Common Level Of Injury Research Articles

Spinal Injuries Due to Falls from Height

Abstract Background: Traumatic spinal injuries (TSIs) due to falls from heights are characterized by unique injury mechanisms, morphological features, and severity. In this study, we conducted an analysis of the epidemiological, clinical, and radiological data of TSI patients caused by falls from heights. We compared these findings with those of patients injured by other mechanisms. Materials and Methods: During a five-year period (2015–2019), all patients with traumatic spinal injuries who received treatment at a tertiary-level trauma center were categorized into two groups: those injured by falls from height (group 1) and those injured by other modes (group 2). Their medical records were reviewed for analysis. Results: Falls from height (group 1) constituted the predominant cause of TSI, affecting 51.8% (1069/2065) of spine trauma patients. The average age in group 1 (44.45 ± 16.76) was significantly higher than in group 2 (42.33 ± 15.81) (P = 0.003). In group 1, the most common level of injury was the lumbar spine (48.6%, n = 520), whereas in group 2, it was the cervical spine (48%, n = 478). Multiple levels of injury were more common in group 1 than in group 2 (25.2% vs. 19.2%, P = 0.002). The most common type of spine injury was AO type B in group 1 (35.43%, n = 377) and AO type C in group 2 (32%, n = 319). Other associated organ system injuries were significantly higher in group 2 than in group 1 (P < 0.05), except for pelvic injuries. Additionally, spinal injury-related complications were higher in group 2 (16.7%) than in group 1 (11.6%) (P = 0.001). The length of hospital stay was significantly higher in group 2 (9.71 ± 9.03 days) compared to group 1 (8.09 ± 7.26 days). Conclusion: Our study has revealed significant demographic and epidemiological variances in TSI caused by falls from heights compared to other injury mechanisms. This information is crucial in understanding the mechanism and injury pattern in TSI due to falls from height, as well as for formulating effective management strategies.

Clinical Characteristics and Outcomes of Patients with Traumatic Spinal Cord Injury at a Tertiary Care Center in the Philippines

Traumatic Spinal Cord Injury (TSCI) is a devastating condition which may result to lifelong complications that impact patient outcome and quality of life. Due to the increasing incidence of TSCI, it is important to comprehend the extent of this condition in terms of demographics, mechanism, and degree of disability to raise awareness and develop strategies in approaching care for these patients. There is lack of information regarding data on TSCI in Southeast Asia, especially in the Philippines. This study aims to describe the clinical characteristics and outcomes of patients with TSCI in a tertiary care hospital in the Philippines. This is a retrospective descriptive cohort study in individuals aged 18 years and above, who were admitted for TSCI in a Philippine tertiary care hospital between 2022 and 2023. Of 118 admitted patients, 100 patients were included in the study. The data were obtained from the review of patients' medical records. Demographics of TSCI, mechanism, presenting clinical characteristics, American Spinal Injury Association Impairment Scale (AIS) grade, radiographic findings, outcomes, and complications were analyzed. A total of 100 patients with TSCI were included in the study. The mean age of the patients is 43.4 ± 15.8 in years with males being predominant, 92%. The most common mechanism of injury was motor vehicular crash (MVC), 68%. followed by fall, 22%. Majority of patients were graded AIS C, 38% on admission. The most common level of injury is cervical, 70%. The usual complications recorded were sacral ulcer 28%, and Hospital Acquired Pneumonia (HAP), 20%. TSCI is common in young adult males with MVC as mechanism of injury. Majority of patients in the study had incomplete spinal cord injury (AIS C), with the cervical region as the most common level. The recorded mean length of hospital stay was 1-2 weeks. The most common co-occurring extra spinal injury was TBI. Upon discharge, majority developed sacral ulcer and HAP, with stable neurologic status. A multi-center prospective data collection with a larger population and inclusion of more variables are necessary to formulate a regression model and establish the factors that improve the outcomes of TSCI.

Evaluation of Clinical Characteristics and Comorbid Conditions in Pediatric Traumatic Spinal Cord Injury Patients.

