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Spinal Cord Series and Cases Jan 2022Retrospective cohort study.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVES
To study the incidence of concomitant calcaneum fractures in participants with traumatic spine fractures and to study the association of calcaneum injury with the mode of trauma, morphology and level of vertebral fracture and neurological status in participants with concomitant spine and calcaneum fracture.
SETTING
Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India.
METHODS
Records of participants with traumatic spine fractures were analyzed. Participants who had calcaneum fracture confirmed on radiographs were considered to have concomitant spine and calcaneum fracture. In these participants, variables noted were age, gender, mode of trauma, level and morphology of vertebral fracture and neurological status.
RESULTS
Concomitant calcaneum fracture was present in 43 participants out of a total of 358. The lumbar spine was involved in 72.09% of participants. 46.51% of participants had complete burst type of vertebral fractures. Neurology was found to be intact in 58.13% of participants. The association of concomitant calcaneum injury with the level of spine fracture and type of fracture were found to be statistically significant (p < 0.05). In particular, the association of concomitant calcaneal fracture with intact neurology and incomplete paraplegia (ASIA B, C or D) as compared to spinal injury cases without calcaneal fractures was statistically significant (p < 0.001).
CONCLUSION
Calcaneum fractures co-exist with spine fractures in 12.01% participants. Concomitant calcaneal fracture(s) with spine trauma indicate a greater chance of incomplete injury or intact neurology possibly due to dispersion of force vectors.
Topics: Calcaneus; Humans; Lumbar Vertebrae; Multiple Trauma; Retrospective Studies; Spinal Fractures
PubMed: 35013109
DOI: 10.1038/s41394-021-00473-8 -
Cancer Control : Journal of the Moffitt... Apr 2014Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures. (Review)
Review
BACKGROUND
Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures.
METHODS
A critical review of the medical literature was performed and controversial issues were analyzed.
RESULTS
Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized.
CONCLUSIONS
In cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure. Address.
Topics: Humans; Kyphoplasty; Spinal Fractures; Spinal Neoplasms; Treatment Outcome; Vertebroplasty
PubMed: 24667402
DOI: 10.1177/107327481402100208 -
Medicine Nov 2022Spinal fractures are common intra-articular fractures. Osteoporosis is a common and frequent disease among the elderly with a poor prognosis and a high risk of spinal...
Spinal fractures are common intra-articular fractures. Osteoporosis is a common and frequent disease among the elderly with a poor prognosis and a high risk of spinal fractures. However, the underlying factors for spinal fractures in patients with osteoporosis are unclear. A total of 105 patients with osteoporosis were recruited. Clinical and followed-up information was recorded. And vitamin B12, vitamin B2, vitamin A, and vitamin B9 in the blood were tested. Pearson's chi-squared and spearman tests were performed to analyze the correlation between spinal fractures and relative parameters. Univariate and multivariate logistic regression, univariate and multivariate Cox proportional hazards regression analysis. There exists strong relation between the expression level of vitamin B12 and spinal fractures. Pearson's chi-square and Spearman correlation test showed a strong association between vitamin B12 and vitamin B9 and a spinal fracture. Univariate logistic regression analysis showed that vitamin B12 and vitamin B9 were significantly associated with a spinal fracture. Multivariate logistic regression analysis showed that vitamin B12 was associated considerably with a spinal fracture. In addition, Cox regression analysis showed that vitamin B12 expression was significantly associated with maintenance time from recovery to recurrence (MTRR) of spinal fractures in patients with osteoporosis. Enhanced vitamin B12 is significantly correlated with the poor prognosis of patients with osteoporosis and the increasing incidence of a spinal fracture. The higher the vitamin B12, the higher the risk of spinal fracture and the shorter the time to spinal fracture recurrence.
Topics: Humans; Aged; Vitamin B 12; Spinal Fractures; Osteoporosis; Folic Acid; Biomarkers
PubMed: 36397346
DOI: 10.1097/MD.0000000000030796 -
Clinics (Sao Paulo, Brazil) Nov 2013The aim of this study was to review the literature on cervical spine fractures. (Review)
Review
OBJECTIVES
The aim of this study was to review the literature on cervical spine fractures.
METHODS
The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed.
RESULTS
Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures.
CONCLUSIONS
Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative.
