Spinal Trauma Research Articles

Thoracic spinal cord trauma: an adequate functional outcome with timely surgical management

Thoracic spinal cord trauma: an adequate functional outcome with timely surgical management

Hight return-to-sport rate following traumatic spine injury in amateur athletes.

Data on the resumption of sporting activity (return-to-sport, RTS) after traumatic spine injuries are mainly available for elite athletes. This study aimed to determine the RTS rate in amateurs after spine injury and to identify factors possibly influencing RTS. First, a retrospective analysis of clinical data of patients with traumatic spine injuries receiving inpatient treatment at a national trauma center from 2016 to 2020 was performed. Patients up to the age of 60 who were active in sports before the injury were included. Patients with the following relevant concomitant injuries were excluded: spinal cord injury, pelvic injury, extremity injuries, as well as craniocerebral trauma grade 2 or higher. A telephone interview on participants' RTS within the first year after the injury was conducted. Participants with early and those with late or no RTS were compared in univariate analysis regarding potential influencing factors. The level of significance was set to p < .05. Thirty-seven women (39%) and 57 men (61%) were included. The mean age was 44 years (16-60). The numbers of patients per injured segment of the spine were: cervical 15 (16%), thoracic 28 (30%), lumbar 33 (35%), multiple spine segments 18 (19%). Thirty patients (32%) were treated conservatively and 64 (68%) surgically. The RTS rate after six months was 62%, corresponding to 57 patients. Compared to patients with late or no RTS, patients with RTS within six months had a significantly lower BMI (24.6 vs. 27.4kg/qm, p = .004), had isolated cervical spine injuries significantly more often (24% vs. 6%, p = .020), and had undergone outpatient or inpatient rehabilitation significantly less often (35% vs. 72%, p < .001). There were non-significant trends regarding mean age (42 vs. 46 years, p = .175), surgical therapy (66% vs. 75%, p = .333), and the proportion of patients who, before the injury, had been physically active for at least five hours per week (50% vs. 33%, p = .113). Patients with RTS within six months had sustained their spinal injury in a sports accident twice as often (28% vs. 14%, p = .121). Gender, preexisting medical or spinal conditions, severe injuries (types A4, B or C according to AO Spine), and surgical therapy were not significantly associated with RTS. The RTS rate within twelve months was 81% (76 patients). The RTS rate in amateur athletes after an isolated spinal injury without spinal cord injury was high, with 62% after six and 81% after twelve months. This reflects the effectiveness of the existing treatment and posttreatment concepts. Normal-weight patients and isolated cervical injury are favorable factors for RTS. The use of inpatient rehabilitation as a marker of protracted healing is associated with delayed or no RTS.

Enabling Technologies in the Management of Cervical Spine Trauma.

Narrative review. The objective of this study is to explore and evaluate the role of novel technologies in enhancing the diagnosis, surgical precision, and rehabilitation of cervical spine trauma, and to discuss their potential impact on clinical outcomes. Traumatic cervical spine injuries are challenging to manage due to their complex anatomy, the potential for long-term disability, and severe neurological deficits. Traditional management approaches are being supplemented by emerging technologies that promise to improve patient care and outcomes. A literature review was conducted to identify and analyze advancements in imaging, navigation, robotics, and wearable technologies in the context of cervical spine trauma. The review focuses on the potential of these technologies to improve early detection, surgical accuracy, and postoperative recovery. Technological innovations, including advanced imaging techniques, machine learning for diagnostics, augmented reality, and robotic-assisted surgery, are transforming the management of cervical spine trauma. These tools contribute to more efficient, accurate, and personalized treatment approaches, potentially improving clinical outcomes and reducing patient care burdens. Although these technologies hold great promise, challenges such as implementation costs and the need for specialized training must be addressed. With continued research and interdisciplinary collaboration, these advancements can significantly enhance the management of cervical spine trauma, improving patient recovery and quality of life. Level V.

Operative Timing in Cervical Spine Trauma.

