Column Injury Research Articles

Spinal column injuries: from the very beginning

The history of medicine is interesting and instructive. In each of the many branches of medical science, the specificity of pathology determines diagnosis and treatment. These processes inevitably continue in time and space in accordance with the conditions existingin a given place and in a given period of time. Spine injury is one of the most striking examples of the longevity and duration of this process.Humanity relatively recently discovered what diabetes is and how it should be treated, but this branch of medicine also has its own history, although not a very long one. Spinal injuries have accompanied man and his predecessors almost always, disrupting the usual rhythmof life, and therefore they have been required to be treated since time immemorial. A true professional is always interested in the history of his specialty. Spine surgeons are no exception. What we managed to collect bit by bit, of course, is not everything, but it is impossible to grasp the immense, and it is necessary to know the past in order to better understand the present and the future.

Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders.

Literature review with clinical recommendations. To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.

Spinal column injuries: from the very beginning

Spinal column injuries: from the very beginning

Safety of anterior cervical corpectomy and fusion (ACCF) for the treatment of subaxial cervical spine injuries, a single center comparative matched analysis

IntroductionAnterior Cervical Discectomy and Fusion (ACDF) and Anterior Cervical Corpectomy and Fusion (ACCF) are both common surgical procedures in the management of pathologies of the subaxial cervical spine. While recent reviews have demonstrated ACCF to provide better decompression results compared to ACDF, the procedure has been associated with increased surgical risks. Nonetheless, the use of ACCF in a traumatic context has been poorly described. The aim of this study was to assess the safety of ACCF as compared to the more commonly performed ACDF.MethodsAll patients undergoing ACCF or ACDF for subaxial cervical spine injuries spanning over 2 disc-spaces and 3 vertebral-levels, between 2006 and 2018, at the study center, were eligible for inclusion. Patients were matched based on age and preoperative ASIA score.ResultsAfter matching, 60 patients were included in the matched analysis, where 30 underwent ACDF and ACCF, respectively. Vertebral body injury was significantly more common in the ACCF group (p = 0.002), while traumatic disc rupture was more frequent in the ACDF group (p = 0.032). There were no statistically significant differences in the rates of surgical complications, including implant failure, wound infection, dysphagia, CSF leakage between the groups (p ≥ 0.05). The rates of revision surgeries (p > 0.999), mortality (p = 0.222), and long-term ASIA scores (p = 0.081) were also similar.ConclusionResults of both unmatched and matched analyses indicate that ACCF has comparable outcomes and no additional risks compared to ACDF. It is thus a safe approach and should be considered for patients with extensive anterior column injury.

Comparison of Traumatic Spinal Fracture Patterns Between Motorcyclists and Occupants of Other Nonheavy Motor Vehicles: A Report from the National Spinal Cord and Column Injury Registry of Iran

ObjectivesTo compare traumatic spinal injury patterns between motorcyclists and occupants of other non-heavy motor vehicles using data from the National Spinal Cord and Column Injury Registry of Iran (NSCIR-IR). MethodsAll drivers/riders and passengers of motorcycles, cars, pick-up trucks, and vans registered between January 2017 to July 2023, met the inclusion criteria for the present study. The logistic regression models were used to compare the patterns of vertebral fracture between the two groups. Results1726 spinal fracture patients were identified, 385 (22.3%) motorcyclists and 1341 (77.7%) car occupants with mean ages 33.2±14.3 and 36.1±13.6 years, respectively (P<0.001). Only 45 (11.7%) motorcyclists used helmets, whereas 856 (63.8%) car occupants used seat belts (P<0.001). The average numbers of fractured vertebrae were 3.9±1.4 and 3.7±1.1 among car occupants and motorcyclists, respectively (P=0.004). The proportions of motorcyclists and car occupants with injuries in each spinal region are as follows: lumbar (50.5% of motorcyclists vs. 40.4% of car occupants; P=0.003), thoracic (39.2% vs. 30.9%; P=0.01), cervical (24.3% vs. 37.0%; P<0.001) and sacral (1.3% vs. 7.5%; P<0.001). The AO Spine type C injuries were present in 6.1% of motorcyclists and 10.1% of car occupants (P=0.03). ConclusionMotorcyclists were younger, less educated, had a higher proportion of males, and less commonly used safety devices than car occupants. The most commonly fractured spine region among both groups was the lumbar region. The cervical and sacral vertebrae fractures were significantly more common in car occupants, whereas the thoracic and lumbar vertebrae fractures were significantly more common in motorcyclists.

