Spinal Trauma Research Articles

A Critical Appraisal of the Congress of Neurological Surgeons Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma.

Background and objective Thoracolumbar spine trauma (TST) is frequently associated with spinal cord injury and other soft tissue and bony injuries.The management of such injuries requires an evidence-based approach. This study used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to assess the methodological quality of clinical guidelines for the management of TST published by the Congress of Neurological Surgeons (CNS). Methods All clinical guidelines on TST published by CNS until 2020 were assessed. Five appraisers from three international centers evaluated the quality of eligible clinical guidelines by using AGREE II. Mean AGREE II scores for each domain were determined. In higher-quality domains, the scores for individual items were analyzed. Results A total of 12 guidelines published by CNSon TST were assessed. Mean scores for all six domains were as follows: Scope and Purpose (75.2%), Stakeholder Involvement (45.4%), Rigor of Development (57.0%), Clarity of Presentation (58.7%), Applicability (16.9%), and Editorial Independence (64.1%). The mean score for the overall quality of all CNS guidelines was 52.9% [95% confidence interval (CI): 52.2-53.5%]. The overall agreement among appraisers was excellent [intra-class correlation coefficients (ICCs) for each guideline ranged from 0.903 to 0.963]. Conclusions CNS guidelines for the management of TST demonstrated acceptable quality across most domains; however, the domains of Applicability and Stakeholder Involvement could befurther improved in future guideline updates. The assessors concluded that all guidelines could still be recommended for clinical practice with or without modifications.

Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border.

This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.-Mexico border and were subsequently admitted. A total of 448 patients were identified. Of the 448 patients, 117 (26.2%) had spine injuries and 39 (33.3%) underwent operative fixation. Females had a significantly higher incidence of spine injuries (60% vs. 40%; p < 0.00330). Patients with a spine fracture fell from a higher median fall height (6.1 vs. 4.6 m; p < 0.001), which resulted in longer median length of stay (LOS; 12 vs. 7 days; p < 0.001), greater median Injury Severity Score (ISS; 20 vs. 9; p < 0.001), and greater relative risk (RR) of ISS >15 (RR = 3.2; p < 0.001). Patients with operative spine injuries had significantly longer median intensive care unit (ICU) LOS than patients with non-operative spine injuries (4 vs. 2 days; p < 0.001). Patients with spinal cord injuries and ISS >15 sustained falls from a higher distance (median 6.1 vs. 5.5 m) and had a longer length of ICU stay (median 3 vs. 0 days). All patients with operative spine injuries had an ISS >15 relative to 50% of patients with non-operative spine injuries (median ISS 20 vs. 15; p < 0.001). Patients with spine trauma requiring surgery had a higher incidence of head (RR = 3.5; p 0.0353) and chest injuries (RR = 6.0; p = 0.0238), but a lower incidence of lower extremity injuries (RR = 0.5; p < 0.001). Thoracolumbar injuries occurred in 68.4% of all patients with spine injuries. Patients with operative spine injuries had a higher incidence of burst fracture (RR = 15.5; p < 0.001) and flexion-distraction injury (RR = 25.7; p = 0.0257). All patients with non-operative spine injuries had American Spinal Injury Association (ASIA) D or E presentations, and patients with operative spine injuries had a higher incidence of spinal cord injury: ASIA D or lower at time of presentation (RR = 6.3; p < 0.001). Falls from walls in border crossings result in significant injuries to the head, spine, long bones, and body, resulting in polytrauma casualties. Falls from higher height were associated with a higher frequency and severity of spinal injuries, greater ISS, and longer ICU length of stay. Operative spine injuries, compared with non-operative spine injuries, had longer ICU length of stay, greater ISS, and different fracture morphology. Spine surgeons and neurocritical care teams should be prepared to care for injuries associated with falls from height in this unique population.

Vertebral Artery Injury in Cervical Spine Fracture Dislocation: An Observational Study in a Tertiary Care Center.

