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Neurocirugia (English Edition) 2023To compare the teachability of the Allen-Ferguson, Harris, Argenson, AOSpine, Subaxial Cervical Spine Injury Classification (SLIC), Subaxial Cervical Spine Injury...
OBJECTIVES
To compare the teachability of the Allen-Ferguson, Harris, Argenson, AOSpine, Subaxial Cervical Spine Injury Classification (SLIC), Subaxial Cervical Spine Injury Classification (CSISS) and to identify the classification that a group of residents and junior neurosurgeons find easiest to learn.
METHODS
We used data from 64 consecutive patients. Answers of nine residents and junior neurosurgeons and four experienced surgeons in two assessment procedures were used. Six raters (workshop group) participated in special seminars between assessments. Three other raters formed the control group. Experienced surgeon's answers were used for comparison. Teachability was measured as the median value of the difference (ΔK) in the interrater agreement on the same patients by the same pairs of subjects.
RESULTS
Median Δ K for the Allen-Ferguson, Harris, Argenson and AOSpine classifications were: (1) 0.01, 0.02, 0.29, and 0.39 for the workshop group; (2). 0.09, -0.03, 0.06 and 0.04 for the control group, respectively. Between numerical scales, median ΔK was higher for SLIC but did not exceed 0.16. Interrater consistency with expert's opinion was increased in the workshop group for Allen-Ferguson, Argenson and AOSpine and did not differ in either group for SLIC and CSISS.
CONCLUSION
The AOSpine classification was the most teachable. Among numeric scales, SLIC demonstrated better results. The successful application of these classifications by residents and junior neurosurgeons was possible after a short educational course. The use of these scales in educational cycles at the stage of residency can significantly simplify the communication between specialists, especially at the stage of patient admission.
Topics: Humans; Cervical Vertebrae; Spinal Injuries; Internship and Residency; Neck Injuries; Communication
PubMed: 36754758
DOI: 10.1016/j.neucie.2022.02.010 -
Journal of Nepal Health Research Council Nov 2022Epidemiology of traumatic thoracolumbar spine injury is a less explored subject in developing/ underdeveloped countries. The number of available studies in Nepal is even... (Observational Study)
Observational Study
BACKGROUND
Epidemiology of traumatic thoracolumbar spine injury is a less explored subject in developing/ underdeveloped countries. The number of available studies in Nepal is even smaller. This study aims to establish the epidemiological characteristics of patients with thoracic and lumbar spine injuries presenting to Dhulikhel Hospital, Kathmandu University Hospital in Nepal.
METHODS
This is a single-center retrospective observational study. Patients with traumatic thoracolumbar spine injuries admitted to to Dhulikhel Hospital, Kathmandu University Hospital from 2015 January to 2019 December were included. International Spinal Cord Injury core data set (version 2) and International Spinal Cord Injury Spinal Column Injury Basic Data Set (version 1.0) were used for data collection.
RESULTS
Three hundred and seventeen patients were included, of which, 50.2% were male and the mean age was 45.5 ± 17 years. Fall was the most common etiology of injury (69.1%). The most common level of injury was L1 (32.5%). Thirty-seven patients (11.7%) had ASIA A neurology. One hundred and seventy-three (54.6%) patients underwent surgical intervention. The median hospital stay of the patients was 7 days (IQR: 3-11) with no recorded in-hospital mortality.
CONCLUSIONS
Males and females are equally vulnerable to thoracic and lumbar spinal injuries, with the majority of patients in 46-60 age groups. More than 1/3rd neurologically impaired patients are with ASIA A neurology. The findings of this study can contribute to traumatic thoracic and lumbar spine injury prevention and rehabilitation.
Topics: Female; Humans; Adult; Male; Middle Aged; Tertiary Care Centers; Lumbar Vertebrae; Nepal; Spinal Injuries; Retrospective Studies; Spinal Cord Injuries
PubMed: 36550718
DOI: 10.33314/jnhrc.v20i02.3984 -
Seminars in Ultrasound, CT, and MR Dec 2018Traumatic injuries of the spine portend long-term morbidity and mortality. Timely diagnosis and appropriate management of mechanical instability of the spine is of... (Review)
Review
Traumatic injuries of the spine portend long-term morbidity and mortality. Timely diagnosis and appropriate management of mechanical instability of the spine is of utmost importance in preventing further neurologic deterioration. We present a comprehensive review of the indications for spinal imaging in the trauma setting, describe each imaging modality including plain radiographs, multidetector computed tomography and magnetic resonance imaging, basic anatomy and common fracture patterns, and discuss the traditional spinal injury classification systems and the new Subaxial Cervical Spine Injury Classification and Thoracolumbar Injury Classification and Severity score.
Topics: Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Radiography; Spinal Injuries; Spine; Tomography, X-Ray Computed
PubMed: 30527520
DOI: 10.1053/j.sult.2018.10.002 -
European Journal of Trauma and... Jun 2022This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization.
