Imaging investigations in Spine Trauma: The value of commonly used imaging modalities and emerging imaging modalities

Upper Extremity Pseudoparalysis: A Case Report of Bilateral Nursemaid's Elbows

Radial head subluxation (RHS), commonly known as 'nursemaid's elbow,' typically presents in pediatric patients with acute-onset unilateral arm pain and pseudoparalysis. The classic mechanism of injury involves a longitudinal traction force pulling the radial head through the annular ligament. Bilateral RHS is exceedingly rare, with only a few cases documented in the literature; notably, all cases with a provided history and physical exam presented with the classic mechanism of injury, aiding in diagnosis and treatment. Here, we report the case of a two-year-old male with bilateral RHS who presented to the emergency department with bilateral upper extremity pain and weakness following an unwitnessed injury. This case required a broad differential diagnosis, including musculoskeletal injury, central cord syndrome, and spinal cord injury without radiographic abnormality (SCIWORA). It underscores the importance of considering RHS in differential diagnoses, even in atypical presentations, to ensure prompt and effective management.

Insights into pathophysiology, management, and outcomes of near-hanging patients: A narrative review

Hanging is suspension of a person by noose or ligature around the neck. Hanging has been used as a judicial execution method since medieval times and is still a common method of suicide in developing countries. The term "near hanging" is used for those who survive long enough to reach the hospital, and these patients still hold mortality as high as 45%. These patients can present with a wide array of complaints involving cardiovascular, neurologic, and pulmonary systems and local injuries to the airway and vascular structures. High serum lactate and cardiac arrest at arrival are some of the prognostic factors which portend a poor prognosis. Early admission and aggressive treatment are essential to provide best neurologic outcome. Due to paucity of definitive guidelines, therapy has to be based on clinical reports and expertise of the treating physician. Hence, near-hanging patients pose a great challenge in primary emergency care and intensive care management. This review aims to outline the pathophysiology, prognostic indicators, and recent evidence in the management of near-hanging patients.

Computed Tomographic Scan for Head Injury Patients: Any Justification for Adapting Routine Cranio-Cervical Examination Irrespective of Clinical Severity?

Background and Objective

This study aimed to assess the prevalence of concomitant cervical spine and head injury at our University Teaching Hospital in Nigeria and attempted to justify examining patients' head and cervical spine using computed tomography (CT) scan at presentation irrespective of the head injury severity by clinical assessment using Glasgow Coma Scale (GCS).

Patients and Methods

All eligible patients, 1-80 years of age who presented with head injuries in the accident and emergency (A&E) unit during the study period, were included if they satisfied the inclusion criteria. Post-resuscitation GCS was assessed clinically, and head and cervical spine injury (CSI) were observed radiologically on cranio-cervical CT scan for all patients. The presence of cervical spine fractures, subluxation or dislocation was considered a confirmation of CSI.

Results

There were 143 patients with head injuries studied; 90.2% of them were males. The mean age of the patients was 28.87 ± 15.93 years. The most common cause of injury was road traffic accidents in 110 (76.90%). The prevalence of CSI was 11.2%. Majority of the patients with CSI in this study (56.25%) had a mild head injury, 25% had a moderate head injury, and 18.75% had a severe head injury. The lower cervical spine was the most frequently injured segment in this study, involving 10 patients. Multi-level cervical vertebral body fractures of C3 to C6 were the most common form of CSI in this segment.

Conclusion

The prevalence of concomitant cervical spine and head injury was significant in this study. This was confirmed among study subjects with a clinical diagnosis of mild-to-moderate head injury as compared with moderate-to-severe head injury. Therefore, all patients who sustained a head injury irrespective of severity are required to have a complete and rapid evaluation of the cervical spine.

Relationship between spinal alignment and functional disability after thoracolumbar spinal fractures: A systematic review

Background

Thoracolumbar spinal fractures (TLSF) can cause pain, neurological deficits, and functional disability. Operative treatments aim to preserve neurological function, improve functional status, and restore spinal alignment and stability. In this review, we evaluate the relationship between spinal alignment and functional impairment in patients with TLSF.

Methods

We performed a systematic review in accordance with the PRISMA guidelines to identify full-text articles that evaluate the correlation between spinal alignment and functional outcomes of TLSF. The artificial intelligence software Rayyan assisted the screening process. Functional outcomes referred to activity/disability, quality of life, and pain scores, as well as return to work metrics. Radiological assessments included were vertebral compression angle, Cobb and Gardner angles, sagittal vertical axis, pelvic incidence, and pelvic tilt. Statistical analyses were performed for the data provided by articles using the SPSS v24.

