal injuries in non-contiguous spine fractures have been frequently described which can result in significant pain, deformity and neurological deficit. The efficacy of whole spine MRI in detecting asymptomatic significant vertebral fractures is not known. METHODOLOGY Consecutive spinal injury patients treated between 2011 and 2013 were retrospectively evaluated based on clinical and radiographic records. Patients' demographics, mode of injury, presence of associated injuries, clinical symptoms and the presence of neurological deficit were studied. Radiographs of the fractured region and whole spine MRI were evaluated for the presence of multi-level injuries. RESULTS Among 484 patients, 95 (19.62%) patients had multilevel injuries including 86 (17.76%) with non-contiguous injuries. Five common patterns of non-contiguous spinal injuries were observed. Pattern I: cervical and thoracic--29.1%, Pattern II: thoracolumbar and lumbosacral--22.1%, Pattern III: thoracic and thoracolumbar--12.8 %, Pattern IV: cervical and thoracolumbar--9.1% and Pattern V: lumbosacral and associated injuries--9.0 %. The incidence of intra-regional non-contiguous injuries was 17.4%. Whole spine MRI scan detected 24 (28.6%) missed secondary injuries of which 5 were unstable. CONCLUSION The incidence of multilevel non-contiguous spine injury using whole spine MRI imaging is 17.76%. Five different patterns of multi-level non-contiguous injuries were found with the most common pattern being the cervical and thoracic level injuries. The incidence of unstable injuries can be as high as 21% of missed secondary injuries.
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Affiliation(s)
- Rishi Mugesh Kanna
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - Chandrasekar V Gaike
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - Anupama Mahesh
- Department of Radiology, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - Ajoy Prasad Shetty
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - S Rajasekaran
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India.
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Abstract
BACKGROUND CONTEXT Spinal gunshot injuries (spinal GSIs) are a major cause of morbidity and mortality in both military and civilian populations. These injuries are likely to be encountered by spine care professionals in many treatment settings. A paucity of resources is available to summarize current knowledge of spinal GSI evaluation and management. PURPOSE The aim was to summarize the ballistics, epidemiology, evaluation, treatment, and outcomes of spinal GSI among civilian and military populations. STUDY DESIGN This was a review of the current literature reporting spinal GSI management. METHODS MEDLINE (PubMed) was queried for recent studies and case reports of spinal GSI evaluation and management. RESULTS Spinal GSI now comprise the third most common cause of spinal injury. Firearms that produce spinal GSI can be divided into categories of high- and low-energy depending on the initial velocity of the projectile. Neural and mechanical spinal damage varies with these types and results from several factors including direct impact, concussion waves, tissue cavitation, and thermal energy. Management of spinal GSI also depends on several factors including neurologic function and change over time, spinal stability, missile tract through the body, and concomitant injury. Surgical treatment is typically indicated for progressive neurologic changes, spinal instability, persistent cerebrospinal fluid leak, and infection. Surgical treatment for GSI affecting T12 and caudal often has a better outcome than for those cranial to T12. Surgical exploration and removal of missile fragments in the spinal canal are typically indicated for incomplete or worsening neurologic injury. CONCLUSIONS Treatment of spinal GSI requires a multidisciplinary approach with the goal of maintaining or restoring spinal stability and neurologic function and minimizing complications. Concomitant injuries and complications after spinal GSI can present immediate and ongoing challenges to the medical, surgical and rehabilitative care of the patient.
