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Spine Jan 2018A retrospective epidemiological study.
STUDY DESIGN
A retrospective epidemiological study.
OBJECTIVE
To reveal incidence and epidemiological features of traumatic spinal injuries (TSI) in Northern Finland.
SUMMARY OF BACKGROUND DATA
In Finland the annual incidence of traumatic spine fractures requiring inpatient care has been found to be 27/100,000, while international incidences have varied across the range of 16-64/100,000. More specific epidemiological data from Finland is not available. Internationally, the most common mechanisms of injury are road traffic as well as low and high falls. Associated injuries occur in 30% to 55% of cases.
METHODS
The study sample included patients with traumatic spinal injury admitted to Oulu University Hospital (OYS) with injury between the January 1, 2007 and December 31, 2011. Patient information was collected from the hospital care register, including all inpatient and outpatient visits and surgical procedures. Traumatic spinal column and spinal cord injuries were identified using International Classification of Diseases 10th revision or Nordic Classification of Surgical Procedures codes and all patient records were manually reviewed.
RESULTS
Nine hundred seventy-one patients met the criteria for TSI. The mean annual incidence of hospitalized traumatic spinal injuries was 26/100,000 in the whole of Northern Finland and 35/100,000 in the OYS main responsibility area. The most frequent etiology of TSI was low falls, which accounted for 35.8% of the injuries, followed by road traffic and high falls. Lumbar spine was the most common site of the fracture. Spinal surgery was performed in 376 (38.7%) cases. Three hundred eight patients (31.7%) suffered from associated injuries, 101 (10.4%) had a spinal cord injury, and 71 (7.3%) a brain injury.
CONCLUSION
Low falls in elderly and road traffic injuries in younger age groups were the most common etiology of traumatic spinal injuries in Northern Finland and should be given more attention in primary prevention.
LEVEL OF EVIDENCE
3.
Topics: Accidental Falls; Accidents, Traffic; Adolescent; Adult; Aged; Aged, 80 and over; Female; Finland; Hospitalization; Humans; Incidence; Lumbar Vertebrae; Male; Medical Records; Middle Aged; Retrospective Studies; Spinal Fractures; Spinal Injuries; Young Adult
PubMed: 28441317
DOI: 10.1097/BRS.0000000000002214 -
Injury Jun 2022To assess the complications and mortality in elderly individuals with cervical spine injuries. (Observational Study)
Observational Study
PURPOSE
To assess the complications and mortality in elderly individuals with cervical spine injuries.
METHODS
This retrospective observational study was conducted in a tertiary care hospital in a rural area in Japan. Data sets from the trauma registry (January 2011 to March 2018) were analyzed. Patients with cervical spine injury were divided into those aged ≥ 65 years (group Y) and > 65 years (group E). We then analyzed age, sex, 30-day mortality, hospital stay, level of cervical spine injury, presence of cervical vertebral fracture, perioperative complications (pneumonia, urinary tract infection, and severe bedsore), neurological deficit (Frankel classification), Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS).
RESULTS
We evaluated a total of 398 patients; among them, 177 were included in group Y and 221 in group E. The assessed parameters were as follows: age (group Y/E; 48.7/75.9 years), men (78.0/72.3%), 30-day mortality (8.5/10.0%, p = 0.159), hospital stay (17.2/19.1 days, p = 0.36), level of cervical spine injury (C1 [5.7/4.5%], C2 [12.4/15.8%], C3 [10.2/17.2%], C4 [14.1/16.3%], C5 [26.6/22.2%], C6 [22.0/12.2%], and C7 [11.3/10.9%]), vertebral fracture (56.6/61.9%), central cord syndrome (36.2/33%), operation (18.6/13.1%), pneumonia (6.8/11.8%, p = 0.077), urinary tract infection (4.0/6.3%, p = 0.26), severe bedsore (0/1.8%, p = 0.068), Frankel classification (grade A [5.7/6.3%], grade B [6.8/7.7%], grade C [24.9/28.5%], grade D [17.5/11.8%], and grade E [34.5/33.9%]), mean AIS score in the cervical spine (3.3/3.5, p = 0.04), and mean ISS (23.2/22.2, p = 0.38). C3 injuries tended to be higher in group E.
CONCLUSION
Mortality and morbidity associated with cervical spine injuries did not differ between younger and older patients. Nevertheless, vigilance is required for the detection of C3 injury in elderly individuals.
Topics: Aged; Cervical Vertebrae; Humans; Injury Severity Score; Male; Neck Injuries; Pressure Ulcer; Retrospective Studies; Spinal Cord Injuries; Spinal Fractures; Spinal Injuries
PubMed: 35513939
DOI: 10.1016/j.injury.2022.04.015 -
Traffic Injury Prevention Feb 2018The objective of this study was to determine the influence of age and injury mechanism on cervical spine tolerance to injury from head contact loading using survival...
OBJECTIVE
The objective of this study was to determine the influence of age and injury mechanism on cervical spine tolerance to injury from head contact loading using survival analysis.
