Spinal Trauma Research Articles

Spinal Injuries Due to Falls from Height

Abstract Background: Traumatic spinal injuries (TSIs) due to falls from heights are characterized by unique injury mechanisms, morphological features, and severity. In this study, we conducted an analysis of the epidemiological, clinical, and radiological data of TSI patients caused by falls from heights. We compared these findings with those of patients injured by other mechanisms. Materials and Methods: During a five-year period (2015–2019), all patients with traumatic spinal injuries who received treatment at a tertiary-level trauma center were categorized into two groups: those injured by falls from height (group 1) and those injured by other modes (group 2). Their medical records were reviewed for analysis. Results: Falls from height (group 1) constituted the predominant cause of TSI, affecting 51.8% (1069/2065) of spine trauma patients. The average age in group 1 (44.45 ± 16.76) was significantly higher than in group 2 (42.33 ± 15.81) (P = 0.003). In group 1, the most common level of injury was the lumbar spine (48.6%, n = 520), whereas in group 2, it was the cervical spine (48%, n = 478). Multiple levels of injury were more common in group 1 than in group 2 (25.2% vs. 19.2%, P = 0.002). The most common type of spine injury was AO type B in group 1 (35.43%, n = 377) and AO type C in group 2 (32%, n = 319). Other associated organ system injuries were significantly higher in group 2 than in group 1 (P < 0.05), except for pelvic injuries. Additionally, spinal injury-related complications were higher in group 2 (16.7%) than in group 1 (11.6%) (P = 0.001). The length of hospital stay was significantly higher in group 2 (9.71 ± 9.03 days) compared to group 1 (8.09 ± 7.26 days). Conclusion: Our study has revealed significant demographic and epidemiological variances in TSI caused by falls from heights compared to other injury mechanisms. This information is crucial in understanding the mechanism and injury pattern in TSI due to falls from height, as well as for formulating effective management strategies.

Validation of the Subaxial Cervical Spine Injury Classification score in children: a single-institution experience at a level 1 pediatric trauma center.

The Subaxial Cervical Spine Injury Classification (SLIC) score has not been previously validated for a pediatric population. The authors compared the SLIC treatment recommendations for pediatric subaxial cervical spine trauma with real-world pediatric spine surgery practice. A retrospective cohort study at a pediatric level 1 trauma center was conducted in patients < 18 years of age evaluated for trauma from 2012 to 2021. An SLIC score was calculated for each patient, and the subsequent recommendations were compared with actual treatment delivered. Percentage misclassification, sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated. Two hundred forty-three pediatric patients with trauma were included. Twenty-five patients (10.3%) underwent surgery and 218 were managed conservatively. The median SLIC score was 2 (interquartile range = 2). Sixteen patients (6.6%) had an SLIC score of 4, for which either conservative or surgical treatment is recommended; 27 children had an SLIC score ≥ 5, indicating a recommendation for surgical treatment; and 200 children had an SLIC score ≤ 3, indicating a recommendation for conservative treatment. Of the 243 patients, 227 received treatment consistent with SLIC score recommendations (p < 0.001). SLIC sensitivity in determining surgically treated patients was 79.2% and the specificity for accurately determining who underwent conservative treatment was 96.1%. The PPV was 70.3% and the NPV was 97.5%. There was a 5.7% misclassification rate (n = 13) using SLIC. Among patients for whom surgical treatment would be recommended by the SLIC, 29.6% (n = 8) did not undergo surgery; similarly, 2.5% (n = 5) of patients for whom conservative management would be recommended by the SLIC had surgery. The ROC curve for determining treatment received demonstrated excellent discriminative ability, with an AUC of 0.96 (OR 3.12, p < 0.001). Sensitivity decreased when the cohort was split by age (< 10 and ≥ 10 years old) to 0.5 and 0.82, respectively; specificity remained high at 0.98 and 0.94. The SLIC scoring system recommended similar treatment when compared with the actual treatment delivered for traumatic subaxial cervical spine injuries in children, with a low misclassification rate and a specificity of 96%. These findings demonstrate that the SLIC can be useful in guiding treatment for pediatric patients with subaxial cervical spine injuries. Further investigation into the score in young children (< 10 years) using a multicenter cohort is warranted.