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Affiliation(s)
- Andre Jakoi
- Department of Orthopaedic Surgery, Drexel University College of Medicine, 245 N 15th St, MS 420, Philadelphia, PA 19102, USA
| | - Justin Iorio
- Department of Orthopaedic Surgery, Temple University, 3401 N Broad Street, Philadelphia, PA 19140, USA
| | - Richard Howell
- Department of Orthopaedic Surgery, Drexel University College of Medicine, 245 N 15th St, MS 420, Philadelphia, PA 19102, USA
| | - Jay M Zampini
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Spine Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Wolf H, Krall C, Pajenda G, Leitgeb J, Bukaty AJ, Hajdu S, Sarahrudi K. Alterations of the biomarker S-100B and NSE in patients with acute vertebral spine fractures. Spine J 2014; 14:2918-22. [PMID: 24780247 DOI: 10.1016/j.spinee.2014.04.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although several publications concerning the use of the biomarkers S100B and neuron-specific enolase (NSE) in vertebral spine fractures in animal experimental studies have proven their usefulness as early indicators of injury severity, there are no clinical reports on their effectiveness as indicators in patients with spinal injuries. As these biomarkers have been examined, with promising results, in patients with traumatic brain injury, there is a potential for their implementation in patients with vertebral spine fractures. PURPOSE To investigate the early serum measurement of S100B and NSE in patients with vertebral spine fractures compared with those in patients with acute fractures of the proximal femur. STUDY DESIGN Prospective longitudinal cohort study. PATIENT SAMPLE A cohort of 34 patients admitted over an 18-month period to a single medical center for suspected vertebral spine trauma. Twenty-nine patients were included in the control group. OUTCOME MEASURES S100B and NSE serum levels were assessed in different types of vertebral spine fractures. METHODS We included patients older than 16 years with vertebral spine fractures whose injuries were sustained within 24 hours before admission to the emergency room and who had undergone a brief neurologic examination. Spinal cord injuries (SCIs) were classified as being paresthesias, incomplete paraplegias, or complete paraplegias. Blood serum was obtained from all patients within 24 hours after the time of injury. Serum levels of S100B and NSE were statistically analyzed using Wilcoxon signed-rank test. RESULTS S100B serum levels were significantly higher in patients with vertebral spine fractures (p=.01). In these patients, the mean S100B serum level was 0.75 μg/L (standard deviation [SD] 1.44, 95% confidence interval [CI] 0.24, 1.25). The mean S100B serum level in control group patients was 0.14 μg/L (SD 0.11, 95% CI 0.10, 0.19). The 10 patients with neurologic deficits had significantly higher S100B serum levels compared with the patients with vertebral fractures but without neurologic deficits (p=.02). The mean S100B serum level in these patients was 1.18 μg/L (SD 1.96). In the 26 patients with vertebral spine fractures but without neurologic injury, the mean S100B serum level was 0.42 μg/L (SD 0.91, 95% CI 0.08, 0.76). The analysis revealed no significant difference in NSE levels. CONCLUSIONS We observed a significant correlation not only between S100B serum levels and vertebral spine fractures but also between S100B serum levels and SCIs with neurologic deficit. These results may be meaningful in clinical practice and to future studies.
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Affiliation(s)
- Harald Wolf
- Department of Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Christoph Krall
- Department of Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Gholam Pajenda
- Department of Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Johannes Leitgeb
- Department of Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Adam J Bukaty
- Department of Anaesthesia and Intensive Care Medicine, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Stefan Hajdu
- Department of Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Kambiz Sarahrudi
- Department of Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Gupta R, Mittal P, Sandhu P, Saggar K, Gupta K. Correlation of qualitative and quantitative MRI parameters with neurological status: a prospective study on patients with spinal trauma. J Clin Diagn Res 2014; 8:RC13-7. [PMID: 25584285 DOI: 10.7860/jcdr/2014/9471.5181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 03/30/2014] [Accepted: 08/30/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Spinal trauma is relatively more common in young active individuals. Although its mortality is low, it is an important cause of long term disability. Magnetic resonance imaging (MRI) can accurately depict presence and extent of spinal cord injury (SCI) in these patients. This study was aimed to look for various qualitative and quantitative MRI findings which are predictive of initial neurological deficit in patients with spinal trauma and final outcome on follow-up. MATERIALS AND METHODS The present study was conducted on 50 patients with suspected acute cervical or dorsal spinal trauma presenting for MRI study. American Spinal Injury Association (ASIA) motor score was used for assessing neurological status at the time of presentation, at the time of discharge/2weeks and at 3-6 months follow up. Various MRI qualitative and quantitative parameters were evaluated for correlation with severity of spinal injury. RESULTS Normal baseline MRI (pattern 0) was seen in 12 subjects and was associated with incomplete SCI in 4 subjects (ASIA grade D) followed by complete recovery in all patients on follow-up examination. Pattern I (haemorrhage) was associated with complete spinal cord injury. Pattern II (oedema) was associated with incomplete SCI and good functional recovery on follow up.Pattern III (contusion) was associated with intermediate severity of injury. Compression and transection patterns were associated with complete neurological deficit at presentation and increased mortality at subsequent follow-up. All the three quantitative parameters i.e. lesion length,maximum (bony) canal compromise (MCC), maximum spinal cord compression (MSCC) were significantly increased in patients with complete SCI as compared to those with incomplete SCI. The best predictors for baseline ASIA score were MCC, cord oedema and cord haemorrhage. For the final ASIA score, the best predictors were baseline ASIA score and cord haemorrhage. CONCLUSION MRI is excellent imaging modality for detecting and assessing severity of spinal trauma. In our study, presence of cord haemorrhage, MCC and cord oedema were best predictors of baseline neurological status at presentation, whereas baseline ASIA score and cord haemorrhage were best predictors of final neurological outcome.