The incidence of traumatic vertebral artery injury (VAI) associated with cervical spine trauma varies widely in published trauma series. The primary aim of this study was to determine the incidence of traumatic VAIin patients who suffered cervical spine injuries by means of routine magnetic resonance imaging, and the secondary objective was to identify any associations with injury mechanism, level ofinjury, and neurologic injury severity. Materials and methods: A retrospective review was conducted on 96 patients who suffered cervical spine fracture dislocation with or without an associated spinal cord injury (SCI) in Indian Spinal Injuries Center (ISIC), New Delhi, Indiafrom January 2013 to April 2023. Cervical magnetic resonance imaging (MRI) was used to diagnose VAI. Patient's age, sex, cervical injury level, mechanism of injury, neurologic level of injury, association with foraminal fracture, facet dislocation,and clinical sequelae of vertebral artery injury were analyzed. In this study, of 96 patients who met the inclusion criteria, 18 patients (18.75%) had VAI on the MRI study. Thirteen (72.22%) of the eighteen patients had right-sided injuries, four (22.22%) had left-sided injuries, and one (5.55%) had bilateral injuries. There was an associated SCI in every VAI patient. VAI was significantly more common in patients who had ASIA A (61%, n = 11) and ASIA B (22%, n = 4)injuries, and no VAI was noted in neurologically intact patients (p<0.001). The incidence of VAI was higher in the flexion distraction type of injury (n = 12, 66%).The most commonly involved cervical spine injury level was C5-C6 (27%, n = 5), followed by 22% (n = 4) at C4-C5 and C6-C7 levels. About 27.8% (n = 5) of VAI was associated with foraminal fractures, and 72% (n = 13) of VAI was associated with facet dislocations, of which 44% (n = 8) were bifacetal and 28% (n = 5) were unifacetal dislocations. On clinical symptoms, only one (5.56%) patient had a headache, and 17 (94.4%) had no clinical features due to VAI. The incidence of traumatic vertebral artery disease is not very uncommon and requires careful and meticulous screening and management. Otherwise, complications like pseudoaneurysm, neurologic deficit, late-onset hemorrhage, infarction, and death can happen. Mostly, it is associated with high-velocity injuries and neurological injuries. MRI can be used as a good screening tool, which can be aided by a CT angiogram or digital subtraction angiographyfor confirmation. Proper pre-operative evaluation of vascular injury in cervical spine fracture dislocation is very important for patient counseling, patient management, and surgical planning.

Epidemiology of Spinal Trauma and Related Complication.

Traumatic spinal injury is leading cause of mortality and morbidity among the people of productive age group. This study aim to find the cause of spinal injury, site ,and mode of injury, treatment option given so that a preventive measures and create awareness among people of this region. This is a prospective observation study done in Karnali Academy of Health Sciences from December 2021 to January 2023. Performa was filled to collect data. Data were entered in excel sheet and transported to SPSS 16.0 and statistical analysis was done . Out of 117 patients male population had higher incidence of spinal trauma (69.2%) with average age 43.9 years . Fall injury was the commonest mode of injury. 65.8% had injury at the thoracolumbar junction followed by lumbar, thoracic and cervical respectively. Cervical injury patients had higher incidence of neurological deficit. The average duration of trauma to hospital presentation was 10.9±11.2 hours. 19.7 % were operated and 6.8 % of patients were referred to other center. Fall injury being the commonest mode of injury in this art of world, prevention and awareness should be raised about the spinal trauma and its consequences. Adequate equipment with health facilities to the distant hospital may reduce the referral rate and duration of presentation to the hospital which ultimately prevent the further damage to the cord.

Pediatric neurosurgery in Ukraine in 2001-2020. Availability, workforce, performance indicators

