Complete Injury Research Articles

Predictors of Early Mortality After Traumatic Spinal Cord Injury in South Africa.

Retrospective cohort study. To identify predictors for early mortality following traumatic spinal cord injury (TSCI), as recognition of factors associated with early mortality is essential for public resource allocation and optimized acute care. Retrospective Analysis of SCI patients admitted to the acute SCI ward from 2003 to 2022 was performed. Days elapsing from the date of injury to date of death established the survival time. Early mortality was defined as survival time ≤ 365days. Multivariable logistic regression was used in modeling of early death following TSCI with age, gender, neurologic deficit, type of neurologic injury, ventilation status, and count of complications as covariates. Simple logistic regression indicated a significant association of early mortality with the number of complications (P < .0001), neurological deficit (P < .0001), complete neurological injury (P < .0001), ventilation status (P < .0001), and age group (P < .0003). After adjusting for other covariates, complete neurological injury (OR: 1.75, P < .0001), ventilation (OR: 2.80, P < .0001), and Age group (over 60 OR: 17.71, P < .0001) were significantly associated with early mortality. The multivariable model showed a good overall fit (Hosmer-Lemeshow P = .315; AUC 0.85). Predictors of early mortality after TSCI are high complete spinal cord injury, age, number of complications, and the need for ventilation. Identification of high-risk patients is crucial to rationalize and improve acute care to potentially reduce mortality rates.

Time Since Injury Is Key to Modeling Trends in Aging and Overall Functioning of Persons With Spinal Cord Injury: A Longitudinal Analysis of a Swiss Community Survey.

The aim of the study is to model the health indicator of functioning for persons with spinal cord injury or disorder living in Switzerland in the long-term context, considering chronological age, time since injury, and age at injury. This is a longitudinal analysis of three waves of a community survey. An interval-scaled functioning metric was constructed using modern test theory. Random effects within-between mixed models were used to investigate trends in functioning over time. Persons with complete injuries have lower levels of functioning than persons with incomplete injuries, and persons with complete tetraplegia have the lowest levels of functioning. The person's age when injured, the level and completeness of the injury, the presence of secondary health conditions, and various combinations of these factors significantly influenced how functioning changed over time. Our study shows that chronological age is not necessarily the best time variable for understanding the aging process of people with spinal cord injury in terms of changes in functioning over time and that modeling functioning over time since injury provides important insights into how functioning of people with complete or incomplete injuries declines with increasing time living with the injury.

Early degenerative changes are different between partial and complete anterior cruciate ligament injury and associate with joint instability in a skeletally immature porcine model

ObjectiveAnterior cruciate ligament (ACL) injuries are a major problem in the pediatric and adolescent populations. Some of these injuries are only partial; yet, there is limited data to inform clinical treatment of such partial tears. It is unknown how injury partial injury impacts long-term degenerative changes in the joint relative to complete injury. In this study, we hypothesized that partial (anteromedial (AM) or posterolateral (PL) bundle) tears would result in small levels of instability and degeneration relative to complete ACL tears and that the degree of degeneration would associate with joint instability. DesignPartial (isolated AM or PL bundle) or complete ACL injury was arthroscopically created in 3-month-old juvenile pigs. The contralateral limb served as a sham-operated control. Six months after injury, joint biomechanics was assessed along with cartilage and meniscus degeneration (via MRI, gross imaging, and histology). ResultsJoint laxity increases were minimal after PL bundle injury (difference relative to controls (confidence interval): 0.5 (-1.2-2.2) mm), minor after AM bundle injury (3.7 (2.0-5.4) mm), and major after ACL injury (15.8 (13.7-17.8) mm). Cartilage MRI T1ρ relaxation times increased minimally after PL bundle injury (-0.9 (-5.1-3.3) ms for lateral tibia), moderately after AM bundle injury (6.6 (1.7-11.4) ms), and substantially after ACL injury (10.8 (2.1-19.5) ms). Changes in meniscus volume followed a similar rank order. Degeneration was associated with the extent of joint destabilization. ConclusionsThese findings suggest that cartilage and meniscus degeneration in the skeletally immature joint are associated with joint laxity after partial and complete ACL injuries.

Civilian ballistic spinal cord injuries versus blunt trauma: comparative analysis of clinical characteristics, management, and outcomes

