Risk Of Spinal Injury Research Articles

Spinal Injuries and Spine Care in the US Military Health System (2001-Present).

Literature Review. The goal of this study was to provide a comprehensive outline of spinal injuries that may transpire over the course of military service from traumatic to repetitive stress injuries and chronic sequalae. We considered studies that assessed spinal injuries in the combat and non-combat settings as reported in the literature over the last 15-20 years. Military service places servicemembers under substantial physical demands, while also exposing them to dangerous, unpredictable environments. As a result, servicemembers are at an increased risk of spinal injuries from combat-related trauma and other causes. They may have different care needs and recovery profiles when compared to civilians with spinal disorders. We performed a review of the available literature on spinal injuries and spinal care in the Military Health System from 2001-present. The studies discussed in this review were primarily focused on the conflicts in both Iraq and Afghanistan from over ten years ago and do not fully capture the present-day advancements in military technology that may have an impact on the potential for spinal injuries. The long-term effects of sustained military service and the relative influence of high demand versus sedentary military occupations on the development of spinal disorders remains poorly understood. Given the changing nature of military service, both with respect to the demographic in uniform and the ever-evolving nature of modern combat, we believe that only a long-term prospective observational study dedicated to the surveillance of spinal problems could effectively answer these questions. Further research into the present-day characterization of spinal injuries is warranted given the advancements in both military technology and spine care that have occurred over the last ten years.

Destruction mechanism of anterior cervical discectomy and fusion in frontal impact.

The aim of this study was to quantitatively study the effect of anterior cervical discectomy and fusion (ACDF) on the risk of spinal injury under frontal impact. A head-neck finite element model incorporating active neck muscles and soft tissues was developed and validated. Based on the intact head-neck model, three ACDF models (single-level, two-level and three-level) were used to analyze the frontal impact responses of the head-neck. The results revealed that various surgical approaches led to distinct patterns of vertebral damage under frontal impact. For single-level and three-level ACDFs, vertebral destruction was mainly concentrated at the lower end of the fused segment, while the other vertebrae were not significantly damaged. For two-level ACDF, the lowest vertebra was the first to suffer destruction, followed by severe damage to both the upper and lower vertebrae, while the middle vertebra of the cervical spine exhibited only partial damage around the screws. Fusion surgery for cervical spine injuries predominantly influences the vertebral integrity of the directly fused segments when subjected to frontal impact, while exerting a comparatively lesser impact on the cross-sectional properties of adjacent, non-fused segments.