METHODS
This study analyzed data from previously conducted experiments using post mortem human subjects (PMHS). Group A tests used the upright intact head-cervical column experimental model. The inferior end of the specimen was fixed, the head was balanced by a mechanical system, and natural lordosis was removed. Specimens were placed on a testing device via a load cell. The piston applied loading at the vertex region. Spinal injuries were identified using medical images. Group B tests used the inverted head-cervical column experimental model. In one study, head-T1 specimens were fixed distally, and C7-T1 joints were oriented anteriorly, preserving lordosis. Torso mass of 16 kg was added to the specimen. In another inverted head-cervical column study, occiput-T2 columns were obtained, an artificial head was attached, T1-T2 was fixed, C4-C5 disc was maintained horizontal in the lordosis posture, and C7-T1 was unconstrained. The specimens were attached to the drop test carriage carrying a torso mass of 15 kg. A load cell at the inferior end measured neck loads in both studies. Axial neck force and age were used as the primary response variable and covariate to derive injury probability curves using survival analysis.
RESULTS
Group A tests showed that age is a significant (P < .05) and negative covariate; that is, increasing age resulted in decreasing force for the same risk. Injuries were mainly vertebral body fractures and concentrated at one level, mid-to-lower cervical spine, and were attributed to compression-related mechanisms. However, age was not a significant covariate for the combined data from group B tests. Both group B tests produced many soft tissue injuries, at all levels, from C1 to T1. The injury mechanism was attributed to mainly extension. Multiple and noncontiguous injuries occurred. Injury probability curves, ±95% confidence intervals, and normalized confidence interval sizes representing the quality of the mean curve are given for different data sets.
CONCLUSIONS
For compression-related injuries, specimen age should be used as a covariate or individual specimen data may be prescaled to derive risk curves. For distraction- or extension-related injuries, however, specimen age need not be used as a covariate in the statistical analysis. The findings from these tests and survival analysis indicate that the age factor modulates human cervical spine tolerance to impact injury.
Topics: Accidents, Traffic; Age Factors; Aged; Biomechanical Phenomena; Cadaver; Cervical Vertebrae; Female; Head; Humans; Male; Middle Aged; Neck; Posture; Probability; Spinal Fractures; Spinal Injuries; Survival Analysis; Weight-Bearing
PubMed: 28738168
DOI: 10.1080/15389588.2017.1355549 -
JAMA Surgery Nov 2023There is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients.
IMPORTANCE
There is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients.
OBJECTIVE
To develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study included pediatric patients (<3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022.
EXPOSURE
Blunt trauma.
MAIN OUTCOMES AND MEASURES
Primary outcome was CSI. The primary and secondary objectives were predetermined.
RESULTS
The current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models' ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915).
CONCLUSION AND RELEVANCE
This study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.
Topics: Adult; Child; Humans; Male; Infant; Female; Cohort Studies; Spinal Injuries; Wounds, Nonpenetrating; Cervical Vertebrae; Tomography, X-Ray Computed; Retrospective Studies; Trauma Centers
PubMed: 37703025
DOI: 10.1001/jamasurg.2023.4213 -
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 -
American Journal of Orthopedics (Belle... 2016In recent years, increased attention has been paid to injuries occurring in Major League Baseball (MLB) players. Although most of the current orthopedic literature... (Review)
Review
In recent years, increased attention has been paid to injuries occurring in Major League Baseball (MLB) players. Although most of the current orthopedic literature regarding baseball injuries pertains to the shoulder and elbow, lumbar spine injuries are another common reason for time out of play. Back and core injuries may represent as many as 12% of all injuries that result in time out of play from MLB. This high rate of injury is likely related to the critical role that the spine plays in every major baseball-related movement. Linking the upper extremities to the hips and lower extremities, a healthy, strong, and stable spine and core is a prerequisite for performance in all levels of baseball. It has been well documented that baseball players with poor spinal control and stabilization are at increased risk for future injury. Common etiologies of lumbar injuries include stress fractures, muscle injury, annular tears with or without disc herniation, facet joint pain, sacroiliac joint pain, and stenosis. This review discusses the epidemiology of spinal injuries in baseball. Special attention is paid to the role of the spine in baseball-related activities, common injuries, tips for making the correct diagnosis, treatment options, outcomes, rehabilitation, and injury prevention.
Topics: Athletic Injuries; Baseball; Humans; Lumbar Vertebrae; Spinal Injuries
PubMed: 26991566
DOI: No ID Found -
Journal of the American College of... May 2019Injuries to the cervical and thoracolumbar spine are commonly encountered in trauma patients presenting for treatment. Cervical spine injuries occur in 3% to 4% and...