BACKGROUND CONTEXTThere are no current guidelines for the management of civilian gunshot wound injuries (GSW) to the spine and patient management often relies on algorithms derived from blunt trauma (BT). However, spinal cord injury due to GSW or blunt trauma mechanism may have significantly different clinical presentation, management, and outcomes. To ensure improved and evidence-based treatment, we need to understand the outcome determining characteristics of civilian GSW to the spine and identify the differences to the well-studied BT. PURPOSEThe aim of this study was to compare clinical characteristics, management, functional outcomes, and mortality associated with GSW to the spine versus BT. DESIGNRetrospective single-center analysis. PATIENT SAMPLEOne thousand nine hundred thirty-nine unique patients admitted to a level 1 trauma center with spinal cord injuries due to GSW or BT between the years 2003–2022. OUTCOME MEASURESPrimary outcome measure was the progression in American Spinal Injury Association (ASIA) motor score. METHODSClinical characteristics were compared followed by age-matched analysis (<45years) of neurological injury, the need for surgery, neurological outcomes and mortality. Stratification by neurological injury allowed for more homogenous subgroups for outcome analysis. RESULTSOf the 1939 patients with spinal cord injury, 566 were included in GSW group, and 1373 patients in BT group. Most patients in the GSW group were males (94.9% GSW vs. 83.5% BT; p<0.001) and younger (28.2 (range 13-62) years vs. 37.9, (range 12-91) years, p<0.001). The age-matched dataset comprised 1536 patients, with 540 in GSW group, and 996 in BT group. There were significantly more complete neurological injuries at admission in GSW group compared with BT (63.5% GSW vs. 34.4% BT, p<0.001). The ASIA motor Score at admission was significantly lower in GSW group (p<0.001), and changed without significant difference between the groups from admission to discharge (p<0.001, p=0.222). Subgroup analysis based on spinal cord injury showed that a higher proportion of patients with incomplete injuries improved neurologically, opposed to complete injuries, with significantly more patients improving in GSW group compared to BT (incomplete 58.9% GSW vs. 44.3% BT, p<0.001). Likewise, a higher proportion of paraplegic patients improved, opposed to quadriplegic patients, and in the paraplegic subgroup GSW patients improved rather than BT (paraplegic 65.1% GSW vs. 35.3%BT, p<0.001). In GSW group significantly less patients were managed operatively compared to BT group (12.2% GSW vs 76.8% BT, p<0.001). Most surgeries were bullet removals (81,4%) and involved the lumbar spine: 38.6% lumbar surgeries (of all GSW surgeries) and 31.4% surgery rate of all lumbar GSW patients. There was no significant difference in ASIA motor and sensory score improvement between patients who underwent surgery for bullet removal compared to nonoperatively managed patients in GSW group (p=0.199). The incidence rate of surgery showed a downwards trend over the study period. GSW group showed significantly less complications than BT group (22.8% GSW vs 27.0% BT, p<0.001). There was no significant difference in mortality rates (p ≥ 0.289). ConclusionTo our knowledge, this is the largest single-center dataset of civilian ballistic spinal cord injuries compared to BT. GSW affect mostly young males and result in significantly more severe, complete neurologic injuries compared with BT at similar mortality rates. Nevertheless, the present data suggest a greater potential for neurological improvement for paraplegic patients and incomplete injuries in GSW group. Patients with spinal cord injuries due to GSW undergo surgery less frequently compared to BT. Operated GSW cases primarily involved the lumbar spine. This study revealed differences between spinal cord injuries due to GSW and BT. In clinical application, this means that guidelines based on BT may not directly be transferable to civilian ballistic spinal cord injuries.

Traumatic spinal cord injuries due to falls from trees in a tertiary rehabilitation center: a retrospective analysis of causes and outcomes

Aims: Falls from heights are a major cause of spinal cord injury. In developing countries such as Turkey, where fruit picking from trees is an important part of the agricultural economy, falls from trees are common. This study aims to comprehensively analyze the causes and consequences of spinal cord injuries due to falls from trees. Methods: This retrospective study reviewed cases of spinal cord injury resulting from falls from trees, treated at a tertiary rehabilitation center between March 2020 and November 2023. Data encompassed demographics (age, gender, occupation, education), spinal injury specifics (level, severity), additional injuries, tree fall details (type of tree, height of fall, cause of fall, safety precautions), and treatment details (surgery need, hospital stay duration). The patients who fell from trees were divided into two groups: those who fell from walnut trees and those who fell from other trees, and statistical analyses were performed accordingly. Results: Among the 49 patients falling from trees, the mean age was 52.3 ± 13.4 years, with 73.5% being male, 32 patients (%65.3) had graduated from primary or secondary school. No safety precautions were taken by any participants. Paraplegia (%87.8) and complete spinal cord injuries (57.1%) were common. Additional injuries occurred in %61.2 of cases. In terms of fall causes, the most common was branch breakage (%57.1), while walnut trees accounted for %44.9 of falls. There was a significant difference in education levels between the group that fell from walnut trees and the group that fell from other trees (p:0.028). Falls from walnut trees resulted in higher fall heights, complete injury rates, and longer hospital stays (p:0.003, p:0.047, p: 0.010). Conclusion: This study found that spinal cord injuries from falls often lead to additional injuries, with none of the patients taking safety precautions. This study found that walnut trees were the most common cause of spinal cord injury from falling trees. This study highlights the need for improved safety precautions and educational interventions.

