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Which traumatic spinal injury creates which degree of instability? A systematic quantitative review.The Spine Journal : Official Journal of... Jan 2022Traumatic spinal injuries often require surgical fixation. Specific three-dimensional degrees of instability after spinal injury, which represent criteria for optimum... (Review)
Review
BACKGROUND CONTEXT
Traumatic spinal injuries often require surgical fixation. Specific three-dimensional degrees of instability after spinal injury, which represent criteria for optimum treatment concepts, however, are still not well investigated.
PURPOSE
The aim of this review therefore was to summarize and quantify multiplanar instability increases due to spinal injury from experimental studies.
STUDY DESIGN/SETTING
Systematic review.
METHODS
A systematic review of the literature was performed using keyword-based search on PubMed and Web of Science databases in order to detect all in vitro studies investigating the destabilizing effect of simulated and provoked traumatic injury in human spine specimens. Together with the experimental designs, the instability parameters range of motion, neutral zone and translation were extracted from the studies and evaluated regarding type and level of injury.
RESULTS
A total of 59 studies was included in this review, of which 43 studies investigated the effect of cervical spine injury. Range of motion increase, which was reported in 58 studies, was generally lower compared to the neutral zone increase, given in 37 studies, despite of injury type and level. Instability increases were highest in flexion/extension for most injury types, while axial rotation was predominantly affected after cervical unilateral dislocation injury and lateral bending solely after odontoid fracture. Whiplash injuries and wedge fractures were found to increase instability equally in all motion planes.
CONCLUSIONS
Specific traumatic spinal injuries produce characteristic but complex three-dimensional degrees of instability, which depend on the type, level, and morphology of the injury. Future studies should expand research on the cervicothoracic, thoracic, and lumbosacral spine and should additionally investigate the destabilizing effects of the injury morphology as well as concomitant rib cage injuries in case of thoracic spinal injuries. Moreover, neutral zone and translation should be measured in addition to the range of motion, while mechanical injury simulation should be preferred to resection or transection of structures to ensure high comparability with the clinical situation.
Topics: Biomechanical Phenomena; Cadaver; Cervical Vertebrae; Fractures, Compression; Humans; Range of Motion, Articular; Spinal Injuries
PubMed: 34116217
DOI: 10.1016/j.spinee.2021.06.004 -
Emergency Radiology Aug 2023The diagnosis of cervical spine injury in the emergency department remains a critical skill of emergency room physicians as well as radiologists. Such diagnoses are... (Review)
Review
The diagnosis of cervical spine injury in the emergency department remains a critical skill of emergency room physicians as well as radiologists. Such diagnoses are often associated with high morbidity and mortality unless readily identified and treated appropriately. Both computed tomography (CT) and magnetic resonance imaging (MRI) often are crucial in the workup of spinal injury and play a key role in arriving at a diagnosis. Unfortunately, missed cervical spine injuries are not necessarily uncommon and often precede detrimental neurologic sequalae. With the increase in whole-body imaging ordered from the emergency department, it is critical for radiologists to be acutely aware of key imaging features associated with upper cervical trauma, possible mimics, and radiographic clues suggesting potential high-risk patient populations. This pictorial review will cover key imaging features from several different imaging modalities associated with upper cervical spine trauma, explore patient epidemiology, mechanism, and presentation, as well as identify confounding radiographic signs to aid in confident and accurate diagnoses.
Topics: Humans; Spinal Injuries; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Wounds, Nonpenetrating; Neck Injuries; Cervical Vertebrae
PubMed: 37254028
DOI: 10.1007/s10140-023-02141-w -
Spine Jan 2021Retrospective cohort study.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
Assess trends in sports-related cervical spine trauma using a pediatric inpatient database.
SUMMARY OF BACKGROUND DATA
Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury (SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking.
METHODS
The Kid Inpatient Database was queried for patients with external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped for cervical spine injury (CSI) type, including C1-4 and C5-7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4-9), pre-adolescents (Pre, 10-13), and adolescents (14-17). Kruskall-Wallis tests with post-hoc Mann-Whitney U's identified differences in CSI type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries.
