Spinal Injury Patients Research Articles

Expertise in Tool Use Promotes Tool Embodiment.

Body representations are known to be dynamically modulated or extended through tool use. Here, we review findings that demonstrate the importance of a user's tool experience or expertise for successful tool embodiment. Examining expert tool users, such as individuals who use tools in professional sports, people who use chopsticks at every meal, or spinal injury patients who use a wheelchair daily, offers new insights into the role of expertise in tool embodiment: Not only does tool embodiment differ between novices and experts, but experts may experience enhanced changes to their body representation when interacting with their own, personal tool. The findings reviewed herein reveal the importance of assessing tool skill in future studies of tool embodiment.

Mechanical ventilation strategy in quadriplegic patients for the intensivist

In France, the number of spinal cord injuries is around 2000 new cases per year, often affecting young men, and thus having a real impact on public health. Seventy percent of patients with spinal cord injury upper than C5 require mechanical ventilation during their hospitalization. The need for this mechanical ventilation expose the spinal cord injury (SCI) patients to 2 risk periods: the intubation phase with a high risk of displacement and compression during the course of the procedure, and the withdrawal phase, which is particularly difficult in this context, resulting in an increase in morbidity and hospitalization times. Recently, the latest guidelines from SFAR-SFMU experts on the management of spinal cord injuries published. In this context, we report on good practices in the management of these patients, particularly in the field of ventilation.

Spinal fractures and/or spinal cord injuries are associated with orthopedic and internal organ injuries in proximity to the spinal injury

Backgroundthe demographics, mechanisms of injury, and concurrent injuries associated with cervical, thoracic and lumbar spinal fracture and/or spinal cord injury remain poorly characterized. MethodsPatients aged 18 and older with spinal injury between 2011 and 2015 in the National Trauma Data Bank (NTDB) were identified. Patient demographics, comorbidity burden, mechanism of injury, and associated injuries were analyzed. Resultsin total, 520,183 patients with acute spinal injury were identified including 216,522 cervical, 191,218 thoracic, and 220,294 lumbar. The age distributions were trimodal with peaks in incidence at around 2155 and a lesser peak around 85 years of age. The number of comorbidities increased while injury severity decreased with advancing patient age. Motor vehicle accidents (MVAs) were the most common mechanism of injury. Associated bony and internal organ injuries were common and occurred in 63% of cervical spine injury patients, 79% of thoracic spine injury patients, and 71% of lumbar spine injury patients. In all three sub-populations, there was a predominance of injuries in the local area of the primary injury. For cervical, these were rib injuries (28%), thoracic spine injuries (22%), skull fractures (20%), intracranial injuries (26%) and lung injuries (21%). For thoracic, these were rib injuries (47%), lumbar spine injuries (26%), cervical spine injuries (25%), lung injuries (35%) and intracranial injuries (24%). For lumbar, these were rib injuries (38%), thoracic spine injuries (22%), pelvic fractures (20%), lung injuries (26%) and intracranial injuries (19%). Multivariate regression analysis demonstrated that increased injury severity was strongly correlated with increased mortality, with lesser contributions from increased age and comorbidity burden. Conclusionsthe current study revealed spinal fractures and/or cord injuries had high incidences of associated injuries that had a predominance of local distribution. These findings, in combination with the mortality analysis, demonstrate the importance of local targeted evaluations for associated injuries.

Vertebral fractures in children during the COVID-19 pandemic

Background. The COVID-19 pandemic has had a significant influence on the main epidemiological indicators of emergency trauma, as well as on the pediatric population.
 Aim. This study aimed to analyze the incidence of compression fractures of vertebral bodies in children between January and July 2020 (the first months of COVID-19 pandemic).
 Materials and methods. A comprehensive examination and treatment of 82 children and adolescents aged 317 years, who received compression fractures of the vertebral bodies in the period from January 1 to July 31, 2020, was carried out. A group of 96 children of the same age who sustained a similar type of injury at the same time in 2019 was studied as a control. To make a clinical diagnosis, we used methods of traditional research examination for emergency traumatology. The severity of vertebrogenic fractures was determined according to the AO/ASIF classification.
 Results. The total number of patients diagnosed with vertebral fractures during the COVID-19 pandemic was 14.58% less than that in the same period in 2019. Patients in the comparison groups were comparable in sex, average age of injury, and age group in which the spine was most often injured. The most frequent mechanism of spinal injuries in patients of the comparison groups was a fall from a height. More often than others, ThVI and ThVII vertebral bodies were broken. The severity of vertebral fractures in all cases corresponded to type A, subtypes A1 and A2. For treatment, conservative methods were used in most cases. During the period of strict self-isolation, in April 2020, no children of the main group had vertebral fracture because they were forbidden to leave their apartments unnecessarily. In May 2020, the number of children with vertebral fractures was half the number in the same month in 2019. In June 2020, the incidence of vertebral fractures was in line with the pre-crisis average.
 Conclusion. Strictly following restrictive anti-epidemic measures during a pandemic is an effective method of reducing the number of cases requiring emergency treatment for compression fractures of the vertebral bodies in children.