Objective: to analyze the development dynamics of pediatric neurosurgical care in Ukraine in 2001-2020. Materials and methods. The number of pediatric neurosurgical beds, pediatric neurosurgeons, hospitalization rates and surgical treatment of children in neurosurgical departments of Ukraine in 2001‒2020 were analyzed. Data for the years 2014-2020 were unavailable for departments located in temporarily non-government-controlled territories. Results. In 2020, there were 22 pediatric neurosurgery departments in Ukraine, with a total of 290 pediatric neurosurgical beds, representing a 26.6% increase compared to 2001. Pediatric neurosurgical departments or pediatric units with neurosurgical beds were operational in almost all regions. The distribution of pediatric neurosurgical beds in Ukraine did not statistically differ from countries with high-income levels (p=0.9987). The increased number of beds contributed to more than doubling the provision of neurosurgical beds per child population. In 2001, there were 17 beds per 1 million children, compared to 38 beds in 2020. In 2020, the number of pediatric neurosurgeons in Ukraine doubled compared to 2001 reaching 58 in 2020 (9.2% of the total number of neurosurgeons in Ukraine and 2.5% of the total number of pediatric neurosurgeons globally). The provision of pediatric neurosurgeons in Ukraine increased more than threefold from 2001 to 2020, reaching 7.7 per 1 million children, meeting the Ministry of Health of Ukraine's standard (7.5). Consequently, the workload per pediatric neurosurgeon decreased almost fourfold, with one specialist per 129,895 children. In 2020, the number of children hospitalized in neurosurgical departments was 9,045, operated on ‒ 3,144, representing a 15.8% decrease and a 3.3% increase, respectively compared to 2001. Per 1 million child population, the hospitalization rate increased by 53, 8% (1201 and 781), the surgery rate increased by 88.7% (417 and 221).Despite the decrease in the number of operated patients over 20 years, surgical activity in neurosurgical institutions of the country increased from 28.3% in 2001 to 34.8% in 2020 (by 23%), postoperative lethality during this period decreased from 2,1 to 1.0% (by 52%).Significant fluctuations in hospital morbidity (HM) rate of children for general neurosurgical pathology and its individual types were recorded during the studied period. In 2020, an increase in these indicators was noted compared to 2001: HM for pediatric neurosurgical pathology in general increased by 53.7% (from 781 to 1,201 cases per 1 million child population), for acute craniocerebral trauma - by 17,5% (from 595 to 699), for hydrocephalus - 5.1 times (from 29 to 149), for neuro-oncological diseases - 3.2 times (from 31 to 100), for congenital anomalies of the nervous system - 4 times ( from 15 to 60), for vascular lesions of the nervous system - 5.1 times (from 5 to 26), for acute spinal trauma - twice (from 9 to 18). Conclusions. Ukraine is a country with high availability of pediatric neurosurgical care. Over the past 20 years, there has been an increase in the provision of pediatric neurosurgery beds and pediatric neurosurgeons. In the first 13 years of the 21st century the trend towards a significant increase in both absolute and relative rates of hospitalization and surgery for children with neurosurgical pathology in subsequent years as a result of the annexation of Crimea, military actions in Donbas and the coronavirus epidemic has changed to a trend towards a decrease in these rates. However, in general, only the absolute number of hospitalized children decreased over 20 years, while the absolute number of operated on and the level of hospitalization and operated on increased. Surgical activity also increased accompanied by a decrease in postoperative lethality.

Review of the guide for doctors by M.A. Kislov “Forensic neuropathology. Craniocerebral and spinal trauma”

The author reviews the scientific and practical publication prepared by the Doctor of Medical Sciences, associate Professor M.A. Kislov, titled “Forensic neuropathology. Craniocerebral and spinal injury.”&#x0D; The manual contains a detailed and accurate analysis of the pathological, physical, biochemical, and molecular genetic processes involved in nervous system disorders in cases of head and cervical spinal column injuries.&#x0D; The scientific work is a timely review of the latest achievements in the field of clinical and forensic neuropathology.&#x0D; This publication is recommended to doctors of forensic medical experts, pathologists, neuropathologists, neurosurgeons, and doctors of other specialties interested in and dealing with central nervous system disorders of traumatic genesis.

Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study.

Trauma to the thoracic, thoracolumbar (TL), and lumbar spine is common and can cause disability and neurological deficits. Using a cohort of patients suffering from thoracic, TL, and lumbar spine trauma in a tertiary hospital in East Africa, the current study sought to: (1) describe demographics and operative treatment patterns, (2) assess neurologic outcomes, and (3) report predictors associated with undergoing surgery, neurologic improvement, and mortality. A retrospective cohort study of patient records from September 2016 to December 2020 was conducted at a prominent East Africa referral center. The study collected data on demographics, injury, and operative characteristics. Surgical indications were assessed using the AO (Arbeitsgemeinschaft für Osteosynthesefragen) TL fracture classification system and neurological function. Logistic regression analysis identified predictors for operative treatment, neurologic improvement, and mortality. The study showed that 64.9% of the 257 TL spine trauma patients underwent surgery with a median postadmission day of 17.0. The mortality rate was 1.2%. Road traffic accidents caused 43.6% of the injuries. The most common fracture pattern was AO Type A fractures (78.6%). Laminectomy and posterolateral fusion were performed in 97.6% of the surgical cases. Patients without neurological deficits (OR: 0.27, 95% CI: 0.13-0.54, P < 0.001) and those with longer delays from injury to admission were less likely to have surgery (OR: 0.95, 95% CI: 0.92-0.99, P = 0.007). The neurologic improvement rate was 11.1%. Univariate analysis showed a significant association between surgery and neurologic improvement (OR: 3.83, 95% CI: 1.27-16.61, P < 0.001). However, this finding was lost in multivariate regression. This study highlights various themes surrounding the management of TL spine trauma in a low-resource environment, including lower surgery rates, delays from admission to surgery, safe surgery with low mortality, and the potential for surgery to lead to neurologic improvement. Despite challenges such as surgical delays and limited resources in East Africa, there is potential for surgical intervention to improve neurologic outcomes in thoracic, TL, and lumbar spine trauma patients.

