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Alve J, Huttunen J, Leinonen V, Jyrkkänen HK, Danner N. Outcome and complications of operatively treated subaxial cervical spine injuries: A population-based retrospective cohort study. World Neurosurg X 2024; 22:100283. [PMID: 38496346 PMCID: PMC10943471 DOI: 10.1016/j.wnsx.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Objective The aim was to study the outcome and complications of operative treatment for subaxial cervical spine injuries with respect to injury morphology and surgical strategy. Methods A population-based cohort of 271 consecutive patients treated at Kuopio University Hospital from 2003 to 2018 was retrospectively reviewed. Results The mean age was 52.4 (range 12-90) years and 78.6% were male. The AOSpine morphological classification was C in 56.5%, B in 24.7% and A in 17.0% of cases. The surgical approach was anterior in 70.8%, posterior in 20.3% and combined in 8.9% of patients. Fixation alignment was maintained in 96.9% of patients. Instrumentation failures were observed only in patients operated anteriorly but no statistical difference was found between the surgical approaches. The American Spinal Injury Association Impairment Scale (AIS) grade improved in 22.1% of patients. Patients with preoperative AIS grade C had significant potential for neurological improvement (OR 10.44; 95% CI 1.77-61.56; p = 0.010). Postoperative, mostly mild, complications manifested in 22.5% of patients. The posterior approach was associated with fewer postoperative complications (OR 0.18; 95% CI 0.06-0.51; p = 0.001). Preoperative AIS grade A was a significant predisposing factor for complications (OR = 4.90; 95% CI = 1.49-16.10; p = 0.009). The perioperative (90-day) mortality rate was 3.3%. The mean follow-up period was 64.7 ± 25.9 (radiological)/136.7 ± 174.8 (clinical) days. Conclusions Operative treatment is safe and effective but the surgical approach should be patient- and injury-specific. The prognosis for neurological recovery from spinal cord injury is superior in patients with partially preserved motor function.
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Affiliation(s)
- Joel Alve
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Henna-Kaisa Jyrkkänen
- Department of Neurosurgery, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Nils Danner
- Department of Neurosurgery, Neurocenter, Kuopio University Hospital, Kuopio, Finland
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2
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Bunzel EW, Gendelberg D. Classifications In Brief: The Allen and Ferguson Classification. Clin Orthop Relat Res 2024:00003086-990000000-01481. [PMID: 38271118 DOI: 10.1097/corr.0000000000002976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/08/2023] [Indexed: 01/27/2024]
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3
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Jo WR, Lee CY, Kwon SM, Kim CH, Kwon MY, Kim JH, Ko YS. Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review. Korean J Neurotrauma 2023; 19:409-421. [PMID: 38222835 PMCID: PMC10782099 DOI: 10.13004/kjnt.2023.19.e64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Odontoid fractures are treated surgically through the anterior or posterior approach. Each surgical approach has its advantages and disadvantages, so the preferred approach remains debatable. There are few meta-analyses or systemic reviews on the mechanical complications of surgical treatment for odontoid fractures. This meta-analysis aimed to compare the operation-related morbidity, including mechanical complications, and mortality of patients with odontoid fractures, treated via the anterior or posterior approach. Methods A systematic search was performed on PubMed/Medline, Embase, and the Cochrane Library for the studies up to October 2023 on the complication rate of the surgical treatment of odontoid fractures, related to the surgical approach. The risk ratios (RR) with the 95% confidence intervals (CIs) were pooled to assess the mechanical complication rates, other complications, revision surgery, and mortality, depending on the surgical approach. Results A total of 1,519 studies were retrieved using the search strategy, and 782 patients from 15 articles were included in this meta-analysis. Mechanical complications were significantly more frequent in the anterior surgical group with low heterogeneity. The incidences of fracture nonunion and revision surgery were also higher in the anterior surgery group. However, there was no significant difference in systemic complications and mortality rates between the two groups. Conclusion The posterior approach was more advantageous than the anterior approach in terms of mechanical complications, fusion rates, and incidence of revision surgery. However, further studies, should be performed to strengthen these results.
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Affiliation(s)
- Woong Rae Jo
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sae Min Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min-Yong Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jae Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
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Kumar A, Khandelwal A, Jamil S. Ventilatory Strategies in Traumatic Cervical Spinal Cord Injury: Controversies and Current Updates. Asian Spine J 2023; 17:615-619. [PMID: 37614075 PMCID: PMC10460671 DOI: 10.31616/asj.2023.0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 08/31/2023] Open
Abstract
Ventilatory management of patients with traumatic cervical spinal cord injury (CSCI) is a complex and controversial area of critical care medicine. Despite significant advances in our understanding of the pathophysiology of CSCI and the development of novel interventions, there remains a lack of consensus about the optimal approach to ventilatory management in these patients. Some of the key controversies in CSCI ventilatory management include timing of tracheal intubation, non-invasive ventilation versus invasive ventilation, high versus low tidal volume, and early versus late tracheostomy. The objective of this review is to discuss the existing controversies and provide an insight on the current evidence.
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Affiliation(s)
- Ashutosh Kumar
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Nagpur, India
| | - Ankur Khandelwal
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Shaista Jamil
- Department of Anaesthesiology and Critical Care, School of Medical Sciences and Research, Sharda University, Greater Noida, India
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Lin LC, Gupta R, McIntyre BB, Castillo EW, Kreshak AA, Vilke GM. Frequency and Outcomes of Cervical Spine Computed Tomography Imaging on Alcohol-Intoxicated Patients in the Emergency Department. J Emerg Med 2023; 64:121-128. [PMID: 36781341 DOI: 10.1016/j.jemermed.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/08/2022] [Accepted: 11/06/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND Cervical spinal (c-spine) injuries range greatly in severity from minor ligamentous injuries to osteoligamentous instability with spinal cord injuries. Initial evaluation begins with stabilization as needed and immediate immobilization. Current practice as to whether the c-spine can be cleared clinically without radiographic evaluation is often guided by using the National Emergency X-Radiography Utilization Study Low-Risk Criteria and the Canadian C-Spine Rule. Under these clinical decision guidelines, stable trauma patients presenting with alcohol intoxication cannot have the c-spine cleared clinically and imaging should be "considered." OBJECTIVE This study aimed to assess the frequency of computed tomography (CT) c-spine scans ordered for patients presenting with alcohol intoxication to the emergency department (ED), the timing of the studies, and subsequently determine the proportion of which showed a clinically significant result that required intervention. METHODS In this retrospective medical record review, all clinically alcohol-intoxicated patients presenting to two academic EDs were included. Overall demographic characteristics, time to order of CT imaging, radiology reads, and outcomes of patient visits were determined. RESULTS There were 8008 patient visits included in the study. Of these visits, 5 patients scanned in ≤3 h had acute findings on CT scan and no patients with a deferred timing of CT scan after patients metabolized had an acute finding on CT scan. No patients required operative management. CONCLUSIONS This study's results suggest that it is a safe clinical practice to defer CT imaging for patients presenting to the ED with alcohol intoxication and low suspicion for c-spine injury per history and examination.
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Affiliation(s)
- Lucia C Lin
- University of California San Diego School of Medicine, San Diego, California
| | - Rishi Gupta
- Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
| | - Brendan B McIntyre
- University of California San Diego School of Medicine, San Diego, California
| | - Edward W Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Allyson A Kreshak
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, California
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Fodor R, Voiță-Mekeres F, Cheregi CD, Indrieș M, Noor H, Pop NO, Marian P, Platona RI, Lascu CF, Marcu OA. Epidemiological Study on Spinal Cord Injuries in a Hospital from North-West of Romania. PHARMACOPHORE 2023. [DOI: 10.51847/ht5jip60uc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Lambrechts MJ, Schroeder GD, Karamian BA, Canseco JA, Oner FC, Benneker LM, Bransford RJ, Kandziora F, Rajasekaran S, El-Sharkawi M, Kanna R, Joaquim AF, Schnake K, Kepler CK, Vaccaro AR. Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System. J Neurosurg Spine 2023; 38:31-41. [PMID: 35986731 DOI: 10.3171/2022.6.spine22454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.