Patterns of Spine Cases in a New Neurosurgery Centre in Southeast Nigeria

Background: The Imo State Specialist Hospital (IMSSH) commenced neurosurgical services in April 2021 and spine procedures in August 2021. The activities of the hospital with respect to surgical management of spine pathologies were audited. Aims: Our aims were to look at the pattern of spinal pathologies surgically managed in the hospital including their age and sex distribution, the pathologies and procedures performed as well as immediate post operative outcomes. Methods: The case files of all spine patients who had surgical procedures at IMSSH from August 2021 to April 2023 (21 months) were retrospectively reviewed. Results: Seventy-two spine patients had surgical procedures during the study period (an average of 3 – 4 spine procedures per month). The mean age of patients was 55.4±16.1 years with a male-to-female ratio of 7: 5. The mean age for male patients was 53.86±17.83 years while that of female patients was 57.5±13.2years. The peak age range at presentation was in the 7th (n=23, 31.9%) decade. The highest frequency of procedures was performed in the lumbar/ lumbosacral spine (56.9%), followed by cervical spine (29.1%), and thoracic/thoracolumbar spine (13.8%). Degenerative spine diseases (69.4%) accounted for the highest number of spine cases, followed by spinal trauma (20.8%) and Spinal tumours (6.9%). Mortality in the immediate post-operative period was 6.9% (n=5). Conclusion: The study showed a male preponderance for spinal surgeries among our spine patients, with most cases being of degenerative spine pathology. We hope this would be helpful in formulating policies for the growth of this new Neurosurgical Centre.

Preoperative Opioid Use Increases Postoperative Opioid Demand, but Not Length of Stay After Spine Trauma Surgery

BackgroundPreoperative opioid use has been well-studied in elective spinal surgery and correlated with numerous postoperative complications including increases in immediate postoperative opioid demand (POD), continued opioid use postoperatively, prolonged length of stay (LOS), readmissions, and disability. There is a paucity of data available on the use of preoperative opioids in surgery for spine trauma, possibly because there are minimal options for opioid reduction prior to emergent spinal surgery. Nevertheless, patients with traumatic spinal injuries are at a high risk for adverse postoperative outcomes. This study investigated the effects of preoperative opioid use on POD and LOS in spine trauma patients. Methods130 patients were grouped into two groups for primary comparison: Group 1 (Preoperative Opioid Use, N=16) and Group 2 (No Opioid Use, N=114). Two subgroups of Group 2 were used for secondary analysis against Group 1: Group 3 (No Substance Abuse, N=95) and Group 4 (Other Substance Abuse, N=19). Multivariable analysis was used to determine if there were significant differences in POD and LOS. ResultsPrimary analysis demonstrated that preoperative opioid users required an estimated 97.5 mg/day more opioid medications compared to non-opioid users (p<0.001). Neither primary nor secondary analysis showed a difference in LOS in any of the comparisons. ConclusionsPreoperative opioid users had increased POD compared to non-opioid users and patients abusing other substances, but there was no difference in LOS. We theorize the lack of difference in LOS may be due to the enhanced perioperative recovery protocol used, which has been demonstrated to reduce LOS.

Physiotherapy in the functional capacity of patients with spinal cord injury: evidence of professional performance in the last 10 years

Objective: To identify, through a systematic literature review, the role of Neurofunctional Physiotherapy in assessing the functional capacity of spinal cord injured patients. Methods: The search was coordinated in the SciELO, PubMed, LILACS databases and on the Google Academic platform, selecting articles published in Portuguese, English and Spanish between 2011 and 2021. The PRISMA methodology model was followed and the PEDro scale was used to analyze the articles found. The following instruments were considered and accepted in the review: Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM), Modified Ashworth Scale, Walking Index for Spinal Cord Injury II (WISCI II), Medical Outcomes Study 36 - Item Short - Form Health Survey (SF-36), Berg Balance Scale, Barthel Index and American Spinal Injury Association (ASIA). Results: The score obtained by the PEDro scale ranged from 0 to 10, it was noted that among the studies included in the review, the average obtained was approximately 6.42. Conclusion: Health care for patients with spinal cord trauma is a process for reintegration into the community, as well as a means of providing an emotional boost in order to stimulate the search for and confidence in achieving a satisfactory functional recovery. The articles investigated show the effectiveness of Neurofunctional Physiotherapy in these patients. The number of visits the patient receives seems to be relevant; the more visits the better for their recovery. Keywords: Spinal cord injury; physiotherapy; international classification of functioning; scale; assessment; functional status.