RESULTS
A total of 38,539 patients were identified (12.76 years, 24.5% F). Adolescents had the highest rate of sports injuries per year (P < 0.001). Adolescents had the highest rate of any type of CSI, including C1-4 and C5-7 fracture with and without SCI, dislocation, and SCIWORA (all P < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18×, C1-4 fx w/ SCI by 7.57×, C5-7 fx w/o SCI 4.11×, C5-7 w/SCI 3.63×, cervical dislocation 1.7×, and cervical SCIWORA 2.75×, all P < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (P < 0.001), and were associated with more SCIWORA (1.6% vs. 1.0%, P = 0.012), and football injuries increased odds of SCI by 1.56×. Concurrent TBI was highest in adolescents at 58.4% (pre: 26.6%, child: 4.9%, P < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports (odds ratio: 2.35 [1.77-3.11], P < 0.001).
CONCLUSION
Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of CSI with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries.
LEVEL OF EVIDENCE
3.
Topics: Adolescent; Athletic Injuries; Cervical Vertebrae; Child; Databases, Factual; Female; Humans; Male; Neck Injuries; Prevalence; Retrospective Studies; Spinal Cord Injuries; Spinal Fractures; Spinal Injuries; Sports
PubMed: 32991512
DOI: 10.1097/BRS.0000000000003718 -
BMC Public Health Jul 2022Surf zone injuries include cervical spine injuries (CSI). Risk factors for CSI have not been extensively investigated. The objective was to examine risk factors...
OBJECTIVE
Surf zone injuries include cervical spine injuries (CSI). Risk factors for CSI have not been extensively investigated. The objective was to examine risk factors associated with diagnosed CSI that occurred in a beach setting.
METHODS
This retrospective case series used manually linked data from Sunshine Coast Hospital and Health Service Emergency Departments, Queensland Ambulance Service, Surf Life Saving Queensland (SLSQ), and Bureau of Meteorology data from 01/01/2015-21/04/2021. Variables included victim demographics, mechanism of injury, scene information, and patient course.
RESULTS
Seventy-nine of the 574 (13.8%) confirmed CSI occurred at the beach. Local residents and visitors were injured equally. Females represented a minority (12.7%) of those diagnosed with CSI but were a higher proportion of suspected spinal incidents reported to SLSQ (45%). Surfers were more likely to be injured through shallow water diving than swimmers (27.6% vs 2.2%). Females were more likely to be injured by shallow water diving than males (30.0% vs 8.7%). Visitors were more likely to be injured swimming and local residents surfing (68.2% vs 77.8% respectively). CSI occurred most commonly (40.0%) with a below average ocean wave height (0.75-1.25 m) and were most likely (45.3%) to occur in the second half of the outgoing tide. One beach had a statistically significant greater incidence of spinal incidents (OR 3.9, 95% CI: 2.1-7.2) and of CSI (OR 10.7, 95% CI: 1.5-79.5).
CONCLUSIONS
Risk factors for CSI at the beach include male sex, smaller wave height and an outgoing tide. Shallow water diving among surfers and females should be addressed urgently.
Topics: Cervical Vertebrae; Female; Humans; Male; Retrospective Studies; Risk Factors; Spinal Injuries; Swimming; Water
PubMed: 35869457
DOI: 10.1186/s12889-022-13810-9 -
Traffic Injury Prevention 2022This objective of the present study is to describe the responses of the human head-cervical spine in terms of injuries, injury mechanisms, injury scoring, and quantify...
This objective of the present study is to describe the responses of the human head-cervical spine in terms of injuries, injury mechanisms, injury scoring, and quantify multiplanar loads. Pretest radiographs of pre-screened five human cadaver head-neck complexes were obtained. Cranium contents and sectioned the structure rostral to skull base. The caudal end was embedded, and cervical-thoracic disc was unconstrained condition. The loading was applied as a torque about the occipital condyle joint. The head and T1 were angulated 30 degrees and 25 degrees. Peak forces and moments at the occipital condyles were recorded using a six-axis load cell. After testing, x-rays and CT images were obtained. Injuries were scored using the Abbreviated Injury Scale, AIS 2015 version. The mean age, stature, total body mass, body mass index of the five subjects were as follows: 63 years, 1.7 m, 78.0 kg, and 28.1 kg/m. The mean peak axial force and coronal, sagittal, and axial bending moments were: 754 N, and 36.8 Nm, 14.8 Nm, and 9.5 Nm. All but one specimen sustained injury. Injuries were scored at the AIS 2 level. Two specimens sustained left anterior inferior lateral mass fractures of the atlas. While the transverse atlantal ligament was intact, some capsular ligament involvement was observed. In the other two specimens, although the same injury was noted, joint diastasis of the atlas-axis joint was identified. Using a PMHS model, the present study described the biomechanics of the initially head rotated head-neck complex under lateral bending in terms of injuries, injury mechanisms, quantification of the multiplanar loads at the occipital condyles, and underscored potential injury scoring issues for occupant protection. The issue of diastasis is not addressed in the AIS 2015 version. While this may not always result in immediate instability and require surgical intervention, it may be necessary to revisit this issue. Upper cervical fractures with diastasis and or transverse atlantal ligament involvement may be potential injury scoring factors for AIS consideration.