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Affiliation(s)
- Mark J Lambrechts
- 1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- 1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brian A Karamian
- 1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jose A Canseco
- 1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - F Cumhur Oner
- 2Department of Orthopedic Surgery, University Medical Center, University of Utrecht, The Netherlands
| | | | - Richard J Bransford
- 4Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | | | | | | | - Rishi Kanna
- 6Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Andrei Fernandes Joaquim
- 8Department of Neurology, Neurosurgery Division, State University of Campinas, São Paulo, Brazil
| | - Klaus Schnake
- 9Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany; and
- 10Department of Orthopedics and Traumatology, Paracelsus Private Medical University, Nuremberg, Germany
| | | | - Alexander R Vaccaro
- 1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Gelinne A, Abumoussa A, Bhowmick D. Case report: Minimally invasive modification of the Goel-Harms atlantoaxial fusion utilizing percutaneous screws and intra-articular cage is feasible and results in decreased blood loss. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:198-200. [PMID: 35837421 PMCID: PMC9274677 DOI: 10.4103/jcvjs.jcvjs_156_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/01/2022] [Indexed: 11/27/2022] Open
Abstract
Treatment of atlantoaxial pathology is often associated with significant morbidity and mortality. While surgical techniques for fixation are well established, approaches that minimize blood loss and muscle dissection are advantageous for expediting recovering and minimizing surgical risk. We present a 34-year-old female who presented with a Type III odontoid fracture requiring surgical fixation. She underwent a C1-2 fusion employing a novel minimally invasive modification of the Goel-Harms atlantoaxial fusion using percutaneous screws and intra-articular cage.
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Abstract
BACKGROUND Injuries of the cervical spine are quite common with an incidence of more than 3% in trauma patients. The incidence is even higher in elderly patients. Cervical spine injuries might induce severe neurological deficits. Therefore, they must be quickly and adequately diagnosed and treated. Depending on the pattern of injury, conservative or surgical treatment is indicated. OBJECTIVE The authors describe the different surgical strategies and treatment options based on the pattern of injury. Typical surgical methods are illustrated by case presentations. CONCLUSION Cervical spine injuries should be treated in a trauma centre with extensive expertise in spine surgery. The immobilisation and gentle transportation is important already at the scene of the accident. Nowadays, there are excellent surgical options and strategies available as well as excellent intensive care therapy. These possibilities lead to rapid and good stabilisation of cervical spine injuries and the posttraumatic morbidity and mortality can be reduced significantly especially in elderly patients.
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Karamian BA, Schroeder GD, Holas M, Joaquim AF, Canseco JA, Rajasekaran S, Benneker LM, Kandziora F, Schnake KJ, Öner FC, Kepler CK, Vaccaro AR. Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1635-1650. [PMID: 33797624 DOI: 10.1007/s00586-021-06818-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty. METHODS A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries. RESULTS A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment. CONCLUSION Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Andrei F Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | | | - Lorin M Benneker
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
| | - Frank Kandziora
- FK- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Klaus J Schnake
- Center for Spinal Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | | | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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Canseco JA, Schroeder GD, Patel PD, Grasso G, Chang M, Kandziora F, Vialle EN, Oner FC, Schnake KJ, Dvorak MF, Chapman JR, Benneker LM, Rajasekaran S, Kepler CK, Vaccaro AR. Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:517-523. [PMID: 32700126 DOI: 10.1007/s00586-020-06535-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. METHODS A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. RESULTS A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. CONCLUSION More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Parthik D Patel
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Michael Chang
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Frank Kandziora
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany
| | | | | | | | | | | | | | | | - Christopher K Kepler
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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Salaria A, Dagar A, Kumar V, Rangasamy K, Dhatt S. Epidemiology of cervical spine injury in Northern India: A retrospective study. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2021. [DOI: 10.4103/jodp.jodp_3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Surgical versus conservative treatment of unilateral subaxial non-subluxed facet fractures: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 199:106280. [PMID: 33080428 DOI: 10.1016/j.clineuro.2020.106280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Unilateral subaxial non-subluxed facet fractures (USNSFF) are a pathology seen in traumatic events such as motor vehicle accidents. Management involves either rigid collar bracing or surgical intervention. There currently is no consensus on the treatment of these injuries; this review aims to examine the extant data for recommendations as to which treatment is more effective. METHODS MEDLINE, Scopus, and the Cochrane trial register were all searched on January 16, 2020, comparing outcomes for surgical and conservative therapy for USNSFF. The meta-analysis examined rates of treatment failure (need for subsequent operative management) in conservative versus surgical management. The meta-analysis was performed using a random effects model, with visualization in forest and L'Abbé plots. RESULTS We identified six retrospective studies describing 270 patients, with three studies describing 137 patients used in the meta-analysis. Overall, a surgical success rate of 97.7 % and a non-operative success rate of 79.7 % was observed. A random effects model risk ratio of 1.66 (95 % CI: 0.61-4.52) was obtained, suggesting efficacy of surgical management over conservative management. CONCLUSION The need for surgical intervention subsequent to initial management in the treatment of USNSFF was found to be lower in surgical treatment in contrast to conservative management. However, the studies that were included in the meta-analysis had patient cohorts with much higher rates of neurological deficit and ligamentous injury on presentation, indicating that these may be prognostic indicators of conservative management failure. Furthermore, those that did fail conservative management did not develop severely debilitating conditions. Accordingly, conservative treatment is generally sufficient as a first step in a majority of cases of USNSFF lacking neurological deficit or ligamentous involvement.
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Abstract
Injuries to the subaxial cervical spine are increasing and have a high risk for neurological injury in comparison to the thoracic and lumbar spine. The current treatment recommendations according to the recommendations of the section spine of the German Society for Orthopaedics and Trauma (DGOU) and the S1 guidelines of the German Society for Trauma Surgery are summarized in this article. High-energy as well as low-energy trauma can cause a significant injury to the cervical spine. If there is a suspicion of a cervical spine injury, a tomographic imaging modality (CT/MRI) is the procedure of choice. Injuries should be classified according to the AOSpine classification for subaxial injuries. Based on this classification, a decision on a conservative or operative treatment regimen as well as individual details of the treatment can be made.
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16
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Unal TC, Aktoklu M, Gel MS, Dolen D, Dolas I. Spontaneous fusion several years after undiagnosed cervical distractive flexion injury: a report of 3 cases. Br J Neurosurg 2020:1-3. [PMID: 32436447 DOI: 10.1080/02688697.2020.1767283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report three cases of spontaneously fused distractive flexion injury (DFI) in the cervical spine detected several years after the trauma. This is the first report in the literature that describes such late presentation of healed DFI. Although injuries are considered highly unstable requiring fusion surgery, all three healed spontaneously without intervention or immobilization. Despite significant misalignment, stability was confirmed with flexion-extension radiographs. All the three patients had no neurologic deficits. The possibility of healed old DFI should be kept in mind for patients who present with neck pain and a history of high-energy trauma.
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Affiliation(s)
- Tugrul Cem Unal
- Department of Neurosurgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Aktoklu
- Department of Neurosurgery, Tunceli State Hospital, Tunceli, Turkey
| | - Mehmet Selim Gel
- Department of Neurosurgery, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Duygu Dolen
- Department of Neurosurgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Kiskämper A, Meyer C, Müller L, Eysel P, Christ H, Stein G. Subaxial Cervical Spine Injury in the Elderly and Treatment-Related Mortality - Anterior or Posterior Approach. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:266-273. [PMID: 32040968 DOI: 10.1055/a-1101-9884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Subaxial cervical spine injury especially in the elderly can be associated to severe complications and disability. Until today there is no consensus concerning the best operative treatment. A potential superiority of anterior or posterior fixation is the subject of controversial discussions. OBJECTIVES The aim of this study was to compare the outcome of anterior and posterior fixation after subaxial cervical spine trauma in the elderly focussing on the postoperative mortality. MATERIAL AND METHODS A retrospective cohort analysis was performed to analyse the data of 43 patients. Especially mortality data were collected. RESULTS A total of 43 patients was identified. Anterior fixation was performed in 21 patients, posterior fixation was performed in 22 patients. There were no significant differences between these groups. Although statistical significance was not reached, a slightly higher mortality was found among patients undergoing anterior fixation (52,4 vs. 31,8%). Furthermore the male sex, a higher age, translation injuries, long duration of operation and hospitalisation as well as postoperative complications were slightly associated to a higher mortality. CONCLUSIONS Subaxial cervical spine trauma is associated to a high mortality in the elderly. Although neither anterior nor posterior fixation could show a significant superiority, every surgical decision making should be performed individually for each patient balancing the advantages and disadvantages of each method.
