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The Journal of the American Academy of... Sep 2023Wound breakdown and infection are common complications after complex spine surgery and may occur in up to 40% of high-risk patients. These are challenging scenarios... (Review)
Review
Wound breakdown and infection are common complications after complex spine surgery and may occur in up to 40% of high-risk patients. These are challenging scenarios which can result in a prolonged hospital stay, revision surgery, and elevated costs. Reconstructive specialists can do prophylactic closures for high-risk groups to potentially reduce the risk of developing a wound complication. These plastic surgery techniques often involve multilayered closure, with the addition of local muscle and/or fasciocutaneous flaps. The goal of this study was to review the literature for risks associated with wound complications, identification of high-risk patients, and the advantages of using plastic surgery techniques. In addition, we elaborate on the multilayered and flap closure technique for complex spine surgery which is done at our institution.
Topics: Humans; Surgery, Plastic; Surgical Wound Infection; Retrospective Studies; Plastic Surgery Procedures; Surgical Flaps; Spinal Injuries
PubMed: 37155731
DOI: 10.5435/JAAOS-D-23-00129 -
Clinics in Sports Medicine Jul 2023Sports participation is a leading cause of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs... (Review)
Review
Sports participation is a leading cause of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. Planning the process of transport for home venues before the start of the season and ensuring that a medical time out occurs at home and away games can reduce complications of transport decisions on the field of play and expedite transport of the spine-injured athlete.
Topics: Humans; United States; Athletic Injuries; Spinal Injuries; Transportation of Patients; Cervical Vertebrae; Physical Examination
PubMed: 37208061
DOI: 10.1016/j.csm.2023.02.011 -
Revue Medicale Suisse Oct 2023The use of corticosteroids is common in our clinical practice. Cortico-induced osteoporosis should be taken into consideration when using a dosage higher than 7.5 mg/d...
The use of corticosteroids is common in our clinical practice. Cortico-induced osteoporosis should be taken into consideration when using a dosage higher than 7.5 mg/d of prednisone or equivalent for a minimum of 3 months. We describe the case of a 69-year-old female patient who received long-term corticosteroid treatment for low back pain and developed secondary vertebral compression fractures. This case illustrates the importance of assessing fracture risk when prescribing corticosteroids, in order to offer preventive measures and introduce (in subjects with high risk) prophylactic treatments aiming to reduce the risk of irreversible consequences.
Topics: Female; Humans; Aged; Fractures, Compression; Spinal Fractures; Osteoporosis; Adrenal Cortex Hormones
PubMed: 37819183
DOI: 10.53738/REVMED.2023.19.845.1852 -
International Orthopaedics Dec 2023The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics. (Review)
Review
PURPOSE
The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics.
METHODS
This is a narrative review of the literature.
RESULTS
The classification is based on the relationship between movement and common forces acting on the spine. A mechanistic concept is incorporated into the classification, which considers both movements and the application of forces, leading to pathomorphological characteristics. A hierarchical ranking determines the severity of fractures within the thoracic spine, and treatment recommendations are presented in each category. The fourth column of the spine is incorporated into the classification through direct and indirect mechanisms.
CONCLUSIONS
The proposed classification accommodates several advantages, such as simplicity and practicality, that make this classification helpful in daily practice. The dynamic relationship between movement and force provides a better understanding of the fracture mechanism. Finally, incorporating the fourth column will strengthen the indication for surgical management. To the best of our knowledge, this classification is the first classification developed uniquely for the thoracic spine fractures and will help to address a critical gap in the literature.
Topics: Humans; Spinal Fractures; Sternum; Thoracic Vertebrae; Fractures, Bone; Thoracic Injuries
PubMed: 36943457
DOI: 10.1007/s00264-023-05778-x -
Skeletal Radiology Oct 2023Vertebral compression fractures (VCFs) are a common pathologic process seen in 30-50% of individuals over the age of 50 years. Historically, VCFs were first treated... (Review)
Review
Vertebral compression fractures (VCFs) are a common pathologic process seen in 30-50% of individuals over the age of 50 years. Historically, VCFs were first treated with nonsurgical management while vertebral augmentation was reserved for severe cases resulting in deformity or significant disability. Current treatment algorithms based on established appropriateness criteria have changed recommendations towards supporting early vertebral augmentation for the VCFs causing the most clinically difficulty and taking into account the degree of vertebral body height loss, kyphotic deformity, and the degree of clinical progression. Percutaneous vertebroplasty (PVP) involves injecting primarily polymethacrylate (PMMA) bone cement directly into the cancellous bone of the vertebral body. There is recent literature showing the effectiveness of PVP including data comparing vertebroplasty to sham treatment. Vertebroplasty evolved into balloon kyphoplasty (BKP) where a balloon is first inserted into the vertebral body to create a cavity and reduce the fracture followed by an injection of bone cement. Both PVP and BKP have been shown to be significantly more effective at treatment of VCFs compared to nonsurgical management. The benefits shown in the literature have been demonstrated randomized control trials, cohort matched trials, post-market trials, registries, and many other data sources with approximately 250 manuscripts produced per year dedicated to the topic of vertebral augmentation.