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department. In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN). Injured children were eligible for enrolment into derivation or validation cohorts by fulfilling one of the following criteria: transported from the scene of injury to the emergency department by emergency medical services; evaluated by a trauma team; and undergone neck imaging for concern for cervical spine injury either at or before arriving at the PECARN-affiliated emergency department. Children presenting with solely penetrating trauma were excluded. Before viewing an enrolled child's neck imaging results, the attending emergency department clinician completed a clinical examination and prospectively documented cervical spine injury risk factors in an electronic questionnaire. Cervical spine injuries were determined by imaging reports and telephone follow-up with guardians within 21-28 days of the emergency room encounter, and cervical spine injury was confirmed by a paediatric neurosurgeon. Factors associated with a high risk of cervical spine injury (>10%) were identified by bivariable Poisson regression with robust error estimates, and factors associated with non-negligible risk were identified by classification and regression tree (CART) analysis. Variables were combined in the cervical spine injury prediction rule. The primary outcome of interest was cervical spine injury within 28 days of initial trauma warranting inpatient observation or surgical intervention. Rule performance measures were calculated for both derivation and validation cohorts. A clinical care algorithm for determining which risk factors warrant radiographic screening for cervical spine injury after blunt trauma was applied to the study population to estimate the potential effect on reducing CT and x-ray use in the paediatric emergency department. This study is registered with ClinicalTrials.gov, NCT05049330. Nine emergency departments participated in the derivation cohort, and nine participated in the validation cohort. In total, 22 430 children presenting with known or suspected blunt trauma were enrolled (11 857 children in the derivation cohort; 10 573 in the validation cohort). 433 (1·9%) of the total population had confirmed cervical spine injuries. The following factors were associated with a high risk of cervical spine injury: altered mental status (Glasgow Coma Scale [GCS] score of 3-8 or unresponsive on the Alert, Verbal, Pain, Unresponsive scale [AVPU] of consciousness); abnormal airway, breathing, or circulation findings; and focal neurological deficits including paresthesia, numbness, or weakness. Of 928 in the derivation cohort presenting with at least one of these risk factors, 118 (12·7%) had cervical spine injury (risk ratio 8·9 [95% CI 7·1-11·2]). The following factors were associated with non-negligible risk of cervical spine injury by CART analysis: neck pain; altered mental status (GCS score of 9-14; verbal or pain on the AVPU; or other signs of altered mental status); substantial head injury; substantial torso injury; and midline neck tenderness. The high-risk and CART-derived factors combined and applied to the validation cohort performed with 94·3% (95% CI 90·7-97·9) sensitivity, 60·4% (59·4-61·3) specificity, and 99·9% (99·8-100·0) negative predictive value. Had the algorithm been applied to all participants to guide the use of imaging, we estimated the number of children having CT might have decreased from 3856 (17·2%) to 1549 (6·9%) of 22 430 children without increasing the number of children getting plain x-rays. Incorporated into a clinical algorithm, the cervical spine injury prediction rule showed strong potential for aiding clinicians in determining which children arriving in the emergency department after blunt trauma should undergo radiographic neck imaging for potential cervical spine injury. Implementation of the clinical algorithm could decrease use of unnecessary radiographic testing in the emergency department and eliminate high-risk radiation exposure. Future work should validate the prediction rule and care algorithm in more general settings such as community emergency departments. The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the US Department of Health and Human Services in the Maternal and Child Health Bureau under the Emergency Medical Services for Children programme.

Traumatic Spinal Injury in Children; Time to Revise Pre-Hospital and Diagnostic Protocols?

Background: Traumatic spinal injury in children is a rare but serious life event. Predicting pediatric patients at risk for spinal injury remains difficult. This study focuses on the cause of the injury and predictors to identify children at risk and appropriate diagnostic procedures. Methods: Retrospective chart review from the Landelijke Trauma Registratie of patients with spinal injury from 2010 to 2021 in a level 1 pediatric trauma center. Results: We included 114 children with spinal injury, 79.8% of whom were aged 12-17 years. In the overall trauma population, the incidence of spinal injury was 10% in children aged 12-17 years, 2.3% in children aged 6-11 years, and 0.4% in children 0-5 years of age. Neurological deficits were present in 27.2% of patients in the emergency department, with permanent deficits in 14.0%. Spinal fractures were present in 91.2% of 12-17-year-olds, 43.8% in 6-11-year-olds, and 71.4% in 0-5-year-olds. ISS was 23 (SD 14) in children with spinal injury compared to 8 (SD 9) for children without spinal injury. Conclusions: In children 0-11 years old, spinal injury is very rare compared to the overall trauma population, and there are more non-osseous injuries. Clinicians should consider MRI as the next step after conventional X-ray to diagnose or exclude spinal injuries in this group. In older children aged 12-17 years, the incidence of spinal injury is much higher, at 10%. Although ISS is higher in children with spinal injury, a low ISS does not exclude spinal injury. If one fracture is found, more fractures in other regions of the spine may be present.