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Affiliation(s)
- Anna Kiskämper
- Department for Orthopaedic and Trauma Surgery, Cologne University Hospital
| | - Carolin Meyer
- Department for Spinal Surgery, Dusseldorf Schoen Hospital
| | - Lars Müller
- Department for Orthopaedic and Trauma Surgery, Cologne University Hospital
| | - Peer Eysel
- Department for Orthopaedic and Trauma Surgery, Cologne University Hospital
| | - Hildegard Christ
- Institute for Medical Statistics and Bioinformatics, Cologne University
| | - Gregor Stein
- Department for Orthopaedic, Trauma and Spinal Surgery, Helios Hospital Siegburg
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Katar S, Aydin Ozturk P, Ozel M, Cevik S, Evran S, Baran O, Akkaya E, Asena M, Cetin A. Pediatric Spinal Traumas. Pediatr Neurosurg 2020; 55:86-91. [PMID: 32580195 DOI: 10.1159/000508332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although childhood trauma is a major cause of morbidity and mortality, the incidence of spinal trauma is significantly lower in children than in adults. Existing studies on pediatric spinal trauma (PST) largely concern cervical trauma because of its frequency of incidence. We aimed to obtain more information by examining all types of spinal trauma, and evaluating factors such as age, trauma type, injury type, and American Spinal Injury Association score and comparing them with data from the literature. METHODS We retrospectively reviewed 30 pediatric trauma patients with spinal pathology confirmed by spinal imaging. RESULTS The mean age was 166.4 months. Mean age for each mechanism of injury was: 142.7 months for a simple fall, 149.0 months for injury involving a foreign object, 163.5 months for a fall from a height, and 181.6 months for traffic accidents. There was no statistically significant difference in mean age for different mechanisms of injury (p = 0.372). The levels of the spinal injuries were: lumbar 53.3% (16), thoracic 26.6% (8), and cervical 20.0% (6). Mean age for each level of spinal injury was 113.3 months for the cervical area, 172.2 months for the thoracic area, and 183.3 months for the lumbar area. Mean age was found to be statistically significant (p = 0.000). DISCUSSION PST is uncommon and the type of trauma and the spinal level affected varies with age. Cervical trauma predominates at younger ages, but adult-like traumas begin to occur with increasing age. It should be considered that the risk of developing neurological deficits is higher in pediatric patients than in adults, and the risk of multisystem injury is also high.
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Affiliation(s)
- Salim Katar
- Department of Neurosurgery, Balikesir University, Balikesir, Turkey
| | - Pinar Aydin Ozturk
- Department of Neurosurgery, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey,
| | - Mehmet Ozel
- Department of Emergency Medicine, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
| | - Serdar Cevik
- Department of Neurosurgery, Memorial Sisli Hospital, Istanbul, Turkey
| | - Sevket Evran
- Department of Neurosurgery, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Oguz Baran
- Department of Neurosurgery, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Enes Akkaya
- Department of Neurosurgery, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Muhammet Asena
- Department of Pediatrics, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
| | - Abdurrahman Cetin
- Department of Neurosurgery, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
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Eren B, Karagoz Guzey F. Is spinal computed tomography necessary in pediatric trauma patients? Pediatr Int 2020; 62:29-35. [PMID: 31765499 DOI: 10.1111/ped.14064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/02/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND To investigate the prevalence of findings of spinal injury on computed tomography (CT) images of pediatric trauma patients and to define indicators for the possible presence of spinal injuries. METHODS Spinal CT for pediatric trauma patients (age ≤ 12 years) over a 2-year period was retrospectively evaluated for the presence of findings suggestive of spinal injury. RESULTS Of the 773 patients reviewed, 19 (2.4%) showed traumatic spinal lesions on their spinal CT images. These patients were significantly older than those without spinal lesions (mean age 7.9 ± 3.3 years vs 6.1 ± 3.3 years; P = 0.02). The prevalence of spinal trauma was significantly lower in patients aged 0-8 years than in those aged 9-12 years (P = 0.025). Spinal injury was significantly higher in female patients (P = 0.014). Most of the spinal injuries were located at the lumbar and sacral vertebral levels, and most did not cause neurological complications or require surgical treatment. Important indicators of the possible presence of spinal injuries were pain, tenderness, or ecchymosis over the spine, a low Glasgow Coma Scale score (≤12), head injury (for cervical injuries), or intrathoracic injuries and pelvic fractures (for lumbar and sacral injuries). CONCLUSIONS Most spinal CT examinations for the diagnosis of spinal injuries in children did not show positive findings. Thus, many children were exposed to an unnecessary high dose of radiation. New clinical evaluation criteria and indicators should be defined to diagnose spinal injuries and avoid unnecessary radiological examinations.
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Affiliation(s)
- Burak Eren
- Department of Neurosurgery, Bagcilar Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Feyza Karagoz Guzey
- Department of Neurosurgery, Bagcilar Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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20
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Wu X, Malhotra A, Geng B, Kalra VB, Abbed K, Forman HP, Sanelli P. Cost-effectiveness of Magnetic Resonance Imaging in Cervical Clearance of Obtunded Blunt Trauma After a Normal Computed Tomographic Finding. JAMA Surg 2019. [PMID: 29541757 DOI: 10.1001/jamasurg.2018.0099] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Magnetic resonance imaging (MRI) continues to be performed for cervical clearance of obtunded blunt trauma, despite poor evidence regarding its utility after a normal computed tomographic (CT) finding. Objective To evaluate the utility and cost-effectiveness of MRI vs no follow-up after a normal cervical CT finding in patients with obtunded blunt trauma. Design, Setting and Participants This cost-effectiveness analysis evaluated an average patient aged 40 years with blunt trauma from an institutional practice. The analysis used a Markov decision model over a lifetime horizon from a societal perspective with variables from systematic reviews and meta-analyses and reimbursement rates from the Centers for Medicare & Medicaid Services, National Spinal Cord Injury Database, and other large published studies. Data were collected from the most recent literature available. Interventions No follow-up vs MRI follow-up after a normal cervical CT finding. Results In the base case of a 40-year-old patient, the cost of MRI follow-up was $14 185 with a health benefit of 24.02 quality-adjusted life-years (QALY); the cost of no follow-up was $1059 with a health benefit of 24.11 QALY, and thus no follow-up was the dominant strategy. Probabilistic sensitivity analysis showed no follow-up to be the better strategy in all 10 000 iterations. No follow-up was the better strategy when the negative predictive value of the initial CT was relatively high (>98%) or the risk of an injury treated with a cervical collar turning into a permanent neurologic deficit was higher than 25% or when the risk of a missed injury turning into a neurologic deficit was less than 58%. The sensitivity and specificity of MRI were varied simultaneously in a 2-way sensitivity analysis, and no follow-up remained the optimal strategy. Conclusions and Relevance Magnetic resonance imaging had a lower health benefit and a higher cost compared with no follow-up after a normal CT finding in patients with obtunded blunt trauma to the cervical spine, a finding that does not support the use of MRI in this group of patients. The conclusion is robust in sensitivity analyses varying key variables in the model. More literature on these key variables is needed before MRI can be considered to be beneficial in the evaluation of obtunded blunt trauma.
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Affiliation(s)
- Xiao Wu
- currently a medical student at Yale School of Medicine, New Haven, Connecticut
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Bertie Geng
- currently a medical student at Yale School of Medicine, New Haven, Connecticut
| | - Vivek B Kalra
- Department of Radiology, Orlando Health, Orlando, Florida
| | - Khalid Abbed
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Department of Economics, Yale School of Medicine, New Haven, Connecticut.,Department of Management, Yale School of Medicine, New Haven, Connecticut.,Department of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Pina Sanelli
- Department of Radiology, Northwell Health, Manhasset, New York
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Dhakal GR, Bhandari R, Dhungana S, Poudel S, Gurung G, Kawaguchi Y, Riew KD. Review of Subaxial Cervical Spine Injuries Presenting to a Tertiary-Level Hospital in Nepal: Challenges in Surgical Management in a Third World Scenario. Global Spine J 2019; 9:713-716. [PMID: 31552151 PMCID: PMC6745644 DOI: 10.1177/2192568219833049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN Epidemiological retrospective study. OBJECTIVE To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country. METHODS Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days. RESULTS There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients. CONCLUSION Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.
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Affiliation(s)
- Gaurav Raj Dhakal
- National Trauma Center, Kathmandu, Nepal,Gaurav Raj Dhakal, National Trauma Center, Mahankal,
Kathmandu Province 3 14126, Nepal.