Narrative review. To review existing literature regarding surgical timing in cervical trauma with a focus on acute traumatic central cord syndrome. Traumatic central cord syndrome is the most common incomplete spinal cord injury. Substantial basic science literature has proposed ischemic and secondary injury-driven mechanisms underpinning the urgency of operative intervention. However, only recently has a relative consensus emerged in the clinical literature regarding the safety, efficacy, and necessity of early operative intervention for acute traumatic central cord syndrome. A literature search was conducted of studies in PubMed Central and Cochrane Database related to timing in cervical spine trauma. Recently, several major systematic reviews and consensus statements have endorsed the importance and safety of early (<24h) operative decompression in the setting of traumatic spinal cord injury. Despite decades of conflicting data, a similar trend appears to be emerging for traumatic central cord syndrome. These clinical developments join a large body of basic science work regarding the importance of early decompressive surgery in relieving acute ischemic insult and minimizing the effects of secondary injury. However, further work is needed to delineate optimal surgical timing, especially regarding "ultra-early" (<8 h) protocols, and to aid in creating accelerated screening pathways.

Pediatric Cervical Spine Trauma: A Narrative Review.

Narrative review. To provide an updated overview of pediatric cervical spine trauma. Pediatric cervical spine trauma can cause debilitating morbidity and mortality and neurological impairment. The unique anatomic features of the developing cervical spine can predispose children to injuries. We reviewed the pediatric cervical spine trauma literature in PubMed and EMBASE. Pediatric cervical spine injury occurs in 1%-2% of pediatric trauma. The most frequent cause is motor vehicle collisions, with sports-related injuries being more common in older children. Larger head-to-body ratios and tissue elasticity can predispose young children to a greater risk of injury higher in the craniocervical junction and cervical spine. Standardized protocols and classification systems, such as the Pediatric Cervical Spine Clearance Working Group protocol and the AO Spine Injury and Subaxial Cervical Spine Injury Classifications, are valuable in triage as well as for assessing the need for operative versus nonoperative management. In general, operative approaches and principles are similar to those in adults, with modern instrumentation and fusion techniques achieving high rates of successful arthrodesis. Effective management and treatment of pediatric cervical spine injuries depends on early and accurate diagnosis, a thorough understanding of pediatric spinal anatomy, and a versatile surgical armamentarium.

A Pictorial Review of Spinal Trauma: Part 2

A Pictorial Review of Spinal Trauma: Part 2

A Pictorial Review of Spinal Trauma: Part 2

A Pictorial Review of Spinal Trauma: Part 2

Canadian Association of Radiologists Spine Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Spine Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurology, neurosurgery, physiatry, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 10 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 23 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 22 recommendation statements across the 8 scenarios (one scenario points to the CAR Trauma Referral Guideline and one scenario points to the CAR Musculoskeletal Guideline). This guideline presents the methods of development and the referral recommendations for myelopathy, suspected spinal infection, possible atlanto-axial instability (non-traumatic), axial pain (non-traumatic), radicular pain (non-traumatic), cauda equina syndrome, suspected spinal tumour, and suspected compression fracture. Spondyloarthropathies and spine trauma point to other CAR Diagnostic Imaging Referral Guidelines, Musculoskeletal and Trauma, respectively.

A Pictorial Review of Spinal Trauma: Part 1

A Pictorial Review of Spinal Trauma: Part 1

From Accidents to Zebras: A Pictorial Review of Spinal Trauma—Part 1

From Accidents to Zebras: A Pictorial Review of Spinal Trauma—Part 1

Surgical Treatment of Primary Spinal Tumors

Primary spinal tumors appear to be much less common than metastatic lesions, but their surgical treatment comprises a complex and multifaceted task. Numerous factors influence indications and timing of surgical intervention, including neurological status of the patient, histological characteristics of the tumor, its localization, stability of the spinal column, and comorbidities. Significant spinal cord compression, rapid progression of neurologic deficits, or pronounced instability of the spinal column may require urgent surgical intervention. When the spinal canal is not affected, treatment should start with a biopsy to accurately determine the histology of the tumor. Some tumor types, such as giant cell tumors, osteoblastomas, chordomas, and chondrosarcomas, require complete removal of the tumor. However, performing a wide resection in a single block is often found difficult due to compression of vascular and nerve structures. Current approaches to surgical management of primary spinal tumors involve minimally invasive techniques that significantly improve postoperative recovery and reduce the risk of complications. These techniques were originally used to treat degenerative spinal diseases and trauma; however, they have also demonstrated their effectiveness in tumor surgery. Adapting surgical strategy based on histology and tumor location, as well as integrating minimally invasive techniques, can improve patient survival and quality of life. The present paper describes the latest advances in the surgical treatment of primary spinal tumors, discusses current techniques and strategies, and prospects for further research in this area.