Injuries to the cervical and thoracolumbar spine are commonly encountered in trauma patients presenting for treatment. Cervical spine injuries occur in 3% to 4% and thoracolumbar fractures in 4% to 7% of blunt trauma patients presenting to the emergency department. Clear, validated criteria exist for screening the cervical spine in blunt trauma. Screening criteria for cervical vascular injury and thoracolumbar spine injury have less validation and widespread acceptance compared with cervical spine screening. No validated criteria exist for screening of neurologic injuries in the setting of spine trauma. CT is preferred to radiographs for initial assessment of spine trauma. CT angiography and MR angiography are both acceptable in assessment for cervical vascular injury. MRI is preferred to CT myelography for assessing neurologic injury in the setting of spine trauma. MRI is usually appropriate when there is concern for ligament injury or in screening obtunded patients for cervical spine instability. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Topics: Contrast Media; Diagnosis, Differential; Evidence-Based Medicine; Humans; Neuroimaging; Societies, Medical; Spinal Injuries; United States
PubMed: 31054754
DOI: 10.1016/j.jacr.2019.02.002 -
Computer Methods and Programs in... Jun 2022Neural reflex is hypothesized as a regulating step in spine stabilizing system. However, neural reflex control is still in its infancy to consider in the previous finite... (Review)
Review
BACKGROUND AND OBJECTIVE
Neural reflex is hypothesized as a regulating step in spine stabilizing system. However, neural reflex control is still in its infancy to consider in the previous finite element analysis of head-neck system for various applications. The purpose of this study is to investigate the influences of neural reflex control on neck biomechanical responses, then provide a new way to achieve an accurate biomechanical analysis for head-neck system with a finite element model.
METHODS
A new FE head-neck model with detailed active muscles and spinal cord modeling was established and globally validated at multi-levels. Then, it was coupled with our previously developed neuromuscular head-neck model to analyze the effects of vestibular and proprioceptive reflexes on biomechanical responses of head-neck system in a typical spinal injury loading condition (whiplash). The obtained effects were further analyzed by comparing a review of epidemiologic data on cervical spine injury situations.
RESULT
The results showed that the active model (AM) with neural reflex control obviously presented both rational head-neck kinematics and tissue injury risk referring to the previous experimental and epidemiologic studies, when compared with the passive model (PM) without it. Tissue load concentration locations as well as stress/strain levels were both changed due to the muscle activation forces caused by neural reflex control during the whole loading process. For the bony structures, the AM showed a peak stress level accounting for only about 25% of the PM. For the discs, the stress concentrated location was transferred from C2-C6 in the PM to C4-C6 in the AM. For the spinal cord, the strain concentrated locations were transferred from C1 segment to around C4 segment when the effects of neural reflex control were implemented, while the gray matter and white matter peak strains were reduced to 1/3 and 1/2 of the PM, respectively. All these were well correlated with epidemiological studies on clinical cervical spine injuries.
CONCLUSION
In summary, the present work demonstrated necessity of considering neural reflex in FE analysis of a head-neck system as well as our model biofidelity. Overall results also verified the previous hypothesis and further quantitatively indicated that the muscle activation caused by neural reflex is providing a protection for the neck in impact loading by decreasing the strain level and changing the possible injury to lower spinal cord level to reduce injury severity.
Topics: Biomechanical Phenomena; Cervical Vertebrae; Finite Element Analysis; Humans; Neck; Reflex; Spinal Diseases; Spinal Injuries; Whiplash Injuries
PubMed: 35344767
DOI: 10.1016/j.cmpb.2022.106761 -
British Journal of Sports Medicine Apr 2015As a collision sport, rugby union has a relatively high overall injury incidence, with most injuries being associated with contact events. Historically, the set scrum... (Review)
Review
As a collision sport, rugby union has a relatively high overall injury incidence, with most injuries being associated with contact events. Historically, the set scrum has been a focus of the sports medicine community due to the perceived risk of catastrophic spinal injury during scrummaging. The contemporary rugby union scrum is a highly dynamic activity but to this point has not been well characterised mechanically. In this review, we synthesise the available research literature relating to the medical and biomechanical aspects of the rugby union scrum, in order to (1) review the injury epidemiology of rugby scrummaging; (2) consider the evidence for specific injury mechanisms existing to cause serious scrum injuries and (3) synthesise the information available on the biomechanics of scrummaging, primarily with respect to force production. The review highlights that the incidence of acute injury associated with scrummaging is moderate but the risk per event is high. The review also suggests an emerging acknowledgement of the potential for scrummaging to lead to premature chronic degeneration injuries of the cervical spine and summarises the mechanisms by which these chronic injuries are thought to occur. More recent biomechanical studies of rugby scrummaging confirm that scrum engagement forces are high and multiplanar, but can be altered through modifications to the scrum engagement process which control the engagement velocity. As the set scrum is a relatively 'controlled' contact situation within rugby union, it remains an important area for intervention with a long-term goal of injury reduction.
Topics: Acute Disease; Age Factors; Athletic Injuries; Biomechanical Phenomena; Chronic Disease; Football; Humans; Posture; Professional Competence; Spinal Injuries; Time Factors
PubMed: 24398223
DOI: 10.1136/bjsports-2013-092972 -
Sports Health 2016Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data... (Review)
Review
CONTEXT
Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine.
EVIDENCE ACQUISITION
Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed.
CONCLUSION
Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury.
Topics: Athletes; Athletic Injuries; Consensus; Decision Making; Evidence-Based Medicine; Humans; Lumbar Vertebrae; Recovery of Function; Return to Sport; Risk Factors; Spinal Cord Injuries; Spinal Injuries; Sports Medicine; Thoracic Vertebrae
PubMed: 26502187
DOI: 10.1177/1941738115610753