Material Optimization in Formula One Seat Fit Based on Structural and Biomechanical Analysis

F1 drivers have reported that they suffer a long-term lower back pain due to ‘Porpoising’ effect, it is a series of bounce that is generated due to Aerodynamic downforce. This downforce is part of drag reduction principle that pulls the air underneath the vehicle, thereby creating an incredible speed of 200 to 230 mph. Also at 200 mph speed, the driver experiences a high amount G-forces up to six times during the race. This can be simply avoided by increasing the ground clearance of vehicle but at the same time it also reduces the max speed of the vehicle. Hence, without compromising the speed, Design optimization is done for driver’s seat-fit through Computational methods of Biomechanical modelling and simulation for determining the optimum Seat Angle for Postural Ergonomics. As an additional Reinforcement and Shock absorption in seat material to protect driver’s spine from the resulting dynamics, Material optimization is done by selecting Graphene as the suitable material over the existing Carbon fiber material. Finite element method was carried out for structural analysis of seat-fit model. The stress, strain and deformation values were found to be lesser in Graphene model when compared to Carbon fiber. The simulation results will provide a solution for eliminating the higher risk of spine injury or pathological condition of a sportsman and thereby improves the sporting performance. Key Word: Motorsports, Computational Biomechanics, Ergonomics, Design optimization, Material optimization, Finite element analysis, Spine Injury prevention

Pelvis and thoracolumbar spine response in simulated under-body blast impacts and protective seat cushion design.

Purpose: The aim of this study is to investigate the dynamic and biomechanical response of the pelvis and thoracolumbar spine in simulated under-body blast (UBB) impacts and design of protective seat cushion for thoracolumbar spine injuries. Methods: A whole-body FE (finite element) human body model in the anthropometry of Chinese 50th% adult male (named as C-HBM) was validated against existing PHMS (Postmortem Human Subjects) test data and employed to understand the dynamic and biomechanical response of the pelvis and thoracolumbar spine from FE simulations of UBB impacts. Then, the protective capability of different seat cushion designs for UBB pelvis and thoracolumbar injury risk was compared based on the predictions of the C-HBM. Results: The predicted spinal accelerations from the C-HUM are almost within the PHMS corridors. UBB impact combined with the effects from physiological curve of the human thoracolumbar spine and torso inertia leads to thoracolumbar spine anterior bending and axial compression, which results in stress concentration in the segments of T4-T8, T12-L1 and L4-L5. Foam seat cushion can effectively reduce the risk of thoracolumbar spine injury of armored vehicle occupants in UBB impacts, and the DO3 foam has better protective performance than ordinary foam, the 60 mm thick DO3 foam could reduce pelvic acceleration peak and DRIz value by 52.8% and 17.2%, respectively. Conclusions: UBB spinal injury risk is sensitive to the input load level, but reducing the pelvic acceleration peak only is not enough for protection of spinal UBB injury risk, control of torso inertia effect would be much helpful.

Biomechanical analysis of wood processing work in tropical forest regions: A study in Midwest Brazil

In the wood processing industry, working with machines exposes workers to occupational risks. This study evaluates the biomechanics of work activities carried out in a wood processing operation in tropical forest regions to identify risks associated with the development of musculoskeletal injuries. Data were collected in a wood processing industry from a tropical forest region in Midwest Brazil. Forty forest workers were evaluated, equivalent to 100% of the population of the company participating in the study. Biomechanical movements were measured using the Three-Dimensional Biomechanical Model for Predicting Stances and Static Forces. There was a risk of injury to the joints of the upper limbs (wrists and shoulders), as well as to the torso. When splitting and manually stacking wood, a risk of spinal injury was identified. All workers had a high risk of developing injuries in all joints evaluated in addition to a risk of serious spinal injury. In this way, the development of these activities without any ergonomic interventions makes the risk of developing musculoskeletal injuries in the workers involved imminent, with consequent early professional incapacity.