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22
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Khanpara S, Ruiz-Pardo D, Spence SC, West OC, Riascos R. Incidence of cervical spine fractures on CT: a study in a large level I trauma center. Emerg Radiol 2019; 27:1-8. [PMID: 31463806 DOI: 10.1007/s10140-019-01717-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/PURPOSE Though spinal fractures constitute a minority of all traumas, the financial burden imposed is immense especially following cervical spine trauma. There have been several papers in the past describing the incidence of cervical spine fractures. In this paper, we report the incidence of cervical spine fractures and correlate with demographic information and cause of injury and review the mechanism of fractures. MATERIALS AND METHODS We performed retrospective analysis of 934 patients who had undergone CT scan for cervical spine trauma at our institute which includes 16 hospitals and one level I trauma center over a period of 2 years. This list was created from a wider database of 13,512 patients imaged for suspected cervical spine injury. All patients who had at least one positive finding on CT were included in this study irrespective of any demographic difference. Each patient was analyzed by reviewing the medical records, and correlation was sought between demographics and cause of injury. RESULTS In our study, the peak incidence of cervical spine trauma was in the age group of 21-30 years followed by 31-40 years with a male:female ratio of 2.1. The major cause of injury in the study population was motor vehicle accidents (66.1%), followed by fall from height of less than 8 ft (12.2%). With regard to the ethnic distribution, Caucasians (46.9%) constituted the major population followed by Hispanic population (23.3%). C1 and C2 were observed to be more frequently fractured as compared with the subaxial spine. Incidence of C2 fractures (188 levels) was higher as compared with C1 (102 levels). Incidence of body and lateral mass fractures was marginally higher as compared with odontoid fractures. C7 (50 levels) was the most fractured vertebral body in the subaxial spine followed by C6 (35 levels) and C5. CONCLUSION Spinal trauma is on the rise and it helps to know the factors which can guide us for better management of these patients. We can utilize these results to prognosticate and streamline clinical management of these patients.
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Affiliation(s)
- Shekhar Khanpara
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States.
| | | | - Susanna C Spence
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States
| | - O Clark West
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States
| | - Roy Riascos
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States
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Glassman DM, Magnusson E, Agel J, Bellabarba C, Bransford RJ. The impact of stenosis and translation on spinal cord injuries in traumatic cervical facet dislocations. Spine J 2019; 19:687-694. [PMID: 30914130 DOI: 10.1016/j.spinee.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although facet dislocations account for only 6% of cervical trauma, the consequences are often devastating. Cervical facet dislocations are associated with a disproportionate amount of spinal cord injuries; however, neurologic examination of patients is often difficult, as patients commonly present with reduced levels of consciousness. There are limited studies that have investigated the impact of spinal canal diameter and translation on neurologic injury following facet dislocations. PURPOSE Review a consecutive series of patients with facet dislocations to assess the impact of sagittal diameter and translation on Spinal Cord Injury (SCI). STUDY DESIGN Retrospective review at a level I trauma center identified 97 patients with facet dislocations. METHODS Between 2004 and 2014, a retrospective review at a level I trauma center identified patients with traumatic facet dislocation. Demographic data, neurologic exams, and radiographic findings were reviewed. We assessed sagittal diameter at the injury level, as well as above and below, and translation. This study has no funding source and its authors have no potential conflicts of interest-associated biases. RESULTS Ninety-seven patients presented with facet dislocations. Fifty-nine (61%) presented with a SCI. Those with ASIA A averaged 8.0 mm of injury level canal diameter, and ASIA E averaged 12.6 mm (p < .001). Additionally, those with ASIA A averaged 8.0 mm of translation, and ASIA E averaged 4.2 mm (p < 0.001). Two groups were created based on their general motor function. Those with ASIA A-C averaged 8.4 mm of injury level canal diameter, and ASIA D-E averaged 12.3 mm (p < .001). Those with ASIA A-C averaged 7.8 mm of translation, and ASIA D-E averaged 4.4 mm (p < .001). Receiver operating characteristic (ROC) curves demonstrated that translation was a good predictor of ASIA A-C and canal diameter was an almost perfect predictor of ASIA D-E. CONCLUSIONS Our data indicate that patients with greater translation and/or a smaller canal diameter at the injury level have a higher rate of SCI. Adjacent canal diameter did not correlate with neurologic injury.
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Affiliation(s)
- David M Glassman
- Orthopaedic Department, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
| | - Erik Magnusson
- Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, WA 98104, USA
| | - Julie Agel
- Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, WA 98104, USA
| | - Carlo Bellabarba
- Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, WA 98104, USA
| | - Richard J Bransford
- Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, WA 98104, USA.
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Pehler S, Jones R, Staggers JR, Antonetti J, McGwin G, Theiss SM. Clinical Outcomes of Cervical Facet Fractures Treated Nonoperatively With Hard Collar or Halo Immobilization. Global Spine J 2019; 9:48-54. [PMID: 30775208 PMCID: PMC6362546 DOI: 10.1177/2192568218771911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVES To evaluate the rate of nonoperative treatment failure for cervical facet fractures while secondarily validating computed tomography-based criteria proposed by Spector et al for identifying risk of failure of nonoperative management. METHODS Single-level or multilevel unilateral cervical facet fractures from 2007 to 2014 were included. Exclusion criteria included spondylolisthesis, dislocated or perched facets, bilateral facet fractures at the same level, floating lateral mass, thoracic or lumbar spine injuries, or spinal cord injury. Patients were placed into 3 groups for evaluation: immediate operative management, successful nonoperative management, and failed nonoperative treatment requiring surgical intervention. RESULTS Eighty-eight patients (106 facets) were included. Twenty-one patients underwent operative treatment with anterior cervical discectomy and fusion or posterior spinal instrumentation and fusion without any failures. Sixty-seven of these patients were treated nonoperatively with either a hard collar (n = 62) or halo vest (n = 5). Eleven patients failed nonoperative treatment (16.4%), all with an absolute fracture height of at least 1 cm and 40% involvement of the absolute height of the lateral mass. Of the 56 patients successfully treated through nonoperative measures, 8 (14.3%) had fracture measurements exceeding both operative parameters. CONCLUSION We conclude that it is safe and appropriate for patients with unilateral cervical facet fractures to receive a trial period of nonoperative management. However, patients who weigh over 100 kg, have comminuted fractures, or have radiographic measurements outside of the proposed computed tomography criteria for nonoperative treatment should be educated on the risks of treatment failure.
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Affiliation(s)
| | - Ross Jones
- University of Alabama at Birmingham, AL, USA
| | - Jackson R. Staggers
- University of Alabama at Birmingham, AL, USA,Jackson R. Staggers, University of Alabama at Birmingham, 723 16th Ave S #723, Birmingham, AL 35205, USA.
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Yoganandan N, Chirvi S, Pintar FA, Banerjee A, Voo L. Injury Risk Curves for the Human Cervical Spine from Inferior-to-Superior Loading. STAPP CAR CRASH JOURNAL 2018; 62:271-292. [PMID: 30608997 DOI: 10.4271/2018-22-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cervical spine injuries can occur in military scenarios from events such as underbody blast events. Such scenarios impart inferior-to-superior loads to the spine. The objective of this study is to develop human injury risk curves (IRCs) under this loading mode using Post Mortem Human Surrogates (PMHS). Twenty-five PMHS head-neck complexes were obtained, screened for pre-existing trauma, bone densities were determined, pre-tests radiological images were taken, fixed in polymethylmethacrylate at the T2-T3 level, a load cell was attached to the distal end of the preparation, positioned end on custom vertical accelerator device based on the military-seating posture, donned with a combat helmet, and impacted at the base. Posttest images were obtained, and gross dissection was done to confirm injuries to all specimens. Axial and resultant forces at the cervico-thoracic joint was used to develop the IRCs using survival analysis. Data were censored into left, interval, and uncensored observations. The Brier score metric was used to rank the variables. The optimal metric describing the underlying response to injury was associated with the axial force, ranking slightly greater than the resultant force, both with BMD covariates. The results from the survival analysis indicated all IRCs are in the "fair" to "good" category, at all risk levels. The BMD was found to be a significant covariate that best describes the response of the helmeted head-neck specimens to injury. The present experimental protocol and IRCs can be used to conduct additional tests, matched-pair tests with the WIAMan and/or other devices to obtain injury assessment risk curves (IARCs) and injury assessment risk values (IARVs) to predict injury in crash environments, and these data can also be used for validating component-based head-neck and human body computational models.
