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British Journal of Sports Medicine Jun 2012Severe cervical spine injury in rugby union (rugby) exerts a major impact on the individual who sustains the injury and on the broader society. Since the late 1970s,... (Review)
Review
BACKGROUND
Severe cervical spine injury in rugby union (rugby) exerts a major impact on the individual who sustains the injury and on the broader society. Since the late 1970s, authors of rugby case report studies have postulated that the underlying mechanism of cervical spine injury is hyperflexion of the neck. However, this is in conflict with findings from more recent experimental studies. These have shown that it is more likely that the majority of cervical spine injuries occur due to buckling of the cervical spinal column.
OBJECTIVE
To investigate the primary mechanism of cervical spine injury in rugby.
METHODS
A comprehensive and systematic review of the literature was undertaken. Six key factors were identified and subsequently used to investigate the two principally postulated mechanisms of cervical spine injury: hyperflexion and buckling.
RESULTS
Facet dislocations, in particular bilateral facet dislocations, were identified as the most common types of cervical spine injury in rugby. Trauma occurred most often at lower cervical spinal levels, notably the C4/5 and C5/6 motion segments. Experimental studies demonstrate that bilateral facet dislocations occurring at the lower cervical spinal levels are primarily produced via buckling.
CONCLUSION
Our analysis of key factors for cervical spine injury in rugby shows that it is unlikely that the majority of injuries occur after hyperflexion of the neck. It appears more likely that they are the result of buckling of the cervical spinal column.
Topics: Cervical Vertebrae; Football; Humans; Joint Dislocations; Spinal Cord Injuries
PubMed: 22378840
DOI: 10.1136/bjsports-2011-090360 -
Acta Neurochirurgica Sep 2023To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades.
METHODS
We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries).
RESULTS
Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9-22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI-related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028).
CONCLUSION
A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.
Topics: Humans; Hospital Mortality; Cervical Cord; Prospective Studies; Retrospective Studies; Neck Injuries; Spinal Cord Injuries; Methylprednisolone
PubMed: 37480505
DOI: 10.1007/s00701-023-05720-5 -
Annals of Internal Medicine Mar 2015Cervical spine clearance protocols are controversial for unconscious patients after blunt traumatic injury and negative findings on computed tomography (CT). (Review)
Review
BACKGROUND
Cervical spine clearance protocols are controversial for unconscious patients after blunt traumatic injury and negative findings on computed tomography (CT).
PURPOSE
To review evidence about the utility of different cervical spine clearance protocols in excluding significant cervical spine injury after negative CT results in obtunded adults with blunt traumatic injury.
DATA SOURCES
MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library were searched from January 2000 through November 2014.
STUDY SELECTION
English-language studies that examined patients with negative CT results having confirmatory routine testing with magnetic resonance imaging (MRI), dynamic radiography, or clinical examination and that reported outcome measures of missed cervical spine injury, need for operative stabilization, or prolonged use of cervical collars.
DATA EXTRACTION
Independent reviewers evaluated the quality of studies and abstracted the data according to a predefined protocol.
DATA SYNTHESIS
Of 28 observational studies (3627 patients) that met eligibility criteria, 7 were prospective studies (1686 patients) with low risk of bias and well-interpreted, high-quality CT scans. These 7 studies showed that 0% of significant injuries were missed after negative CT results. The overall studies using confirmatory routine testing with MRI showed incidence rates of 0% to 1.5% for cervical spine instability (16 studies; 1799 patients), 0% to 7.3% for need for operative fixation (17 studies; 1555 patients), and 0% to 29.5% for prolonged collar use (16 studies; 1453 patients).
LIMITATIONS
Most studies were retrospective. Approaches to management of soft tissue changes with collars varied markedly.
CONCLUSION
Cervical spine clearance in obtunded adults after blunt traumatic injury with negative results from a well-interpreted, high-quality CT scan is probably a safe and efficient practice.
PRIMARY FUNDING SOURCE
None.
Topics: Cervical Vertebrae; Humans; Immobilization; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Unconsciousness; Wounds, Nonpenetrating
PubMed: 25775316
DOI: 10.7326/M14-2351 -
Spine May 2010Methodologic systematic review. (Review)
Review
Methodological systematic review: mortality in elderly patients with cervical spine injury: a critical appraisal of the reporting of baseline characteristics, follow-up, cause of death, and analysis of risk factors.