Effect on functional outcome of robotic assisted rehabilitation versus conventional rehabilitation in patients with complete spinal cord injury: a prospective comparative study.

Prospective Comparative Study. This study aims to compare the functional outcomes of Robotic-assisted rehabilitation by Lokomat system Vs. Conventional rehabilitation in participants with Dorsolumbar complete spinal cord injury (SCI). University level teaching hospital in a hilly state of northern India. 15 participants with Dorsolumbar SCI with ASIA A neurology were allocated to robotic rehabilitation and 15 participants to conventional rehabilitation after an operative procedure. Pre-and Post-rehabilitation parameters were noted in terms of ASIA Neurology, Motor and sensory function scores, WISCI II score (Walking Index in SCI score), LEMS (Lower Extremity Motor Score), SCI M III score (Spinal Cord Independence Measure III score), AO Spine PROST (AO Patient Reported Outcome Spine Trauma), McGill QOL score (Mc Gill Quality of Life score), VAS score (Visual Analogue Scale) for pain and Modified Ashworth scale for spasticity in lower limbs. On comparing robotic group with conventional group there was a statistically significant improvement in Robotic-assisted rehabilitation group in terms of Motor score (p = 0.034), WISCI II score (p = 0.0001), SCIM III score (p = 0.0001), AO PROST score (p = 0.0001), Mc GILL QOL score (p = 0.0001), Max velocity (p = 0.0001) and Step length (p = 0.0001). Whereas LEMS score (p = 0.052), ASIA neurology (p = 0.264 (ASIA A); 1.000 (ASIA B); 0.053 (ASIA C)), VAS score (p = 0.099), Sensory score (p = 0.422) and Modified Ashworth scale for spasticity (p = 0.136) were not statically significant when comparing between two groups. Robot-assisted rehabilitation is superior than conventional rehabilitation in people living with SCI with AIS A neurology. Differences in the patient group, type of a lesion its and severity, duration from onset to initiation of rehabilitation, devices employed, administration of the therapies and regulation of interventions are likely the cause of variations in the findings seen in the literature for robotic assisted training. III.

Türkiye’de Doğu Anadolu bölgesinde spinal travmaların tanımlayıcı özellikleri: 3 yıllık retrospektif analiz.

Purpose: &#x0D; Understanding the descriptive characteristics of traumatic spinal injuries such as etiology, epidemiology, mortality and their associations with mortality may facilitate the diagnosis and management of spinal traumas. Moreover, its incidence can be reduced through eliminating preventable causes. The present study aimed to assess the descriptive characteristics of spinal traumas and the conditions associated with mortality in our country.&#x0D; Materials and methods:&#x0D; Our study was conducted retrospectively in the emergency service of a tertiary care hospital. Data of patients visiting to our hospital’s emergency room between 2020 and 2023 with spinal trauma, were obtained from the hospital information management system by scanning electronic patient records for inclusion in the study.&#x0D; Results:&#x0D; A total of 1835 patients were included in our study, of which 427 (23.3%) were female and 1408 (76.7%) were male. The most common complaint of the included patients who presented to the emergency room was observed as falls (n꞊1112). 52.8% (n=968) of those patients with special traumas had other concomitant injury. 3.7% (n=68) of the included patients resulted in death.&#x0D; Conclusion:&#x0D; Falls are the most common cause of special traumas in our country and concomitant head trauma and thoracic trauma are closely associated with mortality. While men are more frequently presented to the emergency room with special trauma, there has been no difference between both sexes in terms of mortality rate. Moreover, the most common vertebral fractures after spinal trauma occur in the parts of the corpus and spinous processes of the lumbar vertebrae.

