Lumbar Trauma Research Articles

Platelet-Rich Plasma Therapy for Chronic Low Back Pain with Neuropathic Component in a Pain Medicine Clinic in Mexico: Retrospective Study

Introduction: Low back pain is a common problem affecting millions worldwide. Even after surgical treatment some patients do not improve; others suffer from persistent radiculopathy. We define Complex Chronic Low Back Pain (CCLBP) as any low back pain that has lasted for at least three months and has at least two triggering pain mechanisms. Objective: To describe our experience with platelet-rich plasma (PRP) therapy in managing CCLBP with a neuropathic component Methods: Quantitative, retrospective analysis from 57 medical records of patients treated with PRP for CCLBP. We used IBM-SPSS 21 to obtain descriptive statistics, Chi-square, Student T and Odds-Ratio. Results: The mean age of our sample was 59.8 (±14.4) years, with 6.51 (±8.7) years of pain and a follow-up of 9 (±12.2) months. 33.3% had lumbar surgery, 29.8% had lumbar trauma, 31.6% used a walking aid, 56.7% had MODIC changes on MRI, and 42% of them received intraosseous-PRP technic. 84.2% reported severe pain (VAS 8-10). The results showed that 96.5% of patients experienced some improvement after PRP treatment. Additionally, 10.5% experienced pain suppression. No significant differences in age, lumbar trauma, lumbar surgery, diseases, or the use of walking aids between patients who benefited from PRP treatment and those who did not. VAS after treatment shows significance (p<0.01) with 5.36±2.6 points. Subjects with less than five years of radicular pain had an improvement greater than 3 points on VAS (OR 7.38, IC95% 1.72-31.7). Conclusion: Autologous platelet-rich plasma injections for chronic low back pain with a neuropathic component are an effective alternative to address CCLBP’s current challenge. New studies with greater statistical power are necessary to make a statement of efficacy, but with the data obtained, it seems a promising option.
 Keywords: Platelet-Rich Plasma, Low Back Pain, Radiculopathy, Intraosseous

Lumbosacral Traumatic Spondylolisthesis L5 to S1-Classification and Surgical Management of a Difficult Presentation.

Lumbosacral traumatic spondylolisthesis L5-S1 is a rare clinical entity that compromises the stability of the L5 vertebra by displacing it anteriorly, laterally, or posteriorly on the S1 vertebral body secondary to osteotendinous and/or articular compromise of this segment due to trauma. This pathology is difficult to classify and manage; although surgical management remains the gold standard, short- and long-term results in the literature are scarce and highly variable. We present the case of a 53-year-old patient with lumbar trauma due to a free fall from a height of 6 meters. The fall resulted in cauda equina syndrome secondary to lumbosacral traumatic spondylolisthesis L5-S1, which required immediate surgical management. For surgical management, we used a posterior approach for L5-S1 transpedicular screw fixation, spinal decompression, bilateral root foraminotomy of L5, and L5-S1 open transforaminal lumbar interbody fusion with open reduction. After the operation, the patient reported immediate improvement of postoperative lower extremities pain and was discharged on the third postoperative day after achieving clinical improvement with physical therapy and bladder rehabilitation exercises. Lumbosacral traumatic spondylolisthesis L5-S1 is an unusual pathology that requires further study as there is currently no standardized classification. Surgical management is the gold standard and includes open reduction with short transpedicular screw fixation in segment L5-S1 and other surgical interventions such as extension to the pelvis with iliac screws, screws to the L4 vertebral body, and use of lumbar interbody fusion cages.

IMPACTO DO COVID-19 NAS CIRURGIAS DE COLUNA EM UM HOSPITAL DE URGÊNCIAS DE ALTA COMPLEXIDADE

ABSTRACT Objective: To study the impact of the COVID-19 pandemic on spine surgeries at a Reference Center for High Complexity Urgencies in Goiás. Methods: A retrospective, observational study was carried out based on data from medical records of patients undergoing spine surgery between September 2017 and September 2021. Volunteers were divided into two groups: before and during the pandemic, considering April 2020 as a starting point. The following was extracted from the medical records: age, gender, education, etiology, neurological deficit, region of the spine addressed, mechanism of trauma, fractured vertebrae, type of fracture, length of stay in the ICU, COVID test (PCR), and deaths. Student t, chi-square, and Fisher’s exact statistical tests were used to compare the preand post-pandemic profiles. In addition, Spearman’s correlation test was applied to verify the correlation between variables, considering p<0.05. Results: 388 medical records were analyzed, showing a 15% increase in spine surgeries during the pandemic. There was a significant difference in the etiology of surgeries (p=0.05), with lumbar trauma being more prevalent in men and also more cases of neurological deficits (p=0.001). There was also a reduction in the length of stay in the ICU (p=0.0001), which was lower during the pandemic. Conclusion: The COVID-19 pandemic did not directly impact the number of surgeries performed at a Reference Hospital in High Complexity Urgencies in Goiás, but there was a prioritization of emergency surgeries. Level of Evidence II; Retrospective Study.