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Affiliation(s)
- Ranjana Gupta
- Assistant Professor, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences & Research , Mullana, Ambala, India
| | - Puneet Mittal
- Assistant Professor, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences & Research , Mullana, Ambala, India
| | - Parambir Sandhu
- Professor, Department of Radiodiagnosis, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Kavita Saggar
- Professor & Head, Department of Radiodiagnosis, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Kamini Gupta
- Associate Professor, Department of Radiodiagnosis, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
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Gündüz A, Uzun N, Örnek Nİ, Ünalan H, Karamehmetoğlu ŞS, Kızıltan ME. Trigemino-cervical reflex in spinal cord injury. Neurosci Lett 2014; 580:169-72. [PMID: 25128217 DOI: 10.1016/j.neulet.2014.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 04/26/2014] [Revised: 07/24/2014] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
Abnormal enhancement of polysynaptic brainstem reflexes has been previously reported in patients with spinal cord injury (SCI). We aimed to investigate trigemino-cervical reflex (TCR) in SCI since it may reflect alterations in the connections of trigeminal proprioceptive system and cervical motoneurons. Consecutive 14 patients with SCI and 16 healthy subjects were included in this study. All patients were in the chronic phase. TCR was recorded over sternocleidomastoid (SCM) and splenius capitis (SC) muscles by stimulation of infraorbital nerve. We measured onset latency, amplitudes and durations of responses and compared between groups. We obtained stable responses over both muscles after one sided stimulation in healthy volunteers whereas probability of TCR was decreased in patients over both SCM (78.6% vs. 100%, p=0.050) and SC (71.4% vs. 100%, p=0.022). The absence of TCR was related to use of oral baclofen (≥50mg/day). However, when present, responses of SCI group had higher amplitudes and were more persistent. We demonstrated that TCR probability was similar to healthy subjects in SCI patients who used no or low dose oral baclofen. But it had higher amplitudes and longer durations. It was not obtained in only two patients who used oral baclofen more than 50mg/day.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Nurten Uzun
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurettin İrem Örnek
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Ünalan
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Şafak Sahir Karamehmetoğlu
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Karam Y, Hitchon PW, Mhanna NE, He W, Noeller J. Post-traumatic syringomyelia: outcome predictors. Clin Neurol Neurosurg 2014; 124:44-50. [PMID: 25016238 DOI: 10.1016/j.clineuro.2014.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/09/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify risk factors that predispose to post-traumatic syringomyelia (PTS) and describe the outcome of surgical management. METHODS Retrospective cohort study of 27 patients with post-traumatic syringomyelia. Spinal cord injury of these patients spanned the period from 1963 to 2008. All data were collected retrospectively using available medical records and radiological images. RESULTS There were 24 males and 3 females. The level of initial spine injury was thoracic in 21, cervical in 4, and lumbar in 2. The average age (±SD) at diagnosis of PTS was 40±13 years. The mean follow-up ±SD from injury was 18±11 years. On admission after injury, there were 14 patients with American Spinal Injuries Association (ASIA) disability scores of A, 3 with ASIA C, and 10 with ASIA score of D. At the time of diagnosis of PTS, local kyphosis at the site of injury measured 28±12°, and the residual canal was 67±19% compared to the average rostral and caudal anteroposterior diameter. Fourteen patients underwent a single operation for PTS, and 13 needed two or more procedures. In the 11 patients in whom the initial surgery included a duraplasty, 3 required reoperation for unsuccessful reduction in the size of the syrinx and failure to improve symptoms. In the 16 patients in whom the initial procedure was that of a shunt alone, 10 required revision (p=0.0718 rate of revision between shunting and duraplasty). As a result of treatment for PTS, improvement in symptoms of PTS occurred in 14, symptoms were unchanged in 10, and progressed in 3. In the 11 patients with sequential MRI scans, a significant correlation was shown between the reduction in the size of the syrinx and clinical improvement (p<0.001). CONCLUSION PTS is often the result of severe spinal cord injuries, with over half of patients having an ASIA disability score of A. Our review corroborates other published reports showing that PTS is associated with significant deformity and stenosis. Irrespective of treatment, over half of the patients required reoperation for their PTS. Duraplasty and arachnolysis are the preferred treatment for PTS over shunting alone. Treatment was associated with cessation of symptoms or improvement in nearly 90% of the patients.