STUDY DESIGN
Methodologic systematic review.
OBJECTIVE
To determine the validity of reported risk factors for mortality in elderly patients with cervical spine injury.
SUMMARY OF BACKGROUND DATA
In elderly patients with cervical spine injury, mortality has frequently been associated with the type of treatment. To date, however, no review evaluating the validity of reported risk factors for mortality in elderly patients with cervical spine injury has been published.
METHODS
Studies evaluating the treatment of cervical spine injuries in elderly (>/=60 years of age) patients were searched through the Medline and EMBASE databases. In addition to standard methodologic details, reporting of putative confounding baseline characteristics and analysis of risk factors for mortality were appraised critically. For this purpose, patient data presented in included studies were pooled. Exploratory descriptive statistics were used for data analysis.
RESULTS
Twenty-six eligible studies were identified, including a total of 1550 pooled elderly subjects. Except for 2, all studies reported presence or absence of spinal cord injury. Details concerning the severity and/or extent of the injury were reported in 12 (46%) studies. Pre-existing comorbidities were reported in 9 studies (35%). In the pooled subjects, the cause of death was not reported in 155 of 335 deceased patients (42%). Based on own results, 18 (69%) studies reported on risk factors for mortality. Of these studies, 6 (23%) performed statistical analyses of risk factors for mortality outcomes. Only 1 study statistically adjusted potential risk factors for mortality for confounding.
CONCLUSION
Overall, pre-existing comorbidities, concomitant injuries, follow-up and cause of death have been underreported in studies investigating the treatment of cervical spine injuries in elderly patients. To strengthen the validity of risk factors for mortality in future clinical trials, adjustments for appropriately reported putative confounders by regression analysis are mandatory.
Topics: Age Factors; Aged; Cause of Death; Cervical Vertebrae; Comorbidity; Data Interpretation, Statistical; Follow-Up Studies; Humans; Mortality; Risk Factors; Spinal Cord Injuries; Spinal Injuries
PubMed: 20393400
DOI: 10.1097/BRS.0b013e3181bc9fd2 -
World Neurosurgery Nov 2023Our goal was to assess teriparatide's (TP) effectiveness in improving radiographic and functional outcomes after spinal fusion surgery. This meta-analysis included... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Our goal was to assess teriparatide's (TP) effectiveness in improving radiographic and functional outcomes after spinal fusion surgery. This meta-analysis included randomized controlled trials (RCTs) and comparative cohort studies. The findings provide valuable insights and guidance for surgeons treating osteoporotic patients undergoing spinal fusion surgery.
METHODS
We conducted a systematic review to assess TP's efficacy in spinal fusion surgery for osteoporosis. Through thorough selection, data extraction, and quality assessment, we employed network meta-analysis to evaluate radiographic outcomes (fusion rate, screw loosening, vertebral fracture) and changes in bone mineral density measured by Hounsfield units. Functional outcomes were assessed using the Oswestry Disability Index scales. Our study aims to comprehensively understand TP's impact and effectiveness in spinal fusion surgery.
RESULTS
A total of 868 patients were included in the analysis. All patients underwent thoracolumbar internal fixation fusion surgery and were divided into following 2 groups: the TP treatment group and the control group. The results revealed significant differences in radiological outcomes. The fusion rate showed a significant difference, as well as screw loosening, and bone mineral density measured in Hounsfield units. However, there was no significant difference in vertebral fracture. The TP group demonstrated favorable effects with statistical significance. In terms of functional outcomes, there was no significant difference in the assessment of Oswestry Disability Index scores between the 2 treatment groups.
CONCLUSIONS
The meta-analysis demonstrated that the TP group exhibited significantly better outcomes, particularly in radiological measures, when compared to the control group. The use of TP in spinal fusion surgery shows promise in reducing postoperative complications and providing overall benefits.
Topics: Humans; Teriparatide; Spinal Fractures; Spinal Fusion; Osteoporosis; Bone Density Conservation Agents; Lumbar Vertebrae; Treatment Outcome
PubMed: 37479030
DOI: 10.1016/j.wneu.2023.07.056 -
The Spine Journal : Official Journal of... 2009Vertebral artery (VA) injury can be a catastrophic iatrogenic complication of cervical spine surgery. Although the incidence is rare, it has serious consequences... (Review)
Review
BACKGROUND CONTEXT
Vertebral artery (VA) injury can be a catastrophic iatrogenic complication of cervical spine surgery. Although the incidence is rare, it has serious consequences including fistulas, pseudoaneurysm, cerebral ischemia, and death. It is therefore imperative to be familiar with the anatomy and the instrumentation techniques when performing anterior or posterior cervical spine surgeries.