Topics: Cervical Vertebrae; Female; Humans; Joint Dislocations; Male; Medical Illustration; Spinal Fractures
PubMed: 24270959
DOI: 10.6061/clinics/2013(11)12 -
The Journal of International Medical... Nov 2020Chronic pain and limited activities of daily living after spinal fracture may induce the occurrence of major depression (MD); however, risk factors regarding...
BACKGROUND
Chronic pain and limited activities of daily living after spinal fracture may induce the occurrence of major depression (MD); however, risk factors regarding medications, surgical intervention, and severity of fracture are unclear. We aimed to analyze risk factors of MD development after spinal fracture.
METHODS
This was a retrospective database study, using the health care database of the Taiwan government. We included 11,225 patients with new spinal fracture (study group), and 33,675 matched patients without fracture (comparison group). We respectively reviewed data of each participant for 3 years to assess the development of MD. The Cox proportional hazards model was used to determine the prevalence of MD, after adjusting for patient demographics, medications, surgical interventions, spinal cord involvement, and postfracture comorbidities.
RESULTS
In total, 187 fracture patients (1.7%) and 281 nonfracture patients (0.8%) developed new-onset MD (hazard ratio [HR]:1.96, (95% confidence interval [CI]: 1.63-2.36)). Spinal cord involvement (HR: 2.96, 95% CI: 2.54-3.42) and postfracture comorbidities (HR: 3.51, 95% CI: 2.86-3.97) obviously increased the risk of MD.
CONCLUSIONS
Patients with spinal fracture (spinal cord involvement and postfracture comorbidities) were more likely to develop MD. Early surgical interventions (vertebroplasty) and medications (narcotics) may decrease the risk of MD.
Topics: Activities of Daily Living; Depression; Depressive Disorder, Major; Humans; Retrospective Studies; Risk Factors; Spinal Fractures; Taiwan
PubMed: 33259260
DOI: 10.1177/0300060520972885 -
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 -
BMC Musculoskeletal Disorders Mar 2022Pelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical...
Patients with combined pelvic and spinal injuries have worse clinical and operative outcomes than patients with isolated pelvic injuries analysis of the German Pelvic Registry.
BACKGROUND
Pelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical outcome of pelvic fracture.
METHODS
We performed a retrospective analysis of data of patients registered in the German Pelvic Registry between January 2003 and December 2017. Clinical characteristics, surgical parameters, and outcomes were compared between patients with isolated pelvic fracture (group A) and patients with pelvic fracture plus spine injury (group B). We also compared apart patients with isolated acetabular fracture (group C) versus patients with acetabular fracture plus spine injury (group D).
RESULTS
Surgery for pelvic fracture was significantly more common in group B than in group A (38.3% vs. 36.6%; p = 0.0002), as also emergency pelvic stabilizations (9.5% vs. 6.7%; p < 0.0001). The mean time to emergency stabilization was longer in group B (137 ± 106 min vs. 113 ± 97 min; p < 0.0001), as well as the mean time until definitive stabilization of the pelvic fracture (7.3 ± 4 days vs. 5.4 ± 8.0 days; p = 0.147). The mean duration of treatment and the morbidity and mortality rates were all significantly higher in group B (p < 0.0001). Operation time was significantly shorter in group C than in group D (176 ± 81 min vs. 203 ± 119 min, p < 0.0001). Intraoperative blood loss was not significantly different between the two groups with acetabular injuries. Although preoperative acetabular fracture dislocation was slightly less common in group D, postoperative fracture dislocation was slightly more common. The distribution of Matta grades was significantly different between the two groups. Patients with isolated acetabular injuries were significantly less likely to have neurological deficit at discharge (94.5%; p < 0.0001). In-hospital complications were more common in patients with combined spine plus pelvic injuries (groups B and D) than in patients with isolated pelvic and acetabular injury (groups A and C).
CONCLUSIONS
Delaying definitive surgical treatment of pelvic fractures due to spinal cord injury appears to have a negative impact on the outcome of pelvic fractures, especially on the quality of reduction of acetabular fractures.