Radiologic Outcomes after Operative Management of Traumatic Spine Fractures: Stand-Alone Posterior Stabilization versus Combined Anteroposterior Approach.

Previous research emphasizes correcting deformities resulting from spine fractures by restoring sagittal alignment and vertebral height. This study aims to compare radiologic outcomes, including sagittal index (SI) and loss of vertebral body height (LVBH), between stand-alone posterior stabilization (group I) and the posteroanterior/combined approach (group II) in the operative management of traumatic thoracic or lumbar spine fractures. In this retrospective single-center study, all patients with traumatic spine fractures (T1-L5) undergoing surgical stabilization between January 1, 2015, and May 31, 2021, were included. Two spine surgeons independently assessed imaging, recording the SI and LVBH values at baseline, after each surgical intervention, and during follow-up (at least 3 months posttreatment). The mean SI and LVBH values between the assessing surgeons were utilized. Linear mixed-effects regression models, adjusted to baseline values, compared the SI and the LVBH values between the two groups. In all, 71 patients (42 men), with the median age of 38 years (interquartile range [IQR]: 28-54) and median follow-up of 4 months (IQR: 3-17), were included. Thirty-two patients were in group I and 39 patients were in group II. Forty fractures included the thoracolumbar junction (T12 or L1), 15 affected the thoracic spine, and 14 the lumbar spine. The regression model revealed superior sagittal alignment in group II, with an adjusted mean difference for SI of -4.24 (95% confidence interval [CI]: -7.13 to -1.36; p = 0.004), and enhanced restoration of vertebral body height with an adjusted mean difference for LVBH of 0.11 in the combined approach (95% CI: 0.02-0.20; p = 0.02). Nine postoperative complications occurred in the entire cohort (4 in group I and 5 in group II). Combined posteroanterior stabilization for spine fractures improves deformities by enhancing sagittal alignment and increasing vertebral body height, with acceptable morbidity compared with the stand-alone posterior approach.

Postoperative opioid consumption patterns diverge between propensity matched patients undergoing traumatic and elective cervical spine fusion

BACKGROUND CONTEXTProlonged opioid therapy following spine surgery is an ongoing postoperative concern. While prior studies have investigated postoperative opioid use patterns in the elective cervical surgery patient population, to our knowledge, opioid use patterns in patients undergoing surgery for traumatic cervical spine injuries have not been elucidated. PURPOSEThe purpose of this study was to compare opioid use and prescription patterns in the postoperative pain management of patients undergoing traumatic and elective cervical spine fusion surgery. STUDY DESIGNRetrospective cohort study. PATIENT SAMPLEAdult patients with traumatic cervical injuries who underwent primary anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) during their initial hospital admission. The propensity matched, control group consisted of adult elective cervical fusion patients who underwent primary ACDF or PCDF. OUTCOME MEASURESDemographic data, surgical characteristics, spinal disease diagnosis, location of cervical injury, procedure type, operative levels fused, and Prescription Drug Monitoring Program (PDMP) data. PDMP data included the number of opioid prescriptions filled, preoperative opioid use, postoperative opioid use, and use of perioperative benzodiazepines, muscle relaxants, or gabapentin. Opioid consumption data was collected in morphine milligram equivalents (MME) and standardized per day. METHODSA 1:1 propensity match was performed to match traumatic injury patients undergoing cervical fusion surgery with elective cervical fusion patients. Traumatic injury patients were matched based on age, sex, CCI, procedure type, and cervical levels fused. Pre- and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use were assessed for the traumatic injury and elective patients. T- or Mann-Whitney U tests were used to compare continuous data and Chi-Squared or Fisher's Exact were used to compare categorical data. Multivariate stepwise regression using MME per day 0 – 30 days following surgery as the dependent outcome was performed to further evaluate associations with postoperative opioid use. RESULTSA total of 48 patients underwent fusion surgery for a traumatic cervical spine injury and 48 elective cervical fusion with complete PDMP data were assessed. Elective patients were found to fill more prescriptions (3.19 vs 0.65, p=.023) and take more morphine milligram equivalents (MME) per day (0.60 vs 0.04, p=.014) within 1 year prior to surgery in comparison to traumatic patients. Elective patients were also more likely to use opioids (29.2% vs 10.4%, p=.040) and take more MMEs per day (0.70 vs 0.05, p=.004) within 30 days prior to surgery. Within 30 days postoperatively, elective patients used opioids more frequently (89.6% vs 52.1%, p<.001) and took more MMEs per day (3.73 vs 1.71, p<.001) than traumatic injury patients. Multivariate stepwise regression demonstrated preoperative opioid use (Estimate: 1.87, p=.013) to be correlated with higher postoperative MME per day within 30 days of surgery. Surgery after traumatic injury was correlated with lower postoperative MME use per day within 30 days of surgery (Estimate: −1.63 p=.022). CONCLUSIONCervical fusion patients with a history of traumatic spine injury consume fewer opioids in the early postoperative period in comparison to elective cervical fusion patients, however both cohorts consumed a similar amount after the initial 30-day postoperative period. Preoperative opioid use was also a risk factor for higher consumption in the short-term postoperative period. These results may aid physicians in further understanding patients’ postoperative care needs based on presenting injury characteristics and highlights the need for enhanced follow-up care for traumatic cervical spine injury patients after fusion surgery.