Development of a finite element full spine model with active muscles for quantitatively analyzing sarcopenia effects on lumbar load

Background and objectiveThe musculoskeletal imbalance caused by disease is one of the most critical factors leading to spinal injuries, like sarcopenia. However, the effects of musculoskeletal imbalances on the spine are difficult to quantitatively investigate. Thus, a complete finite element spinal model was established to analyze the effects of musculoskeletal imbalance, especially concerning sarcopenia. MethodsA finite element spinal model with active muscles surrounding the vertebrae was established and validated from anatomic verification to the whole spine model in dynamic loading at multiple levels. It was then coupled with the previously developed neuromuscular model to quantitatively analyze the effects of erector spinae (ES) and multifidus (MF) sarcopenia on spinal tissues. The severity of the sarcopenia was classified into three levels by changing the physiological cross-sectional area (PCSA) of ES and MF, which were mild (60% PCSA of ES and MF), moderate (48% PCSA of ES and MF), and severe (36% PCSA of ES and MF). ResultsThe stress and strain levels of most lumbar tissues in the sarcopenia models were more significant than those of the normal model during spinal extension movement. The sarcopenia caused load concentration in several specific regions. The stress level of the L4-L5 intervertebral disc and L1 vertebra significantly increased with the severity of sarcopenia and showed relatively larger values than other segments. From the normal model to a severe sarcopenia model, the stress value of the L4-L5 intervertebral disc and L1 vertebra increased by 128% and 113%, respectively. The strain level of L5-S1 also inclined significantly with the severity of sarcopenia, and the relatively larger capsule strain values occurred at lower back segments from L3 to S1. ConclusionsIn summary, the validated spinal coupling model can be used for spinal injury risk analysis caused by musculoskeletal imbalance. The results suggested that sarcopenia can primarily lead to high injury risk of the L4-L5 intervertebral disc, L1 vertebrae, and L3-S1 joint capsule regarding significant stress or strain variance.

Lumbar Spine Injury in Indian Fast Bowlers: 3D Biomechanical Analysis and Prevention Strategies.

Lumbar spine injuries are among the most common overuse injuries in a fast bowler. Among various causative factors, bowling action technique is a crucial one. Three-dimensional motion analysis has been accepted as a gold standard tool to identify incorrect techniques. Previous studies have identified key biomechanical variables associated with lumbar injury risk in fast bowlers. Despite the large popularity of the sport, there is limited information available on the subject in Indian fast bowlers. This study aims to analyse the lumbar spine injury risk in Indian fast bowlers with respect to key biomechanical variables, using 3D motion analysis. Forty-seven male first class fast bowlers underwent 3D motion analysis in an indoor biomechanics laboratory. Motion capture was done with 3D cameras and 2D video cameras, using a standard marker set. Data processing and analysis was done using proprietary software. Biomechanical variables associated with lumbar spine injury risk including lateral trunk flexion (LTF) and knee angle at front foot contact (KA at FFC) were measured, and peak vertical ground reaction forces (pVGRF) were simultaneously recorded using force plates. Descriptive analysis of the data was done. 26% of bowlers had a high LTF, 29% had low KA at FFC and 43% had high pVGRF. Thus, a large proportion of bowlers in this study were at risk of lumbar spine injury with respect to the assessed variables. This highlights the role of 3D motion analysis in early identification of injurious techniques, which can be modified by coaching and training interventions to prevent injuries. This study thus has implications on coaching and training of fast bowlers in India.

Analysis of lumbar spine injury with different back inclinations under whole-body vibration: A finite element study based on whole human body models