LATERAL COLUMN MIDFOOT INJURY: DO THEY ALL NEED FIXATION?

BackgroundResearch on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Lateral column injuries have historically been treated with Kirschner wire fixation when encountered.ObjectiveOur aim in this study was to analyse lateral column injuries to the midfoot, their method of treatment and the radiological lateral column outcomes. Our nul hypothesis being that fixation is required to obtain and maintain lateral column alignment.MethodsData was retrospectively collected from four centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26.ResultsA total of 235 cases were diagnosed as having a lateral column injury out of the 409 cases included. On cross tabulation, there was a significant association with having a central column injury (234/235, p&lt;.001) and 70% of cases (166/235) also had an additional medial column injury. Of the 235 lateral column injuries, data was available regarding fixation radiographic alignment on 222 cases. There were 44 cases which underwent Kirschner wire fixation, 23 plate fixations and 3 screw fixations. Lateral column alignment loss was seen in 2.84% (4/141) of those which didn't undergo fixation, 13.64% (6/44) which underwent K wires, and 0 % in those fixed by screws or K wires.ConclusionLateral column injury occurs in over half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, additional fixation of injuries to the lateral column do not appear beneficial. The use of a bridge plate to fix the central column appears protective and purely ligamentous injury was a higher risk than an injury that included the bone.

Information Transmission through Biotic-Abiotic Interfaces to Restore or Enhance Human Function.

Advancements in reliable information transfer across biotic-abiotic interfaces have enabled the restoration of lost human function. For example, communication between neuronal cells and electrical devices restores the ability to walk to a tetraplegic patient and vision to patients blinded by retinal disease. These impactful medical achievements are aided by tailored biotic-abiotic interfaces that maximize information transfer fidelity by considering the physical properties of the underlying biological and synthetic components. This Review develops a modular framework to define and describe the engineering of biotic and abiotic components as well as the design of interfaces to facilitate biotic-abiotic information transfer using light or electricity. Delineating the properties of the biotic, interface, and abiotic components that enable communication can serve as a guide for future research in this highly interdisciplinary field. Application of synthetic biology to engineer light-sensitive proteins has facilitated the control of neural signaling and the restoration of rudimentary vision after retinal blindness. Electrophysiological methodologies that use brain-computer interfaces and stimulating implants to bypass spinal column injuries have led to the rehabilitation of limb movement and walking ability. Cellular interfacing methodologies and on-chip learning capability have been made possible by organic transistors that mimic the information processing capacity of neurons. The collaboration of molecular biologists, material scientists, and electrical engineers in the emerging field of biotic-abiotic interfacing will lead to the development of prosthetics capable of responding to thought and experiencing touch sensation via direct integration into the human nervous system. Further interdisciplinary research will improve electrical and optical interfacing technologies for the restoration of vision, offering greater visual acuity and potentially color vision in the near future.

Review of the guide for doctors by M.A. Kislov “Forensic neuropathology. Craniocerebral and spinal trauma”

The author reviews the scientific and practical publication prepared by the Doctor of Medical Sciences, associate Professor M.A. Kislov, titled “Forensic neuropathology. Craniocerebral and spinal injury.”&#x0D; The manual contains a detailed and accurate analysis of the pathological, physical, biochemical, and molecular genetic processes involved in nervous system disorders in cases of head and cervical spinal column injuries.&#x0D; The scientific work is a timely review of the latest achievements in the field of clinical and forensic neuropathology.&#x0D; This publication is recommended to doctors of forensic medical experts, pathologists, neuropathologists, neurosurgeons, and doctors of other specialties interested in and dealing with central nervous system disorders of traumatic genesis.

