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Tidsskrift For Den Norske Laegeforening... Jan 2010Knowledge of biomechanics and the cervical spine's anatomy has become more topical as the incidence of whiplash neck disorders has increased. Unfortunately, injuries... (Review)
Review
BACKGROUND
Knowledge of biomechanics and the cervical spine's anatomy has become more topical as the incidence of whiplash neck disorders has increased. Unfortunately, injuries after traffic accidents are often brought to court, where the medical expert's knowledge is of utmost importance to ensure a correct medical evaluation.
MATERIAL AND METHODS
The article is based on information identified through non-systematic searches of PubMed and on the author's experience as a professor of anatomy.
RESULTS
The cervical spine is particularly vulnerable to forces perpendicular to the length axis. Stability depends largely on the soft tissue. Injuries of soft tissue (especially in ligaments and intervertebral discs) may lead to instability and periosteal reaction with subsequent new formation of bone.
INTERPRETATION
The cervical spine is a relatively weak and vulnerable part of the body. One should consider locally restricted new formations of tissue with corresponding height reduction of the intervertebral disc as a sign of genuine injury.
Topics: Adult; Animals; Biological Evolution; Biomechanical Phenomena; Cervical Vertebrae; Child; Humans; Intervertebral Disc; Ligaments; Odontoid Process; Spinal Injuries
PubMed: 20094120
DOI: 10.4045/tidsskr.09.0296 -
Journal of Neurotrauma Mar 2014The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the... (Review)
Review
The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.
Topics: Cervical Vertebrae; Humans; Immobilization; Spinal Injuries
PubMed: 23962031
DOI: 10.1089/neu.2013.3094 -
European Journal of Sport Science 2013Overuse injuries are predominant in sports involving the repetition of similar movements patterns, such as in volleyball or beach volleyball, and they may represent as... (Review)
Review
Overuse injuries are predominant in sports involving the repetition of similar movements patterns, such as in volleyball or beach volleyball, and they may represent as much a problem as do acute injuries. This review discusses the prevalence of two of the most common overuse-related injuries in volleyball: shoulder and back/spine injuries. Risk factors and the aetiology of these injuries are illustrated in order to make possible to initiate preventive programme or post-injuries solutions. Data collected from literature showed a moderately higher injury rate for overuse shoulder injuries compared to the back/spine (19.0 ± 11.2% and 16.8 ± 9.7%, respectively). These data could be underestimated, and future epidemiological studies should consider overuse injuries separately from the others, with new methodological approaches. In addition to age, biomechanical and anatomical features of a volleyball technique utilised in game and the amount of hours played are considered as the main risk factors for overuse upper limb injuries, both for professional and recreational athletes. Together with post-injuries solutions, great importance has to be placed on preventive programmes, such as preventive rehabilitation, stretching, adequate warm up, strength-power exercises, etc. Furthermore, it is particularly suggested that coaches and players work together in order to develop new game/training techniques that minimise stresses and range of motion of the principal anatomical structures involved, while maintaining athletes performance.
Topics: Adolescent; Adult; Age Distribution; Back Pain; Biomechanical Phenomena; Cumulative Trauma Disorders; Female; Humans; Male; Risk Factors; Sex Distribution; Shoulder Injuries; Spinal Injuries; Volleyball; Young Adult
PubMed: 24251752
DOI: 10.1080/17461391.2013.773090 -
Radiologia Mar 2023Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular...
Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular involvement. The Canadian C-Spine Rule and the NEXUS criteria aim to identify individuals with a low risk of cervical spine trauma who can safely forgo imaging tests. In high-risk patients, an imaging test is indicated. In adult patients the imaging test of choice is multidetector computed tomography. Complementary imaging tests such as CT angiography of the supra-aortic vessels and/or magnetic resonance imaging are occasionally necessary. It can be challenging for radiologists to diagnose and classify these lesions, because some of them can be subtle and difficult to detect. This paper aims to describe the most important imaging findings and the most widely used classification systems.
Topics: Adult; Humans; Canada; Spinal Injuries; Magnetic Resonance Imaging; Cervical Vertebrae; Multidetector Computed Tomography
PubMed: 37024227
DOI: 10.1016/j.rxeng.2022.10.012 -
La Radiologia Medica Jan 2023Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma... (Review)
Review
Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma have a cervical spine injury. The cervical spine accounts for ~ 50% of all spinal injuries. Determination of CS stability is a common challenge in the acute care setting of patients with trauma. Several issues, indeed, are of particular concern: who needs CS imaging; what imaging should be obtained; when should computed tomography (CT), magnetic resonance imaging (MRI), or flexion/extension (F/E) radiographs be obtained; and how is significant ligamentous injury excluded in the comatose patient. CT and MRI both have roles to play. This article aims to present the different imaging to frame techniques to be used with greater precision in the acute event also for the purpose of planning the next therapeutic process. An overview of the applicability of the same methods in forensic pathology is also provided highlighting possible future biomarker to ease in diagnosis of acute TBI.