Objective This study aimed to examine the demographic features and the most common comorbid conditions of pediatric traumatic spinal cord injury (SCI) patients who were admitted to Ankara Physical Therapy and Rehabilitation Training and Research Hospital'sinpatient rehabilitation program. Materials and methods The demographic features, clinical features and cormorbid conditions of 147 pediatric traumatic SCI patients (age of injury 17 and under) who received an inpatient rehabilitation program in the hospital between 2009-2017 were retrospectively examined. Patients were divided into three groups according to the lesion location (cervical, thoracic, and lumbar); and into two groups according to the age of completing the development of osteoligamentous structures in the vertebral column (group 1: ≤ 10 years and group 2: >10 years), and the evaluated data were compared. Results 73.5% of the patients were male, the average age of injury was 13.60 ± 4.19 years, and the average duration of the disease was 11.17 ± 20.80 months. The most common etiological reason was falls from height (34.7%), and the most common level of injury was the thoracic region (49%). The most common comorbid conditions after SCI were found to be neurogenic bladder (91.2%), spasticity (41.54%), and neuropathic pain (29.3%). It was determined that neurogenic bladder was seen less in the lumbar region (p<0.001). Urinary tract infection was found more in the cervical group (p=0.004). In Group 1 (0-10 years), the median disease duration was longer, and the rate of thoracic region injury and complete injury was higher (p<0.05); in Group 2 (11-17 years), the rate of having stabilization operation after the injury was significantly higher (p<0.001). Conclusion It is crucial to prevent the etiological reasons in pediatric traumatic SCI patients, to treat the arising comorbid conditions in the early period, to take protective measures, and to follow up the patients regularly when necessary.

Advantages of Short-Segment Fusion in the Surgical Management of Thoracolumbar Traumatic Fractures: A Case Series and Review of the Literature.

Spinetrauma is a commonpathology that frequently requires neurosurgical intervention. Few studies have examined short-segment, 360-degree stabilization of traumatic thoracolumbar fractures. A retrospective review was completed of adult and pediatric patients who underwent surgical correction for thoracolumbar fractures between December 2011 and December 2021. Forty patients met the inclusion criteria. The majority of patients presented with an American Spinal Injury Association (ASIA) score of D (n = 11) or E (n = 21). The most common level of injury was L1 (n = 20). The average length of stay was 11.7 days. Postoperatively, two patients had pulmonary emboli or deep venous thrombosis, and two had surgical site infections. Most patients were discharged to home(n = 21) or acute rehab (n = 14). The fusion rate at six months was 97.5%. Neurologically, all patients regained ambulation by>18 months follow-up. For the ASIA scale, most had a score of D (n = 4) or E (n = 32) at six months. The same trend was observed with the Frankel score, where most patients had either D (n = 5) or E (n = 31), improving to only two having a score of D at >18 months. Corpectomy followed by posterior fusion has a number of biomechanical benefits. This construct permits circumferential decompression, larger surface area for fusion, improved reconstitution of vertebral body height, reduced kyphosis, and an overall shorter segment. This results in fewer levels needing to be fused while enabling the greatest changes of successful fusion.

Observational study of short-segment pedicle screw fixation for dorsolumbar spine injury: A prospective study

Background: Traumatic injury of dorsolumbar spine is one of the most common sites of spinal injuries because of its location between rigid kyphotic thoracic and mobile lordotic lumbar spine. Its treatment by pedicle screw fixation by short segment (one level above and below the fractured vertebra) or long segment (two levels above and below the fractured vertebra) has always remained a matter of debate. The aim of this study was to assess the functional outcome of short-segment fixation in dorsolumbar spine injury.Materials and Methods: This prospective study was conducted on thirty, single-level, unstable dorsolumbar spine fracture patients, who underwent short-segment pedicle screw instrumentation at Indira Gandhi Institute of Medical Sciences, Patna, between October 2019 and September 2021. All the patients were operated by posterior approach and stabilized the vertebrae with short-segment pedicle screw instrumentation. All patients were followed up for 1 year.Results: Thirty patients (21 males and 9 females) of mean age 34.2 ± 11.74 years were included in the study. The most common mode of injury was fall from height (24 patients, 80%), followed by road traffic accident (six patients, 20%). The most common fracture pattern was compression fractures in 23 (76.67%) patients, followed by burst fractures in 7 (23.33%) patients. The most common level of injury was L1, followed by D12. Neurological improvement of at least one level was seen in 21 patients, and nine patients had no neurological improvement. There was a statistically significant correction of kyphotic angle of 14.9°. At 1 year of follow-up, 21 (70%) patients had <40% Oswestry Disability Index (ODI) and 9 (30%) patients had more than 40% ODI. Out of 30 patients, 2 (6.67%) patients had bedsore, 1 (3.33%) patient had superficial infection, and 1 (3.33%) patient had implant failure.Conclusion: The short-segment posterior instrumentation system is a very stable construct. It maintained the corrected deformity after fracture reduction and spares the motion segment which is sacrificed in the conventional long-segment fixation. The soft tissue dissection, blood loss, and duration of surgery are less in this procedure.

