Signs Of Spinal Injury Research Articles

Two rare cases of idiopathic spontaneous extra-axial spinal hematoma

Spinal hematoma is a rare condition but can cause significant spinal injury and resultant morbidity. Magnetic resonance imaging (MRI) is the gold standard of radiological investigation and is often an emergency indication for imaging. Early diagnosis is crucial for treatment and better patient outcome. Herein, we report two cases of rare idiopathic spontaneous extra-axial hematoma highlighting the role of MRI in the diagnosis.

MR imaging of spinal haematoma: a pictorial review.

Spinal haematoma is a rare occurrence, however has the potential to cause significant spinal injury and morbidity. MRI is the gold-standard of investigation, and urgent imaging is required for early diagnosis and treatment to ensure best patient outcomes. We present a pictorial review demonstrating the imaging features of spinal haematoma based on meningeal space assignment; epidural, subdural, subarachnoid, intramedullary and a combination of these locations. In this review, we summarise the literature and imaging findings of spinal haematoma on MRI. Particular imaging features which help to differentiate between haematoma in the different spinal meningeal compartments are discussed below.

Spine and Spinal Cord Injury

Spinal injury has the potential to dramatically change a patient’s life. Prompt diagnosis, appropriate supportive medical care, early transfer to a spinal injury center and, if necessary, surgical intervention within 24 hours are essential to optimizing outcomes. Clinical decision rules aid in determining the need for imaging. When needed, non-contrast enhanced CT is the initial imaging test of choice with MRI being used in patients with neurologic findings, significant pathology on CT, and/or high suspicion for injury. CT or MRI with intravenous contrast is preferred in penetrating trauma. Radiographs are of limited utility in evaluating spinal injury in adults. Classification of spinal injury based on appearance on imaging and neurologic exam is important for surgical management decisions. Cervical injury may lead to respiratory distress requiring early intubation. Hypotension is most often a result of hemorrhage from concomitant traumatic injuries to other organ systems. Crystalloid, blood products, atropine and norepinephrine should be used as needed to avoid systolic BP< 90 mm Hg or heart rate< 60 BPM and maintain a MAP of 85-90 mm Hg. Steroid administration within the first 8 hours of significant spinal injury is controversial and the decision to administer steroids should be made through consultation with patient, family and spinal specialist. The review contains 8 figures, 2 videos, 13 tables, and 59 references. Keywords: blunt trauma, neurologic assessment, penetrating trauma, spinal anatomy, spinal cord injury, spinal injury, steroid use, vertebrae, vertebral anatomy, vertebral injury

Spine and Spinal Cord Injury

Spinal injury has the potential to dramatically change a patient’s life. Prompt diagnosis, appropriate supportive medical care, early transfer to a spinal injury center and, if necessary, surgical intervention within 24 hours are essential to optimizing outcomes. Clinical decision rules aid in determining the need for imaging. When needed, non-contrast enhanced CT is the initial imaging test of choice with MRI being used in patients with neurologic findings, significant pathology on CT, and/or high suspicion for injury. CT or MRI with intravenous contrast is preferred in penetrating trauma. Radiographs are of limited utility in evaluating spinal injury in adults. Classification of spinal injury based on appearance on imaging and neurologic exam is important for surgical management decisions. Cervical injury may lead to respiratory distress requiring early intubation. Hypotension is most often a result of hemorrhage from concomitant traumatic injuries to other organ systems. Crystalloid, blood products, atropine and norepinephrine should be used as needed to avoid systolic BP< 90 mm Hg or heart rate< 60 BPM and maintain a MAP of 85-90 mm Hg. Steroid administration within the first 8 hours of significant spinal injury is controversial and the decision to administer steroids should be made through consultation with patient, family and spinal specialist. The review contains 8 figures, 2 videos, 13 tables, and 59 references. Keywords: blunt trauma, neurologic assessment, penetrating trauma, spinal anatomy, spinal cord injury, spinal injury, steroid use, vertebrae, vertebral anatomy, vertebral injury

When Should Magnetic Resonance Imaging Be Considered With Neck Pain?

Review of recent evidence with translation to practice for the advanced practice nurse role is presented using a case study module for "Cervical Spine Magnetic Resonance Imaging in Alert, Neurologically Intact Trauma Patients With Persistent Midline Tenderness and Negative Computed Tomography Results." The study was designed to identify factors predictive of clinically significant spinal injury in neurologically intact trauma patients with persistent midline cervical tenderness, despite negative computed tomography and plain film findings. The authors reported a lack of guidelines to help emergency care providers identify which of these patients should undergo magnetic resonance imaging studies. The authors highlight the need to develop a clinical prediction rule, or clinical decision rule, to help providers caring for patients such as those with persistent neck pain. The implications and clinical relevance of these findings for advanced practice nurses are discussed highlighting best evidence.

