Spine In Trauma Patients Research Articles

P311. Chemical anticoagulant administration within 48 hours lowers the odds of VTEs without increasing complications in spine trauma patients

P311. Chemical anticoagulant administration within 48 hours lowers the odds of VTEs without increasing complications in spine trauma patients

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.

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.

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.

Defining futile and potentially avoidable interhospital trauma transfers

PurposeInterhospital transfer of critically injured patients to a major trauma service reduces preventable death in major trauma. Yet some of those transferred die without intervention. These ‘futile’ interhospital trauma transfers (IHTs), and other potentially avoidable IHTs place enormous stress on families of trauma victims, can delay care, and incur great cost to public health resources. This study sought to characterise these IHTs using current state guidelines for interhospital transfer. MethodsA retrospective cohort study was conducted using our institution's trauma registry from January 2016–December 2020. All adult patients transferred to our major trauma service were analysed. Futile IHTs were defined as death or transfer to hospice care without surgical, endoscopic, or radiological intervention, and without ICU admission, within 72 h of admission. Potentially avoidable IHTs were defined as all patients discharged alive without intervention or ICU care, and secondary over-triage patients are a subset of these patients who were discharged within 72 h of admission. Patient demographics, injuries, and treatments were categorised from electronic records and analysed. ResultsOf 2,837 IHTs, seven (0.2 %) met criteria for futility. The majority were female, median age of 80 (IQR 85–75) and had a median Injury Severity Score (ISS) of 16 (IQR 25.5–11.5). By contrast, 1391 patients (49 %) were classified as potentially avoidable and 513 (18 %) were considered secondary over-triage. The majority were male, median age of 43 (IQR 62–28), and had a median ISS of 9 (IQR 13–4). Of these potentially avoidable IHTs, 984 (70.7 %) were discharged directly home. ConclusionFutile IHTs were infrequent, however over half of all trauma patients transferred from other hospitals were discharged without tertiary-level intervention. Trauma services should consider developing systems such as telehealth to support regional general and orthopaedic surgeons to co-manage lower risk trauma, particularly minor head and minor spinal trauma patients. This could be an integral part of safely reducing potentially avoidable IHTs and their associated costs while maintaining a low rate of preventable mortality in trauma.

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.

Our experience with the surgical management of lower cervical spine fractures: fifty case series.

Trauma to the lower cervical spine is a serious lesion due to its neurological consequences which jeopardize the vital and functional prognosis. They constitute a public health problem due to their frequency and seriousness requiring rapid and adequate treatment. The aim of our study is to (1) describe the epidemiological, clinical, and radiological characteristics of lower cervical spine trauma patients; (2) support the therapeutic management of these patients and show our experience in surgery for lower cervical spine trauma; and (3) analyze the anatomical and functional results and discuss them with literature data. This is a retrospective descriptive study of 50 patients with lower cervical spine trauma treated surgically over a period of five years from January 1, 2016, to December 2020. The average age of our patients was 34.5 years, with a sex ratio of 1.7. The etiologies are dominated by accidents on public roads (58%). They show neurological disorders such as spinal cord damage in 30% of cases and root damage in 20% of cases. The radiological assessment revealed eight tear drops, ten comminuted fractures, 12 severe sprains, 12 biarticular dislocations, six uniarticular dislocations, and two herniated discs. Treatment was surgical in all patients with an anterolateral approach and anterior arthrodesis. The evolution was favourable in 21 patients and stationary in 29 patients. Our study concluded that dislocations and fracture dislocations were the predominant type of injury in cases of AVP. Tetraplegia was mainly observed with uni- and biarticular dislocations. The variation in consolidation time was not correlated with trauma-to-surgery time. Better neurological recovery was observed with mild initial neurological damage than with initially severe damage. The appearance of an adjacent syndrome is less frequent with monosegmental arthrodesis than with multisegmental arthrodesis. Cage arthrodesis was an alternative to iliac harvesting with similar results.

Clinical Effectiveness of Minimally Invasive Surgery on Spinal Trauma.