Results

Of 1,616 articles reviewed, 6 were included for final analysis. Only 1 study primarily addressed the effects of spinopelvic parameters and functional outcomes. Four studies correlated Cobb angles with functional outcome, while 3 others compared vertebral compression angles with functional outcomes. Outcomes were assessed using work status or a combination of VAS pain and spine score, ODI, SF-36, and RMDQ-24. Neither the analysis done within the articles, nor the one made with the raw data provided by them, showed a significant correlation between the radiological measurements assessed at time of injury and final functional outcomes.

Conclusions

A correlation between the assessed spinal radiological measurements assessed with the functional outcomes of TLSF was not found in this review. Further well-designed prospective studies are necessary to evaluate spinal alignment measurements in TLSF with functional outcomes.

The hidden value of MRI: modifying treatment decisions in C-spine injuries

BACKGROUND DATA

Computed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED.

METHODS

We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into "c-spine injured" and "c-spine uninjured". Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers.

RESULTS

We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients' stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7-90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients.

CONCLUSION AND RELEVANCE

Our study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis.

Inter-observational analysis of computed tomography parameters to predict nonobvious posterior ligament complex injury in neurologically intact patients with thoracolumbar trauma

Introduction

Assessing the integrity of the posterior ligament complex (PLC), as a key element in the characterization of an unstable Thoracolumbar fracture (TLF), is challenging, but crucial in the choice of treatment.

Research question

How to create a reproducible score using combined parameters of Computed Tomography (CT) to predict nonobvious PLC injury. How CT parameters relate with PLC status.

Material and methods

Retrospective analysis of neurologically intact patients with an acute traumatic TLF, who underwent CT and Magnetic Resonance Imaging (MRI) within 72 h, in the Emergency Department of a single institution between January 2016 and 2022. Four investigators rated independently 11 parameters on CT and PLC integrity on MRI. The interrater reliability of the CT parameters was evaluated, and two risk scores were created to predict PLC injury on CT using the coefficients of the multivariate logistic regression.

Results

154 patients were included, of which 62 with PLC injury. All CT measurements had excellent or good interrater reliability. Patients with Horizontal Fracture of the lamina or pedicle (HLPF), Spinous process fracture (SPF) and Interspinous Distance Widening (IDW) were positively associated with PLC injury (p < 0.001, p < 0.001 and p = 0.045, respectively). Risk Score 2 (RS2), which included only statistically significant variables, had a total of 75.9% of correct classifications (p < 0.001), with a sensitivity of 71.0% and specificity of 78.3% to estimate PLC injury detected in the MRI.

Discussion and conclusion

Standardized procedures pre-established in the CT measurement protocol were effective. Identically to early findings, those three CT measurements showed a positive relation to PLC injury, thus enhancing the conclusions of previous studies. Comparing to the reliability of the CT findings above mentioned, the score was less precise.

Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm

Isolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality. Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.

Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis

BACKGROUND

Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma.

METHODS

A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology.

RESULTS

744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity.

CONCLUSIONS

Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma.

IMPLICATIONS OF KEY FINDINGS

Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.

Intraoperative neural monitoring during head and neck surgery in patients with concern for cervical spine instability

Cervical and craniocervical instability are associated with catastrophic procedural outcomes. We discuss three individuals who required otolaryngologic surgical intervention: two with symptomatic spinal instability and one in whom spinal stability was unable to be assessed. Two cases were managed with procedural positioning precautions and evoked potential monitoring, and the other with procedural positioning precautions alone. Methods of monitoring and triggers for repositioning are discussed. This series is intended to discuss the approach and potential added value of evoked potential monitoring for risk mitigation in pediatric patients with concern for cervical spine instability.

Plain radiography has a role to play in current clinical practice in Western Switzerland

AIM

The aim of the study was to investigate the current role of conventional radiography examinations in Western Switzerland and the main clinical indications required to justify the use of this imaging examination.