Functional characterization of human IL-8 in vascular stenosis using a novel humanized transgenic mouse model

IL-8 (aka interleukin 8, CXCL8) is a prototypic cytokine that is highly expressed in the diseased vessel wall and its plasma concentration is strongly associated with cardiovascular events. However, whether IL-8 plays a causative role in cardiovascular diseases remains largely unknown. In this study we used a human IL-8 transgenic (Tg) mouse strain with a bacterial artificial chromosome (BAC) integrated into its genome. This BAC encompasses 166 kb of sequence encompassing the human IL-8 gene locus as well as upstream and downstream DNA sequences containing regulatory elements. This BAC ensured a pathophysiologically regulated, rather than forced constitutive, expression of human IL-8 in the mouse. Tg mice were subjected to complete carotid ligation injury. IL-8 was highly expressed in the ligation-injured carotid artery from 3 days until 2 weeks after injury. As a result, exacerbated neointimal hyperplasia and increased Mac2 and PCNA positive cells were observed in Tg mice. To further confirm its role in promoting neointimal formation, IL-8 was neutralized by anti-IL8 treatment at the ligation site. Consequently, the size of neointima was significantly reduced. Our results provided new insights into the regulation and function of IL-8 in response to vascular insult and during neointima formation.

Fish Species Spinal Cord Injury Models Utility for Research: A Systematic Review of Methodologies and Outcomes

Context: Spinal cord injury (SCI) is a devastating condition that results in severe disability and significant comorbidities. The complex pathophysiology of SCI repair and difficulties understanding neural regeneration are treatment challenges. Objectives: The aim of this study is to systematically review the diverse applications of various fish species as models for SCI research. Evidence Acquisition: PRISMA guidelines were used to review observational and interventional studies that utilized fish species as SCI models, published from inception to July 2023. Two independent reviewers screened and performed the data extraction. One independent reviewer assessed the risk of bias for the included studies. Results: Five thousand six hundred and thirty-three records were reviewed, and 144 met the inclusion criteria and were categorized by fish species. The majority of studies employed complete transection injuries, with the remainder being crush injuries, laser injuries, electro-ablations, and demyelination with substances. Zebrafish (Danio rerio) were most commonly utilized 102/144 (71%), primarily with larval models. Other models included Lamprey (Petromyzon marinus and Lethenteron reissneri); Goldfish (Carassius auratus); European eel (Anguilla Anguilla); Knifefish (Apteronotus leptorhynchus and Apteronotus albifrons); Sailfin Molly (Poecilia latipinna); and African turquoise killifish (Nothobranchius furzeri). Conclusions: This systematic review highlights that fish models, particularly zebrafish, goldfish, and European eels, are important models for further defining SCI pathophysiology and regenerative processes. These models provide a less complex model to gain insights into apoptosis and glial networks.

Clinical risk factors associated with the need for tracheostomy in traumatic cervical and high thoracic spinal cord injury

BackgroundOur objective was to assess the association of completeness and level of spinal cord injury (SCI) with the need for tracheostomy and identify additional risk factors predictive of tracheostomy. MethodsThis was a retrospective review of patients with SCI between January 2017 and December 2022. ResultsPatients with complete SCI were roughly thirty-three times more likely to have a tracheostomy when compared to incomplete injury (82 ​% vs 12 ​%, p ​< ​0.001, OR ​= ​32.9). The rate of tracheostomy did not differ between spinal cord levels for complete (p ​= ​0.68) or incomplete (p ​= ​0.08) injuries. Penetrating injury, low GCS, high ISS, and polytrauma were associated with tracheostomy need in incomplete SCI. ConclusionComplete injury was statistically significantly associated with the need for tracheostomy while level of injury failed to reach significance. Patients with incomplete SCI that have certain clinical risk factors should be considered for early tracheostomy.

Urban-Rural Disparities in Community Participation after Spinal Cord Injury in Ontario.

Personal, social, and environmental factors may influence self-efficacy and social reintegration among people living with spinal cord injury or disease (SCI/D) in urban and rural areas. Novel data collection methods have the potential to characterize community participation (CP) in diverse settings. The objectives were (1) to describe and compare self-reported community participation (Reintegration to Normal Living Index (RNLI) and Moorong Self-Efficacy Scale (MSES)) levels of individuals with SCI/D living in urban or rural Ontario, Canada; and (2) to determine the accuracy of an artificial intelligence (AI) optical mark recognition tool for extracting data from CP surveys conducted among participants after transitioning from inpatient rehabilitation to home and residing in the community. We partnered with SCI Ontario staff to collect MSES and RNLI survey data from adults with motor complete (e.g., AIS A-B) and incomplete (AIS C-D) SCI/D living in urban or rural Ontario, Canada, between January and October 2022. The Rurality Index of Ontario (RIO) from the postal code determined urban or rural residency. Optical mark recognition (OMR) software was used for survey data extraction. A Research Associate validated the extracted survey responses. Descriptive statistics, correlation analysis, and non-parametric statistics were used to describe the participants, their impairments, and their reported CP levels across urban and rural settings. Eighty-five individuals with SCI/D (mean age 53.7 years, 36.5% female) completed the survey. Most of the participants resided in major urban areas (69.4%) and had traumatic injuries (64.7%). The mean total MSES score for Ontarians with SCI/D was 87.96 (95% confidence interval [CI]: 84.45, 91.47), while the mean total RNLI score for the same individuals was 75.61 (95% CI: 71.85, 79.37). Among the MSES domains, the lowest score was observed in response to sexual satisfaction (mean: 4.012, 95% CI: 3.527, 4.497), while the lowest RNLI domain item score was associated with the ability to travel out of town (mean: 5.965, 95% CI: 5.252, 6.678). Individuals with incomplete injuries in rural areas reported lower MSES and RNLI scores than those with complete motor injuries, whereas no significant differences were found in MSES and RNLI scores among urban residents based on impairment. These findings suggest that, depending on the environmental context (e.g., rural vs. urban areas), AIS categories may influence the perception of CP among people living with SCI/D. The OMR tool had 97.4% accuracy in extracting data from the surveys. The CP (MSES and RNLI) scores reported by individuals with SCI/D differ based on their living setting. In rural Ontario, individuals with greater functional ability reported lower CP than their counterparts living in urban settings. Although CP remains a challenge, the needs of individuals with motor incomplete SCI/D and heterogeneous levels of mobility residing in rural areas require exploration and targeted interventions. The OMR tool facilitates accurate data extraction from surveys across settings.