Development of a Novel Risk Stratification Score to Predict 30-Day Mortality in Cervical Trauma Patients: CLAAD Score.

Case control. Traumatic cervical spine injuries are associated with a substantial risk of mortality. The aim of this study is to develop a novel mortality prediction model for patients with cervical trauma who require operative treatment. Patients with cervical spine trauma have a high risk of postoperative complications and mortality. There are few reliable systems that can accurately predict mortality after surgery for cervical spine trauma, and those that do exist are typically not specific to cervical trauma. The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients undergoing surgery for cervical spine trauma. Univariate analyses were performed to identify variables associated with mortality. Variables that were found to be significant in the univariate models were compiled into a multivariable model. The final model was compared with the American Society of Anesthesiologists (ASA), a modified Charlson comorbidity index (mCCI), and the 5-factor modified frailty index (mFI-5) in respect to predicting 30-day mortality after cervical trauma. The score was then externally validated using the Nationwide Inpatient Sample (NIS) database. Fifty-five (6.7%) of 822 patients did not survive 30 days after surgery. The final multivariable logistic regression model consisted of the following variables: circumferential fusion "C." long "L" fusion (more than 4 levels), anemia "A," age over 60 "A," and dialysis "D." The risk of mortality increased with increasing CLAAD score, with mortality rates of 0.9%, 3.1%, 7.4%, 22.7%, and 14.3% for scores of 0, 1, 2, 3, and 4, respectively. The CLAAD model had an AUC of 0.73 for predicting mortality after cervical trauma. The CLAAD score is a simple and effective system that can help identify patients at risk of increased mortality within 30 days of cervical trauma. Level III.

Care needs of adults with spinal trauma in the prehospital and hospital setting from the perspective of patient care team: A qualitative research.

Appropriate care of patients with definite spinal cord injury or at risk of it in the prehospital and hospital stages requires comprehensive planning in the health system. It is also the requirement of any successful program to explain the needs from the perspective of its stakeholders. Thus, this study aimed to discover the care needs of adults with spinal trauma in prehospital and hospital settings from the perspective of the patient care team. This qualitative study was conducted with the participation of urban and rural prehospital emergency personnel and emergency departments of educational and therapeutic hospitals affiliated to Isfahan, Tehran, Shiraz, Kermanshah, Ahvaz, and Yasuj Universities of Medical Sciences, through conducting 36 in-depth semi-structured interviews from September to December 2021. Using purposive sampling method, the participants were selected considering the maximum variation. The data saturation was reached after conducting interviews and group discussions with 36 subjects. Data were analyzed using conventional content analysis approach. Lundman and Graneheim approach were used for the study rigour. Data were simultaneously analyzed using MAXQDA software version 10. During the data analysis, two themes of prehospital care with two main categories (emergency care and management of secondary complications of spinal trauma) and hospital care with two main categories (emergency care and management of secondary complications of spinal trauma) emerged. Emergency care and management of secondary complications of spinal cord injury in the prehospital and hospital stages can affect treatment results, improve quality of life, and reduce mortality rate, secondary injuries, and healthcare costs. Thus, identification of the care needs of the adults with spinal trauma from the perspective of the patient care team can help the authorities to plan appropriate interventions.

Does the use of tranexamic acid intraoperatively reduce postoperative blood loss and complications following biportal endoscopic lumbosacral decompression?