The design of a quality improvement dashboard for monitoring spinal cord and column injuries

BackgroundInteractive dashboards are a powerful tool for dynamic visualization and monitoring of patient performance and serve as a useful to for optimal decision-making. The National Spinal Column and Cord Injury Registry of Iran (NSCIR-IR) was designed to efficiently display and broadcast important patient care data. This has been achieved through an electronic dashboard display (graph and visual displays), rather than traditional static paper reports (text). ObjectivesThe objective of this study was to design and develop an electronic visual dashboard as a display system to monitor the quality of care in the NSCIR-IR collaborating centers. MethodsThe indicators chosen were 20 pre-hospital and in-hospital quality of care (QoC) assessment tool indicators. A structured query was created from the NSCIR-IR system database to create the dashboard database. The Microsoft Power BI software was used. After data cleaning, filtering of erroneous records, and modeling, visual displays were designed and evaluated. ResultsThe dashboard reported on quality of care (QoC) for 2,745 patients registered in NSCIR-IR. 17% of registered cases had at least one data error in the quality of care indicators. These errors were automatically filtered by the system. The two most prominent weaknesses in (QoC indicators were delay in patient transfer by EMS (Mean and SD were 9.54 ± 13.8 h) and timing of surgical spinal cord decompression (114.5 ± 45.3 h). ConclusionsElectronic dashboards provide efficient and concise data summaries “at a glance”. However, their value and accuracy are dependent on the entered data quality. Identifying data source errors and correcting them continuously led to improved quality of data.

Epidemiologija povreda kičmenog stuba pre, za vreme i nakon pandemije izazvane kovidom 19 - ima li razlike?

Introduction: The lack of information in international literature regarding the impact of the introduction and the subsequent termination of epidemiological restrictions during the COVID-19 pandemic on the epidemiology of spinal injuries has led to the constant monitoring and recording of all relevant data on patients with spinal column injuries since the beginning of the pandemic. Study Aim: To analyze and compare epidemiological data on patients with spinal column injuries treated at a tertiary healthcare facility in Serbia, before, during, and after the COVID-19 pandemic. Materials and methods: This is a retrospective study spanning three observation periods analyzing patients with spinal column injuries. Results: The average age of patients in the first observation period was 47 years, 68 years in the second, and 39 years in the third period. In the first two observation periods, the dominant mechanism of injury was same-level fall, and most of the patients were treated conservatively. When comparing the data on the three groups of respondents, statistically significant differences in the age of the patients and the mechanism of injury can be observed. Conclusion: The COVID-19 pandemic contributed to spinal column injuries being more common among the elderly, due to falls occurring at home. However, after people returned to an active lifestyle, which was especially true of the younger population, there was a sudden increase in the number of spinal column injuries due to road traffic accidents, while due to the frequent occurrence of spinal cord injuries, there was also an increase in the number of emergency surgeries.

Analysis of the Epidemiology of Traumatic Vertebral Column Injuries in Eastern European Countries

Vertebral column fractures (VCF), despite their relatively small proportion in the overall structure of human musculoskeletal trauma, represent a significant medical and social problem. Even injuries not accompanied by neurological deficits often lead to persistent impairments in the functional capacity of the affected individuals, significantly affecting their quality of life, employability, and social activity. The epidemiology of spinal trauma is insufficiently understood, largely due to the difficulty in accurately assessing its true frequency. Existing literature on the epidemiology of vertebral column trauma is mostly based on single-center or multicenter studies focused on specific region. Objective: To conduct a preliminary analysis of the epidemiological features of vertebral column trauma in Eastern European countries. Materials and Methods: Statistical data from the Global Burden of Disease database were analyzed to investigate the epidemiology of spinal trauma. The study focused on countries located entirely within the European part of the Eurasian continent. A 30-year period prior to the onset of the COVID-19 pandemic (1990–2019) was selected as the optimal time frame to reflect the current state of the problem. The main analysis parameters included disease incidence and years lived with disability. Results: It was found that the relative frequency of vertebral column trauma is higher in countries with a higher gross domestic product. Over the analyzed period, all Eastern European countries exhibited a declining trend in the relative frequency of vertebral column trauma. In the overall structure of musculoskeletal trauma, vertebral column trauma accounts for 3.5‒4.5% in Eastern European countries, and this figure is progressively increasing. Armed conflicts in the Republic of Moldova in 1992 and in Ukraine starting from 2014 are characterized by an increase in the frequency of vertebral column trauma. The proportion of males among those with vertebral column trauma is relatively stable and specific to each of the examined countries. In contrast to the conflict in Transnistria, the armed conflict in eastern Ukraine did not significantly alter the gender structure of vertebral column trauma patients, indicating a larger proportion of civilians among the affected individuals. Analysis of the causes of vertebral column injuries revealed that, on average, unintentional injuries account for approximately 81%, injuries resulting from road traffic accidents account for 16%, intentional injuries represent about 3%, with the latter two gradually decreasing. Almost half (42‒46%) of vertebral column trauma cases occur in the age group of 20‒44 years. In countries with a high gross domestic product, a significantly higher frequency of injury among elderly and senile population is recorded, possibly due to more efficient diagnostic methods. Conclusions: Gender and age characteristics of vertebral column trauma have a relatively stable pattern specific to each of the examined countries. Numerous socio-economic and behavioral factors influence the frequency of vertebral column trauma, but the significance of these parameters requires further research.