Disability trajectories individuals with spinal cord injury in mainland China: do psychosocial resources and diseases factors predict trajectories?

Observational cohort study. To identify classes of disability trajectories from 1 month post-injury (acute hospital) to 6 months post-injury (individuals with SCI individuals who stay in rehabilitation setting or back in the community), and to investigate whether psychosocial resources and disease factors can predict disability trajectory. Spinal surgery in three Class III hospitals. Hospitals in China are divided into three classes (Class I, II and III). All the participants were submitted to WHO Disability Assessment Schedule (WHO-DAS 2.0) at three times; and personal data anamnesis, level of hope, level of PTSD, level of social support were recorded at first time. All the data collected by the master's students who participated in this study. Two disability trajectories were identified using the latent class growth model: the continuous high disability group (N = 196, 93.3%) and the low starting point stabilization group (N = 14, 6.7%). Complete injury(ASIA-A) with SCI and more depression in the stable condition after SCI surgery were more likely to be classified as having higher disability than those with a lower disability trajectory. Occupation, annual family income, hope, social support, and Post-traumatic Stress Disorder (PTSD) cannot predict individuals belonging to trajectory classes. These findings emphasize the importance of ASIA and depression in the early recovery stage after SCI and support the opinion that strengthening psychological nursing and rehabilitation management at an early stage after SCI will benefit individuals with a lower disability trajectory.

Quantifying Treatments as Usual and with Technologies in Neurorehabilitation of Individuals with Spinal Cord Injury.

Several technologies have been introduced into neurorehabilitation programs to enhance traditional treatment of individuals with Spinal Cord Injury (SCI). Their effectiveness has been widely investigated, but their adoption has not been properly quantified. The aim of this study is to assess the distribution of conventional (Treatment As Usual-TAU) and technology-aided (Treatment With Technologies-TWT) treatments conveniently grouped based on different therapeutic goals in a selected SCI unit. Data from 104 individuals collected in 29 months were collected in a custom database and categorized according to both the conventional American Impairment Scale classification and a newly developed Multifactor (MF) clustering approach that considers additional sources of information (the lesion level, the level of independence in the activities of daily living, and the hospitalization duration). Results indicated an average technology adoption of about 30%. Moreover, the MF clusters were less overlapped, and the differences in TWT adoption were more pronounced than in AIS-based clustering. MF clustering was capable of grouping individuals based both on neurological features and functional abilities. In particular, individuals with motor complete injuries were grouped together, whereas individuals with sensorimotor incomplete SCI were collected separately based on the lesion level. As regards TWT adoption, we found that in the case of motor complete SCI, TWT for muscle tone control and modulation was mainly selected (about 90% of TWT), while the other types of TWT were seldom adopted. Even for individuals with incomplete SCI, the most frequent rehabilitation goal was muscle tone modulation (about 75% of TWT), regardless of the AIS level, and technologies to improve walking ability (about 12% of TWT) and balance control (about 10% of TWT) were mainly used for individuals with thoracic or lumbar lesions. Analyzing TAU distribution, we found that the highest adoption of muscle tone modulation strategies was reported in the case of individuals with motor complete SCI (about 42% of TAU), that is, in cases when almost no gait training was pursued (about 1% of TAU). In the case of cervical motor incomplete SCI, compared to thoracic and lumbar incomplete SCI, there was a greater focus on muscle tone control and force recruitment in addition to walking training (38% and 14% of TAU, respectively) than on balance training. Overall, the MF clustering provided more insights than the traditional AIS-based classification, highlighting differences in TWT adoption. These findings suggest that a wider overview that considers both neurological and functional characteristics of individuals after SCI based on a multifactor analysis could enhance the personalization of neurorehabilitation strategies.

