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Turaczyk Kolodziej DA, Lung M, Lilienthal M, Galet C, Mani V, Skeete D. Shifting Perspectives: Equal Blunt Cerebrovascular Risk in Low-Versus High-Energy Cervical Fracture. J Surg Res 2024; 300:63-70. [PMID: 38795674 DOI: 10.1016/j.jss.2024.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Clinical implications of screening for blunt cerebrovascular injury (BCVI) after low-energy mechanisms of injury (LEMI) remain unclear. We assessed BCVI incidence and outcomes in LEMI versus high-energy mechanisms of injury (HEMI) patients. METHODS In this retrospective cohort study, blunt trauma adults admitted between July 2015 and June 2021 with cervical spine fractures, excluding single spinous process, osteophyte, and chronic fractures were included. Demographics, comorbidities, injuries, screening and treatment data, iatrogenic complications, and mortality were collected. Our primary end point was to compare BCVI rates between LEMI and HEMI patients. RESULTS Eight hundred sixty patients (78%) were screened for BCVI; 120 were positive for BCVI. LEMI and HEMI groups presented similar BCVI rates (12.6% versus 14.4%; P = 0.640). Compared to HEMI patients (n = 95), LEMI patients (n = 25) were significantly older (79 ± 14.9 versus 54.3 ± 17.4, P < 0.001), more likely to be on anticoagulants before admission (64% versus 23.2%, P < 0.001), and less severely injured (LEMI injury severity score 10.9 ± 6.6 versus HEMI injury severity score 18.7 ± 11.4, P = 0.001). All but one LEMI and 90.5% of the HEMI patients had vertebral artery injuries with no significant difference in BCVI grades. One HEMI patient developed acute kidney injury because of BCVI screening. Eleven HEMI patients developed BCVI-related stroke with two related mortalities. One LEMI patient died of a BCVI-related stroke. CONCLUSIONS BCVI rates were similar between HEMI and LEMI groups when screening based on cervical spine fractures. The LEMI group exhibited no screening or treatment complications, suggesting that benefits may outweigh the risks of screening and potential bleeding complications from treatment.
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Affiliation(s)
| | - Michael Lung
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Michele Lilienthal
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Colette Galet
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Vishnu Mani
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Dionne Skeete
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, Iowa.
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Marland H, Barve A, McDonnell JM, Wilson KV, Darwish S, Butler JS. Geriatric Traumatic Spinal Cord Injuries: Should Surgical Intervention Be Delayed? Clin Spine Surg 2024; 37:79-81. [PMID: 38409685 DOI: 10.1097/bsd.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Harry Marland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University of Galway, Galway
| | - Arnav Barve
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University College Dublin
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- Trinity Centre of Biomedical Engineering, Trinity College Dublin
| | - Kielan V Wilson
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University College Dublin
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University College Dublin
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Lundy ME, Zhang B, Ditillo M. Management of the Geriatric Trauma Patient. Surg Clin North Am 2024; 104:423-436. [PMID: 38453311 DOI: 10.1016/j.suc.2023.09.010] [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] [Indexed: 03/09/2024]
Abstract
With a rapidly aging worldwide population, the care of geriatric trauma patients will be at the forefront of every career in Trauma and Acute Care Surgery. The unique intersection of advanced age, comorbidities, frailty, and physiologic changes presents a challenge in the care of elderly injured patients. It is well established that increasing age is associated with higher mortality and worse outcomes after injury, but it is also clear that there is room for improvement in the management of this special patient population.
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Affiliation(s)
- Megan Elizabeth Lundy
- University of Arizona Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, 1501 North Campbell Avenue, Tucson, AZ 85724, USA. https://twitter.com/MLundyMD
| | - Bo Zhang
- University of Arizona Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, 1501 North Campbell Avenue, Tucson, AZ 85724, USA. https://twitter.com/bo_zhang1
| | - Michael Ditillo
- University of Arizona Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
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4
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Burton KR, Magidson PD. Trauma (Excluding Falls) in the Older Adult. Clin Geriatr Med 2023; 39:519-533. [PMID: 37798063 DOI: 10.1016/j.cger.2023.05.005] [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] [Indexed: 10/07/2023]
Abstract
Trauma in the older adult will increasingly become important to emergency physicians hoping to optimize their patient care. The geriatric patient population possesses higher rates of comorbidities that increase their risk for trauma and make their care more challenging. By considering the nuances that accompany the critical stabilization and injury-specific management of geriatric trauma patients, emergency physicians can decrease the prevalence of adverse outcomes.
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Affiliation(s)
- Kyle R Burton
- Department of Emergency Medicine, Johns Hopkins Hospital, 1830 Eas, Monument Street, Suite 6-110, Baltimore, MD 21287, USA
| | - Phillip D Magidson
- Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Suite A150, Baltimore, MD 21224, USA.
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Lenga P, Issa M, Krull L, Kiening K, Unterberg AW, Schneider T, Oskouian RJ, Chapman JR, Ishak B. Radiological Features in Type II Odontoid Fractures in Older Adults After High- and Low-Energy Trauma. Global Spine J 2023; 13:2471-2478. [PMID: 35344677 PMCID: PMC10538308 DOI: 10.1177/21925682221088215] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Although type II odontoid fractures mainly occur due to high-energy trauma (HET), the number of odontoid type II fractures after low-energy trauma (LET) in the elderly is on the rise. However, there is a paucity of conclusive evidence on the relationship between trauma mechanism and cervical spine alignment in the elderly population. Consequently, we examined cervical alignment and osteoporotic and osteoarthritic patterns in elderly individuals (aged ≥65 years) with type II odontoid fractures. METHODS We retrospectively assessed cervical spine alignment in 76 elderly individuals who experienced type II odontoid fractures after HET (n = 36) and LET (n = 40) between 2005 and 2020. Osteoporotic and osteoarthritic changes on computed tomography and cervical alignment parameters on sagittal plane radiographs were examined. RESULTS Moderate and severe osteoporosis of the dens-body junction and osteoarthritis of the atlanto-odontoid joint were more prevalent in the LET than the HET group (P<.005). The anterior atlantodental interval (ADI) was significantly smaller in the LET group than in the HET group (.7 [.7] millimeter vs 1.2 [.8] mm; P=.003). An ADI equal 0 mm indicative for anterior fusion of C1/C2 was present in 37.5% of patients of the LET group. The C0-C2 angle, C1-C2 lordosis, and C2-C7 sagittal vertical axis were significantly different (HET vs LET: 33.2 [7.2]° vs 41.6 [11.4]°, P=.005; 28.1 [7.0]° vs 34.0 [8.0]°, P=.002; and 16.1 [11.1] millimeter vs 27.1 [12.4] mm, P=.008; respectively). CONCLUSION Significantly higher rates of osteoporotic and degenerative changes were observed after LET. Furthermore, previous cervical malalignment represents a risk factor for type II odontoid fractures after LET.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Lennart Krull
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Till Schneider
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rod J. Oskouian
- Division of Complex Spine Swedish Neuroscience Institute, Seattle, WA, USA
| | - Jens R. Chapman
- Division of Complex Spine Swedish Neuroscience Institute, Seattle, WA, USA
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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6
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Wilson KV, McDonnell JM, O'Malley S, Lynch D, Larouche J, Cunniffe GM, Darwish S, Morris S, Butler JS. Morbidity and mortality of traumatic cervical spinal cord injuries in a geriatric cohort. Ir J Med Sci 2023; 192:1719-1725. [PMID: 36151362 PMCID: PMC9510192 DOI: 10.1007/s11845-022-03169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Traumatic injuries are among the leading causes of death and disability worldwide. Major trauma presentations have seen a demographic shift recently from the young to the elderly, with significant associated neurological deficit. AIMS To review the presentation and outcome of elderly patients presenting with cervical spinal injuries and associated neurological deficit that underwent surgical intervention in order to optimise treatment strategies. METHODS A retrospective review was conducted at a national tertiary referral centre to analyse admission trends from June 2016 to July 2020 for outcomes of elderly patients (≥ 65) presenting with traumatic cervical spine injuries associated with spinal cord injuries (SCI). Demographic, clinical, and radiological characteristics were collected and analysed. RESULTS Forty-two patients met the inclusion criteria. The most common mechanisms of injury (MOIs) were falls from standing (38.1%) and falls from height (≥ 2 m) (33.3%). Complete SCIs had increased mean LOS (57.6 vs 21.6 days; p = 0.013), postoperative complications (100% vs 60.6%; p = 0.022), life-threatening complications (57.1% vs 9.1%; p = 0.001), and 90-day mortality (37.5% vs 5.9%; p = 0.007) compared to incomplete SCIs. CONCLUSION Elderly patients with complete SCIs have poorer outcomes and mortality than those with less extensive SCIs. They require more resources, have greater risk of complications, and have higher mortality than those with incomplete SCIs, with subsequent implications on optimal treatment strategies. More robust studies are needed to derive improved risk stratification tools for geriatric patients with spinal injuries.