Traumatic Thoracic and Lumbar Spine Injury in Adult Population Presenting to a Tertiary Care Hospital.

Epidemiology of traumatic thoracolumbar spine injury is a less explored subject in developing/ underdeveloped countries. The number of available studies in Nepal is even smaller. This study aims to establish the epidemiological characteristics of patients with thoracic and lumbar spine injuries presenting to Dhulikhel Hospital, Kathmandu University Hospital in Nepal. This is a single-center retrospective observational study. Patients with traumatic thoracolumbar spine injuries admitted to to Dhulikhel Hospital, Kathmandu University Hospital from 2015 January to 2019 December were included. International Spinal Cord Injury core data set (version 2) and International Spinal Cord Injury Spinal Column Injury Basic Data Set (version 1.0) were used for data collection. Three hundred and seventeen patients were included, of which, 50.2% were male and the mean age was 45.5± 17years. Fall was the most common etiology of injury (69.1%). The most common level of injury was L1 (32.5%). Thirty-seven patients (11.7%) had ASIA A neurology. One hundred and seventy-three (54.6%) patients underwent surgical intervention. The median hospital stay of the patients was 7 days(IQR: 3-11) with no recorded in-hospital mortality. Males and females are equally vulnerable to thoracic and lumbar spinal injuries, with the majority of patients in 46-60 age groups. More than 1/3rd neurologically impaired patients are with ASIA A neurology. The findings of this study can contribute to traumatic thoracic and lumbar spine injury prevention and rehabilitation.

820 Management and Outcomes of Traumatic Paediatric Spinal Cord Injuries in Low- and Middle-Income Countries: A Scoping Review

Abstract Introduction Traumatic spinal cord injury (TSCI) is a subset of neurotrauma, which is a significant contributor to global trauma mortality and morbidity in children. The management and outcomes of paediatric TSCI in low- and middle-income countries (LMICs) is unknown. We conducted a scoping review to characterise the methods of management and outcomes of TSCI in LMICs. Method MEDLINE, EMBASE, and Global Index Medicus were searched from database inception to February 15, 2021. Studies reporting management or outcomes of paediatric TSCI in LMICs were included. Pooled statistics were calculated using measures of central tendency and spread. Results A total of 1171 studies were identified, of which, five were included. A total of 212 patients were included in our review with age of participants ranging from 2.5 to 18 years old (mean = 15.4 years). Most patients were male (n=162/212, 76.4%, 95% confidence interval [CI] = 70.7–82.1%). The commonest cited cause of injury was falls (n=104/212, 49.1%, 95% CI = 42.3–55.8%). The most common level of injury was cervical (n=83/212, 39.2%, 95 CI% = 32.6–45.7%). The majority of patients underwent surgery (n=134/212, 63.2%, 95 CI% = 56.7–69.7%). The extent of injury was quantified and classified using the ASIA chart in only one paper. Long-term management data was not present in any of the included studies. Conclusions There is a scarcity of published studies reporting the management and outcome of paediatric TSCI in LMICs. There is insufficient data to be compared and to draw a strong conclusion. This hinders the development of guidelines to inform best practice.

