-
Medicine Sep 2023The Injury Severity Score (ISS) is widely used to evaluate patients with multiple injuries. This study investigated the association between ISS and clinical outcomes of...
The Injury Severity Score (ISS) is widely used to evaluate patients with multiple injuries. This study investigated the association between ISS and clinical outcomes of patients with spinal cord injury (SCI) in an aging Japanese population. This retrospective cohort study investigated patients admitted to a Japanese university hospital. In the study, 89 patients with traumatic SCI were included. Traumatic SCI was categorized as monotrauma or polytrauma, and the ISS was used to evaluate trauma severity. Spearman's correlation coefficient was used to estimate the correlation between ISS and the American Spinal Injury Association (ASIA) motor score, Barthel Index (activities of daily living assessment), and the European Quality of Life (QOL) scale (EQ5d) as an assessment of QOL at admission or the last follow-up with the adjustment for age, sex, and body mass index. Return to home and work were analyzed using the chi-squared test after the ISS was divided into three groups (<14, 14-19, and 20). The mean ISS was significantly higher for polytrauma than monotrauma. Significant negative correlations between the ISS and ASIA motor scores at the first visit (P < .001, r = -0.37) and the last follow-up (adjusted, P = .007, r = -0.30) were observed. The Barthel Index was also negatively correlated with ISS at the first visit (P = .04, r = -0.21) and at the last follow-up period (P < .001, r = -0.35). Moreover, ISS was significantly negatively correlated with EQ5d score at the last follow-up (P = .01, r = -0.28). The chi-squared test demonstrated that patients with an ISS of < 14 returned home (P = .03), while those with an ISS of < 19 returned to work (P = .02). ISS is associated with paralysis, activities of daily living, QOL, and lifestyle in patients with SCI and is an important initial injury assessment method.
Topics: Humans; Injury Severity Score; Quality of Life; Retrospective Studies; Activities of Daily Living; East Asian People; Spinal Cord Injuries; Multiple Trauma; Aging; Spinal Injuries
PubMed: 37773811
DOI: 10.1097/MD.0000000000035369 -
European Spine Journal : Official... Jun 2021To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and...
PURPOSE
To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty.
METHODS
A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries.
RESULTS
A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment.
CONCLUSION
Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
Topics: Cervical Vertebrae; Humans; Magnetic Resonance Imaging; Spinal Fractures; Spinal Fusion; Surgeons
PubMed: 33797624
DOI: 10.1007/s00586-021-06818-z -
BMJ Case Reports Aug 2020Rib fractures due to blunt trauma are a common chest injury seen at the emergency department; however, injuries to the costovertebral joints are very rare. We present a...
Rib fractures due to blunt trauma are a common chest injury seen at the emergency department; however, injuries to the costovertebral joints are very rare. We present a case of a 24-year-old man who was admitted after a high-speed car collision and was assessed in a level 1 trauma centre in Amsterdam. He had multiple injuries, including dislocation of the costovertebral joint of ribs 7-10. After performing a literature search we concluded that patients with traumatic costovertebral joint dislocations have a high incidence of vertebral fractures, neurological deficits and additional fractures. We believe that isolated dislocation of one or multiple costovertebral joint(s) can safely be treated conservatively. Close monitoring of the patients is advisable as these injuries are caused by high impact and are associated with other injuries.
Topics: Accidents, Traffic; Contusions; Humans; Imaging, Three-Dimensional; Joint Dislocations; Lumbar Vertebrae; Male; Pneumothorax; Rib Fractures; Spinal Fractures; Sternum; Thoracic Vertebrae; Tomography, X-Ray Computed; Wounds, Nonpenetrating; Young Adult
PubMed: 32816931
DOI: 10.1136/bcr-2020-234931 -
PloS One 2022The incidences of spine fractures and fusion surgeries have increased. A few studies have reported an increased rate of caesarean sections (CS) in women who have...
BACKGROUND
The incidences of spine fractures and fusion surgeries have increased. A few studies have reported an increased rate of caesarean sections (CS) in women who have undergone spine surgery but have not reported on the health of neonates.
OBJECTIVE
We report the incidence of spine fractures, spine fracture surgeries and fusion surgery for other reasons and the effect of these injuries and procedures on later pregnancy outcomes in Finland.
METHODS
Data on all fertile-aged women (1998-2018) who had undergone spine fracture or spine fusion surgery were retrieved from the Care Register for Healthcare and combined with data from the National Medical Birth Register. Women with spine fracture or spine surgery before pregnancy were compared with women without previous spine fracture or surgery. We calculated incidences of spine fracture, spine fracture surgery and fusion surgery for other reasons with 95% confidence intervals (CI). We used multivariable logistic regression to evaluate CS and neonatal health. Results are reported as adjusted odds ratios (AOR).