Whole-body vibration was found to be a cause of low back pain. Different back inclinations might change the forces on the lumbar spine, resulting in different responses to the vibration. The aim of this study was to investigate the effects of back inclinations on the lumbar spine from the perspective of analysing the internal loads and deformations on the intervertebral discs. Whole human body finite element models at 90°, 95°, 100°, 105°, 110° and 115° inclinations were used to provide a whole-body condition when predicting the behaviour of the lumbar spine. Von Mises stress on the annulus fibrosus, intradiscal pressure, and intervertebral disc height were extracted. The Risk Factors were calculated to evaluate the spinal injury risk under long-term vibration conditions. The results showed that the internal loads and deformations on the intervertebral disc decreased and then increased with the increase of the inclination, and the responses were lower at the 95° and 100° inclinations. The Risk Factors at different inclinations at the 3 Hz load were 0.61, 0.49, 0.53, 0.58, 0.58, and 0.69, respectively, at the 7 Hz load were 0.97, 0.66, 0.71, 0.86, 0.87, and 0.97, respectively, which also showed that injury risk was at a lower level at 95° and 100° inclinations. This study found a relationship between injury risk and back inclination. Occupational drivers are advised to choose a back inclination between 95° and 100° to reduce the possible adverse effects of whole-body vibration during the working condition.

Human Lumbar Spine Injury Risk in Dynamic Combined Compression and Flexion Loading.

Anticipating changes to vehicle interiors with future automated driving systems, the automobile industry recently has focused attention on crash response in novel postures with increased seatback recline. Prior research found that this posture may result in greater risk of lumbar spine injury in the event of a frontal crash. This study developed a lumbar spine injury risk function (IRF) that estimated injury risk as a function of simultaneously applied compression force and flexion moment. Force and moment failure data from 40 compression-flexion tests were utilized in a Weibull survival model, including appropriate data censoring. A mechanics-based injury metric was formulated, where lumbar spine compression force and flexion moment were normalized by specimen geometry. Subject age was incorporated as a covariate to further improve model fit. A weighting factor was included to adjust the influence of force and moment, and parameter optimization yielded a value of 0.11. Thus, the normalized compression force component had a greater effect on injury risk than the normalized flexion moment component. Additionally, as force was nominally increased, less moment was required to produce injury for a given age and specimen geometry. The resulting IRF may be utilized to improve occupant safety in the future.

Effect of Active Muscles on Astronaut Kinematics and Injury Risk for Piloted Lunar Landing and Launch While Standing.

While astronauts may pilot future lunar landers in a standing posture, the response of the human body under lunar launch and landing-related dynamic loading conditions is not well understood. It is important to consider the effects of active muscles under these loading conditions as muscles stabilize posture while standing. In the present study, astronaut response for a piloted lunar mission in a standing posture was simulated using an active human body model (HBM) with a closed-loop joint-angle based proportional integral derivative controller muscle activation strategy and compared with a passive HBM to understand the effects of active muscles on astronaut body kinematics and injury risk. While head, neck, and lumbar spine injury risk were relatively unaffected by active muscles, the lower extremity injury risk and the head and arm kinematics were significantly changed. Active muscle prevented knee-buckling and spinal slouching and lowered tibia injury risk in the active vs. passive model (revised tibia index: 0.02-0.40 vs. 0.01-0.58; acceptable tolerance: 0.43). Head displacement was higher in the active vs. passive model (11.6 vs. 9.0cm forward, 6.3 vs. 7.0cm backward, 7.9 vs. 7.3cm downward, 3.7 vs. 2.4cm lateral). Lower arm movement was seen with the active vs. passive model (23 vs. 35cm backward, 12 vs. 20cm downward). Overall simulations suggest that the passive model may overpredict injury risk in astronauts for spaceflight loading conditions, which can be improved using the model with active musculature.

Recommendation for changes to the guidelines of trauma patients with potential spinal injury within a regional UK ambulance trust.