Patterns of Traumatic Spinal Injuries in the Developing World: A Five-Year Longitudinal Review

Retrospective review. A 5-year longitudinal study documenting and comparing patterns of traumatic spinal injuries (TSIs) observed in developing countries. Current knowledge of the patterns and epidemiology of TSI are based on evidence from developed countries and there is a lack of data from developing countries to enable a comparison of information to formulate healthcare policies. A review of case records of all patients treated at a tertiary level trauma center over a 5-year period (2015-2019) was performed. Epidemiological, clinical, and radiological data were analyzed. The incidence of spinal trauma was 6.2% (2,065/33,072) among all trauma patients. Among these 2,065 patients, the mean age was 43.4±16.3 years and 77.3% (n=1,596) were aged 21-60 years. The major cause of injury was falls (52.1%, n=1,069) and 49.8% were high-energy falls (>10 feet). In patients with TSI due to falls, injuries occurred at the workplace (n=376), home (n=309), trees (n=151), wells (n=77), and electric poles (n=57). Road traffic accidents contributed to 42% (n=862) of TSIs and predominantly affected motorcyclists (52%, n=467). Around half (53.5%, n=1,005) of all patients were in the lower socioeconomic strata. The most common injury level was thoracic region (37.2%, n=769). Spinal cord injury (SCI) occurred in 49% (n=1,011) of patients and 49.7% (n=1,028) had injuries associated with other organs. Our study indicated different demographic patterns and epidemiological features of TSI compared with the Western literature, including a preponderance of young male patients, falls from heights, motorcycle accidents, and a larger percentage of SCI. The high number of falls at workplace indicates a lack of knowledge among the public and policy makers about safety measures.

Patterns of Traumatic Spinal Injuries in the Developing World: A Five-Year Longitudinal Review.

Retrospective review. A 5-year longitudinal study documenting and comparing patterns of traumatic spinal injuries (TSIs) observed in developing countries. Current knowledge of the patterns and epidemiology of TSI are based on evidence from developed countries and there is a lack of data from developing countries to enable a comparison of information to formulate healthcare policies. A review of case records of all patients treated at a tertiary level trauma center over a 5-year period (2015-2019) was performed. Epidemiological, clinical, and radiological data were analyzed. The incidence of spinal trauma was 6.2% (2,065/33,072) among all trauma patients. Among these 2,065 patients, the mean age was 43.4±16.3 years and 77.3% (n=1,596) were aged 21-60 years. The major cause of injury was falls (52.1%, n=1,069) and 49.8% were high-energy falls (>10 feet [=3.048 m]). In patients with TSI due to falls, injuries occurred at the workplace (n=376), home (n=309), trees (n=151), wells (n=77), and electric poles (n=57). Road traffic accidents contributed to 42% (n=862) of TSIs and predominantly affected motorcyclists (52%, n=467). Around half (53.5%, n=1,005) of all patients were in the lower socioeconomic strata. The most common injury level was thoracic region (37.2%, n=769). Spinal cord injury (SCI) occurred in 49% (n=1,011) of patients and 49.7% (n=1,028) had injuries associated with other organs. Our study indicated different demographic patterns and epidemiological features of TSI compared with the Western literature, including a preponderance of young male patients, falls from heights, motorcycle accidents, and a larger percentage of SCI. The high number of falls at workplace indicates a lack of knowledge among the public and policy makers about safety measures.

Epidemiological profile of 338 traumatic spinal cord injury cases in Shandong province, China.

Hospital-based retrospective review. To describe the epidemiological characteristics of traumatic spinal cord injury (TSCI) in Liaocheng, China. Liaocheng People's Hospital. Medical records of 338 persons with TSCI admitted to Liaocheng People's Hospital from 2013 to 2017 were reviewed. The detailed information included gender, age, marital status, occupation, time, etiology, level of injury, ASIA grade, spinal stenosis, concomitant injury, treatment, length of stay. Over this period, the mean age (SD) of persons with TSCI was 50.1 (14.1) years, and the male/female ratio was 3.1:1. 96.4% of all were married. The leading cause was fall, followed by motor vehicle accident (MVA). The most common level of injury was the cervical cord. ASIA grade D and A injuries were the most common, accounting for 48.5 and 29.3% respectively. Among the concomitant injuries, spinal fractures were the most common. Within 24 h, 91.1% of individuals with TSCI arrived hospital, 63.3% of all accepted surgery. The results showed that fall and MVA were the two main causes, so we should focused on preventing fall and reducing MVA. Cervical spinal stenosis can increase the risk of TSCI, so education should be provided to this population to raise their risk awareness. In addition, timely treatment was critical for TSCI, but the data showed that rescue process was not standard, so it was necessary for medical staff to popularize professional knowledge.