Topics: Humans; Spinal Injuries; Tomography, X-Ray Computed; Radiography; Magnetic Resonance Imaging; Wounds, Nonpenetrating; Cervical Vertebrae
PubMed: 36719553
DOI: 10.1007/s11547-022-01578-2 -
Magnetic Resonance Imaging Clinics of... Aug 2022This article is devoted to the MR imaging evaluation of spine emergencies, defined as spinal pathologic conditions that pose an immediate risk of significant morbidity... (Review)
Review
This article is devoted to the MR imaging evaluation of spine emergencies, defined as spinal pathologic conditions that pose an immediate risk of significant morbidity or mortality to the patient if not diagnosed and treated in a timely manner. MR imaging plays a central role in the timely diagnosis of spine emergencies. A summary of MR imaging indications and MR imaging protocols tailored for a variety of spinal emergencies will be presented followed by a review of key imaging findings for the most-encountered emergent spine pathologic conditions. Pathologic conditions will be broadly grouped into traumatic and atraumatic pathologic conditions. For traumatic injuries, a practical and algorithmic diagnostic approach based on the AO Spine injury classification system will be presented focused on subaxial spine trauma. Atraumatic spinal emergencies will be dichotomized into compressive and noncompressive subtypes. The location of external compressive disease with respect to the thecal sac is fundamental to establishing a differential diagnosis for compressive emergencies, whereas specific patterns of spinal cord involvement on MR imaging will guide the discussion of inflammatory and noninflammatory causes of noncompressive myelopathy.
Topics: Emergencies; Humans; Magnetic Resonance Imaging; Spinal Diseases; Spinal Injuries; Spine
PubMed: 35995469
DOI: 10.1016/j.mric.2022.04.004 -
BMC Musculoskeletal Disorders May 2023Thoracolumbar spine injury (TLSI) is a major concern worldwide despite its low prevalence. Studies demonstrate a gradual rise in annual incidence. There have been...
BACKGROUND
Thoracolumbar spine injury (TLSI) is a major concern worldwide despite its low prevalence. Studies demonstrate a gradual rise in annual incidence. There have been improvements in its management. However, a lot is still to be done. TLSI secondary to trauma usually occurs abruptly and leaves demeaning consequences, especially in our setting where the prognosis from several studies is poor. This study aimed to describe the etiology, management principles, and prognosis of TLSI in Douala General Hospital and as such contribute data on those aspects in the research community.
METHOD
This was a hospital-based five-year retrospective study. The study population was patients treated for TLSI in the Douala General Hospital from January 2014 to December 2018. Patients' medical records were used to retrieve data. Data analysis was done using SPSS Version 23. Logistic regression models were fitted to assess the association between dependent and independent variables. Statistical significance was set at 95% CI, with a P-value < 0.05.
RESULTS
We studied a total of 70 patients' files including 56 males. The mean age of occurrence of TLSI was 37.59 ± 14.07 years. The most common etiology was road traffic accidents (45.7%) and falls (30.0%). Half of our patients (n = 35) had an incomplete neurological deficit (Frankel B - D). Paraplegia was the most common motor deficit (42.9%). The lumbar spine was affected in 55.7% of cases. The most common CT scan finding was fracture of the vertebrae (30%) while the most reported MRI finding was disc herniation with contusion (38.5%). More than half (51.4%) of our patients were referred from peripheral health centers. The median arrival time was 48 h (IQR: 18-144) with 22.9% reporting after a week post-injury. Less than half (48.1%) benefited from surgery, and 41.4% of our population benefited from in-hospital rehabilitation. The median in-hospital delay time for surgery was 120 h (IQR: 66-192). While the median time between injury and surgery was 188 h (IQR: 144-347). The mortality rate was 5.7% (n = 4). Almost all (86.9%) of the patients developed complications and we had a 61.4% improvement in neurological status upon discharge. Being covered by health insurance was a predictor of improved neurological status (AOR = 15.04, 95%CI:2.90-78.20, P = 0.001) while being referred was a predictor of a stationary neurological status upon discharge (AOR = 0.12, 95%CI:0.03-0.52, P = 0.005). The average hospital stay was 20 days. We did not identify any predictors of lengthy hospital stay.
CONCLUSION
Road traffic accident is the most common etiology of TLSI. The arrival time to a neurosurgery specialized center after a traumatic injury, and the in-hospital delay time for surgery is high. Reduction of these delays, encouraging universal health insurance coverage, and improving on management to reduce complications would better the outcome of TLSI which is comparable with those in other studies.