Diagnostic, Prognostic and Therapeutic Role of MRI in Spinal Trauma

Diagnostic, Prognostic and Therapeutic Role of MRI in Spinal Trauma

Lumbar Total Disc Replacement Leads to Increased Subsequent Facet Injections Compared to Anterolateral Lumbar Interbody Fusions

Study Design Retrospective Matched Cohort. Objective Despite known consequences to the facet joints following lumbar total disc replacement (TDR), there is limited data on facet injection usage for persistent postoperative pain. This study uses real-world data to compare the usage of therapeutic lumbar facet injections as a measure of symptomatic facet arthrosis following single-level, stand-alone TDR vs anterolateral lumbar interbody fusion (ALIF/LLIF). Methods The PearlDiver database was queried for patients (2010-2021) with lumbar degenerative disc disease who received either a single-level, stand-alone TDR or ALIF/LLIF. All patients were followed for ≥2 years and excluded if they had a history of facet injections or spinal trauma, fracture, infection, or neoplasm. The two cohorts were matched 1:1 based on age, sex, insurance, year of operation, and medical comorbidities. The primary outcome was the use of therapeutic lumbar facet injections at 1-, 2-, and 5-year follow-up. Secondary outcomes included subsequent lumbar surgeries and surgical complications. Results After 1:1 matching, each cohort had 1203 patients. Lumbar facet injections occurred significantly more frequently in the TDR group at 1-year (6.07% vs 1.66%, P &lt; .0001), 2-year (8.40% vs 3.74%%, P &lt; .0001), and 5-year (11.47% vs 6.40%, P &lt; .0001) follow-up. 5-year injection-free probability curves demonstrated an 87.1% injection-free rate for TDR vs 92.9% for ALIF/LLIF. There was no clinical difference in the incidence of subsequent lumbar surgeries or complications. Conclusion Compared with ALIF/LLIF, patients who underwent TDR received significantly more facet injections, suggesting a greater progression of symptomatic facet arthrosis. TDR was not protective against reoperations compared to ALIF/LLIF.

Evaluation of traumatic spinal injuries: a pediatric perspective.

The aim of the present study is to provide information about pediatric patients with spinal trauma. A single-center retrospective chart review was carried out. Children who arrived at the pediatric emergency department due to trauma and those with spinal pathology confirmed by radiological assessment were included. Demographics, mechanisms of trauma, clinical findings, radiological investigations, applied treatments, hospital stay and prognosis were recorded. A total of 105 patients [59 (56.2%) boys; mean age: 12.9 ± 3.8years (mean ± SD)] were included. The most common age group was that of 14-18years (58.1%). The three most common trauma mechanisms were road traffic collisions (RTCs) (60.0%), falls (32.4%), and diving into water (2.9%). A fracture of the spine was detected in 97.1% patients, vertebral dislocation in 10.7%, and spinal cord injury in 16.3%. Of the patients, 36.9% were admitted to the ward and 18.4% to the pediatric intensive care unit; 17.1% were discharged with severe complications and 2.9% cases resulted in death. While 34.3% of the patients had a clinically isolated spine injury, the remaining cases entailed an injury to at least one other body part; the most common associated injuries were to the head (39.8%), abdomen (36.1%), and external areas (28.0%). Spinal trauma was found to have occurred mostly in adolescent males, and the majority of those cases were due to RTCs. Data on the incidence and demographic factors of pediatric spinal trauma are crucial in furthering preventive measures, allowing for the identification of at-risk populations and treatment modalities.