RNA-Seq Comprehensive Analysis Reveals the Long Noncoding RNA Expression Profile and Coexpressed mRNA in Adult Degenerative Scoliosis.

Objective: Owing to the intensification of the aging process worldwide, the prevalence of adult degenerative scoliosis (ADS) is increasing at an alarming rate. However, genomic research related to the etiology of ADS is rarely reported worldwide. Since long noncoding RNAs (lncRNAs) play a pivotal role in the progression of human diseases, this study aimed to investigate ADS-associated messenger RNAs (mRNAs) and lncRNAs by RNA sequencing (RNA-seq), as well as performed comprehensive bioinformatics analysis based on the lncRNA–mRNA coexpression network and protein–protein interaction (PPI) network. Methods: Initially, six whole blood (WB) samples were obtained from three ADS and three nondegenerative lumbar trauma patients who underwent surgical operation for RNA-seq exploration to construct differential mRNA and lncRNA expression profiles. Subsequently, quantitative RT-PCR (qRT-PCR) was performed to validate three randomly selected differentially expressed mRNAs and lncRNAs derived from the nucleus pulposus (NP) tissue of 14 other subjects (seven ADS patients and seven nondegenerative lumbar trauma patients), respectively. Results: A total of 1,651 upregulated and 1,524 downregulated mRNAs and 147 upregulated and 83 downregulated lncRNAs were screened out from the RNA-Seq data, which constructed coexpression networks to investigate their regulatory interactions further. GO gene function prediction revealed that lncRNA-targeted genes might play a vital role in ADS via participation in multiple biological processes such as the AMPK signaling pathway, lysosomes, and ubiquitin-mediated proteolysis, as well as cellular metabolic processes. Moreover, the expression levels of three selected lncRNAs and mRNAs were validated by qRT-PCR, respectively, demonstrating that the relative expression levels were consistent with the RNA-seq data. Notably, the dysregulated RNAs, AKT1, UBA52, PTPN12, and CLEC16A, were significantly differentially expressed in ADS WB samples and might serve as potentially regulated genes for research in the future. Conclusions: This study provides the first insight into the altered transcriptome profile of long-stranded noncoding RNAs associated with ADS, which paves the way for further exploration of the clinical biomarkers and molecular regulatory mechanisms for this poorly understood degenerative disease. However, the detailed biological mechanisms underlying these candidate lncRNAs in ADS necessitate further elucidation in future studies.

Retrospective Analysis of Causes and Risk Factors of 30-Day Readmission After Spine Surgery for Thoracolumbar Trauma.

Retrospective Case Series. This study aims to evaluate readmission rates, risk factors, and reason for unplanned 30-day readmissions after thoracolumbar spine trauma surgery. A retrospective chart review was conducted for patients undergoing operative treatment for thoracic or lumbar trauma with open or minimally invasive surgical approach at a Level 1 urban trauma center. Patients were divided into two groups based on 30-day readmission status. Reason for readmission, reoperation rates, injury type, trauma severity, and incidence of polytrauma were compared between the two groups. A total of 312 patients, 69.9% male with an average age of 47 ± 19years were included. The readmitted group included 16 patients (5.1%) of which 9 (56%) were readmitted for medical complications and 7 for surgical complications. Wound complications (31.3% of readmissions) were the most common cause of readmission, followed by non-wound related sepsis (18.9% of readmissions). A total of 6 patients (37.5%) required reoperation; 2 instrumentation failures underwent revision surgery, and 4 wound complications underwent irrigation and debridement. Patients with higher Injury Severity Scale (ISS) were more likely to be readmitted (27.8% vs 22.1%, P = .045). Concomitant lower limb surgery increased odds of readmission (OR, 4.40; 95% CI, 1.10-17.83; P = .037). Spine trauma 30-day readmission rate was 5.1%, comparable to those reported in the elective spine surgery literature. Readmitted patients were more likely to sustain concomitant operative lower limb trauma. Wound complications were the most common cause of readmission, and almost half of the patients were readmitted due to surgery-related complications.