METHODS

Ethical approval was obtained from Vaud Ethics committee (Ref 2020-00311). An online questionnaire was specifically designed and implemented on the data collection tool LimeSurvey composed of two parts: a) to characterise the participants' profile and their institutions and b) 169 projections for the different anatomical area (upper and lower limbs, pelvis, skull, spine, thorax, abdomen) were presented to collect data about the frequency and main clinical indications. Statistical analysis was performed using the software IBM SPSS® (Statistical Package for the Social Sciences) version 26.

RESULTS

Radiographers from 60% (26/43) of the invited institutions participated in this survey, mainly from Vaud region. The upper and lower limbs were the most commonly examined by using conventional radiography mainly for trauma and degenerative disorders. The thorax was also an anatomical area commonly explored by X-rays, so were the spine (cervical and lumbar lateral). The skull radiographs were rarely performed in clinical practice and some of the projections were not being used, namely Hirtz, Tangential Nose Bones, Worms and Caldwell's views.

CONCLUSIONS

Plain radiography is being used in clinical practice mainly for appendicular skeleton studies and for trauma and degenerative pathologies. Adaptations in radiographers' education and training and other healthcare professionals are needed to provide the judicious use of data that radiographs can give to better manage the patients' imaging pathway.

Cervical spine trauma - Evaluating the diagnostic power of CT, MRI, X-Ray and LODOX

BACKGROUND

Traumatic cervical spine (c-spine) injuries account for 10% of all spinal injuries. The c-spine is prone to injury by blunt acceleration/deceleration traumas. The Canadian C-Spine rule and NEXUS criteria guide clinical decision-making but lack consensus on imaging modality when necessary. This study aims to evaluate the sensitivity and specificity of CT, MRI, X-Ray, and, for the first time, LODOX-Statscan in identifying c-spine injuries in patients with blunt trauma and neck pain.

METHODS

We conducted a retrospective monocenter cohort study using patient data from the emergency department at Inselspital, Bern, Switzerland's largest level one trauma center. We identified patients presenting with trauma and neck pain during the recruitment period from 01.01.2012 to 31.12.2017. We included all patients that required a radiographic c-spine evaluation according to the NEXUS criteria. Certified spine surgeons reviewed each case, analyzed patient demographics, injury classification, trauma mechanism, and emergency management. The retrospective full case review was established as gold standard to decide whether the c-spine was injured. Sensitivity and specificity were calculated for CT, MRI, LODOX, and X-Ray imaging methods.

RESULTS

We identified 4996 patients, of which 2321 met the inclusion criteria. 91.3% (n = 2120) patients received a CT scan, 8.9% (n = 206) a MRI, 9.3% (n = 215) an X-ray, and 21.5% (n = 498) a LODOX scan. By retrospective case review, 186 participants were classified as injured. The sensitivity of CT was 88.6% (specificity 99%), and 89.8% (specificity 99.2%) with orthopedic surgeon consultation. MRI had a sensitivity of 88.5% (specificity of 96.9%); highlighting 14 cases correctly diagnosed as injured by MRI and misdiagnosed by CT. Projection radiography (36.4% sensitivity, 95.1% specificity) and LODOX (5.3% sensitivity, 100% specificity) were unsuitable for ruling out spinal injury.

CONCLUSION

While CT offers high sensitivity for detecting traumatic c-spine injury, MRI holds clinical significance in revealing injuries not recognized by CT in symptomatic patients. LODOX and projection radiography are insufficient for accurately ruling out c-spine injury. For patients with neurological symptoms, we recommend extended MRI use when CT scans are negative.

CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?

STUDY DESIGN

Cross-sectional survey.

OBJECTIVES

Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture.

METHODS

A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures.

RESULTS

There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%.

CONCLUSIONS

Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.

Virtual CT Myelography: A Patch-Based Machine Learning Model to Improve Intraspinal Soft Tissue Visualization on Unenhanced Dual-Energy Lumbar Spine CT