Determining the Optimal Morphometry of Pedicle Screws in Lumbar and Thoracic Spine in the Iranian Population

Background: The improper length and direction of pedicle screw may also cause it to penetrate the adjacent organs. Unknowing the safe zone of dimensions and directions of the pedicles is essential to proper screw placement. Methods: The present study is a cross-sectional morphometric study on patients with spinal trauma referred to the neurosurgical department in 2021. The MARCO PACS software scale measured the CT scan images and included the vertebral left pedicle diameter, pedicle body distance, body aorta distance, pedicle diameter, height, and area. The entry point and direction of the pedicle screw were made with the “free-hand” method. Results: 301 patients were included, consisting of 113 females (37.5%) and 188 males (62.5%). The mean age of the participants was 42.87±12.3 years. “Among all T12 vertebra parameters, just body aorta distance was not significant between genders (p-value=0.311). The pedicle height and body aorta distance were lowest among 18-35 years patients (p-value=0.001) (p-value=0.003), respectively. Post-hoc analysis revealed a significant difference between 18-35 and 51-70 years for body aorta distance in the L1 vertebra (p-value=0.002). Conclusion: The present investigation has shown significant differences between genders for optimal left pedicle screw parameters, which should be considered before surgery.

7635 Severe Osteoporosis in a Patient with Heterotopic Calcification: A Case Report

Abstract Disclosure: D. Salih Bacha: None. L.Z. Khan: None. Background: While osteoporosis and heterotopic ossification (HO) are distinct conditions affecting bone health, their coexistence poses intriguing clinical challenges. Osteoporosis, characterized by increased bone fragility, typically results from various factors such as aging, steroid use, or malabsorption. HO is a condition where bone forms abnormally in soft tissues. Risk factors that predispose to HO include male sex, spinal cord injury, trauma, surgery, and genetic factors. Treatment of HO is typically surgical resection and NSAIDs. Initial evidence supported the use of bisphosphonates for preventing ectopic bone formation post-trauma, but recent data failed to show significant benefit in HO prevention. This case presents a patient with unique challenges of both HO and bone fragility with multiple severe vertebral fractures. Case: A 44-year-old male patient had a major motor vehicle accident necessitating multiple recurrent abdominal surgeries. During one exploratory laparotomy, diffuse mesenteric calcifications were noted, indicative of HO. A baseline Dual X-ray Absorptiometry (DXA) scan revealed bone density of 1.003 g/cm2 and 0.788 g/cm2 at the spine and femoral neck, respectively, concerning for osteopenia. He was started on zoledronic acid in preparation for upcoming intestinal transplant. Few months after the transplant, he was started on daily tacrolimus and hydrocortisone for immunosuppression. Within months, he experienced sudden back pain while riding an elevator, and was found to have acute fractures in T8 and T9 vertebrae. A repeat DXA scan showed a further decline in bone density to 0.909 g/cm2 and 0.748 g/cm2 at the spine and femoral neck, respectively. Within a year, additional fractures occurred in the thoracic and lumbar spine (T10, T11, T12, L1, L2, L3, and L4), requiring multiple kyphoplasty interventions. Over time, worsening kyphosis, back pain, and height loss occurred, significantly affecting the patient's quality of life. He continued receiving yearly zoledronic acid infusions and underwent regular DXA scans, which revealed mild improvement in his bone density. Currently, there are no established guidelines specifying the optimal duration for bisphosphonate treatment in such cases. Therefore, our individualized treatment plan involves a tentative 10-year course of bisphosphonate treatment with yearly assessment of bone mineral density. Conclusion: Although the patient had some risk factors for osteoporosis, including daily steroid and tacrolimus use, the severity and frequency of his fractures suggested a potential synergy between osteoporosis and HO, where the formation of heterotopic calcifications may have been exacerbating his bone loss. The coexistence of osteoporosis and HO in this patient underscores the need for individualized care and establishment of treatment guidelines in patients with multiple bone disorders. Presentation: 6/3/2024

Epidemiology of craniofacial and spinal injuries in French Rugby union: A report including medical, social, and professional consequences