Spine-Related Malpractice Claims in China: A 2-year National Analysis.

Retrospective cross-sectional study. To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period. The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff's main allegations, and arbitration outcomes. A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff's favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant's favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability. The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.

Clinical, surgical characteristics and long-term outcomes of lumbar hernia

Background/AimLumbar hernia is caused by a defect in the abdominal wall. Due to its rarity, there is no established consensus on optimal treatment for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients from our hospital.MethodsPatients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded.ResultsA consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46%) and 15 females (54%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6 ± 14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39%), 15 (54%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89%) and 3 (11%) patients. General anesthesia was adopted in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5 ± 1.3 days vs. 7.1 ± 3.2 days, p = 0.001), as well as total hospitalization expenses between the two groups (2989 ± 1269 dollars vs. 1299 ± 229 dollars, p < 0.001). With a median follow-up duration of 45.9 months (range: 1–113 months), only 1 (3%) lumbar hernias recurred for the entire cohort.ConclusionsLumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia.

SAT-088 RETROPERITONEAL FIBROSIS: DIAGNOSTIC AND THERAPEUTIC APPROACH

Retroperitoneal fibrosis (RPF), also named Ormond’s disease, is characterized by a fibrosis reaction that takes place in the retroperitoneal space around the abdominal aorta, compressing the ureters and others structures. It is a rare disease. Its incidence rate goes from 0.7 to 1.3/100000 inhabitants per year. The purpose of our work is to realize a descriptive, epidemiological, clinical, etiological, therapeutic and evolutive study of the RPF. We have conducted a retrospective study in our department between 1985 and 2019. A clear male predominance was noted with 32 men and 7 women. Ten patients were recieving treatments for more than 2 pathologies. The leading medical histories among our patients, which can be a predictive factor of occurrence of RPF, were breast tumor for 1 patient who was in remission at the time of the diagnosis of RPF and abdominal or pelvic surgery in 8 cases. One patient was operated for aortic aneurysm. Three patients were victims of abdominal or lumbar trauma as a result of a road accident. Lymphadenitis tuberculosis was noted in one case. One patient was recieving an antagonist beta adrenergic. Circumstances of discovery were dominated by lumbar pain in 31 cases. Abdominal pain was objectified in 29 patients. Twenty five patients presented a wasting syndrome with anorexia and / or weight loss, and three patients had legs‘ oedema. Acute kideny injury, high blood pressure, biological inflammatory syndrome have been found as a circumstance of discovery, respectively in 23.3 and 16 patients. One case of RPF was discovered following an hepatic cholestasis and another one after an operation for a testicular hydrocele. The abdominal scan confirmed the diagnosis in all the cases. We practiced the biopsy of the RPF for only 8 patients. It had showed an extended fibrosis relative to a chronic pancreatitis (1 case), a non specific inflammatory tissue (1 case). It was not interpretable in 1 case. A metastatic localization of a prostatic carcinoma was found in 1 case. The RPF was idiopahtic in 29 patients. It was due to: abdominal trauma (2 cases), tuberculosis (2 cases), pelvic and abdominal surgery (2 cases), sclerosing pancreatitis (1 case) prostatic tumor (1 case), aortic aneurysm (1 case) and mesenteric panniculitis (1 case). Twenty two patients had an urinary diversion by JJ catheter. No patient required hemodialysis. One patient had been referred to urology for the treatment of a prostatic tumor, 2 patients needed ureterolysis. Left nephrectomy because of pyonephrosis was practiced in one case.A tuberculosis treatment was prescribed for 2 patients. All our patients had a cortecosteroid therapy. We prescribed immunosuppressive therapy for only 7 patients who presented recurrence RPF. The JJ catheter was changed in 14 cases. Twenty patients presented a recurrence of their RPF during the follow up. Nineteen patients never had a recurrece. Eight patients kept a chronic kideny failure. Two patients have died. Because of its insidious nature and the irreversible development towards the chronic renal failure if an early diagnosis was not applied and the treatment did not immediately debuted, FRP requires all attention needed from the clinician. The important relapse rate proposes rethinking the actual therapeutic conduct.