PURPOSE
To provide a review of VA injury during common anterior and posterior cervical spine procedures with an evaluation of the surgical anatomy, management, and prevention of this injury.
STUDY DESIGN
Comprehensive literature review.
METHODS
A systematic review of Medline for articles related to VA injury in cervical spine surgery was conducted up to and including journal articles published in 2007. The literature was then reviewed and summarized.
RESULTS
Overall, the risk of VA injury during cervical spine surgery is low. In anterior cervical procedures, lateral dissection puts the VA at the most risk, so sound anatomical knowledge and constant reference to the midline are mandatory during dissection. With the development and rise in popularity of posterior cervical stabilization and instrumentation, recognition of the dangers of posterior drilling and insertion of transarticular screws and pedicle screws is important. Anomalous vertebral anatomy increases the risk of injury and preoperative magnetic resonance imaging and/or computed tomography (CT) scans should be carefully reviewed. When the VA is injured, steps should be taken to control local bleeding. Permanent occlusion or ligation should only be attempted if it is known that the contralateral VA is capable of providing adequate collateral circulation. With the advent of endovascular repair, this treatment option can be considered when a VA injury is encountered.
CONCLUSIONS
VA injury during cervical spine surgery is a rare but serious complication. It can be prevented by careful review of preoperative imaging studies, having a sound anatomical knowledge and paying attention to surgical landmarks intraoperatively. When a VA injury occurs, prompt recognition and management are important.
Topics: Cervical Vertebrae; Humans; Orthopedic Procedures; Spinal Injuries; Vertebral Artery
PubMed: 18504163
DOI: 10.1016/j.spinee.2008.03.006 -
Emergency Medicine Journal : EMJ Jan 2006Emergency airway management for trauma adults is practised by physicians from a range of training backgrounds and with differing levels of experience. The indications... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Emergency airway management for trauma adults is practised by physicians from a range of training backgrounds and with differing levels of experience. The indications for intubation and technique employed are factors that vary within EDs and between hospitals.
OBJECTIVES
To provide practical evidence based guidance for airway management in trauma resuscitation: first for the trauma adult with potential cervical spine injury and second the management when a difficult airway is encountered at intubation.
SEARCH STRATEGY AND METHODOLOGY
Full literature search for relevant articles in Medline (1966-2003), EMBASE (1980-2003), and the Cochrane Central Register of Controlled Trials. Relevant articles relating to adults and written in English language were appraised. English language abstracts of foreign articles were included. Studies were critically appraised on a standardised data collection sheet to assess validity and quality of evidence. The level of evidence was allocated using the methods of the Australian National Health and Medical Research Council.
Topics: Adult; Algorithms; Cervical Vertebrae; Emergencies; Emergency Service, Hospital; Evidence-Based Medicine; Humans; Intubation, Intratracheal; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Wounds and Injuries
PubMed: 16373795
DOI: 10.1136/emj.2004.020552 -
The American Journal of Emergency... May 2023Adults ≥ 65 are at risk of cervical spine (C-spine) injury, even after low-level falls. The objectives of this systematic review were to determine the prevalence of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adults ≥ 65 are at risk of cervical spine (C-spine) injury, even after low-level falls. The objectives of this systematic review were to determine the prevalence of C-spine injury in this population and explore the association of unreliable clinical exam with C-spine injury.
METHODS
We conducted this systematic review according to PRISMA guidelines. We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic reviews to include studies reporting on C-spine injury in adults ≥ 65 years after low-level falls. Two reviewers independently screened articles, abstracted data, and assessed bias. Discrepancies were resolved by a third reviewer. A meta-analysis was performed to estimate overall prevalence and the pooled odds ratio for the association between C-spine injury and an unreliable clinical exam.
RESULTS
The search identified 2044citations, 138 full texts were screened, and 21 studies were included in the systematic review. C-spine injury prevalence in adults ≥ 65 years after low-level falls was 3.8% (95% CI: 2.8-5.3). The odds of c-spine injury in those with altered level of consciousness (aLOC) v/s not aLOC was 1.21 (0.90-1.63) and in those with GCS < 15 v/s GCS 15 was 1.62 (0.37-6.98). Studies were at a low-risk of bias, although some had low recruitment and significant loss to follow-up.