Analysis of treatment outcomes in patients with combat spinal column and spinal cord injuries

Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).

Circular frame fixation of complex tibial plateau fractures in the elderly: Functional and radiological outcomes for Schatzker V and VI type fractures

Tibial plateau fracture fixation in the elderly poses a unique challenge due to poor bone stock, comminution and co-morbidities. There is limited evidence available in older patients sustaining multiple column Schatzker type V and VI injuries. In our institutions these injuries have traditionally been managed with circular frame fixation, often augmented with cross knee frame extension, internal screw fixation +/- bone graft substitutes. This study has reviewed the over 60-year-old cohort to better understand this complex injury. MethodsElectronic fracture databases were queried for ‘tibial plateau fracture’ and ‘Ilizarov frame’ between July 2009 and 2019. Inclusion criteria; age >60 years; CT identified multiple column (Schatzker V or VI) injuries; Ilizarov fixation; adequate follow-up data. Patient demographics, fixation technique, time to frame removal, residual radiological tibial deformity, joint incongruity, significant peri‑operative complications and progression to salvage TKA were reported. Results35 patients >60 years were treated with Ilizarov frame techniques for multiple column injuries. 84 % were female. Average age was 68 (62–81) with a follow-up of 6.6 years (2.3–11.3). 33 of the 35 patients investigated for osteoporosis had evidence of decreased bone mass (94 %). 94 % were Schatzker VI injuries. 22 cases required cross knee extension with a frame duration 155 days (range 103–317). Those without had a frame duration 128 days (range 93–212). 20 cases had a combined internal/external fixation technique and 9 cases required allograft or bone substitute. There was one case of non-union requiring salvage to constrained TKA. Three cases (9 %) of metalwork removal, two for prominent metalwork and one for deep infection. There were no VTE events and there was 0 % mortality in the two post-operative years. Oxford knee scores and SF-12 scores demonstrate that minimal residual deformities in the coronal and sagittal planes following frame removal are tolerated well within this age group. This study demonstrates Ilizarov techniques are highly successful at permitting early weight bearing and achieving union with associated low morbidity rates in an older population.

Neuropathic Pain and Lumbar Spinal Column Injuries: A Chronic Perspective

Background: Neuropathic pain commonly occurs as a consequence of spinal cord injuries, manifesting as persistent and often debilitating pain sensations resulting from damage or dysfunction of the nervous system within the spinal column. This systematic review aimed to analyze existing guidelines on rehabilitation interventions for neuropathic pain and clarify their significance. Methodology: A comprehensive search of literature was performed using the databases Google Scholar, Microsoft Academic, and PubMed. The inclusion criteria encompassed research articles written in Greek, English, and French languages, while articles that were not directly relevant to the subject of investigation were excluded. Results: A systematic review of published guidelines on rehabilitation interventions for neuropathic pain to elucidate their significance. While some interventions, such as TENS therapy, physiotherapy, and psychological interventions, have been proposed, the core approach to managing neuropathic pain lies in the implementation of comprehensive multidisciplinary interventions that address all the various aspects affected by this chronic and highly disabling condition. It is worth noting the limited literature examining the role of rehabilitation specifically in patients with neuropathic pain, with a focus on individual interventions solely targeting the treatment of neuropathic pain. Conclusions: Neuropathic pain has significant effects not only on the injuries of the lumbar spine, but also on subsequent functions. Therefore, the involvement of a specialist focused on managing and restoring functional impairments is necessary. This role can be fulfilled by a physical therapist who specializes in addressing the functional issues associated with the patient’s condition. Physiotherapists should employ a multiprofessional and multidisciplinary approach, collaborating closely with various healthcare professionals involved in the patient’s management to ensure optimal pain management.