Topics: Male; Humans; Young Adult; Adult; Middle Aged; Retrospective Studies; Cameroon; Spinal Injuries; Paraplegia; Lumbar Vertebrae
PubMed: 37189065
DOI: 10.1186/s12891-023-06481-z -
The Spine Journal : Official Journal of... Dec 2022Prior upper cervical spine injury classification systems have focused on injuries to the craniocervical junction (CCJ), atlas, and dens independently. However, no...
BACKGROUND CONTEXT
Prior upper cervical spine injury classification systems have focused on injuries to the craniocervical junction (CCJ), atlas, and dens independently. However, no previous system has classified upper cervical spine injuries using a comprehensive system incorporating all injuries from the occiput to the C2-3 joint.
PURPOSE
To (1) determine the accuracy of experts at correctly classifying upper cervical spine injuries based on the recently proposed AO Spine Upper Cervical Injury Classification System (2) to determine their interobserver reliability and (3) identify the intraobserver reproducibility of the experts.
STUDY DESIGN/SETTING
International Multi-Center Survey.
PATIENT SAMPLE
A survey of international spine surgeons on 29 unique upper cervical spine injuries.
OUTCOME MEASURES
Classification accuracy, interobserver reliability, intraobserver reproducibility.
METHODS
Thirteen international AO Spine Knowledge Forum Trauma members participated in two live webinar-based classifications of 29 upper cervical spine injuries presented in random order, four weeks apart. Percent agreement with the gold-standard and kappa coefficients (ƙ) were calculated to determine the interobserver reliability and intraobserver reproducibility.
RESULTS
Raters demonstrated 80.8% and 82.7% accuracy with identification of the injury classification (combined location and type) on the first and second assessment, respectively. Injury classification intraobserver reproducibility was excellent (mean, [range] ƙ=0.82 [0.58-1.00]). Excellent interobserver reliability was found for injury location (ƙ = 0.922 and ƙ=0.912) on both assessments, while injury type was substantial (ƙ=0.689 and 0.699) on both assessments. This correlated to a substantial overall interobserver reliability (ƙ=0.729 and 0.732).
CONCLUSIONS
Early phase validation demonstrated classification of upper cervical spine injuries using the AO Spine Upper Cervical Injury Classification System to be accurate, reliable, and reproducible. Greater than 80% accuracy was detected for injury classification. The intraobserver reproducibility was excellent, while the interobserver reliability was substantial.
Topics: Humans; Reproducibility of Results; Spinal Injuries; Cervical Vertebrae; Surgeons; Observer Variation
PubMed: 35964830
DOI: 10.1016/j.spinee.2022.08.005 -
Chinese Journal of Traumatology =... Aug 2020Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against... (Review)
Review
Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Cross Infection; Emergency Service, Hospital; Humans; Pandemics; Patient Care Team; Pneumonia, Viral; Practice Guidelines as Topic; SARS-CoV-2; Spinal Injuries; Transportation of Patients
PubMed: 32674856
DOI: 10.1016/j.cjtee.2020.06.003 -
European Spine Journal : Official... Oct 2013The AO Spine Classification Group was established to propose a revised AO spine injury classification system. This paper provides details on the rationale, methodology,...
PURPOSE
The AO Spine Classification Group was established to propose a revised AO spine injury classification system. This paper provides details on the rationale, methodology, and results of the initial stage of the revision process for injuries of the thoracic and lumbar (TL) spine.
METHODS
In a structured, iterative process involving five experienced spine trauma surgeons from various parts of the world, consecutive cases with TL injuries were classified independently by members of the classification group, and analyzed for classification reliability using the Kappa coefficient (κ) and for accuracy using latent class analysis. The reasons for disagreements were examined systematically during review meetings. In four successive sessions, the system was revised until consensus and sufficient reproducibility were achieved.
RESULTS
The TL spine injury system is based on three main injury categories adapted from the original Magerl AO concept: A (compression), B (tension band), and C (displacement) type injuries. Type-A injuries include four subtypes (wedge-impaction/split-pincer/incomplete burst/complete burst); B-type injuries are divided between purely osseous and osseo-ligamentous disruptions; and C-type injuries are further categorized into three subtypes (hyperextension/translation/separation). There is no subgroup division. The reliability of injury types (A, B, C) was good (κ = 0.77). The surgeons' pairwise Kappa ranged from 0.69 to 0.90. Kappa coefficients κ for reliability of injury subtypes ranged from 0.26 to 0.78.
CONCLUSIONS
The proposed TL spine injury system is based on clinically relevant parameters. Final evaluation data showed reasonable reliability and accuracy. Further validation of the proposed revised AO Classification requires follow-up evaluation sessions and documentation by more surgeons from different countries and backgrounds and is subject to modification based on clinical parameters during subsequent phases.
Topics: Consensus; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Practice Guidelines as Topic; Reproducibility of Results; Spinal Fractures; Thoracic Vertebrae; Trauma Severity Indices
PubMed: 23508335
DOI: 10.1007/s00586-013-2738-0