Spinal assessment and immobilisation has been a topic of debate for many years where, despite an emerging evidence base and the delivery of new guidance overseas, little has changed within UK pre-hospital practice. Since 2018, South East Coast Ambulance Service NHS Foundation Trust has spent time working with local trauma networks and expertise from within the region and international colleagues to develop a set of C-spine assessment and immobilisation guidelines that reflect the current best available international evidence and significant changes in international pre-hospital practice from settings such as Scandinavia and Australasia. A specialist group was commissioned to review the topic of pre-hospital spinal immobilisation and explore potential for evidence-based improvement. In conjunction with local trauma networks, subject matter experts and a thorough review of recent literature, a series of recommendations were made in order to improve spinal care within the authoring trust. Seven recommendations were made, and an updated set of guidelines produced. These included the removal of semi-rigid collars from pre-hospital spinal immobilisation; the creation of two tiers of patients to ensure that the high-risk and low-risk populations are considered separately and an accompanying decision tool to safeguard both cohorts; an increased emphasis on the risk of spinal injury in the frail and older patient; an emphasis on spinal motion restriction rather than rigid immobilisation; an increased emphasis on self-extrication; and the use of a marker for emergency departments. An updated set of guidance has been produced using a combination of specialist and expert opinion alongside a literature review with close involvement of key stakeholders, both public and professional. The new guidance helps to ensure a patient-centred approach where each person is considered an individual with their risk of injury and management measures tailored to their specific needs.

Optimizing Backrest Geometry to Minimize Interfacial Pressure Concentrations in the Mid-to-Lumbar Region During Leg Press Resistance Training.

The leg press is a resistance training (RT) exercise common to both weight- and powerlifting, where spine-related injuries remain prevalent. Here, the elevated loading has the potential to result in increased pressure on vertebral bodies and introduce the risk of spinal injury. This study, therefore, investigates back interfacial pressure under leg press loading conditions and offers design recommendations to minimize spatial pressure concentrations. A pressure mat was used to assess the back-backrest interfacial pressure distribution of 15 subjects executing RT leg-presses at 50% body weight, over 16 different back-support geometries. Real-time forces, knee angles, and pressures were captured. The resulting data show that more prominent (≥2.1 cm) back-supports, positioned 19 cm above the seat pan typically produced greater peak pressures (41.8 ± 7.2 kPa). Conversely, less prominent supports (∼0.7 cm) generally achieved lower peak pressures (with greater distribution). Our data suggest that the most prudent choice for fixed-shape backrests to best distribute interfacial pressure on leg-press devices is to incorporate shallow convex supports (∼0.7 cm) and locate them away from P = 19 cm. The result is surprising as this prominence location is a common ergonomic feature. If an adjustable backrest is considered, peak pressures may be reduced by up to 26 ± 8% (9.7 ± 3.1 kPa) compared to flat geometries.

High fat diet causes inferior vertebral structure and function without disc degeneration in RAGE-KO mice.

Back pain and spinal pathologies are associated with obesity in juveniles and adults, yet studies identifying causal relationships are lacking and none investigate sex differences. This study determined if high fat (HF) diet causes structural and functional changes to vertebrae and intervertebral discs (IVDs); if these changes are modulated in mice with systematic ablation for the receptor for advanced glycation endproducts (RAGE-KO); and if these changes are sex-dependent. Wild-type (WT) and RAGE-KO mice were fed a low fat (LF) or HF diet for 12 weeks starting at 6 weeks, representing the juvenile population. HF diet led to weight/fat gain, glucose intolerance, and increased cytokine levels (IL-5, MIG, and RANTES); with less fat gain in RAGE-KO females. Most importantly, HF diet reduced vertebral trabecular bone volume fraction and compressive and shear moduli, without a modifying effect of RAGE-KO, but with a more pronounced effect in females. HF diet caused reduced cortical area fraction only in WT males. Neither HF diet nor RAGE-KO affected IVD degeneration grade. Biomechanical properties of coccygeal motion segments were affected by RAGE-KO but not diet, with some interactions identified. In conclusion, HF diet resulted in inferior vertebral structure and function with some sex differences, no IVD degeneration, and few modifying effects of RAGE-KO. These structural and functional deficiencies with HF diet provide further evidence that diet can affect spinal structures and may increase the risk for spinal injury and degeneration with aging and additional stressors.Back pain and spinal pathologies are associated with obesity in juveniles and adults, yet studies identifying causal relationships are lacking and none investigate sex differences.