Minimally invasive spinal trauma surgery includes percutaneous pedicle screw fixation and miniature open anterolateral retractor-based approaches, which can improve surgical outcomes by reducing blood loss, operative time, and postoperative pain. Therefore, this study aimed to evaluate the effect of minimally invasive surgery on pain scores, functional recovery, and postoperative complications in patients with spinal trauma. This retrospective study included 100 spinal trauma patients treated in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine between May 2019 and May 2022. Patients who underwent traditional open surgery were included in the traditional group, and those who received percutaneous pedicle screw internal fixation combined with posterior minimally invasive small incision decompression were included in the research group, each comprising 50 patients. The effectiveness of these two surgical approaches was determined by assessing their outcome measures, including surgery-related indices, postoperative pain, spinal morphology, functional recovery, and postoperative complications. Minimally invasive surgery was associated with significantly shorter surgical wounds, length of hospital stay, operative time, and postoperative time-lapse before off-bed activity, and less intraoperative hemorrhage volume and postoperative drainage volume compared to open surgery (p < 0.001). Compared to open surgery, patients with minimally invasive surgery showed significantly lower visual analogue scale (VAS) scores at 3 days, 3 months, and 6 months after surgery and lower Oswestry dysfunction index (ODI) at 7 days and 3 months after surgery (p < 0.05). Furthermore, the difference in the spine morphology between the two arms did not achieve statistical significance (p > 0.05). Additionally, minimally invasive surgery resulted in a significantly lower incidence of postoperative complications than open surgery (p < 0.05). Minimally invasive surgery causes less surgical damage for patients with spinal trauma, improves surgery-related indexes, alleviates postoperative pain, and provides better morphological and functional recovery of the spine.

A STUDY ON THE PATTERN OF SPINE TRAUMA IN PATIENTS PRESENTED TO KHYBER TEACHING HOSPITAL

This study was conducted to assess the pattern of spine trauma in patients presenting to Khyber Teaching Hospital in terms of etiology, level of injury, type of fracture, and neurologic deficit. This cross-sectional study was conducted at the Department of Orthopedic Surgery at Khyber Teaching Hospital, Peshawar. Patients presenting with spinal cord injuries were included. Etiology, level of injury, types of fracture, and the neurologic deficit were recorded and assessed. The Chi-square test was used to assess the association. The mean age of the patients was 33.28±9.63 years. There were 88 (69.3%) males and 39 (30.7%) females. Fall from height (50.4%) was the most prevalent etiology, followed by RTA (30.7%). Thoracolumbar spine injury (49.6%) was the most prevalent level of spinal injury, followed by cervical spine injury (29.9%). Most patients had type A fractures 43.3%), and type B (37%) was the second leading fracture. The neurologic deficit was seen in 54.3% of patients. Fall from height is the most common cause of spinal traumas in our country, and road traffic accidents are the second leading cause. Thoracolumbar spine injury was the primary presentation of the spinal injury location, and type A was the most common type of fracture. The majority of the patients had a neurologic deficit.

Comparative study of two models predicting the risk of deep vein thrombosis progression in spinal trauma patients after operation