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Affiliation(s)
- Kielan V Wilson
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
- UCD School of Medicine, Dublin, Ireland
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland.
| | - Sandra O'Malley
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
| | - Deirdre Lynch
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
| | | | - Gráinne M Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
| | - Seamus Morris
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
- UCD School of Medicine, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St., Dublin, D07 R2WY, Ireland
- UCD School of Medicine, Dublin, Ireland
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Sunder A, Chhabra H, Aryal A. Geriatric spine fractures - Demography, changing trends, challenges and special considerations: A narrative review. J Clin Orthop Trauma 2023; 43:102190. [PMID: 37538298 PMCID: PMC10393813 DOI: 10.1016/j.jcot.2023.102190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/16/2023] [Indexed: 08/05/2023] Open
Abstract
The aim of this manuscript was to summarize the demography and changing trends of geriatric spinal injuries and to enumerate the challenges and special considerations in the care of geriatric spinal injuries. PubMed, Scopus and Embase databases were searched for literature on geriatric spine fractures using MeSH terms 'aged', 'aged, 80 and over', 'elderly', 'spinal fracture/epidemiology', spinal fracture/therapy∗' and keywords pertaining to the same. The search results were screened for appropriate articles and reviewed. There is a high community prevalence of elderly vertebral fractures ranging from 18% to as high as 51%. The proportion of older patients among the spinal injured is rising as well. There is a higher chance of missing spinal injuries in the elderly and clinical guidelines may not be applicable to this patient group. Classification and surgical treatment are different from younger adult counterparts as the elderly osteoporotic spine behaves differently biomechanically. There is a high incidence of respiratory complications both for surgically and conservatively managed groups. Older age generally is associated with a higher complication rate including mortality.
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Manville C, Edwards S, Bloom B, Moore N. Cervical immobilisation in elderly patients with a suspected cervical spine fracture: a retrospective study. Eur J Emerg Med 2023; 30:202-204. [PMID: 37103897 DOI: 10.1097/mej.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
| | - Sian Edwards
- Emergency Department, Whipps Cross Hospital, Barts Health NHS Trust
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health NHS Trust
- Blizard Institute, Queen Mary University of London, London
| | - Nicholas Moore
- Emergency Department, Bristol Royal Infirmary, University Hospital Bristol and Weston NHS Trust, Bristol, UK
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9
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Spiegl UJA, Keil H, Krause J, Osterhoff G, Scheyerer MJ, Schnake KJ, Perl M. Combined Odontoid (C2) and Atlas (C1) Fractures in Geriatric Patients: A Systematic Review and Treatment Recommendation. Global Spine J 2023; 13:22S-28S. [PMID: 37084349 PMCID: PMC10177310 DOI: 10.1177/21925682221127951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to conduct a systematic overview of the pathogenesis and the treatment options of combined odontoid and atlas fractures in geriatric patients. METHODS This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for articles published until February 2021 dealing with combination fractures of C1 and C2 in geriatric patients. RESULTS Altogether, 438 articles were retrieved from the literature search. A total of 430 articles were excluded. The remaining eight original articles were included in this systematic review depicting the topics pathogenesis, non-operative treatment, posterior approach, and anterior approach. The overall level of evidence of the studies is low. CONCLUSION Combined odontoid and atlas fractures in the geriatric population are commonly caused by simple falls and seem to be associated with atlanto-odontoid osteoarthritis. Non-operative treatment with a cervical orthosis is a feasible treatment option in the majority of patients with stable C2 fractures. In case of surgery posterior C1 and C 2 stabilization and anterior triple or quadruple screw fixation are possible techniques. Some patients may also deserve an occipito-cervical fusion. A possible treatment algorithm is proposed.
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Affiliation(s)
- Ulrich J A Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Holger Keil
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Krause
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Max J Scheyerer
- Department of Orthopedics and Trauma Surgery, University hospital, Duesseldorf, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien gGmbH, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Mario Perl
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Mora-Boga R, Vázquez Muíños O, Pértega Díaz S, Meijide-Faílde RM, Rodríguez-Sotillo A, Ferreiro-Velasco ME, Salvador-de la Barrera S, Montoto-Marqués A. Prognostic value of early magnetic resonance imaging in the morbidity and mortality of traumatic spinal cord injury. Med Intensiva 2023; 47:157-164. [PMID: 36068148 DOI: 10.1016/j.medine.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). DESIGN Retrospective study. SETTING Third-level hospital, Spinal Cord Injury Unit and ICU. PATIENTS Individuals with acute TSCI between 2010 and 2019. INTERVENTION Analysis of MRI performed in the first 72 h. VARIABLES OF INTEREST Admission to ICU and mortality. RESULTS 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013). CONCLUSIONS The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Olalla Vázquez Muíños
- Unidad de Neurorradiología, Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Sonia Pértega Díaz
- Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Rosa María Meijide-Faílde
- Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
| | | | | | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
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Lau L, Ajzenberg H, Haas B, Wong CL. Trauma in the Aging Population. Emerg Med Clin North Am 2023; 41:183-203. [DOI: 10.1016/j.emc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Kobayashi M, Yokogawa N, Kato S, Sasagawa T, Tsuchiya H, Nakashima H, Segi N, Ito S, Funayama T, Eto F, Yamaji A, Yamane J, Nori S, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Suzuki N, Kato K, Uei H, Sawada H, Nakanishi K, Misaki K, Terai H, Tamai K, Kuroda A, Inoue G, Kakutani K, Kakiuchi Y, Kiyasu K, Tominaga H, Tokumoto H, Iizuka Y, Takasawa E, Akeda K, Takegami N, Funao H, Oshima Y, Kaito T, Sakai D, Yoshii T, Ohba T, Otsuki B, Seki S, Miyazaki M, Ishihara M, Okada S, Imagama S, Watanabe K. Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries-A Multicenter Retrospective Study of 1512 Cases. J Clin Med 2023; 12:jcm12020708. [PMID: 36675636 PMCID: PMC9865717 DOI: 10.3390/jcm12020708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/19/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 hospitals between 2010 and 2020. Early mortality was defined as death within 90 days after injury. We evaluated the relationship between early mortality and the following factors: age, sex, body mass index, history of drinking and smoking, injury mechanisms, presence of a cervical spine fracture and dislocation, cervical ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, American Spinal Injury Association Impairment Scale, concomitant injury, pre-existing comorbidities, steroid administration, and treatment plan. Overall, 1512 patients (mean age, 75.8 ± 6.9 years) were included in the study. The early mortality rate was 4.0%. Multivariate analysis identified older age (OR = 1.1, p < 0.001), male sex (OR = 3.7, p = 0.009), cervical spine fracture (OR = 4.2, p < 0.001), complete motor paralysis (OR = 8.4, p < 0.001), and chronic kidney disease (OR = 5.3, p < 0.001) as risk factors for early mortality. Older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease are prognostic factors for early mortality in older patients with traumatic cervical spine injuries.
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Affiliation(s)
- Motoya Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
- Correspondence: ; Tel.: +81-76-265-2374
| | - Takeshi Sasagawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
- Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama 930-8550, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, Sakai 306-0433, Japan
| | - Junichi Yamane
- Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo 208-0011, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Atsushi Yunde
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
- Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, Nagoya-shi 454-0933, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
- Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo 001-0018, Japan
| | - Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Hidenori Suzuki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Munehiro Sakata
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Department of Orthopaedics, Saiseikai Shiga Hospital, Ritto 520-3046, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Yoshito Onoda
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Yohei Haruta
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo 101-8393, Japan
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yuji Kakiuchi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku 783-8505, Japan
| | - Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hiroto Tokumoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie Tsu City 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie Tsu City 514-8507, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-0124, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Chiba 286-0124, Japan
- Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Daisuke Sakai
- Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu-shi 879-5593, Japan
| | - Masayuki Ishihara
- Department of Orthopaedic Surgery, Kansai Medical University Hospital, Osaka 573-1191, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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Differences in clinical characteristics of cervical spine injuries in older adults by external causes: a multicenter study of 1512 cases. Sci Rep 2022; 12:15867. [PMID: 36151125 PMCID: PMC9508126 DOI: 10.1038/s41598-022-19789-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
Although traumatic cervical spine injuries in older adults are commonly caused by minor traumas, such as ground-level falls, their prognosis is often unfavorable. Studies examining the clinical characteristics of cervical spine injuries in older adults according to the external cause of injury are lacking. This study included 1512 patients of ≥ 65 years of age with traumatic cervical spine injuries registered in a Japanese nationwide multicenter database. The relationship between the external causes and clinical characteristics, as well as factors causing unfavorable outcomes at the ground-level falls, were retrospectively reviewed and examined. When fall-induced cervical spine injuries were categorized and compared based on fall height, the patients’ backgrounds and injury statuses differed significantly. Of note, patients injured from ground-level falls tended to have poorer pre-injury health conditions, such as medical comorbidities and frailty, compared with those who fell from higher heights. For ground-level falls, the mortality, walking independence, and home-discharge rates at 6 months post-injury were 9%, 67%, and 80%, respectively, with preexisting medical comorbidities and frailty associated with unfavorable outcomes, independent of age or severity of neurological impairment at the time of injury.
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14
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Corrales MA, Bolte J, Malcolm S, Pipkorn B, Cronin DS. Methodology to geometrically age human body models to average and subject-specific anthropometrics, demonstrated using a small stature female model assessed in a side impact. Comput Methods Biomech Biomed Engin 2022:1-12. [PMID: 35980145 DOI: 10.1080/10255842.2022.2112187] [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: 11/03/2022]
Abstract
The aged population has been associated with an increased risk of injury in car-crash, creating a critical need for improved assessment of safety systems. Finite element human body models (HBMs) have been proposed, but require representative geometry of the aged population and high mesh quality. A new hybrid Morphing-CAD methodology was applied to a 26-year-old (YO) 5th percentile female model to create average 75YO and subject-specific 86YO HBMs. The method achieved accurate morphing targets while retaining high mesh quality. The three HBMs were integrated into a side sled impact test demonstrating similar kinematic response but differing rib fracture patterns.