CONCLUSIONS
Adults ≥ 65 years are at risk of cervical spine injury after low-level falls. More research is needed to determine whether there is an association between cervical spine injury and GCS < 15 or altered level of consciousness.
Topics: Humans; Adult; Consciousness Disorders; Spinal Injuries; Cervical Vertebrae
PubMed: 36893628
DOI: 10.1016/j.ajem.2023.02.008 -
Journal of Neurotrauma Dec 2023Although many frailty tools have been used to predict traumatic spinal injury (TSI) outcomes, identifying predictors of outcomes after TSI in the aged population is... (Meta-Analysis)
Meta-Analysis Review
Although many frailty tools have been used to predict traumatic spinal injury (TSI) outcomes, identifying predictors of outcomes after TSI in the aged population is difficult. Frailty, age, and TSI association are interesting topics of discussion in geriatric literature. However, the association between these variables are yet to be clearly elucidated. We conducted a systematic review to investigate the association between frailty and TSI outcomes. The authors searched Medline, EMBASE, Scopus, and Web of Science for relevant studies. Studies with observational designs that assessed baseline frailty status in individuals suffering from TSI published from inception until 26th March 2023 were included. Length of hospital stay (LoS), adverse events (AEs), and mortality were the outcomes of interest. Of the 2425 citations, 16 studies involving 37,640 participants were included. The modified frailty index (mFI) was the most common tool used to assess frailty. Meta-analysis was employed only in studies that used mFI for measuring frailty. Frailty was significantly associated with increased in-hospital or 30-day mortality (pooled odds ratio [OR]: 1.93 [1.19; 3.11]), non-routine discharge (pooled OR: 2.44 [1.34; 4.44]), and AEs or complications (pooled OR: 2.00 [1.14; 3.50]). However, no significant relationship was found between frailty and LoS (pooled OR: 3.02 [0.86; 10.60]). Heterogeneity was observed across multiple factors, including age, injury level, frailty assessment tool, and spinal cord injury characteristics. In conclusion, although there is limited data concerning using frailty scales to predict short-term outcomes after TSI, the results showed that frailty status may be a predictor of in-hospital mortality, AEs, and unfavorable discharge destination.
Topics: Humans; Aged; Frailty; Length of Stay; Patient Discharge; Hospital Mortality; Spinal Injuries; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 37432902
DOI: 10.1089/neu.2023.0008 -
Neurosurgical Review Feb 2020The biomechanical relationship between cranial and spinal structures makes concomitant injury likely. Concomitant cranio-spinal injuries are important to consider... (Meta-Analysis)
Meta-Analysis
The biomechanical relationship between cranial and spinal structures makes concomitant injury likely. Concomitant cranio-spinal injuries are important to consider following trauma due to the serious consequences of a missed injury. The objective of this review was to estimate the prevalence of concomitant cranio-spinal injury in the adult trauma population. A systematic search of MEDLINE and EMBASE databases to identify observational studies reporting the prevalence of concomitant cranio-spinal injury in the general adult trauma population was conducted on 21 March 2017. The prevalence of concomitant cervical spinal injury in patients with a traumatic brain injury (TBI); the prevalence of concomitant spinal injury in patients with a TBI; the prevalence of concomitant TBI in patients with a cervical spinal injury; and the prevalence of concomitant TBI in patients with a spinal injury were calculated by meta-analysis. Twenty-one studies met the inclusion criteria and were included in this review. The prevalence of concomitant cervical spinal injury in patients with a TBI was found to be 6.5% (95% CI 6.0-7.1%); the prevalence of concomitant spinal injury in patients with a TBI to be 12.4-12.5%; the prevalence of concomitant TBI in patients with a cervical spinal injury to be 40.4% (95% CI 33.0-48.0%); and the prevalence of concomitant TBI in patients with a spinal injury to be 32.5% (95% CI 10.8-59.3%). This review reports the prevalence of concomitant cranio-spinal injury and highlights the importance of considering concomitant injury in patients with a cranial or spinal traumatic injury.
Topics: Brain Injuries, Traumatic; Humans; Prevalence; Spinal Injuries
PubMed: 29882173
DOI: 10.1007/s10143-018-0988-3