Biportal endoscopic spine surgery is an effective minimally invasive technique for treating common lumbar pathologies. We aim to evaluate the impact of intraoperative tranexamic acid (TXA) use on postoperative blood loss in biportal endoscopic decompression surgery. Patients undergoing biportal endoscopic lumbar discectomies and decompressions either by same day surgery or overnight stay at a single institution beginning in October 2021 were prospectively enrolled. This study was non-randomized, non-blinded with the first cohort of consecutive patients receiving 1 g of intravenous TXA intra-operatively before closure and the second cohort of consecutive patients receiving no TXA. Exclusion criteria included any revision surgery, any surgery for the diagnosis of spinal instability, infection, tumor, or trauma, any contraindication for TXA. Eighty-four patients were included in the study, with 45 (54%) receiving TXA and 39 (46%) not receiving TXA. Median follow-up was 168 days [interquartile range (IQR), 85-368 days]. There were no differences in patient or surgical characteristics between cohorts. Estimated blood loss (EBL) was similar (P=0.20), while post-operative drain output was significantly lower in the TXA cohort (P=0.0028). Single level discectomies had significantly less drain output as compared to 2 level unilateral laminotomy, bilateral decompression (ULBD) cases (P<0.005). Post-operative complications were similar, with low rates of wound complication (1.2%) and transient postoperative weakness (2.4%, P>0.99 for both). Oswestry disability index (ODI), visual analog scale (VAS) back and VAS leg scores decreased significantly; the absolute decrease in scores did not differ between groups (P=0.71, 0.22, 0.86, respectively). Systemic intraoperative TXA administration is associated with a significant decrease in post-operative blood loss in biportal spinal endoscopy, with no impact on the improvement in patient-reported outcomes (PROs) or rate of post-operative complications. Single level biportal discectomies had significantly less postoperative drainage with TXA and may not need drains postoperatively. Larger, randomized studies are necessary to evaluate the cost-effectiveness of TXA use in biportal spinal endoscopy.

Motor Recovery after Spinal Cord Trauma and Effect of Local Hypothermia in a Porcine Experimental Model

Abstract This study was aimed to assess the therapeutic potential (expressed by improvement of pelvic extremities motor functions) of a 5-hour local application of hypothermia with cold saline (4 °C), or saline at room temperature (≈ 24 °C) conveyed via perfusion chamber placed epidurally over the epicenter of spinal cord lesion in minipigs paraplegic due to acute spinal cord injuries (SCIs) inflicted through L3 laminectomy with the force of 8N, 15N, or 18N by a computer operated contusion apparatus. Eighteen 5–8-month-old minipigs (Göttingen-Minnesota-Liběchov crossbreed strains weighing 28–35 kg) were randomly divided into 6 subgroups (each containing three animals) another 3 minipigs were added as sham controls. To evaluate the pelvic extremities motor recovery was used the porcine 20-point neurological scale. Regular evaluations of motor scores showed gradual spontaneous recovery of this parameter in all experimental animals, however, the best results achieved minipigs after SCI inflicted by 8N impacts. The data achieved in the study suggest that local application of therapeutic hypothermia (TH) is well tolerated and may improve functional outcomes after SCI. Further experimental and preclinical studies in different SCI animal models are required before the introduction of the method in healthcare practice.

Finite element analysis of different pedicle screw internal fixations for first lumbar vertebral fracture in different sports conditions.

Lumbar fractures are the most common spinal injuries, and surgery is required for severe fracture. This study aimed to investigate the variations in motion and stress in varying states of activity after minimally invasive and traditional open pedicle screw placement for L1 vertebral fracture stabilization. We studied a male volunteer (26 years old) with no history of chronic back pain or lumbar spine trauma. We used the finite element method for this investigation. Using finite element software, we created a three-dimensional model of L1 vertebral compression fracture. We also constructed models for four percutaneous pedicle screws spanning the fractured vertebra and four screws traversing the damaged vertebra with transverse fixation. In all three-dimensional movement directions, the open pedicle fixation system experienced maximum stress higher than its percutaneous counterpart. With axial spinal rotation, von Mises stress on the traditional open pedicle screw was considerably lower than that with percutaneous pedicle fixation, but peak stress was elevated at the transverse connection. Traditional open pedicle fixation displayed less maximum displacement than percutaneous pedicle internal fixation. During axial spinal movements, high peak stress is observed at the transverse connection. Patients should avoid excessive axial rotation of the spine during recovery.

Spinal Cord Termination and Lumbar Puncture Safety in Spinal Deformities.