Correlation of Player and Imaging Characteristics With Severity and Missed Time in National Football League Professional Athletes With Hamstring Strain Injury: A Retrospective Review

Background: Hamstring strain injuries (HSIs) are prevalent in US National Football League (NFL) players, but there is a paucity of information regarding imaging characteristics, injury severity, and player factors associated with time missed and risk of recurrent injury. Purpose: To describe player, football activity, clinical, and imaging characteristics of NFL players with HSIs, as well as determine player characteristics, clinical examination results, and magnetic resonance imaging (MRI) findings associated with injury occurrence, severity, and missed time. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective cohort of NFL players with acute HSI (n = 180) during the 2018-2019 season was identified. Injury data were collected prospectively through a league-wide electronic health record system. Three musculoskeletal radiologists graded MRI muscle injury parameters using the British Athletics Muscle Injury Classification (BAMIC) system. Player, football, clinical, and imaging characteristics were correlated with HSI incidence and severity and with missed time from sport. Results: Of the 1098 HSIs identified during the 2018-2019 season, 416 (37.9%) were randomly sampled, and 180 (43.3%) had diagnostic imaging available. Game activity, preseason period, and wide receiver and defensive secondary positions disproportionately contributed to HSI. The biceps femoris was the most commonly injured muscle (n = 132, 73.3%), followed by the semimembranosus (n = 24, 13.3%) and semitendinosus (n = 17, 9.4%) muscles. The most common injury site was the distal third of the biceps femoris and semitendinosus muscles (n = 60, 45.5% and n = 10, 58.8%, respectively) and central part of the semimembranosus muscle (n = 17, 70.8%). Nearly half of the injuries (n = 83, 46.1%) were BAMIC grade 2; 25.6% (n = 46), grade 3; and 17.8% (n = 32), grade 4. MRI showed sciatic nerve abnormality in 30.6% (n = 55) of all HSIs and 81.3% (n = 26) of complete tendon injuries. BAMIC grade correlated with both median days and games missed. Combined biceps femoris and semitendinosus injuries resulted in the highest median days missed (27 days). Conclusion: Among NFL players with acute HSIs, the most common injury was a moderate-severity injury of the distal biceps femoris. BAMIC grade was associated with missed time.

Surgical Treatment of Proximal Hamstring Avulsion Injuries Compared With Nonsurgical Treatment: A Matched Comparative Study With a Mean Follow-up of >4 Years From the Proximal Hamstring Avulsion Surgery Cohort Study

Background: Surgical outcomes for proximal hamstring avulsion injury (PHAI) are well documented, yet comparative analyses with nonsurgical approaches remain scarce. Purpose: To compare the functional outcomes between surgical and nonsurgical interventions for PHAI. Study Design: Cohort study; Level of evidence, 3. Methods: This comparative study, conducted at a sports surgery center between January 2012 and July 2021, focused on patients with primary PHAI. The study was a retrospective analysis of prospectively collected data. Group selection involved utilizing propensity score matching to compare an arm of patients who were surgically treated (indications included patients with complete injury, patients with partial injury with >2 cm of retraction, and patients for whom 6 months of nonsurgical treatment failed) with another arm of patients who refused surgery. The primary outcome was evaluated using the Parisian Hamstring Avulsion Score (PHAS). The secondary outcomes included the Tegner Activity Scale (TAS) score; University of California, Los Angeles (UCLA) score; rate and quality of return to sport (RTS); and patient satisfaction. Results: The study included 32 patients (mean age, 55.8 years [SD, 8.4 years]) in the nonsurgical treatment arm and 95 patients in the surgical treatment arm (mean age, 53.4 years [SD, 7.7 years]) (P > .05). The interval from injury to treatment was 5.7 months (SD, 9.6 months) for the surgical group and 12.7 months (SD, 25.9 months) for the nonsurgical group (P > .05). At the final follow-up (nonsurgical group: mean, 56.5 months [SD, 28.2 months]; surgical group: mean, 50.7 months [SD, 33.1 months]), the PHAS was significantly higher in the surgical group (mean, 86.3 [SD, 13.7]) compared with the nonsurgical group (mean, 69.8 [SD, 15.1]) (P < .0001). Higher activity scores were also observed in the surgical group for the TAS and UCLA scores (P = .0224 and P = .0026, respectively). A higher percentage of the surgical group (68.4%) returned to sports compared with the nonsurgical group (46.9%) (P = .0354), with a greater proportion in the surgical group returning at the same or higher level (67.7% vs 26.7%) (P = .0069). Additionally, a higher satisfaction level was reported by patients in the surgical group (89.5%) in contrast to the nonsurgical group (25%) (P < .0001). Three patients in the surgical group experienced complications (2 reruptures and 1 hyperesthesia at the pudendal nerve territories). Odds ratios (ORs) indicated that patients in the surgical group were significantly more likely to achieve or exceed median scores for the PHAS (OR, 6.79; P < .001), TAS score (OR, 2.29; P = .045), and UCLA score (OR, 3.63; P = .003), as well as to RTS at any level (OR, 2.46; P = .031) or at the preinjury level or higher (OR, 6.04; P < .001). Conclusion: This study demonstrated that surgical treatment of PHAI significantly enhances long-term functional scores, including the PHAS, TAS score, UCLA score, satisfaction, and RTS, at a mean follow-up of >4 years compared with nonsurgical treatment. Registration: NCT02906865 (ClinicalTrials.gov identifier)

Traumatic peripheral nerve injuries in young Korean soldiers: a recent 10-year retrospective study.