Delayed Surgical Treatment of Cervical Spine Injury in an Adolescent Patient

Introduction. Cervical spine injury is recognised as one of the most disabling types of vertebral column and spinal cord injuries. With a high level of disability, this type of injury remains quite rare among children. The main types of complications in this kind of injury include impaired regulations of the respiratory and cardiovascular systems, tetra- and paraparesis, and pelvic organ disorders. The analysis of recent publications indicated early surgery (in less than 24 hours) as the main condition for reducing post-traumatic complications.Materials and methods. The paper presents a clinical case of delayed surgery (in more than 24 hours) performed in a 17-year-old patient who was admitted to hospital after a traffic accident. After diagnostic measures, according to indications, a delayed surgery was performed on day 3: anterior spine fusion at the level of C5-Th1 with the installation of a vertebral body endoprosthesis and fixation with a bone plate.Results and discussion. The present case confirms the need for patients with combined spinal cord injury and mild traumatic brain injury to undergo a full range of diagnostic examinations including: brain and spine imaging, and, in the presence of compression and signs of spinal cord injury, MRI of the spinal cord (if necessary, the brain) at the level of injury. In the absence of gross structural damage to the brain, urgent decompression of the spinal cord and spine stabilization are indicated to eliminate the traumatic and spinal shock.Conclusion. Mild traumatic brain injury cannot be considered a contraindication for delayed cervical spine surgery. The present case is indicative of early surgical treatment of spinal injury, especially of the cervical spine, without neurological onset. All diagnostic measures were performed in full. Despite the surgical treatment and rehabilitation measures, the neurological deficit in the patient was not completely eliminated and persisted after 1 year.

Cervical Column and Cord and Column Responses in Whiplash With Stenosis: A Finite Element Modeling Study.

Spine degeneration is a normal aging process. It may lead to stenotic spines that may have implications for pain and quality of life. The diagnosis is based on clinical symptomatology and imaging. Magnetic resonance images often reveal the nature and degree of stenosis of the spine. Stenosis is concerning to clinicians and patients because of the decreased space in the spinal canal and potential for elevated risk of cord and/or osteoligamentous spinal column injuries. Numerous finite element models of the cervical spine have been developed to study the biomechanics of the osteoligamentous column such as range of motion and vertebral stress; however, spinal cord modeling is often ignored. The objective of this study was to determine the external column and internal cord and disc responses of stenotic spines using finite element modeling. A validated model of the subaxial spinal column was used. The osteoligamentous column was modified to include the spinal cord. Mild, moderate, and severe degrees of stenosis commonly identified in civilian populations were simulated at C5-C6. The column-cord model was subjected to postero-anterior acceleration at T1. The range of motion, disc pressure, and cord stress-strain were obtained at the index and superior and inferior adjacent levels of the stenosis. The external metric representing the segmental motion was insensitive while the intrinsic disc and cord variables were more sensitive, and the index level was more affected by stenosis. These findings may influence surgical planning and patient education in personalized medicine.

Clinical Characteristics and Intraoperative Reduction Technique of Thoracolumbar Fractures Combined with Posterior Column Injury.