P152. Vertebral fractures and neurological injury associated with increased recreational vehicle use

<h3>BACKGROUND CONTEXT</h3> Recreational vehicle use has become increasingly popular over the past decade. The global all-terrain vehicle market size was valued at 3.9 billion USD in 2018 and is expected to grow at a rate of 3.1% between 2019 and 2025. Those who suffer accidents while using such vehicles are prone to spinal injury. However, few have examined this relationship at the national scale. <h3>PURPOSE</h3> The goal of this study was to investigate the trends between recreational vehicle use and spinal injury nationwide. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective study reviewing the number of spinal injury cases involved with recreational vehicle use nationwide, utilizing the NEISS (National Electronic Injury Surveillance System) database. <h3>PATIENT SAMPLE</h3> This study isolated spinal injury cases associated with recreational vehicles, ranging from bicycles to four wheeled ATVs, two wheeled ATVs, and other all-terrain vehicles, and evaluated the rate of neurological injury and vertebral fractures in these cases. <h3>OUTCOME MEASURES</h3> Measures evaluated included proportions of vertebral fractures and nerve injuries related to recreational vehicle use. <h3>METHODS</h3> National estimates, standard errors, and 95% confidence intervals were derived using the provided survey parameters in the NEISS database. Crude rate was defined as number of cases per 100,000 persons. Significance was determined using adjusted Wald tests, for which p<.05 (2-sided) were considered significant. Proportions of fracture and nerve injury by recreational vehicle were determined by Pearson's Chi-Squared Test between bicycles, four wheeled ATVs, two wheeled ATVs, and other all-terrain, recreational vehicles. <h3>RESULTS</h3> A total of 56,349 spine injuries related to recreational vehicle use were isolated from the database. Injuries located in the lower trunk/lumbar vertebrae were most common (47.9%). A total of 78.0% of all spine injuries were experienced by males. Between 2010 and 2019, there was an increase in national cases of spine injury involving recreational vehicles (p<0.00001). Nerve injury was more prevalent in four wheeled ATVs (10.2%) when compared to all-terrain vehicles and two wheeled powered vehicles (2.93%) (p<0.0001). Lumbar spine injury, despite being the most prevalent region of spine injury, showed lower odds (p<0.0001) of being admitted. <h3>CONCLUSIONS</h3> With the increasing popularity of recreational vehicles, there is high concern for traumatic spinal injury. This study was able to identify increasing numbers of spinal injury related to such vehicle use. Such injuries are not trivial and lead to not only life-altering limitations for patients but also increasing health care costs. Physicians and patients alike should remain aware and discuss the potential harms regarding the use of recreational vehicles and their high risk for spinal injury. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

WS5.8. Anaesthesia and Intraoperative Neurophysiological Monitoring

There has been a growth of monitoring in the operating room today. From a “finger on the pulse” as a standard to ECGs and pulse oximeters. Now neurological monitoring in also used extensively in the OR. There are three types of neuro monitoring in the OT which will be discussed today. Firstly, single nerve monitoring, eg the facial nerve during parotid surgery. Next, we have the monitoring of the depth of anaesthesia via the bispectral index and density spectral array. This helps us understand the depth of anaesthesia especially in total intravenous anaesthesia. BIS monitoring is good at indicating an “alert” state, which is why it can reduce the incidence of intraoperative awareness. However, its algorithm does not always accurately predict an “asleep” state. This means an unknown percentage of patients who are already asleep will not be identified because of falsely elevated BIS values. These patients will receive unnecessary dosage of anesthetics resulting in a deep hypnotic state. Given that there may be falsely elevated values, we have to consider when it is best to use the monitors and if it is cost effective. Lastly, we monitor the spinal cord using SSEPs and MEPs during spine surgery especially scoliosis surgery. Today it is standard practice to conduct some form of monitoring when performing any spinal operation that is associated with a high risk of spinal injury. Generally, operations are considered to carry such a risk when corrective forces are applied to the spine, the patient has preexisting neurological damage, the cord is being invaded, or an osteotomy or other procedure is being carried out in immediate juxtaposition to the cord. In this presentation we will look at the latter two monitoring modalities and whether they are needed and are cost effective in the OR.

Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data

Identifying the prevalence of degenerative spinal pathologies and relevant demographic risk factors is important for understanding spine injury risk, prevention, treatment, and outcome, and for distinguishing acute injuries from degenerative pathologies. Prevalence data in the literature are often based on small-scale studies focused on a single type of pathology. This study evaluates the prevalence of diagnosis of selected degenerative spinal pathology diagnoses using Medicare insurance claim data in the context of published smaller-scale studies. In addition, the data are used to evaluate whether the prevalence is affected by age, sex, diagnosed obesity, and the use of medical imaging. The Medicare Claims 5% Limited Data Set was queried to identify diagnoses of degenerative spinal pathologies. Unique patient diagnoses per year were further evaluated as a function of age, gender, and obesity diagnosis. Participants were also stratified by coding for radiological imaging accompanying each diagnosis. The overall prevalence of diagnosed spinal degenerative disease was 27.3% and increased with age. The prevalence of diagnosed disc disease was 2.7 times greater in those with radiology. The results demonstrate that degenerative findings in the spine are common, and, since asymptomatic individuals may not receive a diagnosis of degenerative conditions, this analysis likely underestimates the general prevalence of these conditions.

Supine percutaneous nephrolithotomy in a patient with a history of previous spinal surgeries

Patients with abnormal body habitus because of spinal deformities and patients having undergone previous spinal surgeries present a challenge during surgical, anesthesiologic, and technical procedures. In these patients, management of urolithiasis may be difficult because of anatomic variations and respiratory dysfunction, stone size, spinal deformities, or risk of spinal injuries. Percutaneous nephrolithotomy (PCNL) as monotherapy has advantages in removing large stones and achieving excellent results with minimal morbidity. PCNL in supine position has several advantages attached to it, which include improvement in anesthetic management, decreased intrarenal pressures, decreased radiation exposure and improved ergonomics of fluoroscopy, improvements in patient positioning, and shorter operative time. We report a case of supine PCNL in a patient who was operated previously on the cervical and lumbar spine.

The impact of forward head posture on the electromyographic activity of the spinal muscles

ObjectiveThis study aims to examine the electromyographic activity of the regional spinal muscle between patients with forward head posture (FHP) and those with a normal cranio-vertebral (CV) angle. MethodsWe recruited 60 adult women aged between 18 and 29 years from a single institution. The CV angle was measured in the sagittal plane, which helped us to assign the participants in the FHP group (n = 30) with a large CV angle (53.1 ± 2.3) and the control group (n = 30) with a normal CV angle (43.0 ± 3.6). The surface electromyography (EMG) was used to measure the magnitude of normalised muscle activity of eight spinal muscles (cervical, lumbar, and thoracic levels) while standing and performing a specific manual handling task. ResultsThe CV angle was significantly lower in the FHP group than in the control group (p = .001). The cervical erector spinae (CES) muscle activity was significantly increased in the FHP group compared to that in the control group. The right and left CES of those in the FHP group exhibited 73% and 87%, respectively, higher normalised muscle activity than those in the control group while performing the manual handling task (p = .001). No significant difference was detected for the thoracic or lumbar segment muscles between groups. ConclusionOur results indicate that greater neck muscle demands result from anterior head translation in FHP. This effect is a counterbalance to the reduced CV angle and to support the neck. The increased activity of the neck muscles in FHP could demand more support from the neck muscles and might increase the risk of spinal injuries. Management of FHP is essential to avoid overloading the spinal muscles.