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Affiliation(s)
- Narayan Yoganandan
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Sajal Chirvi
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Frank A Pintar
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Liming Voo
- Applied Physics Laboratory, Johns Hopkins University, Laurel, MD
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Wirbelsäulenimmobilisation bei Patienten mit schwerem Schädel-Hirn-Trauma – Einfach, praktisch. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0466-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O'Leary SA, Paschos NK, Link JM, Klineberg EO, Hu JC, Athanasiou KA. Facet Joints of the Spine: Structure–Function Relationships, Problems and Treatments, and the Potential for Regeneration. Annu Rev Biomed Eng 2018; 20:145-170. [DOI: 10.1146/annurev-bioeng-062117-120924] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The zygapophysial joint, a diarthrodial joint commonly referred to as the facet joint, plays a pivotal role in back pain, a condition that has been a leading cause of global disability since 1990. Along with the intervertebral disc, the facet joint supports spinal motion and aids in spinal stability. Highly susceptible to early development of osteoarthritis, the facet is responsible for a significant amount of pain in the low-back, mid-back, and neck regions. Current noninvasive treatments cannot offer long-term pain relief, while invasive treatments can relieve pain but fail to preserve joint functionality. This review presents an overview of the facet in terms of its anatomy, functional properties, problems, and current management strategies. Furthermore, this review introduces the potential for regeneration of the facet and particular engineering strategies that could be employed as a long-term treatment.
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Affiliation(s)
- Siobhan A. O'Leary
- Department of Biomedical Engineering, University of California, Davis, California 95616, USA
| | - Nikolaos K. Paschos
- Department of Orthopedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts 02115, USA
| | - Jarrett M. Link
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
| | - Eric O. Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California 95816, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, California 92617, USA
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Long-term clinical outcomes following surgical management of cervical spine fractures in elderly patients. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Cervical spine injuries are frequent and often caused by a blunt trauma mechanism. They can have severe consequences, with a high mortality rate and a high rate of neurological lesions.Diagnosis is a three-step process: 1) risk assessment according to the history and clinical features, guided by a clinical decision rule such as the Canadian C-Spine rule; 2) imaging if needed; 3) classification of the injury according to different classification systems in the different regions of the cervical spine.The urgency of treatment is dependent on the presence of a neurological lesion and/or instability. The treatment strategy depends on the morphological criteria as defined by the classification. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170076.
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Affiliation(s)
- Philipp Schleicher
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany
| | - Andreas Pingel
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany
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Thesleff T, Niskakangas T, Luoto T, Iverson GL, Öhman J, Ronkainen A. Preventable diagnostic errors in fatal cervical spine injuries: a nationwide register-based study from 1987 to 2010. Spine J 2018; 18:430-438. [PMID: 28822822 DOI: 10.1016/j.spinee.2017.08.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fall-induced injuries in patients are increasing in number, and they often lead to serious consequences, such as cervical spine injuries (CSI). CSI diagnostics remain a challenge despite improved radiological services. PURPOSE Our aim is to define the incidence and risk factors for diagnostic errors among patients who died following a CSI. STUDY DESIGN/SETTING A retrospective death certificate-based study of the whole population of Finland was carried out. PATIENT SAMPLE We identified 2,041 patients whose death was, according to the death certificate, either directly or indirectly caused by a CSI. OUTCOME MEASURES Demographics, injury- and death-related data, and adverse event (AE)-related data were the outcome measures. METHODS All death certificates between the years 1987 and 2010 from Statistics Finland that identified a CSI as a cause death were reviewed to identify preventable AEs with the emphasis on diagnostic errors. RESULTS Of the 2,041 patients with CSI-related deaths, 36.5% (n=744) survived at least until the next day. Errors in CSI diagnostics were found in 13.8% (n=103) of those who died later than the day of injury. Those with diagnostic errors were significantly older (median age 79.4 years, 95% confidence interval 75.9-80.1 vs. 74.9, 95% confidence interval 70.2-72.9, p<.001) and the mechanism of injury was significantly more often a fall (86.4%, n=89 vs. 69.7%, n=447, p=.002) compared with those who did not have a diagnostic error. The incidence of diagnostic errors increased slightly during the 24-year study period. CONCLUSIONS Cervical spine injury diagnostics remain difficult despite improved radiological services. The majority of the patients subjected to diagnostic errors are fragile elderly people with reduced physical capacity. In our analysis, preventable AEs and diagnostic errors were most commonly associated with ground-level falls.
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Affiliation(s)
- Tuomo Thesleff
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.
| | - Tero Niskakangas
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Teemu Luoto
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Center for Health and Rehabilitation Research, 79/96 Thirteenth Street, Charlestown Navy Yard, Charlestown, MA, 02129, Massachusetts, USA
| | - Juha Öhman
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
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Umana E, Khan K, Baig MN, Binchy J. Epidemiology and Characteristics of Cervical Spine Injury in Patients Presenting to a Regional Emergency Department. Cureus 2018; 10:e2179. [PMID: 29651372 PMCID: PMC5893180 DOI: 10.7759/cureus.2179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aims to establish the demographics and characteristics of patients with cervical spine injury (CSI) in an Irish cohort presenting to a regional emergency department. Methods We performed a retrospective analysis of the medical records of patients who underwent cervical spine computed tomography (CT) scans following trauma from January 2013 to July 2016. We looked at the mechanism of injury, mode of arrival to the emergency department, triage category, correlation between examination, and site of CSI and neurological status. Results Over the study period, 808 patients underwent CT scans of the cervical spine for potential CSI. The incidence of CSI in our cohort was 9.4% (n = 76). Approximately 70% (n = 53) were men. Falls (53%) and motor vehicle accidents (29%) were noted to be the more common mechanisms of injury in this cohort. The C2 region was the most common location for CSI. Only 7% (n = 5) of patients had documented neurology. Conclusion This study demonstrates the epidemiology and characteristics of CSI presenting in an Irish cohort. The incidence of CSI was found to be 9.4% with a male preponderance and falls being the most common cause of trauma.
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Affiliation(s)
- Etimbuk Umana
- Department of Emergency Medicine, University Hospital Galway
| | - Khalid Khan
- Department of Emergency Medicine, University Hospital Galway
| | - M N Baig
- Trauma & Orthopaedics, University Hospital Galway
| | - James Binchy
- Department of Emergency Medicine, University Hospital Galway
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Kinematics of the Cervical Spine After Unilateral Facet Fracture: An In Vitro Cadaver Study. Spine (Phila Pa 1976) 2017; 42:E1042-E1049. [PMID: 28146029 DOI: 10.1097/brs.0000000000002080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Biomechanical study utilizing human cadaveric cervical spines. OBJECTIVE To quantitatively assess the effects on intervertebral motion of isolated unilateral cervical facet fracture, and after disruption of the intervertebral disc at the same level. SUMMARY OF BACKGROUND DATA Clinical evidence has indirectly suggested that cervical facet fractures involving 40% of the height of the lateral mass can cause instability of the involved segment. No study to date has demonstrated the kinematic effects of such an injury in a cadaveric model of the cervical spine. METHODS Nine six-segment cervical spines were defrosted and fixated to a spine motion simulator capable to apply unconstrained bending moments in the three anatomical planes. The spines were subjected to a maximum torque of 2 N · m in flexion, extension, left and right lateral bending, and of 4 N · m in left and right axial rotation. Each spine was tested in the intact configuration (INTACT), and following two increasing degrees of injury at C4-C5: fracture of the facet (CF1), and CF1 with disruption of the intervertebral disc at the same level (CF2). Intervertebral kinematics was tracked via clusters of active markers fixated on each vertebra. Differences in kinematics between INTACT and the two injured configurations were assessed via one-way Analysis of Variance (P < 0.05). RESULTS No significant differences were detected between INTACT and CF1 across all kinematic parameters (P > 0.05) at C4-C5. CF2, however, resulted in significant increase of flexion, left axial rotation, and left lateral bending with respect to INTACT (flexion at C4-C5: INTACT = 8.7° ± 3.5°; CF2 = 14.3 ± 5.7; P < 0.05). CONCLUSION Our findings suggest that superior articular facet fractures alone involving 40% of the lateral mass may not necessarily result in intervertebral instability under physiologic loading conditions. The addition of partial injury to the intervertebral disc, however, resulted in statistically significant increase in angular displacement. LEVEL OF EVIDENCE N /A.
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Wu X, Malhotra A, Geng B, Liu R, Abbed K, Forman HP, Sanelli P. Cost-effectiveness of Magnetic Resonance Imaging in Cervical Spine Clearance of Neurologically Intact Patients With Blunt Trauma. Ann Emerg Med 2017; 71:64-73. [PMID: 28826754 DOI: 10.1016/j.annemergmed.2017.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/05/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE Use of magnetic resonance imaging (MRI) for cervical clearance after a negative cervical computed tomography (CT) scan result in alert patients with blunt trauma who are neurologically intact is not infrequent, despite poor evidence in regard to its utility. The objective of this study is to evaluate the utility and cost-effectiveness of using MRI versus no follow-up in this patient population. METHODS A modeling-based decision analysis was performed during the lifetime of a 40-year-old individual from a societal perspective. The 2 strategies compared were no follow-up and MRI. A Markov model with a 3% discount rate was used with parameters from the literature. Base cases and probabilistic and sensitivity analyses were performed to assess the cost-effectiveness of the strategies. RESULTS The cost of MRI follow-up was $11,477, with a health benefit of 24.03 quality-adjusted life-years; the cost of no follow-up was $6,432, with a health benefit of 24.08 quality-adjusted life-years. No follow-up was the dominant strategy, with a lower cost and a higher utility. Probabilistic sensitivity analysis showed no follow-up to be the better strategy in all 10,000 iterations. No follow-up was the better strategy irrespective of the negative predictive value of initial CT result, and it remained the better strategy when the incidence of missed unstable injury resulting in permanent neurologic deficits was less than 64.2% and the incidence of patients immobilized with a hard collar who still received cord injury was greater than 19.7%. Multiple 3-way sensitivity analyses were performed. CONCLUSION MRI is not cost-effective for further evaluation of unstable injury in neurologically intact patients with blunt trauma after a negative cervical spine CT result.