Traumatic peripheral nerve injury (PNI), which occurs in up to 3% of trauma patients, is a devastating condition that often leads to permanent disability. However, knowledge of traumatic PNI is limited. We describe epidemiology and clinical characteristics of traumatic PNI in Korea and identify the predictors of traumatic complete PNI. A list of enlisted soldier patients who were discharged from military service due to PNI over a 10-year period (2012-2021) was obtained, and their medical records were reviewed. Patients were classified according to the causative events (traumatic vs. nontraumatic) and injury severity (complete vs. incomplete). Of traumatic PNIs, we compared the clinical variables between the incomplete and complete PNI groups and identified predictors of complete PNI. Of the 119 young male patients who were discharged from military service due to PNI, 85 (71.4%) were injured by a traumatic event; among them, 22 (25.9%) were assessed as having a complete injury. The most common PNI mechanism (n=49, 57.6%), was adjacent fractures or dislocations. Several injury-related characteristics were significantly associated with complete PNI: laceration or gunshot wound, PNI involving the median nerve, PNI involving multiple individual nerves (multiple PNI), and concomitant muscular or vascular injuries. After adjusting for other possible predictors, multiple PNI was identified as a significant predictor of a complete PNI (odds ratio, 3.583; P=0.017). In this study, we analyzed the characteristics of enlisted Korean soldiers discharged due to traumatic PNI and found that the most common injury mechanism was adjacent fracture or dislocation (57.6%). Patients with multiple PNI had a significantly increased risk of complete injury. The results of this study contribute to a better understanding of traumatic PNI, which directly leads to a decline in functioning in patients with trauma.

Functional outcomes in unstable complete subaxial cervical spinal injuries with respiratory paralysis and/or hemodynamic instability

IntroductionSubaxial cervical spine injuries (SCSI) can lead to disastrous consequences such as quadriplegia, with/without respiratory paralysis (RP) and hemodynamic instability (HDI). Till date, there is no literature available for reporting outcomes of SCSI patients specifically pertaining to those presenting with RP/HDI and ours is the first study to document the same. MethodsRetrospective 6-year study from a tertiary trauma centre database including patients >/= 18 years of operated SCSI. Only patients with ASIA A grade with admission RP/HDI and unstable injuries (fractures, subluxations) were included. Patients with ASIA grade B and above, patients with non-osseous injuries (such as disc herniation, central cord syndrome etc.) were excluded. Results24 cases were analysed. C5 and C6 levels were the commonest. Vertebral listhesis/subluxation was the predominant radiological finding. The mean age was 47.4 years (22–79 years) and all, except one were males. Fall from height and road traffic accident (RTA) were the most common mechanisms of injury. The most common surgery was anterior discectomy and fusion followed by corpectomy. The overall mortality rate was 22/24 (92)%. Cord edema and hemorrhage had significant association with survival. None of the grade A survivors with HDI/RP showed improvement. The mean FU duration was 18.5 months (range, 16.5–20.5 months). ConclusionsSubaxial ASIA A cervical spine injuries with pre-operative RP/HDI is an indicator for non-improvement. This is the first study documenting outcome in such patients. The mortality rate in these patients is very high and is an extremely poor prognostic factor for recovery. Hence, surgery in such patients need to be decided judiciously, especially in developing countries that has a significant financial impact on the family members.

Weightbearing Computed Tomography Can Accurately Detect Subtle Lisfranc Injury.

Early detection of Lisfranc injury is critical for improving clinical outcomes, but diagnosing subtle injury can be difficult. Weightbearing computed tomography (WBCT) allows evaluation of such injuries in 3 dimensions (3D) under physiologic load. This study aimed to assess the utility of 1-, 2-, and 3-dimensional measurements on WBCT to diagnose subtle injury in isolated ligamentous Lisfranc injuries. Ten cadaveric specimens underwent WBCT evaluation of the Lisfranc joint complex in the intact state and subsequently with sequential sectioning of the dorsal Lisfranc ligament and interosseous Lisfranc ligament (IOL) to create subtle Lisfranc injury, and finally after transectioning of plantar Lisfranc ligament (PLL) to create the injury conditions for complete ligamentous Lisfranc injury. Measurements under static vertical tibial load of 80 kg were performed on WBCT images including (1) Lisfranc joint (medial cuneiform-base of second metatarsal) volume, (2) Lisfranc joint area, (3) C1-C2 intercuneiform area, (4) C1-M2 distance, (5) C1-C2 distance, (6) M1-M2 intermetatarsal distance, (7) first tarsometatarsal (TMT1) alignment, (8) second tarsometatarsal (TMT2) alignment, (9) TMT1 dorsal step-off distance, and (10) TMT2 dorsal step-off distance. In the subtle Lisfranc injury state, Lisfranc joint volume and area, C1-M2 distance, and M1-M2 distance measurements on WBCT significantly increased, when compared with the intact state (P values .001 to .014). Additionally, Lisfranc joint volume and area, C1-M2 distance, M1-M2 distance, TMT2 alignment, and TMT2 dorsal step-off measurements were increased in the complete Lisfranc injury state. Of all measurements, C1-M2 distance had the largest area under the curve (AUC) of 0.96 (sensitivity = 90%; specificity = 90%), followed by Lisfranc volume (AUC = 0.90; sensitivity = 80%; specificity = 80%) and Lisfranc area (AUC = 0.89; sensitivity = 80%; specificity = 100%). In a cadaveric model we found that WBCT scan can increase the diagnostic accuracy for subtle Lisfranc injury. Among the measurements, C1-M2 distance exhibited the highest level of accuracy. The 2D joint area and 3D joint volume also proved to be accurate, with 3D volume measurements of the Lisfranc joint displaying the most significant absolute difference between the intact state and increasing severity of Lisfranc injury. These findings suggest that 2D joint area and 3D joint volume may have potential as supplementary measurements to more accurately diagnose subtle Lisfranc injuries. WBCT may help surgeons detect subtle Lisfranc injuries.