Epidemiology of pediatric spinal trauma with neurological deficits in Catalonia: a 36-year experience

Epidemiology of pediatric spinal trauma with neurological deficits in Catalonia: a 36-year experience

Increased incidence of traumatic spinal injury in patients aged 65 years and older in the Netherlands

PurposeThe global population is ageing rapidly. As a result, an increasing number of older patients with traumatic spine injuries are seen in hospitals worldwide. However, it is unknown how the incidence of traumatic spinal injury has developed over the past decade. Therefore, this study aimed to determine the incidence and characteristics of traumatic spinal injury in patients aged under and above 65 years.MethodsDuring three time periods: 2009–2010, 2014–2015 and 2019–2020, all adult patients with traumatic spinal injury in the Netherlands were identified from the Dutch National Trauma Registry. Patient-related characteristics and 1-year mortality were collected from a subgroup of patients treated at a level-1 trauma centre, and patients aged ≥ 65 years were compared to patients aged < 65 years.ResultsIn the Dutch National Trauma Registry 25,737 patients with traumatic spinal injury were identified. The incidence of spine injury in patients > 65 years was 49.5/100,000/yr in 2009–2010, 68.8 in 2014–2015 and 65.9 in 2019–2020. The percentage of patients ≥ 65 years increased from 37% in 2009–2010, to 43% in 2014–2015, and to 47% in 2019–2020. In the subgroup of 1054 patients treated in a level-1 trauma centre, a similar increasing incidence was seen in patients aged ≥ 65 years. In these patients low energy falls were the most common trauma mechanism and the cervical spine was the most commonly injured region. Moreover, patients ≥ 65 years had significantly higher 1-year mortality compared with patients aged < 65 years, 22.7% versus 9.2%.ConclusionThe incidence of traumatic spinal injury in older patients in the Netherlands has increased over the last 12 years. Almost half of the patients with traumatic spinal injury are currently aged ≥ 65 years. The increasing incidence and the high 1-year mortality highlight the need to modify existing treatment protocols for these patients.

Bilateral ultrasound-guided erector spinae plane block for postoperative pain relief in major traumatic spine surgery: A randomized controlled trial.

Spine fixation surgery for traumatic vertebral fractures is associated with severe pain and is often difficult to control. Traditionally systemic opioids have been the mainstay of analgesia for these procedures, which can lead to hyperalgesia, nausea, ileus, sedation, cognitive impairment, dependence, etc., limiting usage of opioids. The Erector spinae plane block (ESPB) is a novel ultrasound-guided procedure with easily identifiable sonoanatomy. We hypothesized that a multimodal approach involving ESPB to a conventional analgesic regimen with local infiltration for patients undergoing major traumatic spine surgeries might provide better perioperative analgesia and reduce the need for postoperative opioid requirements. A randomized control prospective trial was conducted on 34 ASA grade I -II patients aged 18 to 65 years who were scheduled to undergo elective posterior spine fixation surgery with ASIA B to E after traumatic spine fracture under general anesthesia. Patients were randomized to Group A which included patients who received general anesthesia with ESPB, and Group B, or the control group, included patients who received general anesthesia with systemic analgesics and postoperative local infiltration without ESPB. Intraoperative total fentanyl consumption, VAS score at 0, 3, 6, 12, 18, and 24 hours, time to activate patient-controlled analgesia (PCA) pump, total morphine consumption, and opioid-related side effects were monitored and compared in both groups. Postoperative PCA morphine consumption was significantly lower in group A patients who received ESPB than those in the control group (17.06 ± 9.59 vs 37.82 ± 9.88 P value = <0.0001). VAS scores at rest and movement at 0, 3, 6, 9, 12, 18, and 24 hours were significantly lower (P value = 0.05) in the ESPB group compared with the control group at all time points. Bilateral ultrasound-guided Erector spinae plane block, when administered in traumatic spine patients undergoing spine fixation surgery, provides better analgesia with statistically decreased VAS scores and less postoperative opioid requirement.