To analyse the clinical characteristics of thoracolumbar fractures combined with posterior column injury, and explore its intraoperative reduction technique with clinical efficacy. Descriptive study. Place and Duration of the Study: Department of Orthopaedics, Fuyang People's Hospital, Anhui, China, from December 2017 to 2021. A total of 60 patients met the inclusion criteria, they were divided into two categories according to injury mechanism and imaging characteristics: flexion-distraction injury (FDI) and burst fracture with lamina fracture (BFLF), and their clinical characteristics were analysed. All patients were treated with posterior pedicle screw internal fixation, and different intraoperative reduction methods were adopted for reduction. Measurements of anterior vertebral heights (AVH), local kyphotic angles (LKA), visual analog scale (VAS) and oswestry disability index (ODI) were evaluated preoperative, after operation, and the last follow-up. The two groups of thoracolumbar fractures combined with posterior column injury had different clinical characteristics, and there were significant differences in preoperative imaging related parameters (p<0.05). All patients in the two groups successfully completed the operation, and there were no direct complications related to the operation. The patients were followed up for 12-24 months. Compared with those before the operation, the AVH, LKA, VAS, and ODI immediately after the operation and at the last follow-up were significantly improved (p<0.05). Bone fusion was achieved in all patients. Careful and comprehensive preoperative clinical data analysis is the key to diagnosis of thoracolumbar fractures combined with posterior column injury. According to the type of fracture, reasonable selection of intraoperative reduction technique can obtain satisfactory clinical results. Burst fracture, Pedicle screw, Internal fixation, Thoracic, Lumbar.

Application of intratissue electrostimulation in the treatment of chronic post-traumatic bone pain syndrome at stages II-III of medical rehabilitation

Objective: to improve the outcomes of medical rehabilitation of mature second-degree patients with spi¬nal cord injury complicated by emotional-volitional disorders in the long-term period of injury, by applying intrathecal electrostimulation. Material and methods. The results of intrathecal electrostimulation in the treatment of chronic bone pain syndrome complicated by the development of anxiety-depressive disorders in patients with mono- and bisegmental fractures of the A1 and A2 types of lumbar vertebrae (according to Magerl) were studied. Two groups of patients (n=36) comparable in gender, age, and degree of functional impairment in the age range from 45 to 65 years were the objects of the study. Intrathecal electrostimulation was used as monotherapy in the patients of the main group (n=17). Patients included in the comparison group (n=19) received treatment corresponding to stages II-III of medical rehabilitation. Pain intensity was assessed by measuring the electrical potential of the skin and using the VAS scale. The degree of anxiety-depressive disorder was determined by a specialized questionnaire, Simptom Check List-90-Revised. Quality of life was assessed using the Oswestry Disability Index. Results. Positive treatment outcomes in the form of reduced anxiety were achieved in 100% (n=17) of patients in the main group and 53% (n=9) in the comparison group (p=0.05). Pain syndrome was eliminated in more patients in the main group (n=17) compared to (n=11) in the com-parison group. There was a difference in a number of numerical measures of quality of life and patient satisfaction with the treatment received: the value (vector) of the level of rehabilitation potential and the value of the outcome level at p=0.01. Conclusion. An effective, pathogenetically grounded technique for rehabilitation of patients with spinal column injuries was proposed, and the tactics of applying intratissue stimulation to mature and elderly patients with disorders of the emotional-volitional sphere at the outpatient stage of rehabilitation treatment was developed.

Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran.

A retrospective study. The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs). The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase. In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1hour and <8hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%). These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.

Traumatic Cervical spine injury epidemiology: a tertiary care center perspective in Nepal

Background: The epidemiology of traumatic cervical spine injury is not well documented in developing/ underdeveloped countries. There are a few single-centered studies on the epidemiology of cervical spine injury in Nepal. Objectives: This study aimed to explore the epidemiology of traumatic cervical spine injuries presented at Dhulikhel Hospital, Kathmandu University Hospital, Nepal. Methods: This was a retrospective study of individuals with traumatic cervical spine injuries admitted to the Department of Orthopedics from 2015 January to 2021 December. Data collection was done by using the International Spinal Cord Injury core data set (version 2) and International Spinal Cord Injury Spinal Column Injury Basic Data Set (version 1.0). Results: One hundred and forty-four patients were included of which the majority (68.8%) were males. The mean age of the patients was 47.89 ± 17 years. Fall injury was the most common etiology (79.2%). C2 was the most common level injured (28.5%). Patients with ASIA A neurology was 18% and surgical treatment was given to nearly 60%. The patients had a median hospital stay of 9 days (4- 16) and a mortality of 4.2%. Conclusion: There was a male predominance with a recent increase in the female proportion for traumatic cervical spine injury. Fall was the most common etiology with the majority of patients in their 30s and 40s. Surgical treatment is more preferred recently. The mortality rate was relatively low which needs further investigation.