Hernia of the Jean Louis Petit triangle in the emergency department: a rare image.

Lumbar hernias are rare lesions. They are exceptionally observed and reported. They are in most of the cases secondary to trauma or previous surgery but primary lumbar hernias are rare. Computed tomography (CT) is a very useful tool for the diagnosis of lumbar hernia. It can delineate the neck of the hernia and hernial contents. All lumbar hernias must be treated with surgery with two possible surgical approaches: the anterior approach and the laparoscopic approach. Many techniques have been described, including primary repair, local tissue flaps and conventional mesh repair. Bowel resection may be required in cases with strangulation. We report in this work an exceptional case of a 43 year old man with a past recent medical history of lumbar trauma who attended the emergency room for a lumbar mass. It was a soft, non-tender, reducible swelling, measuring from five centimeters in diameter, sitting in the right lumbar region. Computed tomography was performed. The hernia was located in the superior triangle of Grynfelt-Lesshaft and contained large intestine of the right bowel. That is called hernia of the Jean Louis Petit triangle. The patient had open surgery (by lumbar incision). We reintroduced the intestine back into the peritoneal cavity. We excised the sac, and repaired the defect by using synthetic mesh placed below the muscular layers, using a tension-free technique. He was discharged at the fifth day from our hospital. He has been followed up four years with no recurrence or postsurgical sequelae.

EVALUATION OF THE EFFECT OF INTRAVENOUS ACETAMINOPHEN IN REDUCING THE NEED FOR RADIOGRAPHY IN PATIENTS WITH LUMBOSACRAL INJURIES ADMITTED TO HOSPITAL EMERGENCY DEPARTMENT

Introduction: Lower back pain is one of the most common symptoms in patients referred to emergency department. Physicians should always keep in mind avoiding unnecessary radiographs for patients. On the other hand, the specificity and sensitivity of midline tenderness for lumbosacral spinal fracture and injury following analgesic analgesia is uncertain, therefore, this study investigated the effect of intravenous acetaminophen in reducing the need for radiography in patients referred to the emergency department with lumbosacral trauma. Materials and Methods: All patients with lumbosacral trauma referred to the emergency department, who had midline tenderness, were evaluated for the first 6 months from September 2017 until the end of March 2018. For these patients, acetaminophen at a dose of 15 mg/kg was given intravenously. Then, lumbosacral area CT imaging was performed by radiology technician. Furthermore, 60 minutes after intravenous acetaminophen, patients were again examined for lumbosacral midline tenderness and the results were compared with imaging. Data were analyzed by SPSS-17 software. Results: 421 patients suffering from blunt lumbar trauma with midline tenderness were enrolled. Mean age of patients was determined to be 34.27 (SD: 9.25). In terms of gender, 284 (67.5%) patients were male and 137 (32.5%) were female. The sensitivity and specificity for midline tenderness after intravenous acetaminophen were 71.43% and 96.97%, respectively. Moreover, positive and negative predictive values were reported as 83.33% and 94.12%, respectively. Conclusion: The results of the present study indicate that the presence of midline tenderness in the lumbosacral area after receiving intravenous acetaminophen in patients with lumbosacral trauma is highly suggestive of fracture and tenderness elimination largely denies the existence of fractures, but these findings are not conclusive.

Path to Prevention of Spinal Trauma in a Low- to Middle-income Country: A Single-center Study in Phnom Penh, Cambodia.

This study sought to characterize the epidemiology and outcomes of spinal trauma, with or without a neurologic deficit, at a major government hospital in Phnom Penh, Cambodia. Patient demographics, American Spinal Injury Association (ASIA) score on presentation, location of injury, and cause of injury from 316 patients from September 2013 through December 2016 were compiled. Outcome measures included length of hospitalization and surgical intervention. Falls were the leading cause of spinal injury (50.6%), followed by motor vehicle accidents (29.3%) and other accidents (20.1%). Patients who fell from height had higher surgery rates (P = 0.014), and men had worse ASIA scores (P = 0.0013). Patients with ASIA A-C had a mean age of 38.17 years, whereas the D-E group was on average 42.88 years. Motor vehicle accidents caused the most cervical spine injuries, whereas falls caused more thoracic and lumbar trauma (P = 0.0005). Younger, working men are experiencing more severe spinal injuries, undergoing more surgery, and staying hospitalized longer than other demographics in Phnom Penh. This study characterizes spinal trauma from falls as a public health issue in Cambodia, highlighting the importance of fall injury prevention. Protecting this cohort is an important investment for Cambodia and necessitates workplace reform and safety standard implementation.