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Affiliation(s)
- Xiao Wu
- Yale School of Medicine, New Haven, CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT.
| | | | - Renu Liu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Khalid Abbed
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT; Departments of Economics, Management, and Public Health, Yale School of Medicine, New Haven, CT
| | - Pina Sanelli
- Department of Radiology, Northwell Health, Long Island, NY
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Abstract
Sub-axial cervical spine injuries are commonly seen in patients with blunt trauma. They may be associated with spinal cord injury resulting in tetraplegia and severe permanent disability. Immobilization of the neck, maintenance of blood pressure and oxygenation, rapid clinical and radiological assessment of all injuries, and realignment of the spinal column are the key steps in the emergency management of these injuries. The role of intravenous methylprednisolone administration in acute spinal cord injuries remains controversial. The definitive management of these injuries is based upon recognition of the fracture pattern, assessment of the degree of instability, the presence or absence of neurologic deficit, and other patient related factors that may influence the outcome. Nonoperative treatment comprises of some form of external immobilization for 8 to 12 weeks, followed by imaging to assess fracture healing, and to rule out instability. The goals of surgery are realignment of the vertebral column, decompression of the neural elements and instrumented stabilization.
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Affiliation(s)
- Gautam Zaveri
- Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India,Address for correspondence: Dr. Gautam Zaveri, 302 Bhaveshwar Kutir, 4th Road Rajawadi, Ghatkopar (East), Mumbai - 400 077, Maharashtra, India. E-mail:
| | - Gurdip Das
- Sunshine Hospitals and Trauma Centre, Bhubhaneshwar, Odisha, India
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Abstract
Subaxial cervical spine trauma is common and an often missed diagnosis. Accurate and efficient diagnosis and management is necessary to avoid devastating complications such as spinal cord injury. Several classification schemes have been devised to help categorize fractures of the subaxial spine and define treatment algorithms. The Subaxial Cervical Spine Injury Classification System (SLIC) is widely used and evaluates not only fracture morphology but also considers ligamentous injury and neurological status in surgical decision making. However, interobserver reliability is poor, which proves to be the defining pitfall of this tool. More modern classification systems have been developed, which aim to improve the interobserver reliability; however, further large-scale studies are needed for more definitive evaluation. Overall, treatment of subaxial cervical spine injuries should include a protocol with initial trauma evaluation, leading to expedient operative intervention if indicated. Surgical techniques include both anterior and posterior approaches to the cervical spine depending on fracture classification.
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Affiliation(s)
- Eric Feuchtbaum
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA.
| | - Jacob Buchowski
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA
| | - Lukas Zebala
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA
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Sharifi MD, Doloo HZM, Hashemian AM, Tourghabe JT, Kakhki BR, Teimoori SJ, Chokan NMJ, Noroozi HR. Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial. Electron Physician 2016; 8:2432-5. [PMID: 27382455 PMCID: PMC4930265 DOI: 10.19082/2432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/07/2016] [Indexed: 11/21/2022] Open
Abstract
Background Cervical spine trauma occurs mostly among young males due to falls and car accidents. The CT scan technology is replacing radiography in many medical clinics as it is very capable in detecting subtle cervical spine injuries. However, the use of CT scan for routine screening in patients with cervical spine trauma remains controversial due to its radiation risks and relatively high cost. Objective The focus of this research was on using morphine in patients with cervical spine trauma. The objective was to determine the ability of morphine to reduce the number of patients in need of CT scans. Methods This double-blinded randomized clinical trial study was conducted from April 2014 to March 2015 in Hasheminejad Hospital in Mashhad, Iran. We enrolled 67 patients with cervical spine trauma and normal radiography in the study. They were divided randomly into two groups (groups A and B), where group A received intravenous morphine, and group B received a placebo. We measured the pain scores in both groups before giving the medication and 10 minutes afterwards using a visual analog scale (VAS). Results As a result of receiving morphine, the patients in group A had significantly lower pain than group B (p-value < 0.001). The average pain score in group A was reduced by 43% versus 23% in group B. However, the most pain reduction was in those in group A with a normal CT scan. The pain score of these patients dropped by 52%. Conclusions The findings of this study suggest that patients with a normal radiography may be discharged with a cervical collar without a need for a CT scan if morphine reduces their pain. This is because the pain in these patients stem from the muscles and non-bony structures in the cervical spine area. Clinical trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2013100214872N1 Funding The authors received no financial support for the research or for the publication of this article.
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Affiliation(s)
- Mohammad Davood Sharifi
- M.D of Emergency Medicine, Associate Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Zamani Moghadam Doloo
- M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Masoud Hashemian
- M.D of Emergency Medicine, Associate Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Tootian Tourghabe
- M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behrang Rezvani Kakhki
- M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sasan Johari Teimoori
- M.D of Emergency Medicine, Department of Emergency, Valieasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Niaz Mohammad Jafari Chokan
- M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Noroozi
- M.D of Radiology, Assistant Professor, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Sime D, Gabbe B, Liew S. Outcomes of halo immobilization in the management of subaxial cervical facet fractures. ANZ J Surg 2016; 87:159-164. [DOI: 10.1111/ans.13656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- David Sime
- Department of Orthopaedic Surgery; Alfred Health; Melbourne Victoria Australia
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Susan Liew
- Department of Orthopaedic Surgery; Alfred Health; Melbourne Victoria Australia
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Perez-Orribo L, Snyder LA, Kalb S, Elhadi AM, Hsu F, Newcomb AGUS, Malhotra D, Crawford NR, Theodore N. Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 1: A clinical study. J Neurosurg Spine 2016; 24:897-902. [DOI: 10.3171/2015.9.spine13808] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Craniovertebral junction (CVJ) injuries complicated by transverse atlantal ligament (TAL) disruption often require surgical stabilization. Measurements based on the atlantodental interval (ADI), atlas lateral diameter (ALD1), and axis lateral diameter (ALD2) may help clinicians identify TAL disruption. This study used CT scanning to evaluate the reliability of these measurements and other variants in the clinical setting.
METHODS
Patients with CVJ injuries treated at the authors' institution between 2004 and 2011 were evaluated retrospectively for demographics, mechanism and location of CVJ injury, classification of injury, treatment, and modified Japanese Orthopaedic Association score at the time of injury and follow-up. The integrity of the TAL was evaluated using MRI. The ADI, ALD1, and ALD2 were measured on CT to identify TAL disruption indirectly.
RESULTS
Among the 125 patients identified, 40 (32%) had atlas fractures, 59 (47.2%) odontoid fractures, 31 (24.8%) axis fractures, and 4 (3.2%) occipital condyle fractures. TAL disruption was documented on MRI in 11 cases (8.8%). The average ADI for TAL injury was 1.8 mm (range 0.9–3.9 mm). Nine (81.8%) of the 11 patients with TAL injury had an ADI of less than 3 mm. In 10 patients (90.9%) with TAL injury, overhang of the C-1 lateral masses on C-2 was less than 7 mm. ADI, ALD1, ALD2, ALD1 – ALD2, and ALD1/ALD2 did not correlate with the integrity of the TAL.
CONCLUSIONS
No current measurement method using CT, including the ADI, ALD1, and ALD2 or their differences or ratios, consistently indicates the integrity of the TAL. A more reliable CT-based criterion is needed to diagnose TAL disruption when MRI is unavailable.
