Cervical Spinal Injury Research Articles

Adverse events after surgery for injuries to the subaxial cervical spine: analysis of incidence and risk factors

PurposeTo determine the incidence of severe surgical adverse events (sSAE) after surgery of patients with subaxial cervical spine injury (sCS-Fx) and to identify patient, treatment, and injury-related risk factors.MethodsRetrospective analysis of clinical and radiological data of sCS-Fx patients treated surgically between 2010 and 2020 at a single national trauma center. Baseline characteristics of demographic data, preexisting conditions, treatment, and injury morphology were extracted. Incidences of sSAEs within 60 days after surgery were analyzed. Univariate analysis and binary logistic regression for the occurrence of one or more sSAEs were performed to identify risk factors. P-values < .05 were considered statistically significant.ResultsTwo hundred and ninety-two patients were included. At least one sSAE occurred in 49 patients (16.8%). Most frequent were sSAEs of the surgical site (wound healing disorder, infection, etc.) affecting 29 patients (9.9%). Independent potential risk factors in logistic regression were higher age (OR 1.02 [1.003–1.04], p = .022), the presence of one or more modifiers in the AO Spine Subaxial Injury Classification (OR 2.02 [1.03–3.96], p = .041), and potentially unstable or unstable facet injury (OR 2.49 [1.24–4.99], p = .010). Other suspected risk factors were not statistically significant, among these Injury Severity Score, the need for surgery for concomitant injuries, the primary injury type according to AO Spine, and preexisting medical conditions.ConclusionsSAE rates after treatment of sCS-Fx are high. The identified risk factors are not perioperatively modifiable, but their knowledge should guide intra and postoperative care and surgical technique.

Clinical characteristics of upper cervical spine injuries in children: a retrospective case series.

Pediatric cervical spine injuries (CSI) can be devastating, and children < 8 years are particularly at risk for upper CSI given unique anatomical differences. Diagnosis of these injuries can be delayed due to variable clinical presentations and a paucity of existing literature. The authors aimed to characterize the spectrum of pediatric upper CSI. This was a retrospective, single-center case series of trauma patients aged < 16 years who were assessed at a level I pediatric trauma center and diagnosed with upper CSI between 2000 and 2020. Patients were included if they had evidence of bony or ligamentous injury from the occiput to C2 on imaging or autopsy. Data were obtained from manual chart review and analyzed using descriptive statistics. In total, 502 patients were screened and 202 met inclusion criteria. Of these, 31 (15%) had atlanto-occipital (AO) joint distractions, 10 (5%) had atlanto-axial (AA) joint distractions, 31 (15%) had fractures of C1-2, and 130 (64%) had ligamentous injury without joint distraction. Of the patients with AO injury, 15 patients had complete dislocation. They presented as hemodynamically unstable with signs of herniation and 14 died (93%). In contrast, 16 had incomplete dislocation (subluxation). They usually had stable presentations and survived with good outcomes. Of the patients with AA injury, 2 had complete dislocation, presented with arrest and signs of herniation, and died. In contrast, 8 patients with subluxation mostly presented as clinically stable and all survived with little residual disability. The most common fractures of C1 were linear fractures of the lateral masses and of the anterior and posterior arches. The most common fractures of C2 were synchondrosis, hangman, and odontoid fractures. Overall, these patients had excellent outcomes. Ligamentous injuries frequently accompanied other brain or spine injuries. When these injuries were isolated, patients recovered well. Among upper CSI, AO and AA joint injuries emerged as particularly severe with high mortality rates. Both could be divided into complete dislocations or incomplete subluxations, with clear clinical differences and the former presenting with much more severe injuries. Lateral cervical spine radiography should be considered during resuscitation of unstable trauma patients to assess for these CSI subtypes. Fractures and ligamentous injuries were clinically heterogeneous, with presentations and outcomes depending on severity and associated injuries.

Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment

Introduction: This study analyzed the incidence of secondary dislocations (sDLs) after surgical stabilization of AO Spine type B and C injuries of the subaxial cervical spine (sCS). Materials and Methods: Patients treated for injuries of the sCS from 2010 to 2020 were retrospectively analyzed for the incidence of sDL within 60 days after first surgery. A univariate analysis of variables potentially influencing the risk of sDL was performed. Patients with solitary anterior stabilization underwent subgroup analysis. The treatment of sDLs was described. Results: A total of 275 patients were included. sDLs occurred in 4.0% of patients (n = 11) in the total sample, most frequently after solitary anterior stabilization with 8.0% (n = 10, p = 0.010). Only one sDL occurred after combined stabilization and no sDLs after posterior stabilization. In the total sample and the anterior subgroup, variables significantly associated with sDL were older age (p = 0.001) and concomitant unstable facet joint injury (p = 0.020). No neurological deterioration occurred due to sDL and most patients were treated with added posterior stabilization. sDL is frequent after solitary anterior stabilization and rare after posterior or combined stabilization. Discussion: Patients of higher age and with unstable facet joint injuries should be followed up diligently to detect sDLs in time. Neurological deterioration does not regularly occur due to sDL, and most patients can be treated with added posterior stabilization.

Surgical Outcomes in Octogenarians with Central Cord Syndrome: A Propensity-Score Matched Analysis

IntroductionCentral cord syndrome (CCS) is a traumatic cervical spine injury that is treated with surgical decompression. In octogenarians (80-89), surgeons often opt for conservative management instead due to fears of postoperative complications and prolonged recovery times. This study aims to assess the in-hospital complications and outcomes in octogenarians undergoing surgery compared to those undergoing non-surgical management for CCS. MethodsThe National Trauma Data Bank was queried from 2017 to 2019 for octogenarians with CCS. Patients who received surgical fusion or decompression were divided into the surgery group and the remaining into the non-surgical group. The surgery group was sampled and propensity score matched with the non-surgery group. Student’s t-tests and Pearson’s chi-squared tests were used to test for group differences. ResultsA total of 759 octogenarians with CCS were identified. Following sampling and propensity score matching, 225 patients were identified in each group. The surgery group experienced longer ICU (6.8 days vs. 3.21 days, p < 0.001) and hospital (13.79 days vs. 7.8 days, p < 0.001) lengths of stay (LOS) and higher rates of deep vein thrombosis (4.89% vs. 0.44%, p = 0.02) and ventilator-associated pneumonia (4% vs. 0%, p = 0.02). Patients did not otherwise differ in mortality rate, other hospital complications, and discharge disposition. ConclusionOctogenarians undergoing surgery for CCS experience longer LOS and complications consistent with prolonged hospitalization, but otherwise have similar mortality, hospital complications, and discharge disposition compared to non-surgical treatment. Given the relative lack of short-term drawbacks, surgery should be considered first-line management when the long-term benefits are substantive.

(O-B1) A Retrospective Cohort Study to Determine the Injury Prevalence of Cervical Spine Injuries in Elderly Patients Undergoing Full Trauma CT

(O-B1) A Retrospective Cohort Study to Determine the Injury Prevalence of Cervical Spine Injuries in Elderly Patients Undergoing Full Trauma CT

Radiology diagnostics of spinal corel injury in early children: a prospective study