Background Lumbar puncture, a common diagnostic and therapeutic procedure, is performed regardless of individual spinal alignment variations. However, the impact of kyphosis, scoliosis, and kyphoscoliosis on spinal cord termination level and lumbar puncture safety remains unclear. Objectives This study aimed to determine if the termination level of the spinal cord is differentin individuals with spinal deformities and to assessthe necessity of routine neuroimaging for safe lumbar puncture localization. Study design and settings This single-center retrospective study was conducted at a university hospital using patients' electronic medical records. The study was focused on patients diagnosed with kyphosis, scoliosis, or kyphoscoliosis using spinal magnetic resonance imaging from January 2010 to December 2022. Participants We evaluated 240 patients: 120 with diagnosed spinal deformities (kyphosis, scoliosis, or kyphoscoliosis) and 120 without deformities, categorized by sex (deformed: 92 females, 28 males; non-deformed: 72 females, 48 males). Patients with spinal trauma, bleeding, or tumors were excluded. Results No statistically significant correlation was found between spinal deformities and spinal cord termination, with L1 remaining the most common endpoint in all groups. Conclusion Routine neuroimaging prior to lumbar puncture in patients with spinal deformities was not associated with a safer procedure due to no observed impact on the termination level of the spinal cord.

Evaluating the Therapeutic Efficacy of L-Lysine Aescinat Supplementation on Neurological Outcomes in Patients with Spinal Fractures and Traumatic Spine Injuries: A Prospective Cohort Study from Tbilisi, Georgia

This prospective study aimed to comprehensively investigate the impact of L-Lysine aescinat supplementation on the neurological outcomes of patients recovering from spinal fractures and traumatic spine injuries. A total of 32 patients were recruited and categorised into two groups: Group A (n=16), receiving L-Lysine aescinat supplementation, and Group B (N=16), serving as the control group without L-Lysine aescinat administration. The primary objective was to assess changes in the Karnofsky performance scale, a functional and well-being neurological assessment tool especially for those undergoing operations or with chronic illness, over a follow up period of one month in order to determine if L-Lysine aescinat had an immediate effect on recovery in the post-operative period. Urinary dysfunction was noted, alongside the location of the fracture, type of surgery and if there were any significant comorbidities.

Validation of the AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting

PurposeTo evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting.MethodsPatients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center. Two separate questionnaires were administered at baseline, 6-months and 1-year: one to surgeons (mainly CROST) and another to patients (AO Spine PROST—Patient Reported Outcome Spine Trauma). Descriptive statistics were used to analyze patient characteristics and feasibility, Cronbach’s α for internal consistency. Inter-rater reliability through exact agreement, Kappa statistics and Intraclass Correlation Coefficient (ICC). Prospective analysis, and relationships between CROST and PROST were explored through descriptive statistics and Spearman correlations.ResultsIn total, 92 patients were included. CROST showed excellent feasibility results. Internal consistency (α = 0.58–0.70) and reliability (ICC = 0.52 and 0.55) were moderate. Mean total scores between surgeons only differed 0.2–0.9 with exact agreement 48.9–57.6%. Exact agreement per CROST item showed good results (73.9–98.9%). Kappa statistics revealed moderate agreement for most CROST items. In the prospective analysis a trend was only seen when no concerns at all were expressed by the surgeon (CROST = 0), and moderate to strong positive Spearman correlations were found between CROST at baseline and the scores at follow-up (rs = 0.41–0.64). Comparing the CROST with PROST showed no specific association, nor any Spearman correlations (rs = −0.33–0.07).ConclusionsThe AO Spine CROST showed moderate validity in a true clinical setting including patients from the daily clinical practice.

Concomitant traumatic brain injury as a determinant of survival, and neurological and functional outcomes after traumatic spinal cord injury: A retrospective cohort study.

Although concomitant traumatic brain injury (TBI) is not infrequently associated with spinal cord injury (SCI), there is relatively scarce information about the effects of concomitant TBI on outcomes after SCI. To assess the impact of concomitant mild-to-moderate TBI on survival, and neurological and functional outcomes within the first year after acute traumatic SCI. Retrospective cohort study. Acute spine trauma centers in the United States. This study includes all individuals who were enrolled into the Third National Spinal Cord Injury Study (NASCIS-3). The study population was classified into SCI + TBI group and SCI-alone group. TBI was defined as a Glasgow Coma Scale score <15 on admission. Not applicable. Both groups were compared regarding their survival and neurological outcomes (ie, NASCIS motor, sensory and pain scores) and functional outcome (ie, Functional Independence Measure score) within the first year following SCI. Data analyses were adjusted for major potential confounders. There were 413 individuals in the SCI-alone group and 86 individuals in the SCI + TBI group (17.2%). Both groups were comparable regarding gender distribution (p = .621). However, the SCI + TBI group was older (p < .001), had a higher proportion of complete (p = .006) and cervical SCI (p = .003), and had a higher blood alcohol level (p < .001) than the SCI-alone group. The SCI + TBI group did not significantly differ from the SCI-alone group regarding survival within the first year after SCI (p = .768). Among the survivors, concomitant mild-to-moderate TBI did not significantly affect neurological and functional outcomes at 1 year after SCI in the multiple regression analyses after adjusting for major potential confounders. The results of this study suggest that concomitant mild-to-moderate TBI did not have a significant impact on survival, neurological recovery, and functional outcomes at 1 year after SCI, even though there were some epidemiological differences between SCI-alone and SCI + TBI groups.