ABORD ANTEROLATERAL DE LA CHARNIERE THORACO-LOMBAIRE : EXPERIENCE D’UN CAS AVEC CHYLOTHORAX PAR PLAIE IATROGENE DU CANAL THORACIQUE.

Despite its advantages, the anterolateral approach to the thoracolumbar spine can present several complications including chylothorax. We present a rare case of thoracic duct injury secondary to an anterolateral surgical approach to the thoracolumbar spine post-vertebromedullary trauma which was successfully treated non-surgically. Observation: This is a 35-year-old patient, hospitalized for the treatment of a spinal trauma whose radiological assessment revealed a type A3 fracture of the 12th thoracic vertebra according to the Ao-spine classification. He had benefited from a corpectomy of the same vertebra followed by the placement of an interbody implant via an anterolateral approach with thoraco-phrenotomy. The immediate aftermath of the operation was marked by the presence in the chest drain of a white lactescent liquid, the chemical study of which revealed the presence of chylomicrons by electrophoresis, lipoproteins and a triglyceride level of 80 g/l, confirming the diagnosis of chylothorax. Conservative medical treatment was instituted consisting of chest drainage for 3 weeks and parenteral nutrition which allowed complete recovery. Conclusion: Iatrogenic chylothorax represents a rare cause of pleural effusion. This case reflects a successful approach to the management of post-dorsal spine surgery lymph leak via anterolateral approach, using drainage and strict dietary changes, which precluded the need for thoracic duct repair surgery. Keywords: Anterolateral approach, Chylothorax, Conservative treatment,

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

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

A perioperative predictive model of early mortality in acute cervical spinal cord injury: A prospective cohort study

BackgroundTraumatic cervical spine injury is common among spinal cord injury which requires an intensive, multidisciplinary approach which can affect the immediate postoperative hospital survival rate. By identifying the risk factors leading to early mortality in cervical spine trauma patients, the prognosis of patients with TCSCI can be better predicted. ObjectiveThe study aims to analyze the variables influencing in-hospital mortality in cervical spine trauma patients treated at a Level I trauma Center. MethodsProspective study was conducted on subaxial cervical spine injuries from July 2019 to March 2022. Patients were divided into two groups: Group A, with in-hospital mortality, and Group B, who got discharged from hospital, and mortality predictors were reviewed and analyzed for as potential risk factors for in-hospital mortality. ResultsOut of 105 patients, 83.8 % were male with mean age of 40.43 ± 12.62 years. On univariate analysis, AIS (p-value: <0.01), ICU stay (p-value: <0.01), level of injury (p-value: <0.01), and MRI parameters like the extent of Parenchymal damage (p-value: <0.01), MSCC (p-value: <0.01), and MCC (p-value: <0.01) were potential risk factors for in-hospital mortality. On multivariate regression analysis AIS at presentation (p-value: 0.02) was the only significant independent parameter for in-hospital mortality. ConclusionsAIS grading at presentation, duration of ICU stay, level of injury, rate of tracheostomy, and MRI parameters like the extent of parenchymal damage, MCC, and MSCC influence and predicts in-hospital mortality, whereas AIS is the only independent risk factor.

Evaluation and Management of Thoracolumbar Spine Trauma in Pediatric Patients: A Critical Analysis Review.

» Pediatric thoracolumbar trauma, though rare, is an important cause of morbidity and mortality and necessitates early, accurate diagnosis and management.» Obtaining a detailed history and physical examination in the pediatric population can be difficult. Therefore, the threshold for advanced imaging, such as magnetic resonance imaging, is low and should be performed in patients with head injuries, altered mental status, inability to cooperate with examination, and fractures involving more than 1 column of the spine.» The classification of pediatric thoracolumbar trauma is based primarily on adult studies and there is little high-level evidence examining validity and accuracy in pediatric populations.» Injury pattern and neurologic status of the patient are the most important factors when determining whether to proceed with operative management.