P149. Timing of surgical decompression for cauda equina syndrome

BACKGROUND CONTEXT Cauda equina syndrome (CES) is a devastating spinal condition without a clear consensus on evidence-based treatment guidelines and reported patient outcomes. Due to the relative infrequency of this condition at individual institutions, the majority of the studies that investigate CES are underpowered with results that are difficult to apply to the general population. PURPOSE The purpose of this investigation was to use a large, nationwide patient sample of CES patients to identify demographic and procedural trends and recognize factors that influence outcomes. STUDY DESIGN/SETTING This investigation was a retrospective cohort study that identified patients with CES registered in the Nationwide Inpatient Sample (NIS) database from 2000 to 2014. PATIENT SAMPLE Patients were identified using the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code for cauda equina syndrome (344.61) and the ICD-9-CM procedure code for either disc excision (8051) or spinal canal exploration and decompression (0309). Demographic analysis included patient age, sex, median income per patient's zip code, and presenting institution (urban teaching vs urban non-teaching vs rural). ICD-9-CM codes for lumbar disc herniation (722.10, 722.73), spinal stenosis (724.02), tumor (198.5), postoperative hematoma (998.12), and trauma (806.4) were utilized to identify the most frequent etiologies of CES. OUTCOME MEASURES Outcome measures were retained for each observation, including inpatient mortality, total complications, postoperative length of stay, total charges, discharge disposition, average total charges and urinary catheterization rates. METHODS The impact of surgical timing on outcomes was investigated by separating patients into an early surgical intervention cohort (surgery on hospital day 0 or 1) versus a delayed intervention cohort (surgery on hospital day 2 or later). Patient outcomes and trends in the timing of surgical decompression were analyzed using linear regression. RESULTS A total of 20,924 cauda equina syndrome patients met inclusion criteria. Following adjustment for age, sex, race and median area code income, the delayed surgical intervention group was associated with significant differences including increased inpatient mortality (OR 9.60, p=.002), total complications (OR 1.41, p=.018) and non-routine discharge (OR 2.37, p CONCLUSIONS This study represents the largest investigation to date examining trends and outcomes in patients with CES. The results reveal that the timing of surgical management in CES patients has not changed appreciably from 2000-2014 despite mounting evidence of the benefit of early decompression. CES patients that undergo surgical decompression on hospital day 0 or 1 are observed to have improved inpatient outcomes, including lower complication and mortality rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Epidemiological Characteristics of Dorsal and Lumbar Spine Trauma Presenting to a Trauma Hospital in Kathmandu, Nepal: Formulation of a National Spine Policy.

Introduction Outcome of spine injury treated in resource constrained regions may not be the same as in developed nations. The aim of the present study was to study the epidemiological characteristics, delay, complications, and outcome of surgically treated dorsal and lumbar trauma. Methods Retrospective study of dorsal and lumbar spine injury patients treated between December 2015 and August 2017. Patients were segregated into four groups based on the timing of surgery: 0-2 days, 3-7 days, 8-30 days, and more than 31 days. Only one operating room twice a week was allotted to spine surgery, and spine had to compete with orthopedic and surgical trauma for admission and surgery. Results Ninety-one patients (male 61) with mean age 33 years were operated for dorsal and lumbar spine injuries. 84% of the total patients sustained a fall, and 86.8% were from the periphery. Though 69.2% presented within 2 days, only 4.4% were operated within 2 days. Majority of the delay was due to unavailability of the operating room followed by financial constraints. Twenty-seven patients had complete deficit, 32 incomplete deficit, and 32 normal neurology. Four patients operated within 2 days improved their neurology, 7 incomplete deficit patients in 3-7 days group improved, 6 in 8-30 days group improved, whereas no patient in more than 31 days group improved. Overall 53.1% of neurologically incomplete deficit patients improved if operated within 30 days. No neurological improvement was seen in the 27 complete deficit patients. Wound infection, pulmonary contusion, and deep vein thrombosis were seen in 3 patients. Conclusions As expected 95.6% of our patients were treated more than 3 days after injury and 60% more than a week later, which may not be acceptable in advanced countries. Despite the delay, 53.1% had an improvement in neurology when operated within 30 days. Hence, surgery still holds the hope of neurological recovery and quicker rehabilitation.