A retrospective study - epidemiological analysis of traumatic spinal injuries in Rajasthan, India

Traumatic spinal injuries (TSI) are major source of morbidity and motility throughout the world. Epidemiological study of TSI has an important role in future planning for prevention and management of them. Aim of this study was determine epidemiology of TSI in Jhalawar Rajasthan state of India. Retrospective analysis of patients hospital data records, admitted in Jhalawar medical college Rajasthan from January 2018 to Dec. 20019 (Period of Two Years).One hundred and fifty eight cases of traumatic spinal injuries reported in period of two years from January 2018 to December 2019. Male to female ratio was 2.16:1, the most prevent age group was 30-39 years (27.8%) followed by 20-29 years (19%). Fall from height (unprotected roof, well, tree, construction site/electric pole) was most common mode of injuries (44.9%) followed by road traffic accidents (43%). Most common level of injury was lumbar spine (55%) followed by thoracic spine (22.78%). Other associated injuries with TSI were head injuries (9.5%) and extremities injuries (9.5%). Maximum number of TSI cases was reported during summer season (may-14.5% and June 15.8%). TSI is major source of morbidity and mortality in Rajasthan India. Younger age group and Male are more commonly affected as compare to older age group and female. Accidental fall and RTA are major cause of TSI.

Epidemiology of traumatic spinal cord injury in Nepal: A systematic review

Spinal cord injury (SCI) leads to disabling condition. In Nepal the nationwide statistics of incidence and prevalence of SCI is still unclear which demands a systematic examination of crucial epidemiological aspects of SCI. An electronic search was conducted on PubMed, Ovid EMBASE, Cochrane Library and Google Scholar. Clinical studies investigating epidemiology of spinal cord injury were included. A narrative synthesis of the data that comprised 1796 patients was conducted. Males comprised 73%, and the mean age varied from 32 to 47 years. The two leading causes of SCI were falls (60%) and accidents (17%). Most patients had incomplete neurology (AIS grade B, C and D = 42%) followed by AIS A grade (36.3%). Cervical injury (37.4%) was the most common level of injury. Mortality during hospital stay was low (1.98%) whereas after rehabilitation was high (24.32%). The review contributes in understanding epidemiology of SCI in Nepal which is expected to help in planning for prevention and management.

Incidence and characteristics of spinal injuries in the victims of intimate partner violence (IPV).

PurposeTo describe the incidence and patterns of the spinal injuries in the victims of physical IPV.Materials and methodsWith institutional review board (IRB) approval, we retrospectively reviewed patients referred to our institution’s domestic violence intervention and prevention program with a diagnosis directly related to physical abuse between January 2013 and June 2018. Electronic health records and radiology reports were reviewed for all patients.ResultsA total of 21/688 (3%) IPV patients with 41 vertebral injuries were identified. The study population comprised of 19/21 (90%) females. Median age of the included patients was 43 years with a range of 21–72 years. All vertebral injuries were AO type A spinal injuries. Upper lumbar spine (L1 and L2) was the most common level of injury followed by upper to mid-thoracic spine. The reported mechanism of the injury was IPV in 8/21 (38.0%), fall in 8/21(38.0%), and incidental in 5/21 (24.0%). Ten out of 21 (48%) patients had concomitant injuries, most commonly to the craniofacial region 5/21 (23%). Psychiatry history was positive in 17/21 (81%), and substance abuse was positive in 15/21 (71%) of the patients.ConclusionIncidence of spinal injuries is relatively low in IPV with morphologic AO type A injury being the most common type of injury and the upper lumbar spine being the most common level of injury.