Topics: Humans; Middle Aged; Accidents, Traffic; Neck; Neck Injuries; Spinal Injuries; Fractures, Bone; Biomechanical Phenomena; Cervical Vertebrae; Posture; Cadaver
PubMed: 36215262
DOI: 10.1080/15389588.2022.2124811 -
International Journal of Surgery... Dec 2023Traumatic spinal injury (TSI) is associated with significant fatality and social burden; however, the epidemiology and treatment of patients with TSI in the US remain...
BACKGROUND
Traumatic spinal injury (TSI) is associated with significant fatality and social burden; however, the epidemiology and treatment of patients with TSI in the US remain unclear.
MATERIALS AND METHODS
An adult population was selected from the National Inpatient Sample database from 2016 to 2019. TSI incidence was calculated and TSI-related hospitalizations were divided into operative and nonoperative groups according to the treatments received. TSIs were classified as fracture, dislocation, internal organ injury, nerve root injury, or sprain injuries based on their nature. The annual percentage change (APC) was calculated to identify trends. In-hospital deaths were utilized to evaluate the prognosis of different TSIs.
RESULTS
Overall, 95 047 adult patients were hospitalized with TSI in the US from 2016 to 2019, with an incidence rate of 48.4 per 100 000 persons in 2019 (95% CI: 46.2-50.6). The total incidence increased with an APC of 1.5% (95% CI: 0.1-3%) from 2016 to 2019. Operative TSI treatment was more common than nonoperative (32.8 vs. 3.8; 95% CI: 32.3-33.2 vs. 3.6-4%). The number of operations increased from 37 555 (95% CI: 34 674-40 436) to 40 460 (95% CI: 37 372-43 548); however, the operative rate only increased for internal organ injury (i.e. spinal cord injury [SCI])-related hospitalizations (APC, 3.6%; 95% CI: 2.8-4.4%). In-hospital mortality was highest among SCI-related hospitalizations, recorded at 3.9% (95% CI: 2.9-5%) and 28% (95% CI: 17.9-38.2%) in the operative and nonoperative groups, respectively.
CONCLUSIONS
The estimated incidence of TSI in US adults increased from 2016 to 2019. The number of operations increased; however, the proportion of operations performed on TSI-related hospitalizations did not significantly change. In 2019, SCI was the highest associated mortality TSI, regardless of operative or nonoperative treatment.
Topics: Adult; Humans; United States; Retrospective Studies; Spinal Injuries; Spinal Cord Injuries; Hospitalization; Hospital Mortality
PubMed: 37678281
DOI: 10.1097/JS9.0000000000000696 -
Journal of Pediatric Orthopedics Feb 2019Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric...
BACKGROUND
Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric spine injury in abused children and determined the anatomic level of the spine affected, while also focusing on patient demographics, length of stay, and total hospital charges compared with spine patients without a diagnosis of abuse.
METHODS
A retrospective review of the Kids' Inpatient Database was conducted from 2000 to 2012 to identify pediatric patients (below 18 y) who sustained vertebral column fractures or spinal cord injuries. Patients with a documented diagnosis of abuse were identified using ICD-9-CM diagnosis codes. Our statistical models consisted of multivariate linear regressions that were adjusted for age, race, and sex.
RESULTS
There were 22,192 pediatric patients with a diagnosis of spinal cord or vertebral column injury during the study period, 116 (0.5%) of whom also had a documented diagnosis of abuse. The most common type of abuse was physical (75.9%). Compared with nonabused patients, abused patients were more likely to be below 2 years of age (OR=133.4; 95% CI, 89.5-198.8), female (OR=1.67; 95% CI, 1.16-2.41), and nonwhite (black: OR=3.86; 95% CI, 2.31-6.45; Hispanic: OR=2.86; 95% CI, 1.68-4.86; other: OR=2.33; 95% CI, 1.11-4.86). Abused patients also presented with an increased risk of thoracic (OR=2.57; 95% CI, 1.67-3.97) and lumbar (OR=1.67; 95% CI, 1.03-2.72) vertebral column fractures and had a multivariate-adjusted mean length of stay that was 62.2% longer (P<0.001) and mean total charges that were 52.9% higher (P<0.001) compared with nonabused patients. Furthermore, 19.7% of all pediatric spine patients under 2 years of age admitted during the study period belonged to the abused cohort.