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Affiliation(s)
| | - Laura A. Snyder
- 2Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Samuel Kalb
- 2Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ali M. Elhadi
- 2Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Forrest Hsu
- 2Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | | | - Nicholas Theodore
- 2Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Badhiwala JH, Lai CK, Alhazzani W, Farrokhyar F, Nassiri F, Meade M, Mansouri A, Sne N, Aref M, Murty N, Witiw C, Singh S, Yarascavitch B, Reddy K, Almenawer SA. Cervical spine clearance in obtunded patients after blunt traumatic injury: a systematic review. Ann Intern Med 2015; 162:429-37. [PMID: 25775316 DOI: 10.7326/m14-2351] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Jetan H. Badhiwala
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chung K. Lai
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Waleed Alhazzani
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Forough Farrokhyar
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Farshad Nassiri
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Maureen Meade
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alireza Mansouri
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Niv Sne
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mohammed Aref
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Naresh Murty
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher Witiw
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sheila Singh
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Blake Yarascavitch
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kesava Reddy
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Saleh A. Almenawer
- From the University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; and University of Texas Southwestern Medical Center, Dallas, Texas
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Fredø HL, Bakken IJ, Lied B, Rønning P, Helseth E. Incidence of traumatic cervical spine fractures in the Norwegian population: a national registry study. Scand J Trauma Resusc Emerg Med 2014; 22:78. [PMID: 25520042 PMCID: PMC4299554 DOI: 10.1186/s13049-014-0078-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 12/06/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The incidence of cervical spine fractures (CS-fx) in the general population is sparingly assessed. The aim of the current study was to estimate the incidence of traumatic CS-fx and of open surgery of cervical spine injuries in the Norwegian population. METHODS The Norwegian Patient Register (NPR) is an administrative database that contains activity data from all Norwegian government-owned hospitals and outpatient clinics. The diagnoses and procedures are coded according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the NOMESCO Classification of Surgical Procedures (NCSP), respectively. We retrieved information on all severe traumatic cervical spine injuries between 2009 and 2012 from the NPR. Updated information on the date of death is included through routine linkage to the General Register Office. RESULTS Between 2009 and 2012, a total of 3 248 patients met our criteria for severe traumatic cervical spine injury. A total of 2 963 patients had one or more CS-fx, and 285 had severe non-fracture cervical spine injuries. The median age was 54 years, and 69% of the patients were male. The incidence of CS-fx and severe non-fracture injuries in the total Norwegian population was 16.5/100 000/year, and the incidence of CS-fx was 15.0/100 000/year. A total of 18% of the patients were treated with open surgery, resulting in an estimated incidence of surgery for acute traumatic cervical spine injury of 3.0/100 000/ year in the Norwegian population. The 1- and 3-month mortality rates were 4% and 6%, respectively.
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Affiliation(s)
- Hege L Fredø
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Inger J Bakken
- Norwegian Patient Register, the Norwegian Directorate of Health, Trondheim, Norway.
- Present address: The Norwegian Institute of Public Health, Oslo, Norway.
| | - Bjarne Lied
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - Pål Rønning
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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Clinical outcomes of the surgical treatment of isolated unilateral facet fractures, subluxations, and dislocations in the pediatric cervical spine: report of eight cases and review of the literature. Childs Nerv Syst 2014; 30:1233-42. [PMID: 24615370 DOI: 10.1007/s00381-014-2395-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We present a small series consisting of eight children with unilateral facet injury of the cervical spine treated surgically. METHODS A retrospective review was performed. Injury data, radiographs, surgical data, and outcomes (Neck Disability Index (NDI), Short Form 36 (SF-36), and Visual Analog Scale for Neck Pain (VAS-NP)) were collected from seven patients. A literature review was performed for one additional case. RESULTS Motor vehicle accidents (62 %, n = 5) and falls (38 %, n = 3) accounted for all injuries. The C6-7 level accounted for most of the injuries (37.5 %, n = 3). The mean NDI score with at least 3 months follow-up was 5.3 (n = 6, range, 1-12; standard deviation, 4.5), corresponding to mild disability. Of the norm-based SF-36 scale scores available (n = 6), the mean physical functioning (PF), role-physical (RP), and role-emotional (RE) scores were significantly less than the adult, age 18-24, norm-based means, with a mean difference of -6.4, -9.13, and -11.3, respectively (p value = 0.03, 0.001, and 0.01, respectively). The mean general health (GH) and vitality (VT) scores, however, were significantly greater than the adult, age 18-24, norm-based mean, with a mean difference of 7.82 and 10.3 (p = 0.04 and 0.02, respectively). VAS-NP showed a return to the "no pain" level at 3 months or more follow-up in all patients. CONCLUSIONS We suggest that surgical treatment of these injuries in the pediatric age group may lead to satisfactory clinical and radiographic outcomes, but HRQoL analysis suggests that patients remain physically and emotionally disabled to some degree after surgery.
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Awad BI, Lubelski D, Carmody M, Mroz TE, Anderson JS, Moore TA, Steinmetz MP. Surgical versus nonsurgical treatment of subaxial cervical pedicle fractures. World Neurosurg 2014; 82:855-65. [PMID: 24907437 DOI: 10.1016/j.wneu.2014.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/09/2014] [Accepted: 05/29/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pedicle fractures in the cervical spine are common. They may occur in isolation or in combination with other concomitant fractures. Multiple classification systems have been introduced to provide a clinical framework when approaching these types of fractures; however, these systems do not provide guidelines for optimal treatment. Data regarding decision making are limited. Conservative treatment with orthoses may result in subluxation and instability requiring further treatment. Surgery may not be required in all instances because many of these injuries may heal without surgical intervention. METHODS All cases of cervical fractures treated at a single institution over a 5-year period were retrospectively reviewed. Cases with pedicle fractures were further evaluated, and 40 cases managed either with or without surgery were identified. Data on presenting history, neurologic examination, imaging findings, comorbidity, method of treatment, complication rate, and length of hospital stay were collected. Fractures were classified based on computed tomography scans. Data on associated injuries were also collected. Fusion rate and fracture displacement were assessed by plain radiographs and computed tomography scans at follow-up. Follow-up time points included 2, 6, and 12 weeks and 6 months after injury. Primary outcome was fracture healing regardless of modality in the absence of progressive deformity (i.e., listhesis, kyphosis) and need for further surgery. RESULTS Conservative therapy was administered to 26 patients, and 14 patients underwent surgery. There were no statistically significant differences between the 2 groups in terms of total levels injured (P = 0.9) or injury severity score (P = 0.5). Patients who presented with intact neurologic status were more likely to be treated conservatively (88% vs. 29%; P = 0.0004), whereas patients presenting with spinal cord injuries were more likely to undergo surgical fixation (35% vs. 0%; P = 0.0004). Length of hospital stay trended toward being significantly greater in patients who underwent surgery (10.6 days vs. 5.5 days; P = 0.07). According to our classification system, the most common fracture type was single line horizontal fracture occurring in 68% (27 of 40 cases). Vertical split pedicle fracture occurred in 28% (11 of 40 cases), and double line horizontal fracture occurred in 5% (2 of 40 cases). Posttreatment progressive listhesis was significantly higher in patients who were treated conservatively (31% vs. 0%; P = 0.03), especially when associated with comminuted lateral mass or subluxation or both. CONCLUSIONS This study describes and classifies unique cervical pedicle fractures and associated injuries. Our findings suggest that surgical treatment results in definitive stability for these injuries compared with conservative therapy, particularly for pedicle fractures associated with comminuted lateral mass or initially displaced fractures. However, nondisplaced vertical split pedicle fractures and isolated single line horizontal fractures may be treated nonsurgically without occurrence of further instability. A larger prospective study is required to confirm these findings.
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Affiliation(s)
- Basem I Awad
- Department of Neurosurgery, Case Western University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA; Department of Neurosurgery, Mansoura University School of Medicine, University Hospitals, Mansoura, Egypt
| | - Daniel Lubelski
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA; Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Margaret Carmody
- Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Thomas E Mroz
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA; Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - James S Anderson
- Department of Neurosurgery, Case Western University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Timothy A Moore
- Department of Orthopedics, Case Western University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Michael P Steinmetz
- Department of Neurosurgery, Case Western University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
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Wong ST, Zovickian J, Hou Y, Sonne C, Pang D. Traumatic rupture of the neurocentral synchondrosis of the axis in a child. J Neurosurg Pediatr 2014; 13:548-52. [PMID: 24628510 DOI: 10.3171/2014.2.peds13499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the first case of unilateral traumatic rupture of the C-2 neurocentral synchondrosis. A 26-month-old child was in a vehicular collision that caused his head to be rotated sharply to the left with the neck flexed. He had severe neck pain but was neurologically normal. Computerized tomography scanning showed rupture of the left C-2 neurocentral synchondrosis, a right C-2 pars interarticularis fracture, and anterior angulation of C-2 on C-3. The neck injury was unrecognized until postinjury Day 9 when an MRI study showed a tear of the posterior longitudinal ligament at C2-3 and separation of the C-2 body from the inferior anular epiphysis. A second CT showed widening of the synchondrosis fracture, increased angulation of C-2 on C-3, and distraction of the right C-2 pars fracture. The mechanism of the neurocentral synchondrosis fracture is thought to be hyperflexion-axial loading combined with leftward rotation, which provided the lateral force that overcame the cartilaginous synchondrosis and extruded the lateral mass. The patient underwent open reduction and posterior fusion of C1-3, and was maintained in a halo jacket for 4 months, when CT scans demonstrated solid C1-C3 fusion and ossification of the injured synchondrosis. Unilateral traumatic rupture of the C-2 neurocentral synchondrosis is one component of several injuries involving C-2 sustained before synchondrosis closure. The resulting C2-3 relationship is highly unstable. Reduction and C1-C3 fusion are necessary in patients with significant displacement of the adjacent bony units.