Topics: Humans; Middle Aged; Bone Cements; Bone Diseases, Metabolic; Fractures, Compression; Kyphoplasty; Osteoporotic Fractures; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35761093
DOI: 10.1007/s00256-022-04092-8 -
Ugeskrift For Laeger Apr 2024Non-traumatic fractures due to seizures are an overlooked diagnostic group. It is well known that patients with generalized tonic-clonic seizures have an increased...
Non-traumatic fractures due to seizures are an overlooked diagnostic group. It is well known that patients with generalized tonic-clonic seizures have an increased trauma risk. However, the cause of fracture is rarely due to the violent forces of muscle contractions. Usually, the primary patient examination focuses on the aetiology of the seizure, which sometimes delays the diagnosis of fractures. This is a case report of a 19-year-old woman who sustained three compression fractures of the thoracic spine due to a generalized tonic-clonic seizure, and a discussion of the diagnostic challenges in such a rare case.
Topics: Humans; Female; Spinal Fractures; Young Adult; Fractures, Compression; Thoracic Vertebrae; Seizures; Fractures, Multiple; Tomography, X-Ray Computed; Epilepsy, Tonic-Clonic
PubMed: 38704711
DOI: 10.61409/V05230296 -
Neurological Research Oct 2023Traumatic spine injuries are a relatively common occurrence and are associated with functional impairment, loss of neurologic function, and spinal deformity. A number of... (Review)
Review
OBJECTIVE
Traumatic spine injuries are a relatively common occurrence and are associated with functional impairment, loss of neurologic function, and spinal deformity. A number of spinal trauma classification systems have been developed with varying degrees of acceptance. This review provides a chronological overview of spinal trauma classification systems, with special consideration towards the benefits and pitfalls related to each. Cervical, thoracolumbar, and sacral trauma classification systems are discussed.
METHODS
A review of the literature was performed. Published articles that reported on bony spinal trauma classification systems were examined. No year exemptions were identified. The reference lists of all selected articles were screened for additional studies. Article inclusion and exclusion criteria were defined a priori.
RESULTS
A total of 20 classification systems were identified from years 1938-2017. Of these 20 classification systems, 6 were cervical, 11 were thoracolumbar and 3 were sacral. The modernization of bony spinal trauma classification has been characterized by the development of weighted scales that include injury morphology, integrity of associated ligamentous structures and neurologic status.
CONCLUSION
For widespread acceptance and adoption in the clinical setting, future spinal trauma scoring classification will need to remain simple, highly reproducible, and impart information with regard to clinical decision-making and prognosis that may be effectively communicated across each medical specialty involved in the care of these patients.
Topics: Humans; Lumbar Vertebrae; Thoracic Vertebrae; Spinal Injuries
PubMed: 32758096
DOI: 10.1080/01616412.2020.1797373 -
Orthopaedic Surgery Nov 2023With an aging population, the osteoporotic vertebral compression fracture (OVCF) has become a constant concern for its physical and neurological complications, such... (Review)
Review
With an aging population, the osteoporotic vertebral compression fracture (OVCF) has become a constant concern for its physical and neurological complications, such as spinal kyphosis and refractory pains. Compared with traditional conservative treatments, the open surgery is more superior in some ways because of its direct decompression and correction. Various operation methods applying to different indications have been developed to deal with different fracture situations, including anterior, posterior, and combined surgery. In this review, we have concluded the latest developments of the surgery treating OVCF and the internal fixation as references for spinal surgeons of the choice of suitable treatments.
Topics: Humans; Aged; Spinal Fractures; Fractures, Compression; Osteoporotic Fractures; Fracture Fixation, Internal; Treatment Outcome; Kyphosis; Lumbar Vertebrae; Retrospective Studies
PubMed: 37587622
DOI: 10.1111/os.13822 -
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 -
British Journal of Sports Medicine Nov 2023
Topics: Humans; Spinal Fractures; Osteoporotic Fractures; Exercise; Bone Density
PubMed: 37775126
DOI: 10.1136/bjsports-2023-107157