Epidemiology of cervical spine injury in Northern India: A retrospective study

Background: The epidemiology of cervical spine injuries in trauma patients of Northern India is largely unknown. Study Design: Retrospective study. Objectives: To find out the epidemiology and demographic factors associated with patients of traumatic cervical spinal injury presented to a level 1 trauma center. Patients and Methods: The study sample includes patients with cervical spine injury admitted to our level one trauma centre from the period of July 2018 to June 2019. Those patients who succumbed to their injuries due to various reasons before imaging or brought dead having suspected cervical spine injury were excluded from the study. Results: During the study period, 83 patients having cervical spine injury were admitted and treated. Out of 83, 75.9% (63) were male and the remaining 24.1% (20) were female. The most common mode of injury was fall from height (66.3%) followed by road traffic accidents (24%). About 64% of the patient population belonged to rural areas. The most affected age group in this study was 20–39 years. The most common associated injury is Extremities fracture (9.6%) followed by head injury (8.4%). C5C6 was the most common level and 69.9% underwent surgery. Pressure sore was presented in 12% of cases. Conclusion: The epidemiology of cervical spine injury in Northern India is different from developed countries. In the present study, the most common cause of cervical spine injury was fall from height followed by motor vehicle accidents. Proper awareness program, educating people, national policymaking, and involvement of NGOs and training primary health care workers will help in reducing the incidence of cervical spine injuries in this region

Associated Injuries in Spine Trauma Patients: A Single-Center Experience

Purpose The purpose of this study was to determine the incidence and characteristics of associated injuries in patients with spine trauma. Methods Data of 3,920 consecutive patients admitted to a regional trauma center during a 3-year period were analyzed retrospectively. Results Of the 3,920 patients who were admitted to the trauma center during the 3-year study period, 389 (9.9%) had major spinal injuries. Among these 389 patients, 303 (77.9%) had associated injuries outside the spine. The most common body region of associated injuries was the extremities or pelvis (194 cases, 49.4%), followed by the chest (154 cases, 39.6%) and face (127 cases, 32.6%). Of these 303 patients, 149 (64%) had associated injuries that required surgical treatment such as laparotomy or internal fixation. Associated injuries were more common in patients with lumbar injuries (93.3%) or multiple spinal injuries (100%) than in those with lower cervical injuries (67.4%). There was a significant correlation between the location of the spinal injury and the body region of the associated injury. However, distant associated injuries were also common. Conclusions Associated injuries were very common in spinal injury patients. Based on demographic groups, the trauma mechanism, and the location of spinal injury, an associated injury should be suspected until proven otherwise. Using a multidisciplinary and integrated approach to treat trauma victims is of the paramount importance. Keywords: Spinal injuries; Multiple trauma; Trauma centers

The Effects of The ReWalk^(TM) Robotic System on Walking Capability in Paraplegic Spinal Cord Injury Patients in Taiwan

背景：腳立可走系統為針對雙下肢癱瘓之脊髓損傷患者步行所開發的外骨骼機器腳系統。本研究的目的在探討腳立可走系統用在台灣雙下肢癱瘓之脊髓損傷患者的安全性以及其步行效益。方法：本研究於2015年4月至2016年4月間收錄8位T4至T11脊髓損傷併雙下肢偏癱病患接受立可走機器腳系統訓練。在完成訓練後接續進行評估測試，評估項目包含最長連續步行時間、最長步行距離、10公尺步行速度及6分鐘步行距離。結果：8位病人中，共有5位完成室內及室外至少40小時的訓練。他們平均步行距離為2937.6公尺，最長連續步行時間為1.6小時；10公尺步行測試中病人平均速度為0.4公尺／秒且最大速度為0.68公尺／秒；6分鐘步行測試中病人平均行走距離為132.48公尺，最大行走距離則為144公尺。過程當中沒有出現明顯的副作用。結論：腳立可走系統是一個創新的機器人系統。大多數的病患在經過適當的訓練之後多能改善步行能力，本系統可應用於台灣脊髓損傷合併下半身癱瘓的病人。