RESULTS
The main finding of our study was the increasing incidence (156%) of spine fusion surgeries for other reasons in fertile-aged women. A total CS rate (including elective and unplanned CS) in the spine fracture group was 19.7% (AOR 1.26, CI 1.17-1.34), in fusion surgery for other reasons group 25.3% (AOR 1.37, CI 1.30-1.49) and 15.9% in the control group. The rate for neonates requiring intensive care in the spine fracture group was 12.2% (AOR 1.18, CI 1.08-1.29), in fusion surgery for other reasons group 13.6% (AOR 1.12, CI 1.02-1.23) and 10.0% in the control group.
CONCLUSIONS
The incidence of fusion surgery for other reasons increased during our study period. The rate of CS was higher in women with preceding spine fracture or fusion surgery. Our results suggest that vaginal delivery after fractures of the spine is both possible and safe for mother and neonate.
Topics: Aged; Cesarean Section; Female; Finland; Fractures, Bone; Humans; Infant, Newborn; Odds Ratio; Pregnancy; Pregnancy Outcome; Spinal Fractures
PubMed: 35930567
DOI: 10.1371/journal.pone.0272579 -
Journal of Neurosurgery. Spine Jan 2023The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System...
OBJECTIVE
The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery).
METHODS
A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility.
RESULTS
The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36).
CONCLUSIONS
The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.
Topics: Humans; Reproducibility of Results; Observer Variation; Spinal Injuries; Cervical Vertebrae; Surgeons
PubMed: 35986731
DOI: 10.3171/2022.6.SPINE22454 -
Clinical Spine Surgery Mar 2023The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type... (Review)
Review
The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type fractures representing less severe injuries and C-type fractures representing the most severe fracture types. C0 fractures represent moderately severe injuries and have historically been referred to as nondisplaced "U-type" fractures. Injury management of these fractures can be controversial. Therefore, the purpose of this narrative review is to first discuss the Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification System and describe the different fracture types and classification modifiers, with particular emphasis on C0 fracture types. The narrative review will then focus on the epidemiology and etiology of C0 fractures with subsequent discussion focused on the clinical presentation for patients with these injuries. Next, we will describe the imaging findings associated with these injuries and discuss the injury management of these injuries with particular emphasis on operative management. Finally, we will outline the outcomes and complications that can be expected during the treatment of these injuries.
Topics: Humans; Spinal Fractures; Spinal Injuries; Sacrum; Fractures, Bone; Retrospective Studies
PubMed: 36006406
DOI: 10.1097/BSD.0000000000001384 -
Clinics in Orthopedic Surgery Dec 2023Traumatic spinal injuries in children are uncommon and result in different patterns of injuries due to the anatomical characteristics of children's spines. However,...
BACKGROUND
Traumatic spinal injuries in children are uncommon and result in different patterns of injuries due to the anatomical characteristics of children's spines. However, there are only a few epidemiological studies of traumatic spinal injury in children. The purpose of this study was to investigate the characteristics of traumatic spinal injury in children.
METHODS
We retrospectively reviewed the cases of pediatric patients (age < 18 years) with traumatic spinal injury who were treated at a level 1 trauma center between January 2017 and December 2021. We divided them into three groups according to age and analyzed demographics, injury mechanism, level of injury, and injury pattern.
RESULTS
A total of 62 patients (255 fractures) were included, and the mean age was 13.8 ± 3.2 years. There were 5 patients (22 fractures) in group I (0-9 years), 24 patients (82 fractures) in group II (10-14 years), and 33 patients (151 fractures) in group III (15-17 years). Both the Injury Severity Score and the Revised Trauma Score were highest in group I, but there was no statistical difference between the age groups. Fall from height was the most common injury mechanism, of which 63% were suicide attempts. The level of spinal injury was different in each age group, T10-L2 injury being the most common. In all age groups, the number of multilevel continuous injury was larger than that of single-level injury or multilevel noncontinuous injury. Surgical intervention was required in 33.9%, and mortality was 3.2%.
CONCLUSIONS
In our study, fall from height was the most common mechanism of injury, and there were many suicide attempts associated with mental health issues. Thoracolumbar junction injuries were predominant, and the rate of multilevel contiguous injuries was high. The support and interest of the society and families for adolescent children seem crucial in preventing spinal trauma, and image testing of the entire spine is essential when evaluating pediatric spinal injuries.
Topics: Adolescent; Child; Humans; Fractures, Bone; Retrospective Studies; Spinal Fractures; Spinal Injuries; Spine; Trauma Centers; Infant, Newborn; Infant; Child, Preschool
PubMed: 38045581
DOI: 10.4055/cios23118 -
Frontiers in Endocrinology 2022This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric...