ObjectivesFirst, to investigate the medico-socio-professional repercussions of non-fatal cranioencephalic and spinal injuries occurring across all levels of play in male and female Rugby Union in France. Second, to determine whether an association existed between the severity of injuries and the circumstances of their occurrence and/or the profiles of the injured players. Third, to gather new epidemiological data regarding the severity and long-term consequences of these injuries in the sport. DesignNational retrospective observational open cohort study conducted using medical expertise files on all injuries registered by the insurer affiliated to the French Rugby Federation. MethodsWe analysed the medical reports of spinal, craniofacial or radicular trauma occurred from 26/08/2011 to 31/01/2018. Data relating to the severity and the circumstances of the injury, and its medical and socio-professional consequences (e.g., ability of players to continue playing rugby and/or professional/scholastic activity, receiving or not financial compensation) were extracted. Results199 cases were identified. The overall incidence rate of injuries was 10.57/100,000 person-years. The median PMI value after consolidation was 6 %. Five cases had a PMI value equivalent or higher than 50 %. 85 % of players were able to return to work/studies whilst 47 % returned to rugby overall. Injury severity did not differ between age groups, genders, performance levels, training/match-play or according to the game situation. ConclusionsAlthough rare, craniofacial and spinal injuries in rugby can leave sequelae with substantial repercussions on personal, professional/scholastic and sporting life. Further research into their potential causes and targeted prevention strategies is warranted.

232 A Multimodal Quality Improvement Intervention to Reduce Head and Cervical Spine Trauma Imaging

232 A Multimodal Quality Improvement Intervention to Reduce Head and Cervical Spine Trauma Imaging

Should the priority examination in spinal trauma be magnetic resonance imaging or computed tomography

Should the priority examination in spinal trauma be magnetic resonance imaging or computed tomography

Spine injuries among severely injured trauma patients: A retrospective single-center cohort study.

We aimed to determine the incidence and severity of spine injuries among severely injured trauma patients (Injury Severity Score (ISS)/New Injury Severity Score (NISS) > 15) treated in a single tertiary trauma center over 15 years. We also wanted to compare the demographics between patients with and without spine injuries and to determine the mortality of spine-injury patients. Data from the years 2006-2020 from the Helsinki Trauma Registry (HTR), a local trauma registry of the trauma unit of the Helsinki University Hospital (HUH), were reviewed. We divided patients into two groups, namely those with traumatic spine injury (TSI) and those without traumatic spine injury (N-TSI). TSI patients were further subdivided into groups according to the level of injury (cervical, thoracolumbar, or multilevel) and the presence of neurological symptoms. We included 2529 patients: 1336 (53%) had a TSI and 1193 (47%) had N-TSI. TSI patients were injured more frequently by a high-fall mechanism (37% vs 21%, p < 0.001). Among TSI patients, 38% of high-fall injuries were self-inflicted. High falls, young age, and female gender were overrepresented in spine-injury patients with a self-inflicted injury mechanism. Cervical spine-injury patients were mostly elderly persons injured by a low-energy mechanism. Unlike other severely injured trauma patients, severely injured trauma patients with spine injuries are more frequently injured by a high-fall mechanism and self-injury.

Imaging of Cervical Spine Trauma: Update of Techniques and Clinical Relevance.

Imaging of cervical spine trauma most commonly begins with computed tomography (CT) for initial osseous and basic soft tissue evaluation, followed by magnetic resonance imaging (MRI) for complementary evaluation of the neural structures (i.e., spinal cord, nerves) and soft tissues (i.e., ligaments). Although CT and conventional MRI sequences have been the mainstay of trauma imaging for decades, there have been significant advances in CT processing, imaging sequences and techniques made possible by hardware and software development, and artificial intelligence. These advancements may provide advantages in increasing sensitivity for detection of pathology as well as in decreasing imaging and interpretation time. Unquestionably, the most important role of imaging is to provide information to help direct patient care, including diagnosis, next steps in treatment plan, and prognosis. As such, there has been a growing body of research investigating the clinical relevance of imaging findings to clinical outcomes in the setting of spinal cord injury. This article will focus on these recent advances in imaging of cervical spinal trauma.

Pediatric Cervical Spine Trauma: Injury Patterns, Diagnosis, and Treatment

Pediatric Cervical Spine Trauma: Injury Patterns, Diagnosis, and Treatment

Odontoid fractures in the pediatric population: a systematic review and management algorithm.

The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm. A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0-18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated. In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach. Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.