INTRODUCTION: Spinal cord injury (SCI) in young children includes a relatively higher prevalence of cervical spine injury, multiple thoracic vertebral compression fractures, and spinal cord injury. Spinal cord injuries without radiological changes/signs of fractures or dislocations (SCIWORA) also occur in young children. X-ray assessment of damage to immature vertebrae and cartilage in young children is difficult, since incompletely formed vertebral bodies can be confused with fractures. Accordingly, an MRI is required, which provides a detailed anatomical image of all structures of the spinal column and also diagnoses damage to the spinal cord, ligaments and muscles.OBJECTIVE: To investigate the possibilities of methods of radiation diagnosis of spinal cord injury in young children (up to 3 years).MATERIAL AND METHODS: 20 children aged from 11 months up to 3 years old were studied with spinal cord injury. X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were performed. The standard MRI protocol for SCI in children under 3 years of age included: MR myelography in the coronary and sagittal projections, sagittal projection STIR, DTI and T2WI FS SE, axial projection T2WI FS SE or T2*WI FS GE; coronary projection T2WI SE; 3D T1WI FS GE before and after contrast enhancement.RESULTS: An analysis of the data of patients included in the category of polytrauma was carried out. The causes of SCI in these patients were road accidents and falls from various heights. X-ray and CT scans were uninformative, and had large discrepancies with MRI results. All anatomical and morphological changes revealed by MRI correlated well with clinical manifestations and corresponded to the classification of the level and severity of spinal cord injury (ASIA). An increase in the volume and change in the signal of the spinal cord due to edema and / or hemorrhage in the spinal cord is the main sign of damage to the spinal cord, and is best indicated on T2WI and STIR, as a hyperintense signal.DISCUSSION: MRI is critical in the emergency assessment of spinal cord injury or compression to predict the outcome of SCI. There is currently no spinal cord imaging technique that can compete with MRI. Increased volume and signal changes in the spinal cord due to edema and/or hemorrhage are a sign of spinal cord injury and are best demonstrated on T2WI and STIR as a hyperintense signal. Incomplete spinal cord injury is also manifested by a hyperintense signal on T2WI and/or FLAIR, which in intensity and extent correlates with the degree of injury. Hemorrhagic injuries are better detected using T2*GRE or SWI, and spinal cord edema is better detected using T2WI SE and STIR. In addition, STIR can identify bone marrow edema in injured vertebrae, even when the injury is not detected on CT.CONCLUSION: When performing MRI in patients with SCI, three quantitative parameters should be assessed: the maximum damage to the spinal cord, the maximum compression of the spinal cord, and the length of the affected area. In addition to the results of quantitative parameters, potential predictive qualitative MRI findings should be evaluated such as intramedullary hemorrhage, focal and diffuse spinal cord edema, soft tissue injury, probable stenosis before injury, and disc herniation.

Early Versus Delayed Surgery for Elderly Traumatic Cervical Spinal Injury: A Nationwide Multicenter Study in Japan.

Retrospective multicenter study. The effectiveness of early surgery for cervical spinal injury (CSI) has been demonstrated. However, whether early surgery improves outcomes in the elderly remains unclear. This study investigated whether early surgery for CSI in elderly affects complication rates and neurological outcomes. This retrospective multicenter study included 462 patients. We included patients with traumatic acute cervical spinal cord injury aged ≥65years who were treated surgically, whereas patients with American Spinal Injury Association (ASIA) Impairment Scale E, those with unknown operative procedures, and those waiting for surgery for >1month were excluded. The minimum follow-up period was 6months. Sixty-five patients (early group, 14.1%) underwent surgical treatment within 24hours, whereas the remaining 397 patients (85.9%) underwent surgery on a standby basis (delayed group). The propensity score-matched cohorts of 63 cases were compared. Patients in the early group were significantly younger, had significantly more subaxial dislocations (and fractures), tetraplegia, significantly lower ASIA motor scores, and ambulatory abilities 6months after injury. However, no significant differences in the rate of complications, ambulatory abilities, or ASIA Impairment Scale scores 6months after injury were observed between the matched cohorts. At 6months after injury, 61% of the patients in the early group (25% unsupported and 36% supported) and 53% of the patients in the delayed group (34% unsupported and 19% supported) were ambulatory. Early surgery is possible for CSI in elderly patients as the matched cohort reveals no significant difference in complication rates and neurological or ambulatory recovery between the early and delayed surgery groups.

Is it true that treatment in patients with Subaxial Cervical Spine Injury Classification System (SLICS) 4 is the surgeon's choice?