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Affiliation(s)
- M A Corrales
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada
| | - J Bolte
- Injury Biomechanics Research Center, Ohio State University, Columbus, OH, USA
| | - S Malcolm
- Honda R&D Americas, Raymond, OH, USA
| | - B Pipkorn
- Division of Vehicle Safety, Department of Mechanics and Maritime Sciences, Chalmers University of Technology, Gothenburg, Sweden.,Autoliv Research, Vårgårda, Sweden
| | - D S Cronin
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada
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Smith S, Somogyi R, Lin C, Yoo JU. Surgical Management of Type II Displaced Dens Fractures Improves One-year Mortality in Elderly Patients. Spine (Phila Pa 1976) 2022; 47:1157-1164. [PMID: 35797519 DOI: 10.1097/brs.0000000000004383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional analysis of US national data collected by PearlDiver Inc. database. OBJECTIVE To determine the rates of surgical/nonsurgical treatments and associated one-year mortality for displaced type II dens fractures without neurological deficit. SUMMARY OF BACKGROUND DATA Existing literature on dens fractures includes small series of patients with highly variable surgical rates. These studies contain insufficient data to determine the benefits of surgical or nonsurgical treatment as surgeon bias in treatment and selection of patients have significant effects on the results. MATERIALS AND METHODS Displaced type II dens fractures and upper cervical surgeries were identified using their respective International Classification of Diseases, 10th Revision (ICD-10) diagnosis and Current Procedural Terminology (CPT) codes. Inclusion criteria included patients older than 65, diagnosed with a displaced type II dens fracture, absent neurological damage, during the years 2015 to 2018. Age, sex, ICD-10 diagnosis codes, CPT codes, displacement type, and Elixhauser Comorbidity Index scores were obtained through the PearlDiver database. Patient-related variables and one-year mortality associated with surgical versus nonsurgical treatment were compared using univariate χ 2 analysis, odds ratios, and multivariate logistic regression analysis. RESULTS Among the 5300 patients who met our inclusion criteria, 59% (n=3108) were female, the mean age was 76.6 (±3.9) years old, and the average Elixhauser Comorbidity Index was 7.1 (±4.0). Only 8.3% (n=437) had surgical treatment for the displaced dens fracture. Multivariate logistic regression analysis for one-year mortality showed surgery was associated with decreased one-year mortality in all patients ( z =-6.26; P <0.001), patients between the ages of 65 and 74 ( z =-2.53; P =0.012), and patients over the age of 75 ( z =-5.81; P <0.001). CONCLUSION Despite surgery improving survival in elderly patients with type II dens fractures, surgical management is rarely pursued. Factors that independently increase the likelihood of surgery include younger age, male sex, and posterior displacement. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR
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16
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Riddoch FI, Leerssen A, Abu-Rajab R, Leung A. Mortality From Combined Fractures of the Atlas (C1) and Axis (C2) in Adults. Cureus 2022; 14:e27554. [PMID: 36059318 PMCID: PMC9428941 DOI: 10.7759/cureus.27554] [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] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Study design A retrospective case report of all upper cervical spine fractures diagnosed by CT imaging between 01/01/2013 and 31/12/2015 in NHS Greater Glasgow and Clyde, Scotland. Objective To compare the mortality following combined fractures of the atlas and axis to that of isolated fractures of either vertebra. Background The mortality from axis fractures is well documented in the literature. However, a combined fracture of the atlas and axis is seldom reported, leading to relatively unknown outcomes and mortality. Methods A total of 171 patients with atlas and/or axis fractures. Thirty-three presented with concurrent lower cervical spine fractures and were excluded from further analysis. Kaplan-Meier curves were used to compare survivorship between 108 patients with isolated and 30 with combined fractures. Similar analysis adjusted for comorbidities, including dementia and previous fragility fractures. Results Patients were followed up for 47.3±10.3 months (SD). Patients with isolated atlas fractures were significantly younger than those with an axis or combined fracture. Nearly half (8/17) of combined fracture mortalities occurred within the first 120 days. The mortality at 120 days was 26.7% in the combined fractures group and 18.5% in the isolated fracture group. There was no significant difference in the 120-day and overall mortality between these injury patterns. Furthermore, cognitive impairment and previous fragility fractures bore no significant impact on mortality. Nevertheless, mortality in the combined fracture group with previous fragility fractures did trend to shorter survivorship. Conclusions Patients with combined fractures are older and with the ever-increasing elderly population, the incidence of these injuries is expected to rise. While our data show that the 120-day mortality is proportionally higher in the combined fractures group, no long-term statistically significant difference is demonstrated. This evidence contests the notion that combined fractures of the atlas and axis have higher mortality than isolated injuries of either cervical vertebra.
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Vaccaro AR, Karamian BA, Levy HA, Canseco JA, Rajasekaran S, Benneker LM, Oner FC, Kandziora F, Schnake KJ, Kepler CK, Schroeder GD. Update on Upper Cervical Injury Classifications: The New AO Upper Cervical Spine Classification System. Clin Spine Surg 2022; 35:249-255. [PMID: 34232156 DOI: 10.1097/bsd.0000000000001215] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 10/20/2022]
Abstract
The upper cervical spine accounts for the largest proportion of cervical range of motion afforded by a complex system of bony morphology and ligamentous stability. Its unique anatomy, however, also makes it particularly vulnerable during both low and high energy trauma. Trauma to this area, referred to as upper cervical spine trauma, can disrupt the stability of the upper cervical spine and result in a wide spectrum of injury. Numerous upper cervical injury classification systems have been proposed, each of which have distinct limitations and drawbacks that have prevented their universal adoption. In this article, we provide an overview of previous classifications, with an emphasis on the development of the new AO Spine Upper Cervical Classification System (AO Spine UCCS).
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Affiliation(s)
- Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Hannah A Levy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | | | - Lorin M Benneker
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
| | | | - Frank Kandziora
- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt
| | - Klaus J Schnake
- Center for Spinal Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Yamashita M, Nagata K, Takami M, Okada M, Takiguchi N, Enyo Y, Nishi H, Nakashima T, Ueda K, Yamada H, Kato S. Mortality and complications in elderly patients with cervical spine injuries. Injury 2022; 53:2114-2120. [PMID: 35513939 DOI: 10.1016/j.injury.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the complications and mortality in elderly individuals with cervical spine injuries. METHODS This retrospective observational study was conducted in a tertiary care hospital in a rural area in Japan. Data sets from the trauma registry (January 2011 to March 2018) were analyzed. Patients with cervical spine injury were divided into those aged ≥ 65 years (group Y) and > 65 years (group E). We then analyzed age, sex, 30-day mortality, hospital stay, level of cervical spine injury, presence of cervical vertebral fracture, perioperative complications (pneumonia, urinary tract infection, and severe bedsore), neurological deficit (Frankel classification), Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS). RESULTS We evaluated a total of 398 patients; among them, 177 were included in group Y and 221 in group E. The assessed parameters were as follows: age (group Y/E; 48.7/75.9 years), men (78.0/72.3%), 30-day mortality (8.5/10.0%, p = 0.159), hospital stay (17.2/19.1 days, p = 0.36), level of cervical spine injury (C1 [5.7/4.5%], C2 [12.4/15.8%], C3 [10.2/17.2%], C4 [14.1/16.3%], C5 [26.6/22.2%], C6 [22.0/12.2%], and C7 [11.3/10.9%]), vertebral fracture (56.6/61.9%), central cord syndrome (36.2/33%), operation (18.6/13.1%), pneumonia (6.8/11.8%, p = 0.077), urinary tract infection (4.0/6.3%, p = 0.26), severe bedsore (0/1.8%, p = 0.068), Frankel classification (grade A [5.7/6.3%], grade B [6.8/7.7%], grade C [24.9/28.5%], grade D [17.5/11.8%], and grade E [34.5/33.9%]), mean AIS score in the cervical spine (3.3/3.5, p = 0.04), and mean ISS (23.2/22.2, p = 0.38). C3 injuries tended to be higher in group E. CONCLUSION Mortality and morbidity associated with cervical spine injuries did not differ between younger and older patients. Nevertheless, vigilance is required for the detection of C3 injury in elderly individuals.
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Affiliation(s)
- Masashi Yamashita
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan.