PURPOSE
This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals.
MATERIALS AND METHODS
3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests.
RESULTS
1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age<50 years to 23.2% at age ≥70 years, and in women from 5.1% at age<50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged < 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture.
CONCLUSION
In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men <50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of <25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.
Topics: Middle Aged; Male; Aged; Humans; Female; Bone Density; Spinal Fractures; Tomography, X-Ray Computed; Fractures, Bone; Lumbar Vertebrae; China; Fractures, Multiple
PubMed: 36387886
DOI: 10.3389/fendo.2022.1013597 -
European Review For Medical and... Dec 2021Traumatic spinal injury (TSI) is a serious trauma-related injury with a significant risk for mortality and morbidity. Road traffic accident (RTA) is the leading cause...
OBJECTIVE
Traumatic spinal injury (TSI) is a serious trauma-related injury with a significant risk for mortality and morbidity. Road traffic accident (RTA) is the leading cause for the spinal and orthopedic injuries globally. Detailed information on the association of orthopedic fractures with TSI and its influence on outcomes is lacking. In this study, RTA-related TSI with orthopedic associated fractures in terms of demographics, prevalence, patterns, and outcomes were studied.
PATIENTS AND METHODS
This was a single-center retrospective study conducted over ten years in the largest tertiary hospital in Southern Saudi Arabia. A total of 184 patients suffered TSI associated with orthopedic fractures out of the 810 RTA-related TSIs (22.71%) were recruited. The majority was males (86%), and 55% of the cohort was between 21-40 years.
RESULTS
The commonest spinal injury level was lumbar (25%) followed by the sacral spine (24.5%), while multiple regions orthopedic fractures and fracture pelvis were the commonest orthopedic fractures, 27.2% and 25%, respectively. The mortality rate was 4.3% and significantly correlated with the spinal injury level (p=.018). The region of orthopedic fracture has significant associations with the gender and hospital length of stay (p=.020 and p=.005, respectively). We also found a significant association between the spinal injury level and orthopedic fracture location (p<0001).
CONCLUSIONS
Traumatic spinal injuries due to traffic accidents are commonly associated with orthopedic fractures. This association has distinct patterns and influences the patient's outcomes.
Topics: Accidents, Traffic; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Fractures, Bone; Humans; Infant; Infant, Newborn; Male; Middle Aged; Retrospective Studies; Saudi Arabia; Spinal Injuries; Young Adult
PubMed: 34982450
DOI: 10.26355/eurrev_202112_27636 -
The Journal of Spinal Cord Medicine Jan 2022Swallowing difficulties (dysphagia) are well recognized after spinal injury. There are no published rehabilitation efficacy studies to date. This study explored...
Swallowing difficulties (dysphagia) are well recognized after spinal injury. There are no published rehabilitation efficacy studies to date. This study explored viability and outcomes of swallowing rehabilitation programs for four patients with persisting dysphagia. Prospective, quantitative experimental longitudinal case series. Spinal rehabilitation unit or patients' homes. Four patients engaged in a 6-week (3×weekly) individualized progressive rehabilitation program. Objective videofluoroscopic measures of timing and displacement and a validated self-reported questionnaire - the Eating Assessment Tool (EAT-10) were taken pre-therapy, immediately post-therapy and EAT-10 was repeated at 3 months. Feeling and fatigue scale scores were taken before and after each therapy session. Patients (63, 67 yr, 67 yr, 76 yr; 3 male) had varying spinal diagnoses (2 traumatic, all involving the C-spine) and length of dysphagia (6 weeks, 6 weeks, 12 weeks, 10 yr). Common physiological impairments across all patients were: reduced maximum hyoid displacement, reduced pharyngeal constriction and reduced pharyngoesophageal segment maximum opening. Therapy programs were well received with 100% compliance. Participants made quantitative improvements in their videofluoroscopic measures of timing and displacement. Three out of four participants were able to have their percutaneous endoscopic gastrostomies (PEG) removed. EAT-10 scores significantly improved for all patients ( < .001). Poor upper limb function and restricted neck flexion prohibited some exercises. For many patients following spinal injury, dysphagia resolves during the acute phase of post-surgery recovery. For some, significant pharyngeal impairments persist. This case series demonstrates potential to regain functional swallowing following a 6-week tailored rehabilitation program. High-quality research exploring efficacy of rehabilitation programs are warranted.
Topics: Deglutition; Deglutition Disorders; Female; Humans; Male; Prospective Studies; Spinal Cord Injuries; Spinal Injuries
PubMed: 32441589
DOI: 10.1080/10790268.2020.1762828