ObjectivePatients with preoperative deep vein thrombosis (DVT) exhibit a notable incidence of postoperative deep vein thrombosis progression (DVTp), which bears a potential for silent, severe consequences. Consequently, the development of a predictive model for the risk of postoperative DVTp among spinal trauma patients is important. MethodsData of 161 spinal traumatic patients with preoperative DVT, who underwent spine surgery after admission, were collected from our hospital between January 2016 and December 2022. The least absolute shrinkage and selection operator (LASSO) combined with multivariable logistic regression analysis was applied to select variables for the development of the predictive logistic regression models. One logistic regression model was formulated simply with the Caprini risk score (Model A), while the other model incorporated not only the previously screened variables but also the age variable (Model B). The model’s capability was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, F1 score, and receiver operating characteristic (ROC) curve. Nomograms simplified and visually presented Model B for the clinicians and patients to understand the predictive model. The decision curve was used to analyze the clinical value of Model B. ResultsA total of 161 DVT patients were enrolled in this study. Postoperative DVTp occurred in 48 spinal trauma patients, accounting for 29.81% of the total patient enrolled. Model A inadequately predicted postoperative DVTp in spinal trauma patients, with ROC AUC values of 0.595 for the training dataset and 0.593 for the test dataset. Through the application of LASSO regression and multivariable logistic regression, a screening process was conducted for seven risk factors: D-dimer, blood platelet, hyperlipidemia, blood group, preoperative anticoagulant, spinal cord injury, lower extremity varicosities. Model B demonstrated superior and consistent predictive performance, with ROC AUC values of 0.809 for the training dataset and 0.773 for the test dataset. According to the calibration curves and decision curve analysis, Model B could accurately predict the probability of postoperative DVTp after spine surgery. The nomograms enhanced the interpretability of Model B in charts and graphs. ConclusionsIn summary, we established a logistic regression model for the accurate predicting of postoperative deep vein thrombosis progression in spinal trauma patients, utilizing D-dimer, blood platelet, hyperlipidemia, blood group, preoperative anticoagulant, spinal cord injury, lower extremity varicosities, and age as predictive factors. The proposed model outperformed a logistic regression model based simply on CRS. The proposed model has the potential to aid frontline clinicians and patients in identifying and intervening in postoperative DVTp among traumatic patients undergoing spinal surgery.

The influence of peri-operative depressive symptoms on medium-term spine surgery outcome: a prospective study.

To investigate the role of depressive symptoms on clinical outcomes in patients undergoing spinal surgery up to 2-year follow-up. The study used data from an institutional spine surgery registry (January 2016, through March 2022) to identify patients (> 18years) undergoing spine surgery. Patients with Oswestry Disability Index (ODI) < 20/100 at baseline or undergoing surgery on the cervical spine or for idiopathic spinal deformity and trauma patients were excluded. The patients were divided into two groups based on the pre-operative Mental Component Summary (MCS) score of the SF-36: depression group (MCS ≤ 35) or non-depression group (MCS > 35). The ODI and MCS scores trajectory were wined over the 24-month post-surgery between groups. Additionally, a secondary subgroup analysis was conducted comparing outcomes between those with depressive symptoms (persistent-depression subgroup) and those without depressive symptoms (never-depression subgroup) at 3months after surgery. A total of 2164 patients who underwent spine surgery were included. The pre-operative depression group reported higher ODI total scores and lower MCS than the pre-operative non-depression group at all time points (P < 0.001). The persistent-depression subgroup reported higher ODI total scores and lower MCS than the never-depression subgroup at all follow-ups (P < 0.001). Functional disability and mental health status improve in patients with depression symptoms undergoing spinal surgery. Despite this improvement, they do not reach the values of non-depressed subjects. Over the 2-year follow-up time, patients with depression show a different trajectory of ODI and MCS. Caregivers should be aware of these results to counsel patients with depression symptoms.

Impact of COVID-19 on neurotrauma cases, mortality rates, and rebound effect: a monocenter retrospective study.

<p>We retro&shy;spec&shy;tively studied the development of neuro&shy;trauma case numbers during the COVID-19 pandemic in the largest trauma center in Hun&shy;gary and compared them to the data of the previous year. We hypothesized that the decrease in the number of neurotrauma cases during the restrictions would sub&shy;sequently lead to a significant increase in a so-called rebound phenomenon. Our goal was to better understand the effect of the pandemic and the restrictive measures on neurotrauma admissions to help better pre&shy;pare for a new pandemic or for other mobility restrictions.&nbsp;</p>. <p>We compiled daily case numbers from January 1, 2019, to April 30, 2021, which included the treatment of 861 patients with spinal trauma and 1244 patients with head injuries from 2019 to 2020, and 871 and 1255 patients with spinal trauma and head injuries, respectively, from March 2020 to April 30, 2021. The parameters studied were patients&rsquo; age, admission date and time from injury to admission. We also conducted a minimum 3-month follow-up study with pa&shy;tients admitted during the pandemic to determine the changes in the hazard ratio of mortality.&nbsp;</p>. <p>We found that in each wave of the pandemic, during the restrictive measures, neurotrauma case numbers decreased. After the first restrictions, we observed a clinically relevant rebound effect among spinal trauma patients. The main findings of the follow-up were that the hazard ratio of mortality for COVID-19 infected patients was 2.5 (p &lt; 0.001), compared with the mortality hazard ratio of COVID-19-negative patients.</p>. <p>Restrictions during the pandemic significantly reduced population mobility helping slow down the spread of the virus and give time to healthcare systems to better prepare. At the same time, it also reduced the number of new neurotrauma cases. In case of spinal trauma patients, a rebound effect was observed after the restrictions, which may be due to increased mobility, activity and travel. The restrictive measures reduced trauma cases effectively, while not increased the time from injury to admission.&nbsp;</p>.