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Motohiro Okada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Noboru Takiguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Yoshio Enyo
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Hideto Nishi
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Kentaro Ueda
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
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Wakim J, Rajan T, Beschloss A, Albayar A, Ozturk A, Saifi C. Etiologies, incidence, and demographics of lumbar vertebral fractures in U.S. emergency departments. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:21-28. [PMID: 35441096 DOI: 10.21037/jss-21-110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/07/2022] [Indexed: 11/06/2022]
Abstract
Background Lumbar vertebral fractures are debilitating injuries widely associated with significant patient deformity, disability, pain, and potentially neurological deficit. This cross-sectional database study investigates the most frequent annual etiologies of lumbar vertebral fractures presented to emergency departments throughout the United States (U.S.) from 2010-2018. Methods The National Electronic Injury Surveillance System (NEISS) database was used to identify all patients who visited participating emergency departments between 2010-2018 and were diagnosed with a lumbar spine fracture. Population estimates by age (18+) were obtained from annual U.S. Census estimates and used to calculate annual incidence rates of lumbar fractures per 100,000 people. Results The annual incidence rate of total lumbar fractures in the U.S. increased from 14.6 to 22.5 per 100,000 people from 2010-2018 (54%). From 2010-2018, there were 382,914 [95% confidence interval (CI): 382,855-382,973] lumbar fractures in the U.S. This increased from 34,328 (95% CI: 34,277-34,379) in 2010 to 57,098 (95% CI: 57,044-57,152) in 2018 (66.3%). Men composed 40.2% and women made up 59.8% of patients. Mean patient age increased by 2.96 years from 65.5 (95% CI: 65.38-65.62) years in 2010 to 68.4 (95% CI: 68.32-68.48) years in 2018 (4.5%). From 2010-2018, floors, stairs/steps, and ladders were the most common etiologies of lumbar fractures. Estimated sum of floor-related fractures was 80,054 (95% CI: 79,986-80,122), stair/step-related fractures was 48,274 (95% CI: 48,209-48,339), and ladder-related fractures was 31,053 (95% CI: 30,987-31,119). The increase in these three etiologies accounted for 48% of the total increase of all-cause lumbar fractures between 2010 and 2018. Conclusions The volume of lumbar vertebral fracture has increased over the last near decade (66.3%), and approximately half (48%) of these fractures can be attributed to accidents caused by flooring, stairs/steps, and ladder-related injuries. The increasing mean patient age, as well as accidents involving ladders, were found to be statistically correlated with the rise in total lumbar fracture volume.
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Affiliation(s)
- Jonathan Wakim
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thriaksh Rajan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alex Beschloss
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ahmed Albayar
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ali Ozturk
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Comron Saifi
- Division of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX, USA
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Watts A, Athanassacopoulos M, Breakwell L, Chiverton N, Cole A, Ivanov M, Tomlinson J. Management of C2 odontoid peg fragility fractures - A UK survey of spinal surgeons. Injury 2022; 53:1057-1061. [PMID: 34635337 DOI: 10.1016/j.injury.2021.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/23/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients sustaining fragility fractures of the C2 odontoid peg have 30-day mortality rates as high as 10% rising up to 34.1% at 1 year. Substantial controversy exists regarding optimal management of these fractures and there is a lack of national guidance to inform best practice. The aim of this study was to determine current practice in the management of these fractures throughout the United Kingdom. METHODS A UK wide, cross sectional survey was conducted, asking 10 questions regarding the initial management, imaging and follow-up of an elderly patient with a type 2 fragility odontoid peg fracture. This was publicised through the British Orthopaedic Association website and sent to all members of the Society of British Neurological Surgeons (SBNS) via email. RESULTS 107 Responses were received. 56% from orthopaedic consultants, 29% from neurosurgical consultants and 15% from senior spine fellows. 86% (92) of respondents choose treatment with a cervical orthosis, with 84% (77) of these opting for a semi rigid Aspen or Philadelphia collar compared to 16% (15) opting for a soft cervical collar. Three (3%) opted for operative intervention with a further three (3%) choosing Halo fixation. Nine respondents (8%) opted for no orthosis and treatment with analgesia alone. Length of immobilisation in cervical orthosis ranged from 6 to 12 weeks. Initial follow-up ranged from 1 week to 6 weeks, with 6% (6) discharged without follow up. There was also marked variation in the use of follow-up imaging with 17% (18) using plain radiographs, 62% (66) requesting lateral flexion / extension radiographs, 10% (11) using CT and 11% (12) not performing any imaging at final follow up. In 60% (64) of cases respondents did not change subsequent management as a result of imaging. CONCLUSION Type-2 fragility peg fractures have high morbidity and mortality. There is marked variation in the treatment modalities used, follow-up regime and use of imaging throughout the UK. Given the rapidly increasing incidence of these injuries and the associated mortality this should be a high priority field for further research. Further large scale studies are urgently required to inform best practice and standardise management of these injuries.
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Affiliation(s)
- Anna Watts
- Speciality Registrar Trauma and Orthopaedics, Sheffield Teaching Hospital NHS Foundation Trust, England.
| | | | - Lee Breakwell
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - Neil Chiverton
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - Ashley Cole
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - Marcel Ivanov
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
| | - James Tomlinson
- Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust.
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21
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Williams JR, Muesch AJ, Svenson JE, Clegg AW, Patterson BW, Ward MA. Utility of bedside assessment to evaluate for cervical-spine fracture post ground-level fall for patients 65 years and older. Am J Emerg Med 2022; 53:208-214. [DOI: 10.1016/j.ajem.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022] Open
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22
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Tang A, Gambhir N, Menken LG, Shah JK, D'Ambrosio M, Ramakrishnan V, Liporace FA, Yoon RS. Identification of concomitant injuries associated with specific spine level fractures in polytrauma patients. Injury 2022; 53:1068-1072. [PMID: 34920875 DOI: 10.1016/j.injury.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Spine fractures are associated with high energy mechanisms and can lead to substantial morbidity and mortality in the trauma setting. Rapid identification and treatment of these fractures and their associated injuries are paramount in preventing adverse outcomes. The purpose of this study is to identify concomitant skeletal and non-skeletal injuries related to cervical, thoracic, and lumbar fractures. METHODS A retrospective review of institutional American College of Surgeons (ACS) registry was conducted on 3,399 consecutive trauma patients identifying those with spine fractures from 1/2016-12/2019. Two-hundred ninety patients were included(8.5%) and separated into three groups based on fracture location: eighty-eight cervical(C)-spine, 129thoracic(T)-spine, and 143lumbar(L)-spine. Logistic regression analyses were performed to identify associated injuries, presenting injury severity score(ISS) and Glasgow coma scale(GCS), mechanism of injury, demographic data, substance use, and paralysis for each group. Cox hazard regression was utilized to identify factors associated with inpatient mortality. RESULTS C-spine fractures were associated with head trauma(OR2.18,p = 0.003),intracranial bleeding (OR2.64,p = 0.001),facial(OR2.25,p = 0.02) and skull fractures(OR3.92,p = 0.001),and cervical cord injuries(OR4.78,p = 0.012). T-spine fractures were associated with rib fractures(OR2.31,p = 0.003). L-spine fractures were associated with rib(OR1.77, p = 0.04), pelvic(OR5.11,p<0.001), tibia/fibula (OR2.31,p = 0.05), and foot/ankle fractures(OR3.32,p = 0.04), thoracic(OR2.43,p = 0.008) and retroperitoneal cavity visceral injuries(OR27.3,p = 0.001). Falls≤6meters were also significantly associated with C-spine fractures(OR1.70,p = 0.04) while falls>6meters were associated with L-spine fractures(OR4.30,p = 0.001). Inpatient mortality risk increased in patients with C-spine fractures(HR4.41,p = 0.002), higher ISS(HR1.05, p<0.001), and lower GCS(HR0.85,p<0.001). Last, patients≥65-years-old were more likely to experience C-spine fractures(OR1.88,p = 0.03). CONCLUSION Patients who experience fractures of the cervical, thoracic, or lumbar spine are at risk for additional fractures, visceral injury, and/or death. Awareness of the associations between spinal fractures and other injuries can increase diagnostic efficacy, improve patient care, and provide valuable prognostic information. These associations highlight the importance of effective and timely communication and multidisciplinary collaboration.
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Affiliation(s)
- Alex Tang
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Neil Gambhir
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Luke G Menken
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Jay K Shah
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Matthew D'Ambrosio
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Vivek Ramakrishnan
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Frank A Liporace
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America.
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Mora-Boga R, Vázquez Muíños O, Pértega Díaz S, Meijide-Faílde R, Rodríguez-Sotillo A, Ferreiro-Velasco M, Salvador-de la Barrera S, Montoto-Marqués A. Valor pronóstico de la resonancia magnética precoz en la morbilidad y mortalidad de la lesión medular traumática. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cervical spine injuries requiring surgery in a Level I trauma centre in a major German city. Acta Neurochir (Wien) 2022; 164:35-41. [PMID: 34704140 PMCID: PMC8761159 DOI: 10.1007/s00701-021-05029-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Cervical spine injuries (CSI) are rare in trauma patients, at about 9.2-16.5/100,000 inhabitants in Scandinavia and Canada, and the annual incidence of CSI surgeries in Norway is around 3.0/100,000 inhabitants. However, despite their rarity, the incidence of CSI has increased, thereby assuming an increasing need for surgery. Outside of Scandinavia, no data about the incidence of CSI and subsequent surgeries exist. Therefore, this study aimed to analyse CSI epidemiology and surgery in a German city with a Level I trauma centre both to understand the injury and improve needs-based planning. METHODS This retrospective, monocentre study included all patients who presented with CSI from 2012-2017 at a university hospital with a Level I trauma centre in a major German city and had permanent residency within the city. Based on the assumption that the patients represented all CSI injuries in the city, as they were treated at the only available Level I trauma centre, the annual incidence of surgeries and neurologic deficits due to CSI were calculated. RESULTS A total of 465 patients with 609 CSI were identified. Of these patients, 61 both received surgery and resided in the city (mean age, 68.1 ± 18.3 years; 26 female, 35 male). The incidence of CSI surgeries was calculated as 3.24/100,000 person years (1.75/100,000 in the upper and 1.54/100,000 in the subaxial cervical spine). Neurologic deficits occurred in 0.64/100,000 person years. The incidence of both surgeries and neurologic deficits showed no significant changes over the 6-year study period. CONCLUSIONS Compared to Scandinavia, an increasing annual incidence for CSI surgeries and neurologic deficits were found. For long-term demand planning with adaptability to demographic changes, cross-regional studies including long-term follow-up are necessary.