Topics: Hip Fractures; Humans; Pelvic Bones; Registries; Retrospective Studies; Spinal Fractures
PubMed: 35291994
DOI: 10.1186/s12891-022-05193-0 -
European Spine Journal : Official... May 2012To investigate the effect of treatment of multiple myeloma (MM)-associated spinal fracture with percutaneous vertebroplasty (PVP) and chemotherapy. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To investigate the effect of treatment of multiple myeloma (MM)-associated spinal fracture with percutaneous vertebroplasty (PVP) and chemotherapy.
METHODS
Patients with MM-associated spinal fracture were randomly divided into combined (PVP and chemotherapy) treatment group (n = 38) and single chemotherapy group (n = 38). For the combined treatment group, bone cement was injected into vertebral body via DSA guided-percutaneous puncture. M2 scheme was used for both groups. And a 5-year follow-up was conducted for the study.
RESULTS
At the 1-year follow-up visits, PVP combined with chemotherapy achieved complete remission (CR) in six patients (15.8%); near complete remission (nCR) in ten patients (26.30%); partial remission (PR) in nine patients (23.7%); minimal response (MR) in three patients (7.9%); no change (NC) in four patients (10.5%), and disease progression (DP) in five patients (13.2%). Only chemotherapy alone resulted in 3 CR (7.9%); 8 nCR (26.30%); 19 PR (77.5%); 4 MR (17.5%); 4 NC (17.5%), and 2 DP (5.0%). While the overall response rate (ORR) in the combined treatment group (65.8%) and the single chemotherapy group (50.0%) were significantly different, their visual analog pain scales (3.01 ± 0.62 and 5.97 ± 0.40, respectively) and Karnofsky performance scores (89.4 ± 6.3 and 80.3 ± 7.2, respectively) were significantly improved after treatment (P = 0.032 and P = 0.002, respectively). And the ORR between the two groups were significantly different (P = 0.001).
CONCLUSION
Percutaneous vertebroplasty is a minimally invasive surgery for MM-associated pathologic fracture. PVP had the characteristics of minimal trauma, easy operation and less complication. PVP can achieve long-term analgesic effect, and enhance the spinal stability.
Topics: Aged; Combined Modality Therapy; Disease Progression; Drug Therapy; Female; Fluoroscopy; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Karnofsky Performance Status; Longitudinal Studies; Male; Middle Aged; Minimally Invasive Surgical Procedures; Multiple Myeloma; Pain Measurement; Remission Induction; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 22173608
DOI: 10.1007/s00586-011-2105-y -
Calcified Tissue International Apr 2022To assess the potential influence of multifidus atrophy and fatty degeneration on the incidence of adjacent vertebral compression fractures within one year after the...
To assess the potential influence of multifidus atrophy and fatty degeneration on the incidence of adjacent vertebral compression fractures within one year after the index fracture. In a retrospective cohort study, patients who underwent surgery for an OVCF were identified and baseline characteristics, fracture patterns and the occurrence of secondary adjacent fractures within one year were obtained by chart review. Multifidus muscle atrophy and fatty degeneration were determined on preoperative MRI or CT scans. In this analysis of 191 patients (mean age 77 years, SD 8, 116 female), OF type 3 was the most common type of OVCF (49.2%). Symptomatic adjacent OVCFs within one year after index fracture were observed in 23/191 patients (12%) at mean 12, SD 12 weeks (range 1-42 weeks) postoperatively. The mean multifidus muscle area was 264, SD 53 mm in patients with an adjacent vertebral fracture and 271, SD 92 mm in patients without a secondary fracture (p = 0.755). Mean multifidus fatty infiltration was graded Goutallier 2.2, SD 0.6 in patients with an adjacent fracture and Goutallier 2.2, SD 0.7 in patients without an adjacent fracture (p = 0.694). Pre-existing medication with corticosteroids was associated with the occurrence of an adjacent fracture (p = 0.006). Multifidus area and multifidus fatty infiltration had no significant effect on the occurrence of adjacent vertebral fractures within one year after the index fracture. Patients with a pre-existing medication with corticosteroids were more likely to sustain an adjacent fracture.
Topics: Aged; Female; Fractures, Compression; Humans; Kyphoplasty; Male; Muscular Atrophy; Osteoporotic Fractures; Paraspinal Muscles; Retrospective Studies; Spinal Fractures; Treatment Outcome
PubMed: 34654940
DOI: 10.1007/s00223-021-00925-1 -
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