Posterior retroperitoneoscopic adrenalectomy—Case series

IntroductionPosterior retroperitoneoscopic adrenalectomy has advantages over transperitoneal technique. However many surgeons prefer the transperitoneal technique because they get a familiar and wider working space. Material and methodsA retrospective analysis of the first 10 patients submitted to posterior retroperitoneoscopic adrenalectomy was conducted. Data collected included: diagnosis, size, operation time, blood loss, conversion rate, morbidity and mortality, in-hospital length of stay. Compare our outcomes with worldwide bigger series, and take conclusions on the feasibility of the technique was the objective. ResultsWe included 2 pheochromocytomas, 1 giant cystic pheochromocytoma, 4 Conn’s, 2 Cushing’s, 1 non-functioning tumor with 4 cm. Mean operation time was 46,7 min for lesions ranging from 1,8 to 14 cm. Blood loss was negligible. One patient (10%) was converted to laparotomy because of a past clinical history of dorsal and lumbar trauma. No morbidity and no mortality. Mean hospital length of stay was 2,2 days. DiscussionMean operation time found in bigger series published in worldwide literature is 40–105,6 min. Complication rate reported ranges from 0 to 14,4%. No mortality has been ever reported. Blood loss reported in other series is 10–50 ml. The data found in our study matches other studies data. Since the same surgeon who had never performed the technique before operated all patients, makes us believe the technique is safe and feasible. ConclusionPosterior retroperitoneoscopic adrenalectomy has a small learning curve. It is technically safe and feasible. More patients will be collected to validate these results.

The Effects of Restraint Type on Pattern of Spine Injury in Children

While the use of vehicular restraints has reduced the morbidity and mortality of children involved in motor vehicle collisions (MVC), to our knowledge, no study has examined the relationship between restraint type and patterns of pediatric spinal injuries. The purpose of this study is to evaluate this association and review the spinal injuries sustained in children involved in MVC. We completed an IRB-approved, retrospective chart review of all patients below 10 years of age presenting to a level 1 pediatric trauma hospital with spine injuries sustained in MVC from 2003 to 2011. We reviewed prehospital data, medical records, and radiographs to establish the restraint type and characterize the spinal injuries sustained. A total of 97 patients were identified with spinal trauma secondary to MVC with appropriate and documentation of restraint type. Results are reported regardless of whether the restraint employed was properly used per established guidelines. Car seat/booster seat (C/B) patients sustained significantly higher rates of cervical spine (62%) and ligamentous (62%) injuries than the 2-point (2P) (10%) and 3-point (3P) restraint (24%) groups (P<0.001). Two-point and 3P restraint use was associated with significantly higher rates of thoracolumbar injuries (67% and 62%, respectively) than the C/B (14%) and unrestrained (0%) groups (P<0.001). Two-point and 3P passengers also had a higher rate of flexion-distraction injuries (P<0.001). Patients in the unrestrained group sustained a significantly higher rate of cervical spine (80%) and ligamentous (40%) injuries than the 2P and 3P groups (P<0.001). No differences were found in the type or location of injury between the 2P and 3P groups. Significant differences in proper restraint use were identified between age groups with younger children demonstrating higher rates of proper restraint use (P<0.01). Two-point or 3P seatbelt use is associated with lower rates of cervical spine trauma but higher rates of thoracic and lumbar trauma, particularly flexion-distraction injuries, when compared with car or booster seats. Children in C/B and those who are unrestrained sustain high rates of cervical spine injury. Level III-prognostic study.

Does usage of a parachute in contrast to free fall prevent major trauma?: a prospective randomised-controlled trial in rag dolls.