The Subaxial Cervical Spine Injury Classification System (SLICS) is a commonly used algorithm for diagnosing and managing subaxial cervical spine trauma. A SLIC score 4 suggests either surgery or non-surgically treatment depending on the surgeon's experience and patient's conditions. Prognosis and treatment results were analyzed in patients with SLIC score 4. The patients with SLIC score 4 were retrospectively reviewed from 2012 to 2019. Forty-one patients were included and divided into two groups: non-surgically treated and surgically treated. Demographic data and radiographs were analyzed. Statistical analysis was performed to determine the difference between the two clinical groups. Twenty-two patients were non-surgically treated, and nineteen patients were surgically treated. There was no neurological deterioration in both groups. However, there was no statistically significant difference in the last follow-up AISA and Nurick grade (p> 0.05). There was no significant difference in the number of patients who showed improvement when comparing the initial and the last follow-up neurological status (p> 0.05). Regardless of the treatment method, the spinal cord injury patients with SLICS point 4 showed a relatively good prognosis. Patients with SLIC score 4 could be treated non-surgically or surgically based on the surgeon's experience and factors associated with the patient's acute health status and chronic comorbidities.

Epidemiology of Cervical Spine Injuries Requiring Surgical Treatment in Plovdiv and Plovdiv Region, Bulgaria.

Cervical spine injuries (CSI) are associated with high rates of permanent disability and mortality, which increase the socioeconomic burden on healthcare systems worldwide. We aimed to investigate the epidemiology of CSI, frequency of operative treatment, and incidence of associated neurological deficits at regional level. We performed a retrospective monocentric study of patients with sustained CSI from January 2017 to December 2021, carried out only in a first-level trauma center in the Plovdiv metro region. Demographic, clinical, and imaging data from the medical records were thoroughly analyzed. Based on the assumption that all patients with CSI were hospitalized in single trauma center, the percentage of cases indicated for surgical treatment was calculated based on the population of the entire Plovdiv metro area. One hundred forty-nine patients permanently residing in the Plovdiv metro region were included in this study. Of the 149 patients, 97 (65.1%) were surgically treated and 61 (62.9%) were over 60 years of age. The frequency of operative interventions for CSI was 2.9/100,000 patients. Annually, 10.6 people from the Plovdiv metro region suffer from neurological deficits as a result of neck injuries (1.6/100,000 residents). The number of patients with complete spinal cord injury in the surgically treated group was 11 (11.3%); that is, the regional frequency was 2.2 people per year. In the Plovdiv metro region, a significant annual frequency of neurological deficits requiring surgical intervention for CSI has been established, especially in patients aged >60 years.

Single-Legged Triple-Hop Propulsion Strategies in Females With and Those Without a History of Anterior Cruciate Ligament Reconstruction.

The single-legged triple hop is a commonly used functional task after anterior cruciate ligament reconstruction (ACLR). Recently, researchers have suggested that individuals may use a compensatory propulsion strategy to mask underlying quadriceps dysfunction and achieve symmetric hop performance. To evaluate the performance and propulsion strategies used by females with and those without ACLR during a single-legged triple hop. Cross-sectional study. Laboratory. A total of 38 females, 19 with ACLR (age = 19.21 ± 1.81 years, height = 1.64 ± 0.70 m, mass = 63.79 ± 7.59 kg) and 19 without ACLR (control group; age = 21.11 ± 3.28 years, height = 1.67 ± 0.73 m, mass = 67.28 ± 9.25 kg). Hop distance and limb symmetry index (LSI) were assessed during a single-legged triple hop for distance. Propulsion strategies were evaluated during the first and second hops of the single-legged triple hop. Separate 2-way analysis-of-variance models were used to examine the influence of ACLR, joint, and their interaction on mechanical joint work, moment impulse, and the relative joint contributions to total work and moment impulse in females with and those without a history of ACLR. Despite achieving a mean LSI of approximately 96%, the ACLR group produced less total work in the reconstructed than the uninvolved limb during single-legged triple-hop propulsion (first hop: t18 = -3.73, P = .002; second hop: t18 = -2.55, P = .02). During the first and second hops, the reconstructed knee generated 19.3% (t18 = -2.33, P = .03) and 27.3% (t18 = -4.47, P < .001) less work than the uninvolved knee. No differences were identified between the involved and uninvolved limbs of the ACLR group in moment impulse (first hop: t18 = -0.44, P = .67; second hop: t18 = -0.32; P = .76). Irrespective of limb or group, the ankle was the largest contributor to both work and moment during both the first and second hops (P < .001). Clinicians should exercise caution when using a single-legged triple hop as a surrogate for restored lower extremity function in females post-ACLR. This recommendation is driven by the compelling findings that knee-joint deficits persisted in the reconstructed limb despite an LSI of approximately 96% and, regardless of previous injury status, single-legged triple-hop propulsion was predominantly driven by the ankle.