C-spine clearance in poly-trauma patients: A narrative review

The incidence of cervical spine injury in patients with polytrauma is 3.7%. Early identification and management of cervical spine injuries in these patients play a crucial role in preventing secondary cervical spine and cord injuries. C-spine clearance assumes a pivotal role in reducing the morbidity and mortality associated with cervical spine injury. Despite the availability of various validated management algorithms and protocols for C-spine clearance, there are several controversies regarding C-spine clearance, such as the ideal protocol and imaging modality, clearance of obtunded patients and management of patients that lie out of the described protocols and rules. The current article aims to provide a comprehensive review of the relevant literature and address the prevalent controversies.

Timing of intervention for spinal injury in patients with polytrauma

ObjectiveThe optimal timing of surgical intervention of spinal fractures in patients with polytrauma is still controversial. In the setting of trauma to multiple organ systems, an inappropriately timed definitive spine surgery can lead to increased incidence of pulmonary complications, hemodynamic instability and potentially death, while delayed surgical stabilisation has its attendant problems of prolonged recumbency including deep vein thrombosis, organ-sp ecific infection and pressure sores. MethodsA narrative review focussed at the epidemiology, demographics and principles of surgery for spinal trauma in poly-traumatised patients was performed. Pubmed search (1995–2020) based on the keywords – polytrauma OR multiple trauma AND spine fracture AND timing, present in “All the fields” of the search tab, was performed. Among 48 articles retrieved, 23 articles specific to the management of spinal fracture in polytrauma patients were reviewed. ResultsSpine trauma is noted in up to 30% of polytrauma patients. Unstable spinal fractures with or without spinal cord injury in polytrauma require surgical intervention and are treated based on the following principles - stabilizing the injured spine during resuscitation, acute management of life-and limb-threatening organ injuries, “damage control” internal stabilisation of unstable spinal injuries during the early acute phase and, definitive surgery at an appropriate window of opportunity. Early spine fracture fixation, especially in the setting of chest injury, reduces morbidity of pulmonary complications and duration of hospital stay. ConclusionRecognition and stabilisation of spinal fractures during resuscitation of polytrauma is important. Early posterior spinal fixation of unstable fractures, described as damage control spine surgery, is preferred while a delayed definitive 360° decompression is performed once the systemic milieu is optimal, if mandated for biomechanical and neurological indications.

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

PurposeThis study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization.MethodsRetrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled.ResultsThe mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2–3 on the AIS, and 4.1% scored 4–6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4–6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4–6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3–6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3–6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI.ConclusionsIn addition to the clinical symptoms of pain, we identify ‘4S’ [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.

Spine injury: how to recognize and stabilize patient in golden hours periods

An acute spinal cord injury (SCI) early management is one of the most challenging tasks in trauma cases. The outcome of its cases depends upon the accuracy, adequacy, and speed of first aid management, diagnosis, and treatment within the “Golden Hours Periods.” Rapid and safe transport of the spinal injury patient allows for early medical stabilization designed to preserve and potentially improve the neurological outcome. The complications that arise from spinal instability or neurological must be prevented immediately and involves all members of the multidisciplinary team. Specialized assessment of people with new spinal cord injuries must take place immediately after an injury. The diagnosis of SCI should include the level and severity of the damage of the spinal cord, type of fracture or/and dislocation of the injured vertebrae, and the stability of the spinal column. Imaging begins from plain radiograph and should include a multi-slice CT protocol of the entire spine to delineate the known injury and to exclude non-contiguous damages. The outcome SCI treatment depends on the number of axons that survived – the higher the number of surviving axons, the restoration of neurological functions might be higher. The management of SCI begins before the patient admitted to the hospital. The principles of treatments include early reduction and fixation, combined extramedullary and intramedullary decompression, cell transplantation, early rehabilitation treatment, and complication prevention. The surgical treatment sometimes needed to evaluate, stabilize the spine, decompress the area that injured, and managed any other injuries that may have been associated with the accident. Once a patient was stabilized, care, and treatment focus on supportive care and rehabilitation.