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Lyons J, Mian H. Epidemiology of atlas fractures in the United States: A 20-year analysis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:85-93. [PMID: 35386248 PMCID: PMC8978844 DOI: 10.4103/jcvjs.jcvjs_164_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: Fractures of the atlas represent a large portion of cervical spine trauma in the geriatric population. With an aging and more active population, it is expected that the number of patients sustaining atlas fractures is increasing. However, epidemiologic data regarding the incidence of atlas fractures in large populations are scarce. The aim of this study was to investigate the incidence and demographic characteristics of patients with fractures of the atlas in the United States (US) over the last 20 years. Materials and Methods: This descriptive epidemiology study retrospectively analyzed the National Electronic Injury Surveillance System database to identify cases of atlas fractures presenting to US Emergency Departments (EDs) from 2001 to 2020. Annual and overall numbers of fractures and fracture incidence rates, patient demographics (age, gender, race), and injury characteristics (mechanism, associated injuries) were analyzed. Incidence rates are expressed as the number of fractures per million at-risk person-years. Patients were split into four different age groups for comparisons (<18, 18–64, 65–79, 80+ years). Results: An estimated 38,092 cases of acute atlas fractures were identified, representing 11.1% of all cervical fractures and corresponding to an overall incidence rate of 6.2. Slightly more than half (54%) occurred in females and the mean age was 71 years. Overall, a majority (64%) of cases occurred in patients > 70 years old. There was substantial increase in incidence rate with age (<18 years: 0.7; 18–64 years: 2.6; 65–79 years: 17.1; 80 + years: 71.8). The most common injury mechanism was a low-energy fall (74%). Overall, only 42% of atlas fractures were isolated injuries, with 58% of patients sustaining at least one concomitant injury and 48% sustaining at least one additional fracture. Accounting for population growth yielded a significantly increasing incidence over the study period from 1.7 in 2001 to 13.4 in 2020 (annual percent increase = 11, P < 0.00001). Disproportionately large increases in incidence rates were observed in the oldest patient groups. Conclusions: Atlas fractures occur in older patients and are often associated with concomitant injuries to the head and spine. These types of fractures are increasing in the US, especially among the elderly. The annual incidence increased nearly 700% over the course of the study period and in 2020 was over 13 per million overall. In elderly patients >80 years old, the most recent annual incidence rate was over 157 per million.
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Corrales MA, Cronin DS. Sex, Age and Stature Affects Neck Biomechanical Responses in Frontal and Rear Impacts Assessed Using Finite Element Head and Neck Models. Front Bioeng Biotechnol 2021; 9:681134. [PMID: 34621726 PMCID: PMC8490732 DOI: 10.3389/fbioe.2021.681134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/06/2021] [Indexed: 11/14/2022] Open
Abstract
The increased incidence of injury demonstrated in epidemiological data for the elderly population, and females compared to males, has not been fully understood in the context of the biomechanical response to impact. A contributing factor to these differences in injury risk could be the variation in geometry between young and aged persons and between males and females. In this study, a new methodology, coupling a CAD and a repositioning software, was developed to reposture an existing Finite element neck while retaining a high level of mesh quality. A 5th percentile female aged neck model (F0575YO) and a 50th percentile male aged neck model (M5075YO) were developed from existing young (F0526YO and M5026YO) neck models (Global Human Body Models Consortium v5.1). The aged neck models included an increased cervical lordosis and an increase in the facet joint angles, as reported in the literature. The young and the aged models were simulated in frontal (2, 8, and 15 g) and rear (3, 7, and 10 g) impacts. The responses were compared using head and relative facet joint kinematics, and nominal intervertebral disc shear strain. In general, the aged models predicted higher tissue deformations, although the head kinematics were similar for all models. In the frontal impact, only the M5075YO model predicted hard tissue failure, attributed to the combined effect of the more anteriorly located head with age, when compared to the M5026YO, and greater neck length relative to the female models. In the rear impacts, the F0575YO model predicted higher relative facet joint shear compared to the F0526YO, and higher relative facet joint rotation and nominal intervertebral disc strain compared to the M5075YO. When comparing the male models, the relative facet joint kinematics predicted by the M5026YO and M5075YO were similar. The contrast in response between the male and female models in the rear impacts was attributed to the higher lordosis and facet angle in females compared to males. Epidemiological data reported that females were more likely to sustain Whiplash Associated Disorders in rear impacts compared to males, and that injury risk increases with age, in agreement with the findings in the present study. This study demonstrated that, although the increased lordosis and facet angle did not affect the head kinematics, changes at the tissue level were considerable (e.g., 26% higher relative facet shear in the female neck compared to the male, for rear impact) and relatable to the epidemiology. Future work will investigate tissue damage and failure through the incorporation of aged material properties and muscle activation.
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Affiliation(s)
- M A Corrales
- Department of MME, University of Waterloo, Waterloo, ON, Canada
| | - D S Cronin
- Department of MME, University of Waterloo, Waterloo, ON, Canada
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Mora-Boga R, Canosa-Hermida E, Toral-Guisasola I, Balboa-Barreiro V, Salvador-de la Barrera S, Ferreiro-Velasco ME, Rodríguez-Sotillo A, Montoto-Marqués A. Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old. NEUROCIRUGÍA (ENGLISH EDITION) 2021; 32:209-216. [PMID: 34493401 DOI: 10.1016/j.neucie.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis METHODS: Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group. RESULTS 379 patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%, p < 0.001), longer delay in diagnosis (31.1% vs. 9.2%, p < 0.001) and higher hospital mortality (34.9% vs. 3.2%, p < 0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI. CONCLUSIONS 1) The frequency of traumatic SCI in the elderly in Galicia is high. 2) Neurological evolution is similar to younger patients but the level of dependence is higher. 3) The level of care provided is similar in both groups, except for the surgical indication. 4) Hospital mortality is high.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Eva Canosa-Hermida
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Iris Toral-Guisasola
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Vanessa Balboa-Barreiro
- Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN), Complexo Hospitalario Universitario, A Coruña (CHUAC), A Coruña, Spain
| | - Sebastián Salvador-de la Barrera
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - María Elena Ferreiro-Velasco
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
| | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
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Benchetrit S, Blackham J, Braude P, Halliday R, Shipway D, Williams A, Carlton E. Emergency management of older people with cervical spine injuries: an expert practice review. Emerg Med J 2021; 39:331-336. [PMID: 34344732 DOI: 10.1136/emermed-2020-211002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Abstract
Spinal fractures are the third most common traumatic injury in older people, of which cervical spine injuries make up around 15%. They are predominantly seen in people living with frailty who fall from standing height. Spinal fractures in this patient group are associated with substantial morbidity and mortality (over 40% at 1 year). For many older people who survive, their injuries will be life changing. Practice between EDs varies significantly, with no universally accepted guidelines on either assessment, investigation or management specific to older people experiencing trauma. This expert practice review examines the current evidence and emergency management options in this patient group through clinical scenarios, with the aim of providing a more unified approach to management.
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Affiliation(s)
| | | | - Philip Braude
- Department of Medicine for Older People, Southmead Hospital, Bristol, UK
| | - Ruth Halliday
- Trauma & Orthopaedic Research Team, Southmead Hospital, Bristol, UK
| | - David Shipway
- Department of Medicine for Older People, Southmead Hospital, Bristol, UK
| | - Adam Williams
- Department of Neurosurgery, Southmead Hospital, Bristol, UK
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Bachhuber A. [Cervical fractures and disc lesions]. Radiologe 2021; 61:714-719. [PMID: 34241638 DOI: 10.1007/s00117-021-00880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
CLINICAL ISSUE The head accounts for about 8% of the total body weight, and only modest ligaments stabilize the cervical spine. In children, the ratio head weight/body mass is even worse, so not surprisingly injuries to the cervical spine are common. This article reviews the most common classifications of different cervical fractures. In addition, ruptures of the ligaments and lesions to the intervertebral discs and the vertebral arteries are discussed. PRACTICAL RECOMMENDATIONS In high velocity trauma, it is vital to exclude lesions to the vertebral arteries and the cervical ligaments to prevent/minimize further harm and to accurately assess the stability of the cervical spine.
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Affiliation(s)
- Armin Bachhuber
- , Kirrberger Straße, Gebäude 90, 66421, Homburg/Saar, Deutschland.