Knowledge acquisition and retention on first-aid management of cervical spine injuries among first-rescuers: A low-fidelity simulation intervention in Mzuzu-city, Malawi

BackgroundCervical spine injuries (CSIs) resulting from road traffic accidents (RTAs) significantly contribute to global fatalities and disabilities. Therefore, immediate first aid for individuals with cervical spine injuries in RTAs is essential for reducing complications. This study aimed to assess knowledge acquisition and retention in the first-aid management of cervical spine injuries among first rescuers in Mzuzu City, Malawi, following a low-fidelity simulation intervention. MethodsA Pre-test – post-test quasi-experimental study design was employed. A total of 84 participants including police officers, minibus drivers, ambulance drivers, and community members aged 18 years and above, were selected using a non-randomised sampling technique. Data were collected using a questionnaire and analysed using the Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics, Chi-squared tests, and paired t-tests were used in this study. ResultsDuring the pre-test, only 24(28.6 %) (n = 84) participants had good knowledge of first aid for cervical spine injury first aid (CSI FA). This number increased significantly to 70 (83.3 %) (n = 84) immediately following the post-test and remained at 64 (80.0 %) (n = 80) at the 4-month post-test. An association was noted between the level of knowledge and previous training in road traffic accident (RTA) first aid (FA) (p = 0.001). Additionally, the results also indicated a significant difference between the CSI FA knowledge mean score before the low-fidelity simulation intervention and the mean score immediately after the intervention and four months post-intervention (p = 0.000). ConclusionThe participants in the study initially demonstrated poor pre-test knowledge, which significantly improved after the post-test and remained good with slight degradation four months later. These findings demonstrate the effectiveness of low-fidelity simulation in the acquisition and retention of CSI FA knowledge among first rescuers.

Effect of a cervical collar on optic nerve sheath diameter in trauma patients.

As advocated in advanced trauma life support and prehospital trauma life support protocols, cervical immobilization is applied until cervical spine injury is excluded. This study aimed to show the difference in optic nerve sheath diameter (ONSD) between patients with and without a cervical collar using computed tomography (CT). This was a single-center, retrospective study examining trauma patients who presented to the emergency department between January 1, 2021, and December 31, 2021. The ONSD on brain CT of the trauma patients was measured and analyzed to determine whether there was a difference between the ONSD with and without the cervical collar. The study population consisted of 169 patients. On CT imaging of patients with (n=66) and without (n=103) cervical collars, the mean ONSD in the axial plane were 5.43 ± 0.50 mm and 5.04 ± 0.46 mm respectively for the right eye and 5.50 ± 0.52 mm and 5.11 ± 0.46 mm respectively for the left eye. The results revealed an association between the presence of a cervical collar and the mean ONSD, which was statistically significant (P<0.001) for both the right and left eyes. A cervical collar may be associated with increased ONSD. The effect of this increase in the ONSD on clinical outcomes needs to be investigated, and the actual need for cervical collar in the emergency department should be evaluated on a case-by-case basis.

Are triage tools effective for detecting cervical spine injury in paediatric trauma patients? - A Cochrane Review summary with commentary.