Thoracolumbar Fractures in Adolescent Patients: Epidemiological, Clinical, Radiological Characteristics and Recent Methods of Management

Background: Spine fractures account for a large portion of musculoskeletal injuries worldwide; approximately 54.9% of the patients had fractures in the thoracolumbar spine; with most of these occurring at the thoracolumbar junction (T10-L2). Objective: To assess the epidemiologic characteristics of spinal injuries in adolescents, their unique anatomic, and radiographic characteristics. Patients and Methods: 18 selected patients presented with traumatic thoracolumbar fractures admitted to the Neurotrauma Unit of Neurosurgery Department, Zagazig University Hospitals, and Al-Ahrar Teaching Hospital, Sharkia, Egypt with our study prospective study and post-resuscitation they were of both sexes and their age range starts from 12:17 years adolescent group. Results: the number of patients (18 patients) was 20.2% from 189 cases of all spine fractures in adolescent patients. Sex were 11 males (61.1%) falling from height is the most common cause of thoracolumbar fractures (50%), followed by road traffic accidents (33.3%). the most common type of fracture in both groups was a wedge and burst where it constituted more than 80%. Orthopedics fractures were the most common associated injuries which were found in 6 patients (33%). According to motor power, 14 patients had full motor power (77.7%). the most common level of injury was L1 vertebrae 11patients (61.1%). The mean height of the vertebral body in the conservative treated group was 26.11±4.85, but in the surgically treated group is 25.55 ±4.63. Conclusion: The most common cause of trauma was fall from a height (50%). The most affected vertebra was L1 (61.1%). Over 80% of patients were neurologically intact. The angle of kyphosis in the surgically treated group improved and decreased from 23 degrees to18.22 degrees.

Outcome of Long Segment Transpedicular Screw Fixation in Unstable Thoracolumbar Spine Injury with Incomplete Neurological Deficit

Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p < 0.05) decreased to 12.5 ± 3 degrees, 11.50 ± 3.5 degrees, 0.86 ± 0.40 and 0.11 ± 0.00011 mm respectively at final follow up visit. Pain was significantly (p < 0.001) decreased, while neurologic function and working capability of the patients were improved from pre-operative to final follow up visit. Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.

Epidemiology of Traumatic Spinal Cord Injury in China

Background: China accounts for nearly one-fifth of the world's population. However, the national epidemiology of traumatic spinal cord injury (TSCI) is still unknown. Therefore, this study aimed to clarify the incidence and epidemiological characteristics of TSCI in China. Methods: We retrospectively reviewed the medical records of patients with spinal cord injury in hospitals and the ability to treat TSCI. TSCI was defined as the clinical manifestation of paraplegia or quadriplegia after trauma. We collected general data, causes of injury, level of injury, severity of injury, multiple injuries, complications and other data through the designed medical record questionnaire, and then performed an analysis according to geographical region, age and gender, and calculated the overall incidence of the whole country and each region. Findings: The study included medical records of 4,134 patients with a male to female ratio of 2·99:1. In 2018, the overall TSCI rate in China was 50·484 cases (95% CI: 50·122, 50·846) per one million persons, and the expected number of cases was 74,890. The highest incidence rate in the East was 53·791 (95% CI: 53·217, 54·365) cases per one million persons, and the expected number of cases was 33,724. The leading cause of injury was high falls (29·58%), the most common level of injury was cervical injury (64·49%). Regarding the severity of injury, the highest percentages of incomplete quadriplegia (55·20%). Interpretation: The estimated overall incidence of TSCI in China is similar to that of the United States. The leading cause of injury in different regions of China was determined. Preventive work should be carried out in a targeted manner. With the ageing population, there are more TSCIs in the elderly population due to low falls. Future public health policies need more strategies to prevent low falls and to widely publicize them. Funding Statement: This study was supported by the Key Program from the National Natural Science Funds (81830077); the General Program from the National Natural Science Funds (81772357);the National Natural Science Foundation of China; the Key Project from the Science and Technology Commission of Shaanxi (2017ZDXM-SF-054); the Department of Health, Shaanxi Province (2018E002); the Major Research from the Xi'an Science and Technology Department (2017123SF/YX017). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The Ethics Committee of Xi'an Honghui Hospital and the ethics committee of each participating centre approved the current study.

Relationships Between Vein Repairs, Postoperative Transfusions, and Survival in Single Digit Replantation.