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Joaquim AF, Lawrence B, Daubs M, Brodke D, Tedeschi H, Vaccaro AR, Patel AA. Measuring the impact of the Thoracolumbar Injury Classification and Severity Score among 458 consecutively treated patients. J Spinal Cord Med 2014; 37:101-6. [PMID: 24090484 PMCID: PMC4066542 DOI: 10.1179/2045772313y.0000000134] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
CONTEXT The Thoracolumbar Injury Classification and Severity Score (TLICS) was proposed to improve injury classification and guide surgical decision-making of thoracolumbar spinal trauma (TLST), but its impact on the care of patients has not been quantified. STUDY DESIGN Retrospective study. PATIENT SAMPLE Analysis of 458 patients treated for TLST trauma from 2000 through 2010 at a single center. Outcome measures Neurological status - ASIA Impairment Scale (AIS), failure of conservative treatment, and surgical complications. METHODS Clinical and radiological data were evaluated. Patients were grouped according to the period before (2000-2006) and after (2007-2010) utilization of the TLICS. RESULTS From 2000 to 2006, 148 patients were initially treated conservatively (C) and 66 were surgically (S) treated. In the C group, the TLICS ranged from 1 to 7 (median 1; mean 1.57). In the S group, the TLICS ranged from 2 to 10 (median 2; mean 4.14). The TLICS matched treatment in 97.9% of conservatively treated patients. From 2007 to 2010, 162 patients were initially treated C and 82 were treated S. In the C group, the TLICS ranged from 1 to 4 (median 1; mean 1.48). In the S group, the TLICS ranged from 2-10 (median 4; mean 4.4). The TLICS matched treatment in 98.8% of C-treated patients. Overall, failure of C treatment occurred in nine patients; most failures (7/9) and all three missed distractive injuries occurred prior to use of the TLICS. CONCLUSIONS After introduction of the TLICS, there was a trend towards more successful conservative treatment with fewer conversions to surgical treatment.
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Affiliation(s)
- Andrei F. Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas-Sao Paulo, Brazil,Correspondence to: Dr. Andrei F. Joaquim, Department of Neurology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Cidade Universitária Zeferino Vaz, ZIP 13083-970, Campinas, São Paulo, Brazil.
| | - Brandon Lawrence
- Departments of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael Daubs
- Departments of Orthopaedic Surgery and Neurosurgery, University of California (UCLA), Santa Monica, CA, USA
| | - Darrel Brodke
- Departments of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Helder Tedeschi
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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van Middendorp JJ, Audigé L, Bartels RH, Bolger C, Deverall H, Dhoke P, Diekerhof CH, Govaert GAM, Guimerá V, Koller H, Morris SAC, Setiobudi T, Hosman AJF. The Subaxial Cervical Spine Injury Classification System: an external agreement validation study. Spine J 2013; 13:1055-63. [PMID: 23541887 DOI: 10.1016/j.spinee.2013.02.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 02/18/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC treatment algorithm outcome improved agreement on treatment decisions among surgeons. STUDY DESIGN An external classification validation study. PATIENT SAMPLE Twelve spinal surgeons (five consultants and seven fellows) assessed 51 randomly selected cases. OUTCOME MEASURES Raw agreement, Fleiss kappa, and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules and latent class modeling were used for accuracy analysis. METHODS Fifty-one randomly selected cases with significant injuries of the cervical spine from a prospective consecutive series of trauma patients were assessed using the SLIC system. Neurologic details, plain radiographs, and computed tomography scans were available for all cases as well as magnetic resonance imaging in 21 cases (41%). No funds were received in support of this study. The authors have no conflict of interest in the subject of this article. RESULTS The inter-rater agreement on the most severely affected level of injury was strong (κ=0.76). The agreement on the morphologic injury characteristics was poor (κ=0.29) and agreement on the integrity of the discoligamentous complex was average (κ=0.46). The inter-rater agreement on the treatment verdict after the total SLIC injury severity score was slightly lower than the surgeons' agreement on personal treatment preference (κ=0.55 vs. κ=0.63). Latent class analysis was not converging and did not present accurate estimations of the true classification categories. Based on these findings, no second survey for testing intrarater agreement was performed. CONCLUSIONS We found poor agreement on the morphologic injury characteristics of the SLIC system, and its treatment algorithm showed no improved agreement on treatment decisions among surgeons. The authors discuss that the reproducibility of the SLIC system is likely to improve when unambiguous true morphologic injury characteristics are being implemented.
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Affiliation(s)
- Joost J van Middendorp
- Stoke Mandeville Spinal Foundation, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK; Harris Manchester College, University of Oxford, Oxford, UK; Spine Unit, Department of Orthopaedics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Hussain M, Nasir S, Moed A, Murtaza G. Variations in Practice Patterns among Neurosurgeons and Orthopaedic Surgeons in the Management of Spinal Disorders. Asian Spine J 2011; 5:208-12. [PMID: 22164314 DOI: 10.4184/asj.2011.5.4.208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/09/2011] [Accepted: 04/25/2011] [Indexed: 12/05/2022] Open
Abstract
Study Design This is a case series. Purpose We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders. Overview of Literature Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders. Methods A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant. Results Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury. Conclusions Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.
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