Pediatric cervical spine injuries (CSIs) from blunt trauma carry a high risk of neurological damage. Accurate diagnosis is vital for preventing harm and aiding recovery, yet the diagnostic accuracy of clinical decision rules (CDRs) remains unclear. To assess the effectiveness of triage tools for detecting CSI in pediatric trauma patients. A summary of the Cochrane Review by Tavender et al. (2024), with comments from a rehabilitation perspective. Five studies with 21,379 participants assessed seven CDRs. Direct comparisons showed high sensitivity but low specificity across different CDRs. Indirect comparison studies also demonstrated varying sensitivities and specificities. Insufficient evidence exists to determine the best tools for deciding if imaging is necessary for diagnosing potential CSI in children. Better quality studies are needed to assess the accuracy of CDRs for cervical spine clearance in this population.

Role of Diaphragmatic Pacing in Cervical Spine Injury: A Review

Role of Diaphragmatic Pacing in Cervical Spine Injury: A Review

Fatal Penetrative Cervical Spine Injury Following Misdeployed Airbag

Abstract Road traffic injuries are one of the leading causes of global mortality rates and entail various health and economic-related consequences. When used in combination with seatbelts, vehicle airbags are intended to reduce cervical spinal injuries to the car driver during sudden impact. However, it is increasingly recognized that airbag misdeployment trauma injuries are becoming more prevalent and can lead to severe injuries or even death. This case report presents a fatal penetrative cervical spine injury in a 22-year-old nonrestrained male following a misdeployed airbag in Saudi Arabia. Misdeployed airbag trauma may be a potential factor in road traffic fatalities, particularly when it is linked to penetrating injuries caused by metal fragments penetrating the car’s passenger compartment. Postmortem imaging assists the medical examiner in planning autopsy procedures and to rule out other injuries. To ensure a safe driving experience, it is imperative to adhere to road safety policies and enhance the safety features of automobiles to meet industry standards.

Factors associated with non-contiguous spine fracture in patients with traumatic cervical spine injury: A 12-year retrospective study

Factors associated with non-contiguous spine fracture in patients with traumatic cervical spine injury: A 12-year retrospective study

Management of sub-axial cervical spine injury with unilateral locked facet: an institutional experience

Management of sub-axial cervical spine injury with unilateral locked facet: an institutional experience

The Epidemiological Characteristics and Type of Treatment in Iranian Patients with Traumatic Cervical Spine Injuries: a cohort study

The Epidemiological Characteristics and Type of Treatment in Iranian Patients with Traumatic Cervical Spine Injuries: a cohort study

Is Intraoperative Blood Loss Volume in Elderly Cervical Spine Injury Surgery Greater in Patients with Ankylosis? A Multicenter Survey

Is Intraoperative Blood Loss Volume in Elderly Cervical Spine Injury Surgery Greater in Patients with Ankylosis? A Multicenter Survey

ESTUDO EPIDEMIOLÓGICO DAS FRATURAS TRAUMÁTICAS DA COLUNA CERVICAL EM UM HOSPITAL PÚBLICO DO ESTADO DE SÃO PAULO

ABSTRACT The study aimed to carry out a retrospective analysis of patients with traumatic fractures of the cervical spine carried out at Mário Covas State Hospital in Santo André, São Paulo, from January 2018 to December 2022. Data were collected from medical records and radiographic image database in the Hospital’s medical-statistical service. The variables analyzed were age group, gender, mechanism of trauma, affected vertebrae, type of fracture and neurological deficit. 89 individuals met inclusion and exclusion requirements. Traumatic injuries to the cervical spine were more frequent in working-age male adults, the most prevalent trauma mechanism was falling from height, the most affected vertebra was C2 followed by C6, the vast majority of patients had no neurological deficit and the most recommended treatment was non-surgical. Obtaining an understanding of the factors involved in this process and the consequences of injuries, public health planning and strategies for the promotion and prevention of traumatic cervical spine injuries are paramount importance. Level of Evidence III; Retrospective Study.