Background: The general teaching is that increased number of vein repairs in digit replantation leads to improved venous outflow, resulting in lower need for iatrogenic bleeding, lower postoperative transfusion requirements, and better survival rates. The purpose of this study was to determine whether the traditional teaching that emphasizes the repair of multiple veins per arterial anastomosis results in superior survival rates. Methods: A retrospective review of a single urban replant center's single-digit replants distal to the mid-metacarpal level in adult patients from 2007 to 2017 was performed. Data on patient demographics, mechanism and level of injury, veins repaired, iatrogenic bleeding, postoperative transfusions, and replant survival were obtained. Results: There were a total of 54 single-digit replants. The most common mechanism was lacerations (N = 38), and the most common injury level was at the proximal phalanx (N = 21). All digits were replanted with a single arterial anastomosis-44% via grafting. In all, 0 to 3 veins were repaired per digit (mean = 1.5 veins). The mean transfusion requirement was 1.7 units. The survival rate was 50%. Digits with 1 or 2 veins repaired had lower transfusion requirements (1.1-1.3 units) and higher survival rates (56%-61%) compared with those replanted with 0 or 3 veins repaired (2.9-3.5 transfused units, 25%-29% survival). There were no differences between those digits replanted with either 1 or 2 veins repaired for transfusion requirements or survival. Conclusions: More veins repaired do not necessarily improve survival or possibly venous outflow, calling into question the traditional teaching that 2 veins should be repaired for every arterial anastomosis.

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

PurposeBCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke.MethodsDenver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma.Results1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p < .0001; OR = 9.77; 95% CI 3.3–28.7). Eleven percent of patients with BCVI would not have met standard screening criteria.ConclusionsThe increase in detection rate for BCVI justifies more liberal screening protocols.

Spinal cord injury in organizational setup - A hospital based descriptive study

Introduction: There is dearth of data on Spinal Cord Injury (SCI) from developing countries where ironically, special focus is required. Aims and Objectives: To study SCI in an organisational set up. Material and Methods: An observational, cross sectional study at a tertiary care rehabilitation centre was conducted. Patients who had injury during service were included. Questionnaire and case records were used to collect socio-demographic variables, cause, level, severity and duration of injury and clinical, functional and psychological status. Organisational support was estimated for pre-hospitalisation services, inpatient welfare measures and post-hospitalisation rehabilitative services. Results: A total of 157 patients participated. Median age at time of injury was 27 years with 89.2% injuries within 18 - 37 years of age. Trauma was underlying cause in 94.3%. Most common level of injury was thoracic (37.6%) and majority (66.9%) were paraplegic. RTA was most common (42.6%) traumatic cause and Tuberculosis among non-traumatic causes(66.6%). Scores suggestive of stress disorder were present in 13%. Pre-hospitalization health facilities were available to 79.6%. Majority (59.2%) had access to health facilities within two hours. Personal assistance was available to 88.5% and 66.9% undertook rehabilitation course. Conclusion: Health education with emphasis to trauma prevention in young is required. Social security measures need to be replicated by all organisations, both public and private in the country.

Evaluation of correction of kyphotic deformity in dorso-lumbar spinal injuries by posterior stabilization with pedicular screw rod fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acute injury to dorso-lumbar spine is the second most frequent site after cervical spine in adults. The injury, although not associated with high mortality, causes severe morbidity. The management of the traumatic dorso-lumbar spine injuries has improved considerably in the last few years. The objective of the study was to evaluate correction of kyphotic deformity in dorso-lumbar spinal injuries by posterior stabilization with pedicular screw rod fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study includes 52 patients with dorso-lumbar spinal injuries with or without neurological deficit treated between 2006 and 2014. Pre and postoperative kyphosis was measured by Cobb’s method on plain radiographs. Pre and postoperative neurological status was evaluated based on Frankel’s classification. All un-stable dorso-lumbar spine injuries where two or more columns are involved on X-ray and CT scan were included in the present study.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority of the patients were in the age group of 20-30 years (38.5%) followed by 31-40 years (30.8%). Males were more than females. The most common mode of injury was road traffic injury in 71.2% of the cases. The most common level of injury was at L1 in 28.8% of the cases followed by at level D12 in 25% of the cases. In all the groups the mean kyphosis angle is reduced significantly. Overall the improvement rate was 94.2% and failure rate was only 5.8%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In conclusion the posterior reduction and internal fixation is a useful procedure in the treatment of the acute injuries of the dorsolumbar spine. &lt;/p&gt;