Clinical Examination is Highly Sensitive for Detecting Clinically Significant Spinal Injuries after Gunshot Wounds: Inaba K, Barmparas G, Ibrahim D, et al. J Trauma 2011;71:523–7.

Rapid assessment of spinal injury in penetrating trauma patients is an important step in the management of these potentially seriously injured patients. In an urban, academic medical center, 282 adult patients with penetrating injury were enrolled over a 6-month period. These patients had a standardized physical examination of their spine using a checklist in an attempt to prospectively determine the sensitivity and specificity of a structured clinical examination to evaluate for spinal injury after penetrating trauma.

Clinical Examination Is Highly Sensitive for Detecting Clinically Significant Spinal Injuries After Gunshot Wounds

The optimal method for spinal evaluation after penetrating trauma is currently unknown. The goal of this study was to determine the sensitivity and specificity of a standardized clinical examination for the detection of spinal injuries after penetrating trauma. After Institutional Review Board approval, all evaluable penetrating trauma patients aged 15 years or more admitted to the Los Angeles County + University of Southern California Medical Center were prospectively evaluated for spinal pain, tenderness to palpation, deformity, and neurologic deficit. During the 6-month study period, 282 patients were admitted after sustaining a penetrating injury; 143 (50.7%) as a result of gunshot wound (GSW) and 139 (49.3%) as a result of stab wound (SW). None of the patients sustaining a SW had a spinal injury. Of the 112 evaluable GSW patients, 9 sustained an injury: 6 with a true-positive and 3 with a false-negative clinical examination. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 89.6%, 46.2% and 95.2%, respectively. For clinically significant injuries requiring surgical intervention, cervical or thoracolumbar spine orthosis, or cord transections, however, the sensitivity of clinical examination was 100.0%, specificity 87.5%, positive predictive value 30.8%, and negative predictive value 87.5%. Clinically significant spinal injury, although rare after SWs, is not uncommon after GSWs. A structured clinical examination of the spine in evaluable patients who have sustained a GSW is highly reliable for identifying those with clinically significant injuries.

The Functional And Neurological Outcome In Cervical Spine Injuries: A Retrospective Review

BACKGROUND: Until recently, vertebral injuries were less commonly in cervical spine than Thoracic and lumbar region. With the decline in accidents from mining and other heavy industry and increase in Road traffic accidents, this incidences has change. At present out of significant spinal injury approx. 50% involves the cervical spine and approx. 40% of them lead to quadriplegia and approx. 10% of traumatic cord injuries have no obvious radiographic evidence of vertebral injury (SCIWORA). Aim of this retrospective case-series with 25 patients was to assess Neurological and functional outcome in Cervical Spine Injuries. RESULTS: There were 10 patients with lower cervical spine fractures (C3-C7),5 patients with upper cervical fractures,10 patients had SCIWORA injuries. Initial ASIA scale: A:4,B:3,C:5, D:8 & E:5. 15 patients were treated conservatively with cervical tongs and orthotics. Rest of 10 patients treated operatively with anterior cervical platting. Full neurological recovery in 10 patients and 40% of patients had poor neurological outcome , which is significantly higher. 5 patients (20%) were associated with glutei sores or cranial sores. 3 patients had chest infection due to respiratory pneumonitis, 3 patients had major depression (psychological complication).Operative patients were commonly associated with cardio respiratory compromise most probably due to ascending cord edema, in 24% patients. CONCLUSIONS: To conclude cervical spine injury is continuing to be fatal and paralyzing injury with poor and unpredictable neurological outcome. Final neurological outcome is depends on primary neurological damage. SCIWORA type of cervical spine injury and stable cervical spine fractures associated with good neurological outcome. Poor Neurological Outcome is associated with High velocity trauma and unstable, lower cervical spine bony injury. Functional Outcome mostly depends on final neurological outcome and can be improved with proper rehabilitation programme.

A descriptive review and discussion of litigation claims against ambulance services

Introduction:Litigation claims against the NHS are increasing. Society is less tolerant of mistakes or inadequate service and litigation claims are now becoming increasingly accepted.Methods:All claims registered with the NHS litigation...

'Bouncy castles' and cervical spine fractures: an under-recognized hazard.

We have recently treated two adult patients with significant spinal injuries after using an inflatable 'bouncy castle'. We highlight the risks associated with these devices in the adult age group and review the current literature. We conclude that these devices should carry a clear warning to adults that their use by above-14 is hazardous.