Functional priorities of individuals with spinal cord injury: a Saudi Arabian perspective.

People with spinal cord injury (SCI) are the deciding force behind the rehabilitation program to improve their quality of life (QoL) based on their personal preferences. Here we aimed to determine the preferences perceived most vital by Saudi SCI population to improve their QoL, and explore if these preferences are affected by gender, education, and duration, level, or extent of injury. Participants ranked seven priorities of bodily functions as Rank I-VII with "I" being "Most important," and "VII" being "Least important." Inpatient rehabilitation facility. 120 participants (>18 years of age) of either sex with SCI without polytrauma, acquired brain injury, neurodegenerative disease, and dementia. Ranking scale of seven priorities of bodily functions as Rank I-VII with "I" being "Most important," and "VII" being "Least important." Of 101 individuals (mean age: 35.2 ± 14.8 years) finally included, 70.3% were males, 66.3% had onset of SCI since ≥ 3 years, 48.5% had a complete injury, and 75% had paraplegia. Most (26.7%) participants ranked walking as the first priority followed by hand/arm function (20.8%). Sexual function was the least important priority (39.6%). Hand/arm function was significantly more important for individuals with tetraplegia (p < 0.001). Trunk strength and balance was significantly less important for individuals with complete injury (p = 0.037). Participants with the onset of injury < 3 years and a complete injury reported bladder/bowel function as significantly more important (p = 0.011). Walking was significantly more important for people with incomplete injury and for people with injury duration ≥ 3 years (p = 0.022, p = 0.002 respectively). The top priority in our sample of Saudi people with SCI was walking followed by hand/arm function while the least desired function was regaining sexual function. Walking was a prioritized function for people with injury duration ≥ 3 years and people with a complete injury while hand/arm function was highly prioritized by people with tetraplegia.

Risk factors for pressure injuries in individuals with spinal cord injuries who have sarcopenic obesity: A comparison of time-dependent changes in sacral region pressure between individuals with and without sarcopenic obesity

Objective To identify the risk factors for pressure injuries in individuals with spinal cord injuries (SCIs) who have sarcopenic obesity, comparing time-dependent changes in sacral region pressure in individuals with and without sarcopenic obesity. Design An experimental time series study. Setting Single-center hospital. Participants Twenty-five adult participants with subacute and chronic paraplegia who visited our rehabilitation center, Republic of Korea, between May 2021 and June 2022. Interventions Whole-body dual-energy X-ray absorptiometry was performed to diagnose sarcopenic obesity. After the participants were placed in the supine position for 1 hour, the average pressure (mmHg), peak pressure (mmHg), and total contact area (cm2) of the sacral region were measured using the pressure-mapping system. Results Compared with the non-sarcopenic obesity group, the sarcopenic obesity group showed significant before-and-after differences in peak pressure. Furthermore, the risk factors that were significantly associated with peak pressure in the sarcopenic obesity group were the American Spinal Injury Association Impairment Scale score and the fat mass index. Conclusion Among participants with SCIs, the risk of pressure injuries is higher in the sarcopenic obesity group than in the non-sarcopenic obesity group. Notably, the risk of pressure injuries increases in participants who have complete injury and an increased fat mass index, indicating the importance of close monitoring and more active management to prevent pressure injuries in this subpopulation.

Changes and clinical significance of NLRP3 inflammasomes and related factors in patients with spinal fracture complicated with acute spinal cord injury