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Vives-Torres CM, Valdano M, Jimenez-Octavio JR, Muehlbauer J, Schick S, Peldschus S, Lopez-Valdes FJ. Comparison of Upper Neck Loading in Young Adult and Elderly Volunteers During Low Speed Frontal Impacts. Front Bioeng Biotechnol 2021; 9:682974. [PMID: 34277584 PMCID: PMC8278284 DOI: 10.3389/fbioe.2021.682974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Cervical pain and injuries are a major health problem globally. Existing neck injury criteria are based on experimental studies that included sled tests performed with volunteers, post-mortem human surrogates and animals. However, none of these studies have addressed the differences between young adults and elderly volunteers to date. Thus, this work analyzed the estimated axial and shear forces, and the bending moment at the craniocervical junction of nine young volunteers (18–30 years old) and four elderly volunteers (>65 years old) in a low-speed frontal deceleration. Since the calculation of these loads required the use of the mass and moment of inertia of the volunteers' heads, this study proposed new methods to estimate the inertial properties of the head of the volunteers based on external measurements that reduced the error of previously published methods. The estimated mean peak axial force (Fz) was −164.38 ± 35.04 N in the young group and −170.62 ± 49.82 N in the elderly group. The average maximum shear force (Fx) was −224.42 ± 54.39 N and −232.41 ± 19.23 N in the young and elderly group, respectively. Last, the estimated peak bending moment (My) was 13.63 ± 1.09 Nm in the young group and 14.81 ± 1.36 Nm in the elderly group. The neck loads experienced by the elderly group were within the highest values in the present study. Nevertheless, for the group of volunteers included in this study, no substantial differences with age were observed.
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Affiliation(s)
- Carmen M Vives-Torres
- Instituto de Investigacion Tecnologica, ICAI, Engineering School, Universidad Pontificia Comillas, Madrid, Spain
| | - Manuel Valdano
- Instituto de Investigacion Tecnologica, ICAI, Engineering School, Universidad Pontificia Comillas, Madrid, Spain
| | - Jesus R Jimenez-Octavio
- Instituto de Investigacion Tecnologica, ICAI, Engineering School, Universidad Pontificia Comillas, Madrid, Spain
| | - Julia Muehlbauer
- Biomechanics and Accident Analysis, Ludwig Maximilians University (LMU), Munich, Germany
| | - Sylvia Schick
- Biomechanics and Accident Analysis, Ludwig Maximilians University (LMU), Munich, Germany
| | - Steffen Peldschus
- Biomechanics and Accident Analysis, Ludwig Maximilians University (LMU), Munich, Germany
| | - Francisco J Lopez-Valdes
- Instituto de Investigacion Tecnologica, ICAI, Engineering School, Universidad Pontificia Comillas, Madrid, Spain
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Agunbiade S, Belton PJ, Mesfin FB. Spinal Cord Transection in a Type II Odontoid Fracture From a Ground-Level Fall. Cureus 2020; 12:e12342. [PMID: 33520537 PMCID: PMC7837629 DOI: 10.7759/cureus.12342] [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] [Indexed: 11/24/2022] Open
Abstract
Odontoid fractures typically occur as a result of trauma: high-velocity injuries like motor vehicle accidents in young people and falls for the elderly. Odontoid fractures are the most common cervical spine fractures in patients over 65, with type II being the most common. However, spinal cord transections are rare with these types of injuries, especially without significant fracture displacement, translation or evidence of ligamentous disruption on post-injury imaging. We report a case of a patient who sustained a spinal cord transection secondary to an acute type II odontoid fracture from a ground-level fall, without computed tomography radiographic evidence of cord disruption or impingement.
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Tarawneh A, Taqvi S, Salem K, Sahota O. Cervical spine fragility fractures in older people: 5-year experience at a regional spine centre. Age Ageing 2020; 49:1102-1104. [PMID: 32520992 DOI: 10.1093/ageing/afaa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less. Atlanto-axial complex (AAC) and, particularly, odontoid process (OP) fractures are the most prevalent injuries. OBJECTIVE to investigate the incidence and characteristics of cervical spine fractures in older patients presenting to a regional spine centre. METHODS a retrospective review of the clinical records and imaging of all patients aged 70 years and over presenting to a regional spinal unit with a cervical injury over a 5-year period was performed. Patient demographics, mechanism of injury, level of fracture, stability of the fracture, treatment modality, imaging modality and mortality rates were collected and analysed. RESULTS during the period between 2015 and 2019, a total of 209 patients aged 70 years and over were presented to the regional spine unit. The mean age at presentation was 82.4 (±7.5) years. Low-energy trauma was the commonest mechanism of injury (n = 169; 80.9%). MRI was undertaken in a quarter of the patients. One-hundred and fifty-one patients (72.2%) suffered an AAC Injury with OP fractures forming the majority of this group (n = 119; 78.8%). One-hundred and ninety-nine patients were treated conservatively, and the overall 30-day mortality rate was 8.1%. CONCLUSION cervical spine fractures are not uncommon amongst older people and are mostly the result of low-energy trauma and predominantly affect the axial cervical spine. The majority of these injuries are managed conservatively with an orthosis. The fractures nevertheless are a serious injury, with a high mortality rate at 30 days.
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Affiliation(s)
- Ahmad Tarawneh
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Syed Taqvi
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Khalid Salem
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Opinder Sahota
- Department of Healthcare of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Kannus P, Niemi S, Parkkari J, Mattila VM. Sharp Rise in Fall-Induced Cervical Spine Injuries Among Older Adults Between 1970 and 2017. J Gerontol A Biol Sci Med Sci 2020; 75:2015-2019. [PMID: 31811293 DOI: 10.1093/gerona/glz283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fall-induced injuries in older adults are a major public health challenge. METHODS We determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2017. Similar patients aged 20-49 years served as a reference group. RESULTS The annual number of fall-induced severe cervical spine injuries among older Finnish adults rose steeply during the follow-up, from 59 in 1970 to 502 in 2017. The age-adjusted incidence of injury (per 100,000 persons) was higher in men than women throughout this period and showed a clear increase from 1970 to 2017: from 8.4 to 25.0 in men, and from 2.8 to 13.9 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 80 years or older. In the reference group, the injury incidence declined by time. CONCLUSIONS The number and incidence of fall-induced severe cervical spine injuries among older Finns showed a sharp rise between 1970 and 2017. An increase in the average risk of serious falls may partly explain the phenomenon. Effective fall and injury prevention measures are urgently needed since further aging of the population is likely to aggravate the problem in the near future.
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Affiliation(s)
- Pekka Kannus
- Department of Orthopedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Tampere.,Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Seppo Niemi
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
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Mora-Boga R, Canosa-Hermida E, Toral-Guisasola I, Balboa-Barreiro V, Salvador-de la Barrera S, Ferreiro-Velasco ME, Rodríguez-Sotillo A, Montoto-Marqués A. Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30084-1. [PMID: 32800694 DOI: 10.1016/j.neucir.2020.06.003] [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: 01/26/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis. METHODS Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group. RESULTS Three hundred seventy-nine patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%; p<0.001), longer delay in diagnosis (31.1 vs. 9.2%; p<0.001) and higher hospital mortality (34.9 vs. 3.2%; p<0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI. CONCLUSIONS 1) The frequency of traumatic SCI in the elderly in Galicia is high; 2) Neurological evolution is similar to younger patients but the level of dependence is higher; 3) The level of care provided is similar in both groups, except for the surgical indication, and 4) Hospital mortality is high.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España.
| | - Eva Canosa-Hermida
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Iris Toral-Guisasola
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Vanessa Balboa-Barreiro
- Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Sebastián Salvador-de la Barrera
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - María Elena Ferreiro-Velasco
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, España
| | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, España
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Neifert SN, Martini ML, Yuk F, McNeill IT, Caridi JM, Steinberger J, Oermann EK. Predicting Trends in Cervical Spinal Surgery in the United States from 2020 to 2040. World Neurosurg 2020; 141:e175-e181. [PMID: 32416237 DOI: 10.1016/j.wneu.2020.05.055] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to predict surgical volumes for 2 common cervical spine procedures from 2020 to 2040. METHODS Using the National Inpatient Sample from 2003-2016, nationwide estimates of anterior cervical diskectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) volumes were calculated using International Classification of Diseases, Ninth and Tenth Revision (ICD-9, ICD-10) procedure codes. With data from the U.S. Census Bureau, estimates of the U.S. population were used to create Poisson models controlling for age and sex. Age was categorized into ranges (<25 years old, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and >85), and estimates of surgical volume for each age group were created. RESULTS From 2020-2040, increases in surgical volume from 13.3% (153,288-173,699) and 19.3% (29,620-35,335) are expected for ACDF and PCDF, respectively. For ACDF, the largest increases are expected in the 45-54 (42,077-49,827) and 75-84 (8065-14,862) age groups, whereas for PCDF, the largest increases will be seen in the 75-84 (3710-6836) age group. In accordance with an aging population, modest increases will be seen for ACDF (858-1847) and PCDF (730-1573) in the >85-year-old cohort. CONCLUSIONS As expected, large growth in cervical spine surgical volumes is likely to be seen, which could indicate a need for increased numbers of spinal neurosurgeons and orthopedic surgeons. Further studies are needed to investigate the needs of the field in light of these expected increases in volume.