Returning to Work After Traumatic Spine Fractures: Current Status in a Military Hospital.

The consequences of traumatic spine fracture (TSF) are complex and have a major burden on patients' social life and financial status. In this study, we aimed to investigate the return to work (RTW) after surgically treated TSFs, develop eventual predictors of delayed or failure to RTW, and assess narcotics use following such injuries. This was a single-center retrospective cohort study that was performed in a tertiary care center. TSF patients who required surgical intervention from 2016 to 2021 were enrolled. Demographic, operative, and complication data, as well as narcotics use, were recorded. RTW was modeled using multivariate logistic regression analysis. Within the 173 patients with TSF, male patients accounted for 82.7%, and motor vehicle accidents were the most common mechanism of injury (80.2%). Neurologically intact patients represented 59%. Only 38.15% returned to work after their injury. Majority of the patients didn't use narcotics more than 1 week after discharge (93.1%). High surgical blood loss, operation time, and hospital length of stay were significantly associated with not returning to work. In multivariant regression analysis, every increase of 100 ml of surgical blood loss was found to decrease the chance of RTW by 25% (P = 0.04). Furthermore, every increase of one hour in operation time decreases the chance of RTW by 31% (P = 0.03). RTW is an important aspect that needs to be taken into consideration by health care providers. We found that age and high surgery time, blood loss, and hospital stay are significantly impacting patients' RTW after operated TSF.

ROLE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF SPINAL CORD LESIONS IN A TERTIARY CARE HOSPITAL, HYDERABAD

Background: Using other imaging modalities, subtle bone marrow, soft tissue, and spinal cord abnormalities, which may not be apparent, can be readily detected on magnetic resonance imaging (MRI). Prompt and accurate diagnosis, expeditious management, and avoidance of unnecessary procedures are achieved by early detection. Aim: The aim is to study the role of MRI in diagnosing spinal cord lesions. Methods: This study was conducted during the period from November 2018 to November 2020 and it is a prospective descriptive study of 50 patients who were referred to the Department of Radiodiagnosis Osmania General Hospital and MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana. Results: In the present study of 50 cases, different spinal cord lesions were found. The most common spinal cord lesions were neoplastic (38%) followed by spinal cord trauma (28%), and congenital lesions (16%). The most common spinal lesions were found in the 20–29 age group (40%), with more male predilection of 72% in comparison to 28% female in the present study. Out of 19 neoplastic lesions, the most common type of intramedullary spinal cord tumor (IMSC) is ependymoma (31.5%). The second most common IMSC tumor is astrocytoma 15.7% of all neoplastic lesions in the present study and the most common tumor among children. The most common location of the lesion is the thoracic cord. Hemangioblastomas constitute 10.5% of all spinal cord tumors in the present study. Meningiomas which are intradural extramedullary lesions constituted 10.5%. Neurofibroma constituted 5.2% which are intradural extramedullary with extradural component noted in NF1. Spinal cord metastasis constituted 26.3%. Intradural intramedullary lesions constituted 48% followed by extradural lesions 40% followed by intradural extramedullary lesions 12%. Conclusion: MRI by virtue of non-invasiveness, lack of radiation hazard, and the ability to demonstrate structural changes is an investigation of choice for spinal cord pathologies. The ability to image the cord directly rather than indirectly as in myelography, the absence of bone artifacts as in computed tomography, and the multiplanar capabilities indicate that MRI is the procedure of choice in the examination of the spinal cord.