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Pain Research & Management 2022Through the follow-up analysis of cervical spine fracture cases with ankylosing spondylitis (AS), a treatment-oriented fracture classification method is introduced to...
OBJECTIVE
Through the follow-up analysis of cervical spine fracture cases with ankylosing spondylitis (AS), a treatment-oriented fracture classification method is introduced to evaluate the clinical efficacy guided by this classification method.
METHOD
A retrospective analysis was performed on 128 AS patients who underwent comprehensive treatment in the Spine Surgery Department of Qingdao University Hospital from January 2009 to May 2018. Statistics of patient demographic data, distribution of different fractures corresponding to surgical methods, 3-year follow-up outcomes, and summary of objective fracture classification methods were analyzed. A prospective 5-year follow-up study of 90 patients with AS cervical spine fractures from June 2015 to August 2020 was also included. Statistical differences on the distribution of factors such as case information, cervical spine sagittal sequence parameters, and fracture classification were assessed. Correlations between surgical information, American Spinal Injuries Association grade (ASIA), modified Japanese Orthopaedic Association scores (mJOA), and other factors were analyzed to establish a nomogram predictive model for curative effect outcomes. Overall, three major types and the four subtypes of AS cervical spine fractures were evaluated based on the clinical efficacy of the classification and the selection of surgical treatment methods.
RESULT
The most common type of fracture was type II (30 cases, 33.33%), most of the subtypes were A (37 cases), followed by B (36 cases) and C (17 cases). Twenty-four of 28 patients with type I underwent anterior surgery, and 47 of 62 patients with type II and III underwent posterior surgery. The average follow-up time was 25.76 ± 11.80 months. The results of predicting clinical variables are different but include factors such as fracture type and subtype, type of operation, and age. The predictor variables include the above-mentioned similar variables, but survival is more affected by the fracture type of the patient.
CONCLUSION
This predictive model based on follow-up information delineation points out the impact of ankylosing spondylitis cervical spine fracture classification on surgical selection and clinical efficacy.
Topics: Cervical Vertebrae; Follow-Up Studies; Humans; Nomograms; Prospective Studies; Retrospective Studies; Spinal Fractures; Spondylitis, Ankylosing; Treatment Outcome
PubMed: 35281345
DOI: 10.1155/2022/7769775 -
Biological Research Dec 2022Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and...
BACKGROUND
Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method.
METHODS
In this study, 0.05 mM KA was administered at dose of 10 µL/100 g body weight, at a rate of 10 µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher.
RESULTS
This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment.
CONCLUSIONS
Kainic acid intra-spinal injection at the concentration of 0.05 mM, and rate 10 µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.
Topics: Humans; Rats; Animals; Rats, Sprague-Dawley; Kainic Acid; Spinal Cord Injuries; Paraplegia; Spinal Injuries; Disease Models, Animal
PubMed: 36494836
DOI: 10.1186/s40659-022-00407-0 -
Sports Health 2021Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce.
CONTEXT
Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce.
OBJECTIVE
To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers.
DATA SOURCES
PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018.
STUDY SELECTION
Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology.
STUDY DESIGN
Systematic review and qualitative analysis.
LEVEL OF EVIDENCE
Level 3.
DATA EXTRACTION
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool.
RESULTS
A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region.
CONCLUSION
Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.
Topics: Humans; Lower Extremity; Muscle Strength; Physical Examination; Posture; Risk Assessment; Risk Factors; Self Report; Spinal Injuries; Swimming; Upper Extremity
PubMed: 32649842
DOI: 10.1177/1941738120920518 -
European Journal of Trauma and... Jun 2021Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but...
PURPOSE
Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre.
METHODS
We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging.
RESULTS
We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first.
CONCLUSION
Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.
Topics: Aged; Cervical Vertebrae; Child; Humans; Magnetic Resonance Imaging; Retrospective Studies; Spinal Injuries; Tomography, X-Ray Computed; Trauma Centers; Wounds, Nonpenetrating
PubMed: 33108476
DOI: 10.1007/s00068-020-01520-z -
Acta Bio-medica : Atenei Parmensis Sep 2021Considering the high rate of mortality and permanent disability related to vertebral traumas, an early and detailed diagnosis of the trauma and subsequently an immediate...