It is undisputed for more than 200years that the use of a parachute prevents major trauma when falling from a great height. Nevertheless up to date no prospective randomised controlled trial has proven the superiority in preventing trauma when falling from a great height instead of a free fall. The aim of this prospective randomised controlled trial was to prove the effectiveness of a parachute when falling from great height. In this prospective randomised-controlled trial a commercially acquirable rag doll was prepared for the purposes of the study design as in accordance to the Declaration of Helsinki, the participation of human beings in this trial was impossible. Twenty-five falls were performed with a parachute compatible to the height and weight of the doll. In the control group, another 25 falls were realised without a parachute. The main outcome measures were the rate of head injury; cervical, thoracic, lumbar, and pelvic fractures; and pneumothoraxes, hepatic, spleen, and bladder injuries in the control and parachute groups. An interdisciplinary team consisting of a specialised trauma surgeon, two neurosurgeons, and a coroner examined the rag doll for injuries. Additionally, whole-body computed tomography scans were performed to identify the injuries. All 50 falls-25 with the use of a parachute, 25 without a parachute-were successfully performed. Head injuries (right hemisphere p=0.008, left hemisphere p=0.004), cervical trauma (p<0.001), thoracic trauma (p<0.001), lumbar trauma (p<0.001), pelvic trauma (p<0.001), and hepatic, spleen, and bladder injures (p<0.001) occurred more often in the control group. Only the pneumothoraxes showed no statistically significant difference between the control and parachute groups. A parachute is an effective tool to prevent major trauma when falling from a great height.

New Haemostatic Agentand Application Tool forNeurosurgery

There are a variety of electrical, mechanical and chemical methods used to achieve haemostasis in Neurosurgery. Generally, chemical haemostatic agents are often preferable to bipolar cautery in spinal procedures. These haemostats have been used in neurosurgical spinal procedures for more than 65 years. This paper focuses on efficacy and technical aspects of the application of biodegradable gelatin haemostatic agents Pahacel Gelatin Powder® and a new application tool. Our experience for a new haemostatic tool in spine surgery has been presented in this study. The efficacy of it was tested on the patients who underwent surgery for lumbar disc hernia, lumbar spinal stenosis and lumbar trauma. Depending on the surgery effective hemostasis was achieved between 60 to 195 seconds following the initial application without any secondary effects. Preliminary results have shown that besides its advantages Pahacel Gelatin Powder® can also be a cost effective choice for the brain surgeries. However, extensive research is necessary for statistical results.

Renal Cell Carcinoma in Children: About Two Case Report

Introduction Renal cell carcinoma (RCC) is extremely rare in children. Several factors could influence prognosis, including stage, grade, histology, symptomatic presentation, and performance status. Among these, tumor stage is the most important predictor of disease prognosis for RCC. We report our experience with two cases of children with renal cell carcinoma in children. Cases Case 1: A 13-year-old girl presented macroscopic hematuria after a right lumbar trauma. The renal ultrasonography and CT urography showed a very limited rounding medio renal mass. Fine needle renal aspiration objectified RCC. Patient underwent transabdominal radical nephrectomy. Histopathology revealed RCC grade 2 of Furhrman T1b N0 M0. The postoperative course was uneventful. Case 2: A 9-year-old girl presented macroscopic hematuria. The renal ultrasonography showed a horseshoe left kidney with limited rounding mass. CT urography showed limited left renal mass of 31 × 25 mm. Fine needle renal aspiration objectified RCC. Patient underwent transabdominal radical nephrectomy with regional lymphadenectomy. Histopathology revealed RCC associated with translocation Xp11.2 grade 2 of Furhrman T1a N1M0. The postoperative course was uneventful. Conclusion RCC is rare in children but in children older than 5 years with renal masses it is very important to suspect diagnosis. Surgery is the best treatment and prognosis is favorable when the tumor is localized and completely eradicated.

Diagnosis of male osteoporosis after severe lumbar trauma

Diagnosis of male osteoporosis after severe lumbar trauma

Weightlifter Lumbar Physiology Health Influence Factor Analysis of Sports Medicine.

Chinese women's weightlifting project has been in the advanced world level, suggests that the Chinese coaches and athletes have many successful experience in the weight lifting training. Little weight lifting belongs to high-risk sports, however, to the lumbar spine injury, some young good athletes often due to lumbar trauma had to retire, and the national investment and athletes toil is regret things. This article from the perspective of sports medicine, weightlifting athletes training situation analysis and put forward Suggestions, aimed at avoiding lumbar injury, guarantee the health of athletes. In this paper, first of all to 50 professional women's weightlifting athletes doing investigation, found that 82% of the athletes suffer from lumbar disease symptoms, the reason is mainly composed of lumbar strain, intensity is too large, motion error caused by three factors. From the Angle of sports medicine and combined with the characteristics of the structure of human body skeleton athletes lumbar structural mechanics analysis, find out the lumbar force's two biggest technical movement, study, and regulate the action standard, so as to minimize lumbar force, for athletes to contribute to the health of the lumbar spine.