CONCLUSIONS
Spine injuries are rare but can be found in the pediatric population. With an additional documented diagnosis of abuse, these injuries affect younger patients in the thoracolumbar region of the spine, and lead to longer lengths of stay and higher hospital costs when compared with nonabused patients. Because of these findings, physicians should maintain a higher level of suspicion of abuse in patients with spine injuries, especially patients under 2 years of age.
LEVEL OF EVIDENCE
Level III evidence-a case-control study.
Topics: Child Abuse; Child, Preschool; Databases, Factual; Female; Follow-Up Studies; Humans; Incidence; Inpatients; Male; Retrospective Studies; Spinal Injuries; Trauma Severity Indices; United States
PubMed: 27662382
DOI: 10.1097/BPO.0000000000000877 -
Rozhledy V Chirurgii : Mesicnik... 2018The main aim of this paper is to introduce a new AOSpine subaxial cervical spine injury classification system to the national medical community since there is no...
INTRODUCTION
The main aim of this paper is to introduce a new AOSpine subaxial cervical spine injury classification system to the national medical community since there is no generally accepted classification system until now.
METHOD
A description of the new AOSpine subaxial cervical spine injury classification and the basic principles of it exploitation are proposed in this text. Usage of the abovementioned classification in clinical practice is demonstrated on a sample of 48 patients who were investigated and treated at the author's department during the last two years. The assessment of injured spine stability and the surgical approach used are based on the above classification.
RESULTS
Type A0 injury was recorded in 5 (10.4%), A1 in 4 (8.3%), A2 in 2 (4.2%), A3 in 1(2.1%), A4 in 7 (14.6%), B2 in 2 (4.2%), B3 in 4 (8.3%), C in 12 (25%), F1 in 2 (4.2%), F2 in 4 (8.3%), F3 in 3 (6.3%) and F4 in 2 (4.2%) patients. Inter-observer agreement on each type of injury was achieved in 64.3%; as regards classification into the main groups A, B, C and D, consensus was reached in 89.3% cases. Eleven (22.9%) patients classified as A0, A1 and F1 were treated conservatively and 37 (77.1%) underwent surgery.
CONCLUSION
New AOSpine subaxial cervical spine injury classification represents a useful tool, allowing for proper assessment of injury severity and helping to select the type of eventual surgical procedure. Key words: classification - fracture - cervical spine - subaxial.
Topics: Arthrodesis; Cervical Vertebrae; Humans; Neck; Spinal Fractures
PubMed: 30442007
DOI: No ID Found -
No Shinkei Geka. Neurological Surgery Nov 2021Spinal cord injuries are not rare in neurosurgical practice. As cervical spine injuries are frequently associated with head injuries, neurosurgeons have critical roles...
Spinal cord injuries are not rare in neurosurgical practice. As cervical spine injuries are frequently associated with head injuries, neurosurgeons have critical roles of immediate evaluation and treatment in an emergency room in Japan. It is crucial to make a correct initial diagnosis and provide appropriate treatment for cervical spine injuries because missed injuries or delayed diagnosis might result in unwarranted neurological sequelae. This paper focuses on tips regarding 1)screening for cervical spine injury in head injury patients, 2)diagnosis and treatment of cranio-vertebral junction injuries, and 3)diagnosis and treatment of acute traumatic central cord syndrome because these conditions are most likely encountered by neurosurgery residents and fellows in their practice.
Topics: Cervical Vertebrae; Craniocerebral Trauma; Humans; Neurosurgical Procedures; Spinal Cord Injuries; Spinal Injuries
PubMed: 34879350
DOI: 10.11477/mf.1436204517 -
Chinese Journal of Traumatology =... Jul 2023Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma...
PURPOSE
Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years.
METHODS
This is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), cause of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24.
RESULTS
Totally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p < 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR= 1.041, p < 0.001) and length of stay (OR = 1.018, p < 0.001) were strong predictors of mortality in trauma patients with spine injury.
CONCLUSION
The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, and passengers, as well as work environment, and improve the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.
Topics: Humans; Incidence; Trauma Centers; Iran; Cross-Sectional Studies; Spinal Injuries; Neck Injuries; Accidents, Traffic
PubMed: 36690521
DOI: 10.1016/j.cjtee.2023.01.001