BACKGROUND AND AIM
Considering the high rate of mortality and permanent disability related to vertebral traumas, an early and detailed diagnosis of the trauma and subsequently an immediate and effective intervention are crucial. Cervical vertebral injury classifications guide treatment choice through a severity grade based on radiological information. The purpose of the present study was to define which imaging classification system could provide the best morphological and clinical-surgical correlations for cervical spine traumas.
METHODS
We retrospectively analyzed patients evaluated for cervical spine trauma at our Institution in the period 2015-2020. Information regarding the morphological examination (using CT and MRI), the neurological evaluation, and the therapeutic management were collected. C3-C7 fractures were classified according to the SLIC and AOSpine criteria; axial lesions were classified according to the modified AOSpine for the C1-C2 compartment and through the Roy-Camille and the Anderson D'Alonzo system for the odontoid process of the axis.
RESULTS
29 patients were included in the final study population. Nine patients with axial spine trauma and 21 with subaxial cervical spine trauma. A conservative approach was applied in 16 patients while nine patients underwent neurosurgery. Considering the therapeutical indications provided by the SLIC system, a 76.9% accordance was found for patients with a <4 score, while a 100% concordance was calculated for patients with a >4 score undergoing neurosurgery. Regarding the AOSspine classification, a 28.6% concordance was observed for patients classified group B being treated with a posterior neurosurgical approach, while for patients belonging to subgroup C, considered for anterior neurosurgical approach, a 66.7% accordance was calculated.
CONCLUSIONS
The study demonstrated a better morphological correlation for the AOSpine classification in subaxial trauma and the AOSpine and Anderson D'Alonzo in axial trauma. The therapeutic indication found a better correlation in the SLIC classification for subaxial trauma and the Anderson D'Alonzo for axial ones.
Topics: Clinical Decision-Making; Humans; Odontoid Process; Radiography; Retrospective Studies; Spinal Injuries
PubMed: 34505843
DOI: 10.23750/abm.v92iS5.11877 -
Journal of Athletic Training Jun 2020Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with...
INTRODUCTION
Sports participation is among the leading causes 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. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs.
METHODS
A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review.
RESULTS
The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved.
CONCLUSIONS
These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.
Topics: Athletic Injuries; Emergency Medical Services; Football; Humans; Neck Injuries; Spinal Injuries; Sports Medicine; United States
PubMed: 32579668
DOI: 10.4085/1062-6050-0434.19 -
European Journal of Orthopaedic Surgery... Aug 2023Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to...
Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to classifying thoracolumbar injuries within the spinal community, but there remains a need to classify, evaluate and manage thoracolumbar fractures. This article aims to provide a guide on classification of thoracolumbar spine injuries using the AO Spine Thoracolumbar Injury Classification System (AO TLICS).
Topics: Humans; Injury Severity Score; Lumbar Vertebrae; Thoracic Vertebrae; Spinal Injuries; Spinal Cord Injuries; Spinal Fractures
PubMed: 36460810
DOI: 10.1007/s00590-022-03430-9 -
BMC Musculoskeletal Disorders Mar 2023Thoracolumbar fascia injury (FI) is rarely discussed in osteoporotic vertebral fracture (OVF) patients in previous literature and it is usually neglected and treated as...
BACKGROUND
Thoracolumbar fascia injury (FI) is rarely discussed in osteoporotic vertebral fracture (OVF) patients in previous literature and it is usually neglected and treated as an unmeaning phenomenon. We aimed to evaluate the characteristics of the thoracolumbar fascia injury and further discuss its clinical significance in the treatment of kyphoplasty for osteoporotic vertebral fracture (OVF) patients.
METHODS
Based on the presence or absence of FI, 223 OVF patients were divided into two groups. The demographics of patients with and without FI were compared. The visual analogue scale and Oswestry disability index scores were compared preoperatively and after PKP treatment between these groups.
RESULTS
Thoracolumbar fascia injuries were observed in 27.8% of patients. Most FI showed a multi-level distribution pattern which involved a mean of 3.3 levels. Location of fractures, severity of fractures and severity of trauma were significantly different between patients with and without FI. In further comparison, severity of trauma was significantly different between patients with severe and non-severe FI. In patients with FI, VAS and ODI scores of 3 days and 1 month after PKP treatment were significantly worse compared to those without FI. It showed the same trend in VAS and ODI scores in patients with severe FI when compared to those patients with non-severe FI.
CONCLUSIONS
FI is not rare in OVF patients and presents multiple levels of involvement. The more serious trauma suffered, the more severe thoracolumbar fascia injury presented. The presence of FI which was related to residual acute back pain significantly affected the effectiveness of PKP in treating OVFs.