Significant Spinal Injury Resulting From Low-Level Accelerations: A Case Series of Roller Coaster Injuries

Freeman MD, Croft AC, Nicodemus CN, Centeno CJ, Elkins WL. Significant spinal injury resulting from low-level accelerations: a case series of roller coaster injuries. Objectives To describe a cohort of significantly injured roller coaster riders and the likely levels of acceleration at which the injuries occurred, and to compare these data with contemporary efforts to define a lower limit of acceleration below which no significant spinal injury is likely to occur. Design A retrospective case series of roller coaster ride–induced significant spinal injuries. Setting Injury incident records and emergency medical service records for the Rattler roller coaster in San Antonio, TX, were evaluated for a 19-month period in 1992 and 1993. Medical records for the more significant injuries were also reviewed and the specific injuries were tabulated, along with the demographics of the cohort. Participants There were 932,000 riders of the Rattler roller coaster, estimated to represent between 300,000 and 600,000 individual riders. Interventions Not applicable. Main Outcome Measures Injury incident reports and medical record review. Results It is estimated that there were a total of 656 neck and back injuries during the study period, and 39 were considered significant by the study inclusion criteria. Seventy-two percent (28/39) of the injured subjects sustained a cervical disk injury; 71% of these injuries were at C5-6 (15 disk herniations, 5 symptomatic disk bulges) and 54% were at C6-7 (11 disk herniations, 4 symptomatic disk bulges). In the lumbar spine, the most frequent injury was a symptomatic disk bulge (20% of the cohort), followed by vertebral body compression fracture (18%), and L4-5 or L5-S1 disk herniation (13%). Accelerometry testing of passengers and train cars indicated a peak of 4.5 to 5 g of vertical or axial acceleration and 1.5 g of lateral acceleration over approximately 100ms (0.1s) on both. Conclusions The results of this study suggest that there is no established minimum threshold of significant spine injury. The greatest explanation for injury from traumatic loading of the spine is individual susceptibility to injury, an unpredictable variable.

Pitfalls in the clinical diagnosis of vertebral fractures: a case series in which posterior midline tenderness was absent

Objective: There is widespread belief among doctors that posterior midline tenderness is virtually a prerequisite for spinal fracture in alert, sober patients without any painful distracting injury or neurological deficit....

Spinal Injuries

The pre-hospital care of patients with suspected spinal injuries involves early immobilisation of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further...

Alpine skiing, snowboarding, and spinal trauma.

This 10-year retrospective review of spinal injuries at a destination ski resort was done to determine the incidence and type of spinal and neurologic injury associated with alpine winter sports. Spinal injury patterns and outcomes in skiers and snowboarders over a period of 11 seasons at a destination resort were studied. One-fourth of cervical injuries were associated with a temporary neurologic deficit. Only 1 in 25 thoracic injuries had an associated neurologic deficit, and this was permanent. None of the lumbar injuries required surgery, nor were any associated with a neurologic deficit. There was approximately one significant spinal injury every 100,000 skier-days, and only 9% of spinal injuries required surgery. The incidence of death or associated permanent neurologic deficit is low (approximately one per two million skier-days). Skiing and snowboarding have a low incidence of significant spinal trauma.

Prehospital clinical findings associated with spinal injury

Objective. The objective of this study was to identify clinical findings that are associated with spinal fracture and/or spinal cord injuries in prehospital trauma patients.Methods. A retrospective chart review was performed at three tertiary referral centers in Southeastern Michigan. All charts of patients with spinal fractures or spinal cord injuries during 1992 and 1993 were reviewed. Patients with available pre-hospital records were included in the study analysis. Prehospital data points included documentation of head injury; altered mental status; neurologic deficit; evidence of intoxication; cervical, thoracic, and lumbar pain or tenderness; nonspecified back pain or tenderness; and a narrative for all other documented injuries. Hospital data collected included type and level of spinal injury and age and sex of the patient.Results. Of 867 injury patients identified, 536 were excluded, leaving 346 analyzable fractures in 331 patients. The 346 spinal fractures/spinal cord injuries were distributed as: 100 (29%) cervical, 83 (24%) thoracic, 128 (37%) lumbar, and 35 (10%) sacral. Prehospital documentation of altered mental status, neurologic deficit, evidence of intoxication, spinal pain, or suspected extremity fracture was found for every patient with a cervical injury, 82/83 patients with thoracic injuries (99%), and 124/128 patients with lumbar injuries (97%). All five patients who were not documented as having one of the predictors had stable injuries.Conclusion. Prehospital clinical findings of altered mental status, neurologic deficit, evidence of intoxication, spinal pain, and suspected extremity fracture were documented for all patients with significant spinal injuries in this series. These findings may be useful to identify patients who require prehospital spinal immobilization.