Background: Distinguishing between the spinal cord and cerebrospinal fluid (CSF) non-invasively on CT is challenging due to their similar mass densities. We hypothesize that patch-based machine learning applied to dual-energy CT can accurately distinguish CSF from neural or other tissues based on the center voxel and neighboring voxels. Methods: 88 regions of interest (ROIs) from 12 patients’ dual-energy (100 and 140 kVp) lumbar spine CT exams were manually labeled by a neuroradiologist as one of 4 major tissue types (water, fat, bone, and nonspecific soft tissue). Four-class classifier convolutional neural networks were trained, validated, and tested on thousands of nonoverlapping patches extracted from 82 ROIs among 11 CT exams, with each patch representing pixel values (at low and high energies) of small, rectangular, 3D CT volumes. Different patch sizes were evaluated, ranging from 3 × 3 × 3 × 2 to 7 × 7 × 7 × 2. A final ensemble model incorporating all patch sizes was tested on patches extracted from six ROIs in a holdout patient. Results: Individual models showed overall test accuracies ranging from 99.8% for 3 × 3 × 3 × 2 patches (N = 19,423) to 98.1% for 7 × 7 × 7 × 2 patches (N = 1298). The final ensemble model showed 99.4% test classification accuracy, with sensitivities and specificities of 90% and 99.6%, respectively, for the water class and 98.6% and 100% for the soft tissue class. Conclusions: Convolutional neural networks utilizing local low-level features on dual-energy spine CT can yield accurate tissue classification and enhance the visualization of intraspinal neural tissue.

Diagnosis, management and outcome of Spinal Cord Injury without Radiographic Abnormalities (SCIWORA) in adult patients with trauma: a case series

Background: Spinal cord injury without radiographic abnormality (SCIWORA) in adults causes diagnostic and prognostic dilemma as radiography and/or computed tomography does not clearly detect bone lesions during the initial assessment. Herein, we report our experience on 11 spinal cord injury cases without radiographic abnormality, regarding the clinicoradiological features, management, and outcomes.

Methods: We conducted a case series of adult patients with SCIWORA who were admitted at the level 1 trauma center at Hamad General Hospital from January 2008 to July 2018. All patients underwent initial head and spine X-ray imaging, computed tomography, magnetic resonance imaging, and 12 months of clinical follow-up.

Results: Eleven patients (mean age, 46.5 ± 14.4 years) met the criteria of SCIWORA. The neurologic status on admission and 12 months after hospital discharge were classified according to the American Spinal Injury Association (ASIA) impairment scale (AIS). On admission, 6 (54.5%) patients had ASIA grade C: 2 (18.2%) each had AIS grade D and B and 1 (9.1%) had AIS grade A. Five cases were treated conservatively with rehabilitation and physiotherapy, and five were treated surgically by anterior cervical discectomy with fusion. One patient who declined surgery was managed with a sternal occipital mandibular immobilizer brace and underwent rehabilitation.

Conclusion: SCIWORA requires higher clinical suspicion and thorough neurological and radiologic assessment to prevent secondary spinal cord injuries and complications.

Prediction Score for Cervical Spine Fracture in Patients with Traumatic Neck Injury

Background

Cervical spine fracture is approximately 2%-5%. Diagnostic imaging in developing countries has several limitations. A computed tomography scan is not available 24 hours and not cost-effective. This study aims to develop a clinical tool to identify patients who must undergo a computed tomography scan to evaluate cervical spine fracture in a noncomputed tomography scan available hospital.

Methods

The study was a diagnostic prediction rule. A retrospective cross-sectional study was conducted between August 1, 2016, and December 31, 2018, at the emergency department. This study included all patients aged over 16 years who had suspected cervical spine injury and underwent a computed tomography scan at the emergency department. The predictive model and prediction scores were developed via multivariable logistic regression analysis.

Results

375 patients met the criteria. 29 (7.73%) presented with cervical spine fracture on computed tomography scan and 346 did not. Five independent factors (i.e., high-risk mechanism of injury, paraparesis, paresthesia, limited range of motion of the neck, and associated chest or facial injury) were considered good predictors of C-spine fracture. The clinical prediction score for C-spine fracture was developed by dividing the patients into three probability groups (low, 0; moderate, 1-5; and high, 6-11), and the accuracy was 82.52%. In patients with a score of 1-5, the positive likelihood ratio for C-spine fracture was 1.46. Meanwhile, those with a score of 6-11 had an LR+ of 7.16.

Conclusion

In a noncomputed tomography scan available hospital, traumatic spine injuries patients with a clinical prediction score ≥1 were associated with cervical spine fracture and should undergo computed tomography scan to evaluate C-spine fracture.

Prevalence of Fractures and Diagnostic Accuracy of Emergency X-ray in Older Adults Sustaining a Low-Energy Fall: A Retrospective Study

BACKGROUND

Plain radiography (XR) series are standard of care for detection of fall-related fractures in older patients with low-energy falls (LEF) in the emergency department (ED). We have investigated the prevalence of fractures and diagnostic accuracy of XR imaging in the ED.