PURPOSE
This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization.
METHODS
Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled.
RESULTS
The mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2-3 on the AIS, and 4.1% scored 4-6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4-6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4-6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3-6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3-6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI.
CONCLUSIONS
In addition to the clinical symptoms of pain, we identify '4S' [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.
Topics: Adult; Aged; Brain Injuries, Traumatic; Humans; Injury Severity Score; Middle Aged; Multiple Trauma; Retrospective Studies; Spinal Injuries
PubMed: 33025171
DOI: 10.1007/s00068-020-01515-w -
Accident; Analysis and Prevention Jun 2023Motor vehicle collisions (MVCs) are a leading cause of acute spinal injuries. Chronic spinal pathologies are common in the population. Thus, determining the incidence of... (Review)
Review
Motor vehicle collisions (MVCs) are a leading cause of acute spinal injuries. Chronic spinal pathologies are common in the population. Thus, determining the incidence of different types of spinal injuries due to MVCs and understanding biomechanical mechanism of these injuries is important for distinguishing acute injuries from chronic degenerative disease. This paper describes methods for determining causation of spinal pathologies from MVCs based on rates of injury and analysis of the biomechanics require to produce these injuries. Rates of spinal injuries in MVCs were determined using two distinct methodologies and interpreted using a focused review of salient biomechanical literature. One methodology used incidence data from the Nationwide Emergency Department Sample and exposure data from the Crash Report Sample System supplemented with a telephone survey to estimate total national exposure to MVC. The other used incidence and exposure data from the Crash Investigation Sampling System. Linking the clinical and biomechanical findings yielded several conclusions. First, spinal injuries caused by an MVC are relatively rare (511 injured occupants per 10,000 exposed to an MVC), which is consistent with the biomechanical forces required to generate injury. Second, spinal injury rates increase as impact severity increases, and fractures are more common in higher-severity exposures. Third, the rate of sprain/strain in the cervical spine is greater than in the lumbar spine. Fourth, spinal disc injuries are extremely rare in MVCs (0.01 occupants per 10,000 exposed) and typically occur with concomitant trauma, which is consistent with the biomechanical findings 1) that disc herniations are fatigue injuries caused by cyclic loading, 2) the disc is almost never the first structure to be injured in impact loading unless it is highly flexed and compressed, and 3) that most crashes involve predominantly tensile loading in the spine, which does not cause isolated disc herniations. These biomechanical findings illustrate that determining causation when an MVC occupant presents with disc pathology must be based on the specifics of that presentation and the crash circumstances and, more broadly, that any causation determination must be informed by competent biomechanical analysis.
Topics: Humans; Accidents, Traffic; Intervertebral Disc Displacement; Spinal Injuries; Fractures, Bone; Motor Vehicles
PubMed: 37003164
DOI: 10.1016/j.aap.2023.107047 -
Neurosurgery Clinics of North America Jan 2017Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options... (Review)
Review
Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years. Future studies of outcomes for children with subaxial cervical spine injury should focus on injury classification and standardized outcome measures to ensure continued improvement in quality of care for this patient population.
Topics: Cervical Vertebrae; Child; Humans; Spinal Injuries; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27886885
DOI: 10.1016/j.nec.2016.07.004 -
Traffic Injury Prevention 2019Motor vehicle occupants aged 8 to 12 years are in transition, in terms of both restraint use (booster seat or vehicle belt) and anatomical development. Rear-seated...
OBJECTIVE
Motor vehicle occupants aged 8 to 12 years are in transition, in terms of both restraint use (booster seat or vehicle belt) and anatomical development. Rear-seated occupants in this age group are more likely to be inappropriately restrained than other age groups, increasing their vulnerability to spinal injury. The skeletal anatomy of an 8- to 12-year-old child is also in developmental transition, resulting in spinal injury patterns that are unique to this age group. The objective of this study is to identify the upper spine injuries commonly experienced in the 8- to 12-year-old age group so that anthropomorphic test devices (ATDs) representing this size of occupant can be optimized to predict the risk of these injuries.
METHODS
Motor vehicle crash cases from the National Trauma Data Bank (NTDB) were analyzed to characterize the location and nature of cervical and thoracic spine injuries in 8- to 12-year-old crash occupants compared to younger (age 0-7) and older age groups (age 13-19, 20-39).
RESULTS
Spinal injuries in this trauma center data set tended to occur at more inferior vertebral levels with older age, with patients in the 8- to 12-year-old group diagnosed with thoracic injury more frequently than cervical injury, in contrast to younger occupants, for whom the proportion of cases with cervical injury outnumbered the proportion of cases with thoracic injury. With the cervical spine, a higher proportion of 8- to 12-year-olds had upper spine injury than adults, but a substantially lower proportion of 8- to 12-year-olds had upper spine injury than younger children. In terms of injury type, the 8- to 12-year-old group's injury patterns were more similar to those of teens and adults, with a higher relative proportion of fracture than younger children, who were particularly vulnerable to dislocation and soft tissue injuries. However, unlike for adults and teens, catastrophic atlanto-occipital dislocations were still more common than any other type of dislocation for 8- to 12-year-olds and vertebral body fractures were particularly frequent in this age group.