Correlation of Clinical Findings in Acute Spinal Injury Patients with Magnetic Resonance Including Diffusion Tensor Imaging and Fiber Tractography.

Introduction Many types of research are being carried out in the fields of understanding of the pathogenesis, early recognition, and improving the outcomes after spinal cord injury (SCI). Diffusion tensor imaging (DTI) is one of the modalities used in vivo microstructural assessment of SCI. The aim of the present study is to evaluate the role of DTI imaging and fiber tractography in acute spinal injury with clinical profile and neurological outcome. Methods The study was carried out on twenty-five patients of acute spinal cord injury who presented within 48 hours of injury and completed minimum of six months follow-up. Results The mean age of patients was 37.32±13.31 years and male & female ratio of 18:7. Total MIS score was 91.64±6.0 initially which improved to 96.92±3.68 after 3 months and 99.4±1.35 after 6 months. Total SIS score was similar at all the time intervals i.e. 224±0. Maximum subjects 14(56%) were classified into AIS C and 5(20%) into AIS D whereas only 6(24%) subjects were having no deficit (AIS E). At the end of 6 months, 13(52%) subjects had no deficit (AIS E). Mean fractional anisotropy (FA) initially was 0.451 (± 0.120) but after 6 months, it increased to 0.482 (± 0.097) (p<0.001). The mean apparent diffusion coefficient (ADC) initially was 3.13 (± 2.68) but after 6 months, it decreased to 3.06 (± 2.68) and this change was found to be statistically highly significant (p<0.001). Mean anisotropy index (AI) initially was 0.420 (± 0.245) but after 6 months, it increased to 0.430 (± 3.41) and this change was found to be statistically significant (p<0.01). Conclusions DTI is a sensitive tool to detect neurological damage in SCI and subsequent neurological recovery. FA correlated with ASIA impairment scale. It can be useful as an adjunct to conventional MRI for better evaluation and predicting prognosis in SCI patients.

Surgery for Spinal Trauma: Early Days at a Young Institution in a Hilly State

Abstract Background Spinal trauma is associated with significant morbidity and affects the overall quality of life of the patient as well as their family. The aim of this study was to study the epidemiology, in-hospital outcome, and follow-up of patients undergoing surgery for spinal trauma. Methods All patients who underwent surgery for spinal trauma at the Department of Neurosurgery between June 2016 and October 2019 were studied retrospectively. Data collected from patient record included demographic profile, mode of injury, level of injury, neurological status at admission, time from injury to operative intervention, hospital stay, neurological outcome at discharge, and follow-up. Postoperative computed tomography scans were done in all patients to check for adequacy of screw placement. Results A total of 70 patients (45 males, 25 females) with a mean age of 36 years (range: 16–65 years) were operated for spinal injuries at our department during the study period. Fall was the most common mode of injury (77.1%), followed by road traffic accident (28.5%). Most common site of injury was lumbar spine (38.6%), followed by dorsal (32.9%) and cervical (28.5%). Out of the total, 27.1% of our patients were American Spinal Injury Association (ASIA) grade A at presentation whereas 18.6% were ASIA E. Remaining 54.3% patients had incomplete injuries (ASIA B, C, and D). Burst fracture was the most common morphology of injury (60%), followed by translational injuries (30%). Mean duration between injury and operative intervention was 20.8 days. The mean duration of hospital stay was 21.4 days (range: 8–90 days). Six patients expired during hospitalization. All these six cases had cervical spinal injury. One patient of dorsal spine injury with a complete neurological injury expired 6 months after discharge from the hospital (cause unknown). Nine of our cases showed neurological improvement on follow-up and in rest of the patients, neurological status remained same as preoperative status. Conclusion Neurological status at admission (ASIA grade) and level of injury remain the most important predictor of the outcome. Spinal injury patients must be managed with a holistic and multidisciplinary approach. Rehabilitation is important for helping these patients in leading a productive life.