Trauma of the spine: Epidemiological aspects and tomodensitometric in Niamey

Introduction: The trauma of spine is a frequent pathology. It is a pathology of young male adults. Medical imaging in particular CT scan is essential in the precise assessment of traumatic bone lesions of the spine. Aim: Study the epidemiological and computed tomography aspects of spine trauma in radiology and medical imaging services at the Niamey National Hospital and the Niamey Reference General Hospital. Materials and methods: This is a retrospective and prospective study about 73 cases collected at Niamey National Hospital and Niamey Reference General Hospital from January 1, 2016 to October 31, 2019. Results: In this study, male sex was largely predominant. The age group 20-30 was the most represented. The cervical and back spinal floors were the most explored. The fracture was the most found lesion. The compact fracture is the most recorded fracture in the vertebral body. The cervical spine was the seat of the majority of fractures. The anterior luxation was notified, and like the fracture, it was mainly located at the level of the cervical spine more precisely at the level of C5-C6. The post-traumatic disc hernia was mainly cervical and the location was majority C5-C6. Note the spinal channel was mostly normal. Conclusion: The trauma of the spine is a frequent pathology which most often affects young male adults. Computed tomography allows a balance of traumatic bone lesions of the spine.

Neurological symptomatology features in patients with spine and spinal cord trauma at the thoracolumbar junction level

Background. Traumatic injuries to the thoracolumbar junction account for over 60 % of all injuries to the thoracolumbar spine. The neurological symptomatology accompanying injuries at this level is characterized by diverse patterns of both motor and sensory dysfunction, which are determined by the topographic-anatomical features of this area. Neurological deficit may be caused by conductive, segmental, and radicular disturbances. The aim of the study is to determine the nature and frequency of neurological disorders in patients with spine and spinal cord trauma at the level of the thoracolumbar junction, depending on the likely substrate of the traumatic impact. Materials and methods. An analysis of the neurological status assessment was conducted in 101 patients who suffered spine and spinal cord trauma at the level of the thoracolumbar junction. The average age of the patients was 41 years (95% confidence interval 36–44). Most patients were male (75.25 %). The number of motor segments with signs of upper and lower motor neuron lesion, and dermatomes with sensory impairment of radicular, segmental, or conductive types were determined. Results. It was found that 83.5 % of motor segments with dysfunction had clinical signs of lower motor neuron lesion, 41.3 % of dermatomes with sensory impairment had traumatic root damage, 57.9 % of dermatomes showed impairments of a segmental type, and 28.9 % were of a conductive type. Conclusions. The data obtained indicate a significant role of segmental disturbances in forming the symptoms in patients with spine and spinal cord trauma at the level of the thoracolumbar junction.

Clinical characteristics and molecular mechanisms underlying bladder cancer in individuals with spinal cord injury: a systematic review

BackgroundPatients with spinal cord injury have a relatively high risk for bladder cancer and often complicated with bladder cancer in advanced stages, and the degree of aggressiveness of malignancy is high. Most of the literature is based on disease clinical features while, our study reviews the clinical characteristics and molecular mechanisms of spinal cord injury patients with bladder cancer, so that it might help clinicians better recognize and manage these patients.MethodWe searched PubMed, Web of Science and Embase, using retrieval type like (“Neurogenic Lower Urinary Tract Dysfunction” OR “Spinal cord injury” OR “Spinal Cord Trauma”) AND (“bladder cancer” OR “bladder neoplasm” OR “bladder carcinoma” OR “Urinary Bladder Neoplasms” OR “Bladder Tumor”). In Web of Science, the retrieval type was searched as “Topic”, and in PubMed and Embase, as “All Field”. The methodological quality of eligible studies and their risk of bias were assessed using the Newcastle-Ottawa scale. This article is registered in PROSPERO with the CBD number: CRD42024508514.ResultIn WOS, we searched 219 related papers, in PubMed, 122 and in Embase, 363. Thus, a total of 254 articles were included after passing the screening, within a time range between 1960 and 2023. A comprehensive analysis of the data showed that the mortality and incidence rates of bladder cancer in spinal cord injury patients were higher than that of the general population, and the most frequent pathological type was squamous cell carcinoma. In parallel to long-term urinary tract infection and indwelling catheterization, the role of molecules such as NO, MiR 1949 and Rb 1. was found to be crucial pathogenetically.ConclusionThis review highlights the risk of bladder cancer in SCI patients, comprehensively addressing the clinical characteristics and related molecular mechanisms. However, given that there are few studies on the molecular mechanisms of bladder cancer in spinal cord injury, further research is needed to expand the understanding of the disease.