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Affiliation(s)
- Sean N Neifert
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Michael L Martini
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Frank Yuk
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - John M Caridi
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Eric Karl Oermann
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
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Does prehospital spinal immobilization influence in hospital decision to obtain imaging after trauma? Injury 2020; 51:935-941. [PMID: 32113741 DOI: 10.1016/j.injury.2020.02.097] [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: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 02/02/2023]
Abstract
IMPORTANCE This study highlights the unnecessarily high suspicion for cervical spine injury among study providers and shows that cervical CT scans were more likely in patients who arrived to the emergency department wearing a cervical collar, even when clinically cleared for suspicion of cervical spine injury by the emergency department provider. OBJECTIVE To determine if patients with a cervical collar were more likely to undergo cervical spine imaging than those who arrived to the emergency department without a collar. DESIGN Adult trauma patients at a level 1 trauma center over 4 months (n = 1,438) were stratified by acuity (1,2, or 3), mechanism, and known injury cephalad to clavicles, defined as pain, wounds, or hematomas. Cervical spine imaging findings were recorded. RESULTS 975 patients (67.8%) had cervical CT scans. Twenty-six (1.81%) sustained a fracture or ligamentous injury, all with known injury cephalad to clavicles. 161 (11.2%) patients without injury cephalad to clavicles all had a negative cervical CT. Category 1 patients with gunshot wounds with injury cephalad to clavicles were more likely to have CT if they arrived with a collar versus without (66.7% vs 14.3%, p = 0.027). Category 2 and 3 patients with injury cephalad to clavicles after motor vehicle collision (MVC) (88.2% vs 69.6%, p = 0.011), low energy falls (88.3% vs 59.4%, p < 0.0001), and assault (86.0% vs 37.1%, p < 0.0001) underwent cervical CT more frequently if they arrived wearing a collar. Category 2 and 3 trauma patients without injury cephalad to clavicles were also more likely to undergo CT when wearing a collar after MVC (66.3% vs 21.4%, p = 0.001), low energy fall (81.8% vs 35.3%, p = 0.016), and pedestrian vs MVC (55.6% vs 12.5%, p = 0.04). CONCLUSION Certain trauma patients were more likely to undergo cervical CT if they arrived wearing a cervical collar. No conscious patients without complaints proximal to the clavicles had cervical injury.
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Abstract
BACKGROUND The influence of trauma-related kinematics on the injury pattern of the cervical spine is currently not considered in the available classification systems, only the force vector. Whether the strength of the trauma has an additional influence on the number and complexity of the injuries and whether this can be classified, has not yet been finally investigated. OBJECTIVE What influence do different kinematics apart from the traumatic force vector have on injuries of the cervical spine? MATERIAL AND METHODS Based on the AOSpine classification system for the upper and subaxial cervical spine, data from 134 trauma patients from a first level trauma center were retrospectively analyzed. Analogue to the S3 guidelines on polytrauma, patients were assigned to six trauma groups and the injuries were classified on the basis of computed tomography (CT) cross-sectional imaging. RESULTS A higher trauma energy had a significant impact on the number of cervical spine injuries (p = 0.005). In low velocity accidents C2 was the most frequently injured vertebra (51%; p = 0.022) and high velocity accidents showed more C7 fractures (37%; p = 0.017). Furthermore, upper cervical spine injuries occurred more often in low energy trauma and older female patients (e.g. falling from a standing position). Subaxial cervical spine involvement was found significantly more often in high velocity accidents and younger male patients (p = 0.012). CONCLUSION Exact knowledge of the trauma mechanism is helpful in the primary treatment of an injured person. Injury patterns can be better estimated and the appropriate diagnostics can be initiated. The results underline the importance of immediate cervical spine immobilization even after minor trauma. In high velocity trauma, patients more often suffer from lower cervical spine injuries, especially C7. Due to the accumulation of multilevel spinal injuries in high velocity trauma, radiographic imaging of the whole spine is advisable.
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Association Between Frailty Status and Odontoid Fractures After Traumatic Falls: Investigation of Varying Injury Mechanisms Among 70 Elderly Odontoid Fracture Patients. J Orthop Trauma 2019; 33:e484-e488. [PMID: 31365449 DOI: 10.1097/bot.0000000000001597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine significant associations between patient frailty status and odontoid fractures across common traumatic mechanisms of injuries (MOIs) in the elderly. DESIGN Retrospective review. SETTING Single, academic-affiliated hospital with full surgical services. PATIENTS/PARTICIPANTS Patients 65 years or older with traumatic odontoid fractures were included. INTERVENTION Nonoperative management (soft/hard collar, halo, traction tongs, and Minerva) and/or operative fixation. MAIN OUTCOME MEASUREMENTS Modified frailty index (mFI), MOI, concurrent injuries, inpatient length of stay (LOS), reoperation, and mortality rates. RESULTS Seventy patients were included (80.6 ± 8.5 years, 60% F, 88% European, 10% Maori/Pacific, 1.4% Asian, Charlson Comorbidity Index 5.3 ± 2.2, mFI 0.21 ± 0.15). The most common MOIs were falls (74.3%), high-speed motor vehicle accidents (MVAs) (17.1%), low-speed MVAs (5.7%), and pedestrian versus car (2.9%). Patients with traumatic falls exhibited significantly higher mFI scores (0.25) compared with low-speed MVAs (0.16), high-speed MVAs (0.08), and pedestrian versus car (0.01) (P = 0.003). Twenty-seven patients with odontoid fractures were frail, 33 were prefrail, and 10 were robust. Ninety-two percent of frail patients had a traumatic fall as their MOI, as opposed to 73% of prefrail and 30% of robust patients (P < 0.001). Prefrail and frail patients were 4.3 times more likely than robust patients to present with odontoid fractures through traumatic fall [odds ratio (OR): 4.33 (1.47-12.75), P = 0.008], and frailty increased likelihood of reoperation [OR: 4.2 (1.2-14.75), P = 0.025] and extended LOS [OR: 5.71 (1.05-10.37), P = 0.017]. Frail patients had the highest 30-day (P = 0.017) and 1-year mortality (P < 0.001) compared with other groups. CONCLUSION Patients with traumatic odontoid fractures from falls were significantly more frail in comparison with any other MOIs, with worse short- and long-term outcomes. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Hadley G, Billingsley S, Nakagawa S, Durkin C. Head injury in the elderly. Clin Med (Lond) 2019; 19:428-429. [PMID: 31530702 DOI: 10.7861/clinmedicine.19-5-428a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Squarza S, Uggetti CL, Politi MA, Pescatori LC, Bisogno R, Campi A, Reganati P, Cariati M. C1-C2 fractures in asymptomatic elderly patients with minor head trauma: evaluation with a dedicated head CT protocol. Radiol Bras 2019; 52:17-23. [PMID: 30804611 PMCID: PMC6383526 DOI: 10.1590/0100-3984.2017.0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the frequency and types of upper cervical spine injuries in
asymptomatic elderly patients undergoing computed tomography (CT) for the
investigation of minor head trauma. Materials and Methods This was a prospective study of 2613 asymptomatic elderly patients with minor
head trauma seen between January 2015 and December 2016. We adopted a
dedicated head CT protocol that included the C1-C2 region. Results Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries,
corresponding to 8.37% of the 394 patients with trauma-related findings. Of
those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of
16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%,
respectively. Conclusion Inclusion of the C1-C2 region in head CT scans allowed us to identify upper
cervical spine injuries in 1.26% of asymptomatic elderly patients with minor
head trauma. The protocol evaluated helps detect potentially
life-threatening injuries and could be adopted for routine use in elderly
individuals with minor head trauma.
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Affiliation(s)
- Silvia Squarza
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | - Carla Luisa Uggetti
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | | | | | | | - Adriana Campi
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | - Paolo Reganati
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
| | - Maurizio Cariati
- Neuroradiology Unit, Radiology Department, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milano, Italy
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Asemota AO, Ahmed AK, Purvis TE, Passias PG, Goodwin CR, Sciubba DM. Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges. World Neurosurg 2018; 120:e114-e130. [DOI: 10.1016/j.wneu.2018.07.228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 12/22/2022]
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Bokhari AR, Sivakumar B, Sefton A, Lin JL, Smith MM, Gray R, Hartin N. Morbidity and mortality in cervical spine injuries in the elderly. ANZ J Surg 2018; 89:412-417. [PMID: 30294850 DOI: 10.1111/ans.14875] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of our study was to identify the demographics and complications in elderly cervical spine injuries and predictive factors for surgery, complications and mortality. We hypothesized younger healthier patients were more likely to undergo surgical intervention. METHODS A retrospective review of 225 consecutive patients aged 65 years and over with cervical spine injuries was carried out over a 3-year period. RESULTS There were 113 males and 112 females with an average of 79.7 years (range 65-98). The most common fracture was C2 peg type (21.8%). Five patients had complete spinal cord injury (2.2%), 25 had incomplete spinal cord injury (11.1%) and 84% were neurologically intact. Fifty-four patients were managed operatively (24%), while 171 patients were managed non-operatively (76%). The operative group had higher rates of pneumonia (odds ratio (OR) 5.3, 95% confidence interval (CI) 2.6-10.7, P < 0.01), cardiac arrhythmia (OR 4.1, 95% CI 1.5-11.2, P < 0.01) and respiratory failure (OR 2.6, 95% CI 1.2-5.5, P < 0.05). There was no difference in mortality between the operative and non-operative group (18.5% and 12.9%, P = 0.3). Patients with complete spinal cord injury had 100% mortality. Significant predictive factors for complications and death were neurological deficits, comorbidities and the presence of other injuries (P < 0.05). Surgery was not predictive for death and the operative group was younger than the non-operative group (P < 0.05). CONCLUSIONS In the setting of a high complication rate, consideration should be given to palliation in elderly patients with complete spinal cord injury and there must be good rational for surgery.