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Affiliation(s)
- Sui-To Wong
- Department of Pediatric Neurosurgery, Regional Center for Pediatric Neurosurgery
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Geriatric Emergency Department Guidelines. Ann Emerg Med 2014; 63:e7-25. [DOI: 10.1016/j.annemergmed.2014.02.008] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 12/16/2022]
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Morrissey JF, Kusel ER, Sporer KA. Spinal motion restriction: an educational and implementation program to redefine prehospital spinal assessment and care. PREHOSP EMERG CARE 2014; 18:429-32. [PMID: 24548084 DOI: 10.3109/10903127.2013.869643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Prehospital spine immobilization has long been applied to victims of trauma in the United States and up to 5 million patients per year are immobilized mostly with a cervical collar and a backboard. OBJECTIVE The training of paramedics and emergency medical technicians on the principals of spine motion restriction (SMR) will decrease the use of backboards. METHODS The training for SMR emphasized the need to immobilize those patients with a significant potential for an unstable cervical spine fracture and to use alternative methods of maintaining spine precautions for those with lower risk. The training addressed the potential complications of the use of the unpadded backboard and education was provided about the mechanics of spine injuries. Emergency medical services (EMS} personnel were taught to differentiate between the critical multisystem trauma patients from the more common moderate, low kinetic energy trauma patients. A comprehensive education and outreach program that included all of the EMS providers (fire and private), hospitals, and EMS educational institutions was developed. RESULTS Within 4 months of the policy implementation, prehospital care practitioners reduced the use of the backboard by 58%. This was accomplished by a decrease in the number of patients considered for SMR with low kinetic energy and the use of other methods, such as the cervical collar only. CONCLUSION The implementation of a SMR training program significantly decreases the use of backboards and allows alternative methods of maintaining spine precautions.
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Adelgais KM, Browne L, Holsti M, Metzger RR, Murphy SC, Dudley N. Cervical spine computed tomography utilization in pediatric trauma patients. J Pediatr Surg 2014; 49:333-7. [PMID: 24528980 DOI: 10.1016/j.jpedsurg.2013.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Guidelines for evaluating the cervical spine in pediatric trauma patients recommend cervical spine CT (CSCT) when plain radiographs suggest an injury. Our objective was to compare usage of CSCT between a pediatric trauma center (PTC) and referral general emergency departments (GEDs). METHODS Patient data from a pediatric trauma registry from 2002 to 2011 were analyzed. Rates of CSI and CSCT of patients presenting to the PTC and GED were compared. Factors associated with use of CSCT were assessed using multivariate logistic regression. RESULTS 5148 patients were evaluated, 2142 (41.6%) at the PTC and 3006 (58.4%) at the GED. Groups were similar with regard to age, gender, GCS, and triage category. GED patients had a higher median ISS (14 vs. 9, p<0.05) and more frequent ICU admissions (44.3% vs. 26.1% p<0.05). CSI rate was 2.1% (107/5148) and remained stable. CSCT use increased from 3.5% to 16.1% over time at the PTC (mean 9.6% 95% CI=8.3, 10.9) and increased from 6.8% to 42.0% (mean 26.9%, CI=25.4, 28.4) at the GED. Initial care at a GED remained strongly associated with CSCT. CONCLUSIONS Despite a stable rate of CSI, rate of CSCT increased significantly over time, especially among patients initially evaluated at a GED.
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Affiliation(s)
- Kathleen M Adelgais
- Department of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO.
| | - Lorin Browne
- Department of Pediatrics, Pediatric Emergency Medicine Section, Medical College of Wisconsin, Milwaukee, WI
| | - Maija Holsti
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Ryan R Metzger
- Department of Surgery, Division of Pediatric Surgery, University of Utah, Salt Lake City, UT
| | | | - Nanette Dudley
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT
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Fujii T, Faul M, Sasser S. Risk factors for cervical spine injury among patients with traumatic brain injury. J Emerg Trauma Shock 2013; 6:252-8. [PMID: 24339657 PMCID: PMC3841531 DOI: 10.4103/0974-2700.120365] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 03/24/2013] [Indexed: 12/16/2022] Open
Abstract
Background: Diagnosis of cervical spine injury (CSI) is difficult in patients with an altered level of consciousness as a result of a traumatic brain injury (TBI). Patients with TBI and older adults are at increased risk for CSI. This study examined the various risk factors for CSI among trauma patients with TBI and whether adults who were older (≥55 years) were at higher risk for CSI when they sustained a fall-related TBI. Materials and Methods: Data used was the 2007 National Trauma Data Bank (NTDB), National Sample Project (NSP) for adults who sustained a TBI. This dataset contains 2007 admission records from 82 level I and II trauma centers. Logistic regression was used to identify potential risk factors for CSI and to test for interaction between age and injury mechanism. Additional model variables included gender, race, Glasgow Coma Score, multiple severe injuries, hypotension and respiratory distress. Results: An analysis of the NTDB NSP identified 187,709 adults with TBI, of which 16,078 were diagnosed with a concomitant CSI. In motor vehicle traffic injuries, the older age group had significantly higher odds of CSI (odds ratio [OR] = 1.26 [1.15-1.39]). In fall-related injuries the older age group did not have a higher odds of CSI compared to the younger age group. Skull/face fracture, other spine fracture/dislocation, upper limb injury, thorax injury, and hypotension were significantly associated with CSI. Pelvic injuries had an inverse association with CSI (OR = 0.60 [0.54-0.67]). Black had significantly higher odds of CSI compared to Whites (OR = 1.25 [1.07-1.46]). Conclusion: The identification of associated injuries and factors may assist physicians in evaluating CSI in patients with TBI.
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Affiliation(s)
- Tomoko Fujii
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
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Fisher BM, Cowles S, Matulich JR, Evanson BG, Vega D, Dissanaike S. Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients? Am J Surg 2013; 206:987-93; discussion 993-4. [DOI: 10.1016/j.amjsurg.2013.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/25/2022]
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Assenmacher B, Schroeder GD, Patel AA. On-Field Management of Spine and Spinal Cord Injuries. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yoganandan N, Stemper BD, Pintar FA, Maiman DJ, McEntire BJ, Chancey VC. Cervical spine injury biomechanics: Applications for under body blast loadings in military environments. Clin Biomech (Bristol, Avon) 2013; 28:602-9. [PMID: 23796847 DOI: 10.1016/j.clinbiomech.2013.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 05/03/2013] [Accepted: 05/08/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND While cervical spine injury biomechanics reviews in motor vehicle and sports environments are available, there is a paucity of studies in military loadings. This article presents an analysis on the biomechanics and applications of cervical spine injury research with an emphasis on human tolerance for underbody blast loadings in the military. METHODS Following a brief review of published military studies on the occurrence and identification of field trauma, postmortem human subject investigations are described using whole body, intact head-neck complex, osteo-ligamentous cervical spine with head, subaxial cervical column, and isolated segments subjected to differing types of dynamic loadings (electrohydraulic and pendulum impact devices, free-fall drops). FINDINGS Spine injuries have shown an increasing trend over the years, explosive devices are one of the primary causal agents and trauma is attributed to vertical loads. Injuries, mechanisms and tolerances are discussed under these loads. Probability-based injury risk curves are included based on loading rate, direction and age. INTERPRETATION A unique advantage of human cadaver tests is the ability to obtain fundamental data to delineate injury biomechanics and establish human tolerance and injury criteria. Definitions of tolerances of the spine under vertical loads based on injuries have implications in clinical and biomechanical applications. Primary outputs such as forces and moments can be used to derive secondary variables such as the neck injury criterion. Implications are discussed for designing anthropomorphic test devices that may be used to predict injuries in underbody blast environments and improve the safety of military personnel.
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Affiliation(s)
- Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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