CONCLUSIONS
Spinal injury location in the cervical and thoracic spine moved downward with age in this trauma center data set. This shift in injury pattern supports the need for measurement of thoracic and lower cervical spine loading in ATDs representing the 8- to 12-year-old age group.
Topics: Accidents, Traffic; Adolescent; Child; Child Restraint Systems; Databases, Factual; Female; Fractures, Bone; Humans; Lumbar Vertebrae; Male; Motor Vehicles; Risk Factors; Spinal Injuries; Thoracic Injuries; Thoracic Vertebrae; Trauma Centers; United States
PubMed: 30715907
DOI: 10.1080/15389588.2018.1529412 -
Radiographics : a Review Publication of... 2019The biomechanical stability of the spine is altered in patients with a rigid spine, rendering it vulnerable to fracture even from relatively minor impact. The rigid... (Review)
Review
The biomechanical stability of the spine is altered in patients with a rigid spine, rendering it vulnerable to fracture even from relatively minor impact. The rigid spine entities are ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis, degenerative spondylosis, and a surgically fused spine. The most common mechanism of injury resulting in fracture is hyperextension, which often leads to unstable injury in patients with a rigid spine per the recent AOSpine classification system. Due to the increased risk of spinal fractures in this population, performing a spine CT is the first step when a patient with a rigid spine presents with new back pain or suspected spinal trauma. In addition, there should be a low threshold for performing a non-contrast-enhanced spine MRI in patients with a rigid spine, especially those with AS who may have an occult fracture, epidural hematoma, or spinal cord injury. Unfortunately, owing to insufficient imaging and an unfamiliarity with fracture patterns in the setting of a rigid spine, fracture diagnosis is often delayed, leading to significant morbidity and even death. The radiologist's role is to recognize the imaging features of a rigid spine, identify any fractures at CT and MRI, and fully characterize the extent of injury. Reasons for surgical intervention include neurologic deficit or concern for deterioration, an unstable fracture, or the presence of an epidural hematoma. By understanding the imaging features of various rigid spine conditions and vigilantly examining images for occult fractures, the radiologist can avoid a missed or delayed diagnosis of an injured rigid spine. RSNA, 2019.
Topics: Adult; Aged; Delayed Diagnosis; Female; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Fractures; Spinal Fusion; Spinal Injuries; Spine; Spondylitis, Ankylosing; Spondylosis; Tomography, X-Ray Computed
PubMed: 30707647
DOI: 10.1148/rg.2019180125 -
European Journal of Trauma and... Oct 2019Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the... (Review)
Review
PURPOSE
Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the patient and their family. Thus, management ought to be exceptional from the initial evaluation at the scene of the injury, through to definitive management and rehabilitation.
METHODS
We set out to review cervical spine injuries in children and advise on current best practice with regards to management.
RESULTS
Epidemiology, initial management at the scene of injury, radiological findings and pitfalls of cervical spine trauma are outlined. Strategies for conservative and surgical management are detailed depending on the pattern of injury. The management of spinal cord injuries without radiological abnormality (SCIWORA) and cranio-cervical arterial injuries is also reviewed.
CONCLUSIONS
Due to a paucity of evidence in these rare conditions, expert opinion is necessary to guide best practice management and to ensure the best chance of a good outcome for the injured child.
Topics: Cervical Vertebrae; Child; Child, Preschool; Emergency Medical Services; Guideline Adherence; Humans; Immobilization; Injury Severity Score; Prospective Studies; Radiography; Spinal Cord Injuries; Spinal Injuries; Time-to-Treatment; Transportation of Patients
PubMed: 30167742
DOI: 10.1007/s00068-018-0992-x -
Pediatric Emergency Care Dec 2014Diagnosing cervical spine injury in children can be difficult because the clinical examination can be unreliable, and evidence-based consensus guidelines for cervical... (Review)
Review
Diagnosing cervical spine injury in children can be difficult because the clinical examination can be unreliable, and evidence-based consensus guidelines for cervical spine injury evaluation in children have not been established. However, the consequences of cervical spine injuries are significant. Therefore, practitioners should understand common patterns of cervical spine injury in children, the evidence and indications for cervical spine imaging, and which imaging modalities to use. Herein, we review the epidemiology and unique anatomical features of pediatric cervical spine injury. In addition, we will summarize current practice for clearance and imaging of the pediatric cervical spine in trauma.
Topics: Cervical Vertebrae; Child; Humans; Magnetic Resonance Imaging; Radiography; Spinal Injuries
PubMed: 25469605
DOI: 10.1097/PEC.0000000000000298