TO ASSESS THE KNOWLEDGE,ATTITUDE AND PRACTICE ABOUT PREHOSPITAL CARE OF TRAUMATIC SPINAL CORD INJURY AMONG EMS STUDENTS, PUNE,INDIA.

Background- Traumatic Spinal Cord injuries (TSCI) are defined as the key factors of mortality and disability. If acute trauma of spinal cord is not recognized and intervened it may cause secondary injury to spinal column. It is therefore very important to create an awareness amongst Emergency medical Services personnel regarding the initial first aid management and transportation of the patients afflicted with spinal cord injuries. Objective- To assess the Knowledge, Attitude and Practice about Prehospital care of Traumatic Spinal Cord Injury among Emergency Medical Service students Methods-The KAP study was conducted among 150 Postgraduate students of Emergency Medical Services at SCHS, Pune, India. The questionnaire consisted of 13 items based on 3 parameters -5 testing Knowledge, 5 measuring Attitude and 5 measuring Practice related to out hospital care of Traumatic Spinal Cord Injuries. Discussion- Majority of the students scored well in items testing the need to take care of maintaining the alignment of head, neck and spine. Majority students were aware of the importance of reassuring a responsive spinal injury patient and asking them not to move there head but a significant percentage of students answered incorrectly on when they should suspect a spinal injury. Conclusion- EMS students showed encouraging level of KAP with regards to TSCI but there are areas of improvement. Improving KAP of EMS students can significantly impact the outcome in spinal injury patients.

Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An Under-Recognized Problem.

Pediatric cervical spine injuries (CSI) are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children, but may be deemed isolated facial fractures and bypass the standard trauma pathway. The objective of this study is to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center. An analysis was performed of all patients under the age of 18 with maxillofacial trauma admissions to a single level 1 trauma center, from 2006 to 2015. Patients were stratified based on the presence or absence of a cervical spine injury. Data was abstracted to include demographic, mechanism and clinical outcomes data. There were 1274 patients who were admitted with maxillofacial trauma during the study period. Of these, 72 (5.7%) experienced a cervical spine injury. Factors associated with cervical spine injuries include older age and penetrating mechanism. Cervical spine injuries were associated with concomitant traumatic brain injuries and skull fractures. Patients with spine injuries were more like to experience a longer length of stay and death. On multivariate analysis, only increased age predicted CSI. Our database demonstrated a 5.7% incidence of pediatric cervical spine injuries in patients with maxillofacial trauma. This incidence is higher than previously published reports of smaller cohorts. Clinicians must take care to stabilize the cervical spine in any patient with facial fractures, especially during work up and diagnostic maneuvers performed before spinal injuries are ruled out.

Validation of Guidelines for Field Triage of Injured Patients for major trauma in patients of brain and spinal injury.

Validation of Guidelines for Field Triage of Injured Patients for major trauma in patients of brain and spinal injury.

Reliability and Validity of the English Version of the AOSpine PROST (Patient Reported Outcome Spine Trauma).

Multicenter validation study. The aim of this study was to translate and adapt the AOSpine PROST (Patient Reported Outcome Spine Trauma) into English, and test its psychometric properties among North-American spine trauma patients. In the absence of an outcome instrument specifically designed and validated for traumatic spinal column injury patients, it is difficult to measure the effect size of various treatment options. The AOSpine Knowledge Forum Trauma initiated a project and developed the AOSpine PROST consisting of 19 items. Patients were recruited from two level-1 North-American trauma centers. For concurrent validity, next to AOSpine PROST also 36-item Short-Form Health Survey (SF-36) was filled out by patients. Patient characteristics were analyzed using descriptive statistics. Floor and ceiling effects as well as the number of inapplicable and missing questions were analyzed for content validity. Cronbach α and item-total correlation coefficients (ITCCs) were calculated for internal consistency. Spearman correlation tests were performed within AOSpine PROST items and in correlation to SF-36. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs). Factor analysis was performed to explore any dimensions within AOSpine PROST. The AOSpine PROST was translated adapted into English using established guidelines. Of 196 enrolled patients, 162 (82.7%) met the inclusion criteria and provided sufficient data. Content validity showed good results, and no floor and ceiling effects were seen. The internal consistency was excellent (Cronbach α = 0.97; ITCC 0.50-0.90) as well as test-retest reliability (ICC = 0.97). Spearman correlations were good (0.29-0.85). The strongest correlations of AOSpine PROST with SF-36 were seen with the physical components (0.69-0.82; P < 0.001). Factor analysis revealed two possible dimensions (Eigen values >1), explaining 75.7% of variance. The English version of AOSpine PROST showed very good validity and reliability. It is considered as a valuable tool, and has the potential to contribute to the reduction of ongoing controversies in spine trauma care. 2.