To investigate the changes and clinical significance of NOD like receptor protein 3 (NLRP3) inflammasomes and related factors in patients with spinal fractures complicated with acute spinal cord injury (SCI). Eighty-six spinal fracture patients complicated with acute SCI admitted to hospital from June 2019 to March 2022 were selected as SCI group, There were 48 males and 38 females, with an average age of (43.48±6.58) years old. And 100 healthy volunteers who underwent physical examination during the same time were selected as control group, including 56 males patients and 44 females patients, with an average age of (45.13±6.43) years old. Peripheral blood mononuclear cell (PBMC) were collected, and the mRNA expressions of NLRP3 and Caspase-1 were detected. Serum was collected and the levels of interleukin (IL)- 1β, IL-18 were detected. According to Frankel's grade, the SCI group was divided into complete injury patients and incomplete injury patients, and according to the Japanese Orthopedic Society (JOA) grade, the SCI group was divided into good prognosis group and poor prognosis group. The difference of NLRP3, Caspase-1, IL-1β, IL-18 among groups were compared, the influencing factors for poor prognosis in SCI patients was analyzed by Logistic regression. The mRNA expression levels of NLRP3 (1.41±0.33) and Caspase-1 (1.44±0.35) in PBMC and the levels of IL-1β(45.34±13.22) pg·ml-1, IL-18(40.95±8.77) pg·ml-1 in serum of SCI group were higher than those of the control group[(1.00±0.19), (1.00±0.16), (16.58±4.24) pg·ml-1, (12.57±3.68) pg·ml-1] (P<0.05). The mRNA expression levels of NLRP3(1.63±0.34) and Caspase-1 (1.67±0.27) in PBMC and the levels of IL-1β(51.09±11.10) pg·ml-1, IL-18 (47.65±7.93) pg·ml-1 in serum of patients with complete injury in the SCI group were higher than those of patients with incomplete injury [(1.31±0.27), (1.34±0.33), (42.85±13.36) pg·ml-1, (38.05±7.48) pg·ml-1](P<0.05). The mRNA expression levels of NLRP3 (1.66±0.31) and Caspase-1 (1.72±0.31)in PBMC and the levels of IL-1β(51.21±11.31) pg·ml-1, IL-18 (45.70±7.25) pg·ml-1 in serum, the proportion of complete injury(21 patients), and the proportion of spinal cord edema or bleeding of patients(15 patients) with poor prognosis in the SCI group were higher than those of patients with good prognosis[(1.28±0.26), (1.37±0.36), (42.79±13.25) pg·ml-1、(38.90±8.63) pg·ml-1, 5、20 cases](P<0.05). Complete injury and the mRNA expression of NLRP3 in PBMC were the influencing factors for poor prognosis in the SCI group (P<0.05). The activation of NLRP3 inflammasomes in patients with spinal fractures complicated with acute SCI is associated with worsening injury and poor prognosis, and NLRP3 expression can serve as a marker for evaluating prognosis.

The changing epidemiology of traumatic spine injuries: a trends analysis of 26 years of patients at a major level 1 trauma center in the United States

BACKGROUND CONTEXTTraumatic spinal injuries (TSI) are associated with high morbidity, mortality, and resource utilization. The epidemiology of TSI varies greatly across different countries and regions and is impacted by national income levels, infrastructure, and cultural factors. Further, there may be changes over time. It is essential to investigate TSI to gain useful epidemiologic information. However, there have been no recent studies on trends for TSI in the US, despite the changing population demographics, healthcare policy, and technology. As a result, reexamination is warranted to reflect how the modern era has affected the epidemiology of US spine trauma patients and their management. PURPOSETo determine epidemiologic trends in traumatic spine injuries over time. STUDY DESIGN/SETTINGRetrospective analysis; level 1 trauma center in the United States. PATIENT SAMPLEA total of 21,811 patients, between the years of 1996 and 2022, who presented with traumatic spine injury. OUTCOME MEASURESAge, sex, race, Injury Severity Score, mechanism of injury, injury diagnosis, injury level, rate of operative intervention, hospital length of stay, intensive care unit length of stay, discharge disposition, in-hospital mortality. METHODSData was collected from our institutional trauma registry over a 26-year period. Inclusion criteria involved at least one diagnosis of vertebral fracture, spinal cord injury, spinal subluxation, or intervertebral disc injury. Exclusion criteria consisted of patients with no diagnosed spine injury or a diagnosis of strain only. A total of 21,811 patients were included in the analysis. Descriptive statistics were tabulated and ordinary least squares linear regression was conducted for trends analysis. RESULTSRegression analysis showed a significant upward trend in patient age (+13.83 years, β=+0.65/year, p<.001), female sex (+2.7%, β=+0.18%/year, p=.004), falls (+10.5%, β=+0.82%/year, p<.001), subluxations (+12.8%, β=+0.35%/year, p<.001), thoracic injuries (+1.5%, β=+0.28%/year, p<.001), and discharges to subacute rehab (+15.9%, β=+0.68%/year, p<.001). There was a significant downward trend in motor vehicle crashes (-7.8%, β=-0.47%/year, p=.016), firearms injuries (-3.4%, β=-0.19%/year, p<.001), sports/recreation injuries (-2.9%, β=-0.18%/year, p<.001), spinal cord injuries (-11.25%, β=-0.37%, p<.001), complete spinal cord injuries (-7.6%, β=-0.24%/year, p<.001), and discharges to home (+4.5%, β=-0.27%/year, p=.011). CONCLUSIONSAt our institution, the average spine trauma patient has trended toward older females. Falls represent an increasing proportion of the mechanism of injury, on a trajectory to become the most common cause. With time, there have been fewer spinal cord injuries and a lower proportion of complete injuries. At discharge, there has been a surge in the utilization of subacute rehabilitation facilities. Overall, there has been no significant change in injury severity, rate of operative intervention, length of stay, or mortality.