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Affiliation(s)
- Ali R Bokhari
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Brahman Sivakumar
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Andrew Sefton
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Juin-Lih Lin
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Margaret M Smith
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Randolph Gray
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nathan Hartin
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Abstract
Fractures of the C1 vertebrae (atlas) are commonly the result of falls and other trauma, which cause hyperextension, or axial compression of the cervical spine. Although historically thought as a benign injury with lower neurological risks, current data suggests that this may not hold true for geriatric patients (aged 65 y and older) who may be predisposed to these fractures even after lower-energy trauma such as ground-level falls. Advancements in orthopedic trauma care has increased our diagnostic abilities to identify and manage patients with C1 fractures and other upper cervical spine trauma. However, there are no universal treatment guidelines based on level I trials. Current treatment ranges from nonoperative to operative management depending on fracture-pattern and integrity of the surrounding ligaments. Furthermore, in the elderly patients these fractures present a unique dilemma due to preexisting comorbidities and contraindications to various treatment modalities. C1 fractures warrant greater recognition to provide optimal treatment to patients and minimize the risk for developing complications. The goal of this review is to highlight the most updated treatment guidelines and to discuss the complications of both operative and nonoperative management of C1 fractures especially among the elderly patient population.
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Atinga A, Shekkeris A, Fertleman M, Batrick N, Kashef E, Dick E. Trauma in the elderly patient. Br J Radiol 2018; 91:20170739. [PMID: 29509505 DOI: 10.1259/bjr.20170739] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of elderly trauma cases is rising yearly, accounting for >25% of all major trauma nationally. The elderly have different physiological reserves and a different response to trauma due to premorbid frailty, co-existing conditions and prescribed medication. These factors need to be appreciated in trauma triaging, radiological assessment and clinical management. A lower threshold for trauma-call activation is recommended, including a lower threshold for advanced imaging. We will review general principles of trauma in the elderly, outline injury patterns in this age group and illustrate the radiological features per anatomical site, from head to pelvis and the extremities. We advocate using contrast-enhanced computed tomography as the primary diagnostic imaging modality as concern about intravenous contrast agent-induced nephropathy is relatively minor. Prompt investigation and diagnosis leads to timely appropriate treatment, therefore the radiologist can discerningly improve morbidity and mortality in this vulnerable group.
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Affiliation(s)
- Angela Atinga
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Andreas Shekkeris
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Michael Fertleman
- 2 Department of Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Nicola Batrick
- 3 Department of Emergency Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Elika Kashef
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
| | - Elizabeth Dick
- 1 Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust , London , UK
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de Melo-Neto JS, de Campos Gomes F, de Morais DF, Tognola WA. Spinal cord injury in elderly patients admitted to a tertiary hospital. J Back Musculoskelet Rehabil 2018; 30:929-936. [PMID: 28453455 DOI: 10.3233/bmr-169686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) has a negative impact on quality of life and healthcare costs. In recent years with the age pyramid inversion, there has been a high prevalence of SCI in the elderly. These patients must be studied in order to invest in the prevention and treatment of SCI in these patients. OBJECTIVE To identify the characteristics and clinical aspects of spinal cord injury (SCI) in the elderly. METHODS Retrospective study of elderly patients (≥ 60 years of age) with a clinical diagnosis of SCI. Clinical and socio-demographic variables were collected from medical records. RESULTS Sixty-two elderly patients were studied (56% men). The patients were analyzed according to gender. Women presented compression fractures associated with thoracolumbar transition, while men presented with listhesis associated with cervical lesions and increased complications. It was found that the need for surgical intervention was higher in men. Among many characteristics that differed between the elderly and younger people (< 60 years; n = 259), in the morphological diagnosis, we observed that compression fractures and dislocation fractures were more highly associated with ages ≥ 60 and < 60, respectively. After SCI, the elderly have a higher risk for late hemodynamic instability. CONCLUSION Elderly individuals with SCI have distinct characteristics and clinical factors related to gender and age.
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Affiliation(s)
- João Simão de Melo-Neto
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brasil.,Departamento Morfofuncional, Faculdade de Medicina Ceres (FACERES), São José do Rio Preto, SP, Brasil
| | | | | | - Waldir Antonio Tognola
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brasil
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Peck GE, Shipway DJH, Tsang K, Fertleman M. Cervical spine immobilisation in the elderly: a literature review. Br J Neurosurg 2018; 32:286-290. [PMID: 29488398 DOI: 10.1080/02688697.2018.1445828] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Developed populations are ageing rapidly and by 2040, approximately 1 in 4 adults will be over 65 years of age. This is resulting in higher incidence of traumatic injury in older patients. Cognitive and physical comorbidities in this group can pose significant challenges. Due to mechanisms of injury and pre-existing degenerative spinal disease, cervical spine fractures are particularly prevalent in elderly patients. These are associated with significant morbidity and mortality. In this literature review we examine current evidence surrounding the use of cervical spine immobilisation in elderly patients in the pre-hospital and emergency department setting and also as a treatment option for cervical spine fractures. We explore evidence surrounding the complications that can arise from cervical spine immobilisation, including the development of pressure sores, raised intracranial pressure, dysphagia, breathing difficulties, delirium, compliance issues, mobility and functional outcome.
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Affiliation(s)
- George Edward Peck
- a Division of Surgery , Imperial College Healthcare NHS Trust, St Mary's Hospital , London , UK
| | | | - Kevin Tsang
- c Division of Neurosurgery , Imperial College Healthcare NHS Trust, St Mary's Hospital , London , UK
| | - Michael Fertleman
- a Division of Surgery , Imperial College Healthcare NHS Trust, St Mary's Hospital , London , UK
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Friesen B, Brownlee R. The Role of CT and MRI in Suspected Acute Cervical Spine Trauma. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the accuracy of computed tomography (CT) in evaluation of patients with acute cervical spinal injury. Design Retrospective case series. Setting Three major public emergency departments in the southern hemisphere. Methods We performed a retrospective review of patients with neck injury aged at least 16, with CT cervical spine examinations performed for blunt trauma over a 6 month period (1 January 2011 to 30 June 2011) and magnetic resonance imaging (MRI) cervical spine performed for same indications over two and a half years (12 January 2010 to 22 June 2012). Results Acute cervical spine trauma was present on CT in 35 of 783 patients (4.5%) and on MRI in 98 of 206 patients (48%). Eleven of the 35 patients (31%) with CT confirmed trauma did not meet the Hanson criteria; the majority were at least 60 years of age and none had unstable injuries. CT is 100% sensitive in excluding an unstable injury if there is no soft tissue abnormality or fracture (with MRI as gold standard). An abnormal CT (including subtle paravertebral fat stranding) is often non-specific and often cannot reliably confirm an unstable ligamentous injury. Close attention to soft tissue axial and sagittal soft tissue CT reconstructions is important, as abnormalities can be subtle. Conclusions An unstable injury can often be excluded if CT is completely normal, without the need for MRI. (Hong Kong j.emerg.med. 2014;21:368-372)
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Blizzard SR, Krishnamoorthy B, Shinseki M, Betsch M, Yoo J. The magnitude of angular and translational displacement of dens fractures is dependent on the sagittal alignment of the cervical spine rather than the force of injury. Spine J 2017; 17:1859-1865. [PMID: 28694217 DOI: 10.1016/j.spinee.2017.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although it is generally believed that the magnitude of dens fracture displacement is proportional to the amount of force applied to the cervical spine during injury, the factors responsible for displacement have not been studied. PURPOSE Our aim was to determine factors that contribute to horizontal and angular displacement of dens fractures. STUDY DESIGN/SETTING We conducted a retrospective review of adult patients who were admitted to our level 1 trauma center between January 1, 2008 and December 31, 2013. PATIENT SAMPLE Angular and horizontal displacements of the fractured dens in 57 patients were measured. Subjects were grouped based on mechanism of fracture: motor vehicle accident, ground level fall, and higher falls. OUTCOME MEASURES Cervical lordosis was measured between C2 and T1. C3-C4, C4-C5, C5-C6, and C6-C7 disc inclination angles were measured. Anteroposterior sagittal balance was assessed by comparing the sagittal position of the C2 body with the C7 body. METHODS Data were analyzed using Pearson correlations, independent t tests, and support vector regression to construct predictive models that determine factors contributing to the angular and horizontal displacements. RESULTS The mean horizontal displacement of the fractured dens was not significantly different among groups. However, the dens in those with ground level falls had a significantly greater mean fracture angle compared with the higher energy trauma groups (p=.01). There were positive correlations between angular displacement and C5-C6 disc space inclination angle (r=0.67, p<.01) and C6-C7 disc space inclination angle (r=0.61, p<.01). There were positive correlations between horizontal displacement and C6-C7 inclination angle (r=0.40, p<.01) and sagittal alignment (r=0.32, p<.01). The predictive model using all variables demonstrated that angular fracture displacement was only dependent on C5-C6 disc space inclination angle. Horizontal displacement was only dependent on C6-C7 inclination angle and anteroposterior sagittal balance. CONCLUSIONS Disc space inclination angles of the lower cervical spine and the cervical sagittal balance most contribute to the magnitude of angular and horizontal displacement of the dens after fracture.
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Affiliation(s)
- Sabina R Blizzard
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Bala Krishnamoorthy
- Department of Mathematics and Statistics, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA 98686, USA
| | - Matthew Shinseki
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Marcel Betsch
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jung Yoo
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
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