Construction of the continuous nursing need index system based on discharge readiness for patients with spinal cord injury

Objective To construct the continuous nursing need index system based on discharge readiness for patients with spinal cord injury so as to guide the clinical nursing practice. Methods From January 2017 to July 2018, this study selected 115 spinal cord injury inpatients of Spine Surgery Department at a ClassⅢ Grade A hospital in Qingdao as subjects by convenience sampling. The Readiness for Hospital Discharge Scale (RHDS) was used to investigate those patients. According to the investigation results, this study primarily built the continuous nursing need index system for spinal cord injury patients. Delphi method was used to select 25 experts for two rounds of consultation so as to establish the final the continuous nursing need index system for spinal cord injury patients. Results Among 115 spinal cord injury patients, the total score and item average score of RHDS were (60.39±22.12) points and (5.27±2.75) points respectively. Among two rounds of consultation, the authoritative coefficients of experts were 0.78 and 0.81 respectively, and the coordination coefficients were 0.343 and 0.423. In the second round of consultation, the variation coefficients ranged from 0.09 to 0.18. The final the continuous nursing need index system for spinal cord injury patients included 5 first-level indexes and 33 second-level indexes. Conclusions The continuous nursing need index system for spinal cord injury patients has a high level of authoritative coefficients and is scientific practical which can provide a basis for discharge health instruction in spinal cord injury patients and promote the safe transition in hospital-community-family as well as comprehensive rehabilitation. Key words: Spinal cord injuries; Continuous nursing; Discharge readiness; Nursing needs; Delphi method

Rib Hyperostosis as a Risk Factor for Poor Prognosis in Cervical Spine Injury Patients With Diffuse Idiopathic Skeletal Hyperostosis.

Retrospective multi-center study. To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injury patients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis. Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injury patients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality. From 1999 to 2017, a total of 50 DISH patients (44 males) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 yrs). Prognosis and clinical risk factor data were collected; the morphological features of the patients' costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses. The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio [HR] = 8.65, 95% confidence interval [CI] = 1.10-68.28, P = 0.041) and rib hyperostosis (HR = 3.82, 95% CI = 1.38-10.57, P = 0.010) were associated with mortality. Reduced chest wall mobility associated with rib hyperostosis in cervical spine injury patients with DISH leads to a poor prognosis. 3.

鈍的頸椎損傷に合併する椎骨動脈閉塞症例の検討(Vertebral artery occlusion associated with blunt traumatic cervical spine injury)

要旨【目的】鈍的頸椎損傷に合併する椎骨動脈損傷（以下VAI）は，時に重篤な脳梗塞を生じるが，確立された治療指針はない。我々は不安定型頸椎損傷に合併する椎骨動脈閉塞の症例を血管内治療の適応とし，整復固定術前に塞栓術を行ってきた。当院のVAI症例を検討し，椎骨動脈閉塞症例に対する塞栓術や長期予後について報告する。【対象】2015年1月～2018年4月に入院加療を行った全鈍的頸椎外傷症例を対象とした。頭頸部造影CT検査にてVAIの合併を認めた症例について，患者背景，頸椎損傷の形態，Denver grade，治療内容，脳梗塞合併の有無を後方視的に検討した。【結果】対象の鈍的頸椎外傷患者は89例で，15例（16.7%）にVAIを合併した。VAI患者の平均年齢は62.6歳で，半数が転倒転落を受傷機転とした。VAIの原因となった頸椎損傷は①亜脱臼，②環椎破裂骨折，③横突起骨折の3つであった。Denver grade IVの症例が最も多く12例であり，うち整復固定術を必要とした9例に血管内治療を行い，入院中および退院後のフォローにおいて明らかな脳梗塞を生じた症例は認めなかった。【結語】不安定性頸椎損傷に合併する椎骨動脈閉塞症例に対する整復固定術前の予防的塞栓術は，脳梗塞発症の予防に有効な治療手段となる可能性がある。