METHODS

2839 patients with LEF, who were presented to two urban level I trauma centers in 2016 and received XR and computed tomography (CT), were consecutively included in this retrospective cohort study. The primary endpoint was the prevalence of fractures of the vertebral column, rib cage, pelvic ring, and proximal long bones. Secondary endpoints were diagnostic accuracy of XR for fracture detection with CT as reference standard and cumulative radiation doses applied.

RESULTS

Median age was 82 years (range 65-105) with 64.1% female patients. Results revealed that 585/2839 (20.6%) patients sustained fractures and 452/2839 (15.9%) patients received subsequent XR and CT examinations of single body regions. Cross-tabulation analysis revealed sensitivity of XR of 49.7%, a positive likelihood ratio of 27.6, and negative likelihood ratio of 0.5.

CONCLUSIONS

XR is of moderate diagnostic accuracy for ruling-out fractures of the spine, pelvic ring, and rib cage in older patients with LEF. Prospective validations are required to investigate the overall risk-benefit of direct CT imaging strategies, considering the trade-off between diagnostic safety, health care costs, and radiation exposure.

Management of multiple traumas in emergency medicine department: A review

One of the main causes of adults' disability during their working age is multiple trauma. The process of medical care of patients who are injured seriously is still a challenging job. The primary treatment of these patients in the emergency medicine departments is the most required choice after the wilderness first aid and also would be very required before definitive care in the hospital. The main aim of emergency medicine departments is quick recognition and treatment of injuries which pose severe threat to patients' life in appropriate order of priority. The procedure of primary evaluation in emergency medicine department with the help of medical routine examination and ultrasonography is based on the concept of focused assessment with sonography in trauma (FAST) for identifying spontaneous intraperitoneal hemorrhage. Emergency patients who suffer from massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest would undergo thoracotomy and patients who have few symptoms of perforated hollow viscous will undergo emergency laparotomy. Based on the trauma severity, emergency treatment could be the way to fast recovery of the structure of injured organ and its function. The subsequent goal, in the acute phase, will concentrate on preventing and stopping bleeding and secondary injuries like painful compartment syndrome or intra-abdominal infections (IAIs). However, the main aim of emergency medicine department in taking care of severely injured patients is the management of airway, protecting circulation and breathing, identification of neurologic problems, and whole body clinical examination with the help of healthcare providers.

Progression of Diagnostic Imaging Findings of a Patient With Traumatic Spondylolisthesis Secondary to Unilateral Facet Fractures: A Case Report

Objective

The purpose of this case study is to describe the diagnostic imaging studies of a patient who had a traumatic spondylolisthesis at L5-S1 secondary to unilateral facet fractures.

Clinical Features

A 21-year-old man experienced a rollover motor vehicle crash that led to low back pain and progressive left-sided radiculopathy. Later, he sought treatment from a doctor of chiropractic because he continued to have low back pain with progressive pain down his left leg. A magnetic resonance imaging study demonstrated a left paracentral disc protrusion at L5-S1. Follow-up computed tomography demonstrated multiple transverse process fractures and left-sided L5-S1 facet fractures with spondylolisthesis that progressed over time.

Intervention and Outcome

The patient was referred for a neurosurgical consultation 10 months after the injury. At 12 months after the injury, he underwent transforaminal lumbar interbody fusion with a posterior approach. The patient's pain and radicular symptoms resolved after the surgery.

Conclusion

This patient exhibited posterior element fractures, had continued symptom progression, and was monitored for the development of a spondylolisthesis. Because of progression and exacerbation of symptoms, neurosurgical consultation for surgical stabilization was mandated.

Preprocessing of Medical Image Data for Three-Dimensional Bioprinted Customized-Neural-Scaffolds

IMPACT STATEMENT

Nerve damage, which can be devastating, triggers several biological cascades, which result in the insufficiencies of the human nervous system to provide complete nerve repair and regain of function. Since no therapeutic strategy exists to provide immediate attention and intervention to patients with newly acquired nerve damage, we propose a strategy in which accelerated medical image processing through graphical processing unit implementation and three-dimensional printing are combined to produce a time-efficient, patient-specific (custom-neural-scaffold) solution to nerve damage. This work aims to beneficially shorten the time required for medical decision-making so that improved patient outcomes are achieved.