The use of robot-assisted surgery for the unstable traumatic spine: A retrospective cohort study

BackgroundRobotic assistance has been shown to increase instrumentation placement accuracy in open and minimally invasive spinal fusion. These gains have been achieved without increases in operative times, blood loss, or hospitalization duration. However, most work has been done in the degenerative population and little is known of the utility of robotic assistance when applied to spinal trauma. This is largely due to the uncertainty stemming from the disruption of normal anatomy by the traumatic injury. Since the robot depends upon registration for instrumentation guidance according to the fiducials it uses, trauma can introduce unique challenges. The present study sought to evaluate the safety and efficacy of robotic assistance in a consecutive cohort of spine trauma patients. MethodsAll patients with Thoracolumbar Injury Classification and Severity Scale (TLICS) >4 who underwent robot-assisted spinal fusion using the Globus ExcelsiusGPS at a single tertiary care center for trauma between 2020 and 2022 were identified. Demographic, clinical, and surgical data were collected and analyzed; the primary endpoints were operative time, fluoroscopy time, estimated blood loss, postoperative complications, admission time, and 90-day readmission rate. The paired t-test was used to compare differences between mean values when looking at the number of surgical levels. ResultsForty-two patients undergoing robot-assisted spinal surgery were included (mean age 61.3±17.1 year; 47% female. Patients were stratified by the number of operative levels, 2 (n = 10), 3-4 (n = 11), 5 to 6 (n = 13), or >6 (n = 8). There appeared to be a positive correlation between number of levels instrumented and odds of postoperative complications, admission duration, fluoroscopy time, and estimated blood loss. There were no instances of screw malposition or breach. ConclusionsThis initial experience suggests robotic assistance can be safely employed in the spine trauma population. Additional experiences in larger patient populations are necessary to delineate those traumatic pathologies most amenable to robotic assistance.

Weight-Based Dosing for Venous Thromboembolism Prophylaxis in Spinal Trauma Patients Appears Safe

IntroductionVenous thromboembolism (VTE) is a substantial cause of morbidity and mortality in trauma patients. VTE prophylaxis (VTEP) initiation is often delayed in certain patients due to the perceived risk of bleeding complications. Our VTEP guideline was changed from fixed-dosing to a weight-based dosing strategy using enoxaparin in June 2019. We investigated the rate of postoperative bleeding complications with a weight-based and a standard dosing protocol in traumatic spine injury patients requiring surgical stabilization. MethodsA retrospective pre-post cohort study using an institutional trauma database was conducted, comparing bleeding complications between fixed and weight-based VTEP protocols. Patients undergoing surgical stabilization of a spine injury were included. The preintervention cohort received fixed-dose thromboprophylaxis (30 mg twice daily or 40 mg daily); the postcohort received weight-based thromboprophylaxis (0.5 mg/kg q12 h with anti-factor Xa monitoring). All patients received VTEP 24-48 h after surgery. International Classification of Diseases codes were used to identify bleeding complications. ResultsThere were 68 patients in the pregroup and 68 in the postgroup with comparable demographics. Incidence of bleeding complications in the pre- and postgroups were 2.94% and 0% respectively. ConclusionsVTEP initiated 24-48 h after surgical stabilization of a spine fracture using a weight-based dosing strategy and has a similar rate of bleeding complications as a standard dose protocol. Our study is limited by the low overall incidence of bleeding complications and small sample size. These findings could be validated by a larger multicenter trial.