TRIAL REGISTRATION
retrospectively registered.
Topics: Humans; Spinal Fractures; Spine; Osteoporotic Fractures; Kyphoplasty; Fascia
PubMed: 36879207
DOI: 10.1186/s12891-023-06280-6 -
Sovremennye Tekhnologii V Meditsine 2021Intermediate transpedicular fixation, i.e. additional insertion of transpedicular screws into the injured vertebrae, is an improvement to the most popular surgical...
UNLABELLED
Intermediate transpedicular fixation, i.e. additional insertion of transpedicular screws into the injured vertebrae, is an improvement to the most popular surgical intervention for spinal injuries, currently gaining widespread use in clinical practice. Unilateral insertion of transpedicular screws into the injured vertebrae allows combining the advantages of intermediate transpedicular fixation with the possibility to perform anterior column support without remounting the transpedicular system. was to use biomechanical computer modeling for evaluating the stability of intermediate transpedicular fixation components, which allow performing anterior column support if necessary.
MATERIALS AND METHODS
DICOM files obtained during CT scan of a patient with intermediate thoracolumbar spine injury and the ANSYS software were used. Stability of the transpedicular system and supportability of the complementary Mesh implant installed with unilateral intermediate transpedicular screws were evaluated using computer modeling based on the finite element method.
RESULTS
The values of stress and displacement fields for spine-hardware systems with various arrangements have been obtained. The maximum loads exceeding bone tissue strength (153-161 MPa) were registered for standard 4-screw system (190 MPa) when modeling the load equivalent for walking and falling from a standing position. The use of the proposed fixation system arrangement supplemented with intermediate screws allows obtaining loads in the spine-hardware system not exceeding these thresholds. Complementary eccentric Mesh implant enhances fixation stability of the transpedicular system with intermediate screws.
CONCLUSION
The results show the high degree of mechanical stability of the proposed hardware arrangement and its potential efficacy for thoracolumbar transitional vertebra stabilization.
Topics: Fracture Fixation, Internal; Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Vertebrae; Treatment Outcome
PubMed: 34795990
DOI: 10.17691/stm2020.12.4.04 -
Journal of Orthopaedic Surgery and... Jan 2023Spinal cord injuries are extremely debilitating and fatal injuries. There is currently little research focusing on traumatic spinal cord injuries, and there is little...
BACKGROUND
Spinal cord injuries are extremely debilitating and fatal injuries. There is currently little research focusing on traumatic spinal cord injuries, and there is little information available about the epidemiological characteristics of patients with traumatic spinal cord injury (TSCI).
OBJECTIVE
To describe the epidemiological features of traumatic spinal cord injury in Wuhan, China.
DESIGN
A retrospective hospital-based study.
SETTING
Rehabilitation department of Wuhan's Tongji Hospital.
PARTICIPANTS
People who had been diagnosed with a traumatic spinal cord injury (TSCI) were admitted to Tongji Hospital from 2016 to 2021 (n = 463).
INTERVENTIONS
Not applicable.
OUTCOME MEASURES
Epidemiological features such as sex, age, marital status, etiology, occupation, neurological level of injury, and the American Spinal Injury Association Impairment Scale on admission, hospitalization, and concomitant injuries were collected.
RESULTS
The mean age of patients with TSCI was 39.4 ± 14.3 years, and the male/female ratio was 3:1. The leading causes of TSCIs were traffic accidents (38.4%), followed by falls (low falls 24.0%, high falls 13.2%). The most common injury site was the cervical spinal cord, followed by the thoracolumbar level. Of all patients, 463 patients (67.2%) had complications and other injuries. During the hospitalization period, a total of 217 patients experienced complications, with a percentage of 46.9%. Urinary tract infection was the most common (15.6%), followed by pulmonary infection (14.0%).
CONCLUSION
The results found that the proportion of males was greater, and the first two main reasons were falls and traffic accidents. Farmers and workers are the occupations most vulnerable to SCI. We need to pay more attention to the elderly's risk of falling. These findings suggested that preventive strategies should be based on the features of different types of TSCI patients. Finally, the importance of SCI rehabilitation must be highlighted.
Topics: Humans; Male; Female; Aged; Adult; Middle Aged; Retrospective Studies; Spinal Cord Injuries; Accidents, Traffic; China; Spinal Injuries; Incidence
PubMed: 36717867
DOI: 10.1186/s13018-023-03554-6