Celecoxib alleviates nociceptor sensitization mediated by interleukin-1beta-primed annulus fibrosus cells

PurposeThis study aims to analyze the effect of pro-inflammatory cytokine-stimulated human annulus fibrosus cells (hAFCs) on the sensitization of dorsal root ganglion (DRG) cells. We further hypothesized that celecoxib (cxb) could inhibit hAFCs-induced DRG sensitization.MethodshAFCs from spinal trauma patients were stimulated with TNF-α or IL-1β. Cxb was added on day 2. On day 4, the expression of pro-inflammatory and neurotrophic genes was evaluated using RT-qPCR. Levels of prostaglandin E2 (PGE-2), IL-8, and IL-6 were measured in the conditioned medium (CM) using ELISA. hAFCs CM was then applied to stimulate the DRG cell line (ND7/23) for 6 days. Then, calcium imaging (Fluo4) was performed to evaluate DRG cell sensitization. Both spontaneous and bradykinin-stimulated (0.5 μM) calcium responses were analyzed. The effects on primary bovine DRG cell culture were performed in parallel to the DRG cell line model.ResultsIL-1ß stimulation significantly enhanced the release of PGE-2 in hAFCs CM, while this increase was completely suppressed by 10 µM cxb. hAFCs revealed elevated IL-6 and IL-8 release following TNF-α and IL-1β treatment, though cxb did not alter this. The effect of hAFCs CM on DRG cell sensitization was influenced by adding cxb to hAFCs; both the DRG cell line and primary bovine DRG nociceptors showed a lower sensitivity to bradykinin stimulation.ConclusionCxb can inhibit PGE-2 production in hAFCs in an IL-1β-induced pro-inflammatory in vitro environment. The cxb applied to the hAFCs also reduces the sensitization of DRG nociceptors that are stimulated by the hAFCs CM.

Reliability and Validity of the German Version of the AO Spine Patient Reported Outcome Spine Trauma Questionnaire.

A single-center validation study. To translate and cross-culturally adapt the AO Spine PROST (Patient Reported Outcome Spine Trauma) into German, and to test its psychometric properties among German-speaking Swiss spine trauma patients. Patients were recruited from a level-1 Swiss trauma center. Next to the AO Spine PROST, the EQ-5D-3L questionnaire was used for concurrent validity. Questionnaires were filled out at two-time points for test-retest reliability. Patient characteristics were analyzed using descriptive statistics. For content validity, floor, and ceiling effects, as well as any irrelevant and missing questions were analyzed. Construct validity of the AO Spine PROST questionnaire to the EQ-5D-3L was tested using Spearman correlation tests. The AOSpine PROST was translated and adapted into German using established guidelines. We included 179 patients. The floor effect for all items was well within the optimal range (below 15%), while the ceiling effect of seven items was within the optimal range. None of the items displayed a problematic floor or ceiling effect. The overall test-retest reliability of the total PROST score was excellent, with an ICC of .83 (95% CI .69-.91). The Spearman correlation coefficient between the total PROST summary score and EQ-5D-3L was ρ = .63. The German version of the AO Spine PROST questionnaire demonstrated very good validity and reliability results.

Chemoprophylaxis Timing Is Not Associated With Postoperative Bleeding After Spinal Trauma Surgery

BackgroundLittle is known regarding appropriate timing for chemical venous thromboembolism (VTE) prophylaxis initiation in operative traumatic spinal injuries. We hypothesized that the incidence of post-operative bleeding leading to neurological decline or re-operation would not increase in patients who received early VTE prophylaxis (≤2 days post-surgery) as compared to those who received late VTE prophylaxis (≥ 3 days post-surgery). MethodsThis is a retrospective cohort study. Spine trauma patients who underwent spinal surgery, defined as anterior cervical discectomy and fusion, posterior cervical spinal fusion, anterior or posterior thoracic/lumbar spinal fusion, or vertebral percutaneous fixation from July 2015 to July 2020 were included. Demographics, pre-injury anti-thrombotics, operative characteristics, pre- and post-operative VTE prophylaxis, and post-operative complications, including spinal bleeding, and VTE were collected. Univariate analysis was performed, comparing baseline characteristics, VTE prophylaxis timing, and complications between the early and late groups. ResultsTwo-hundred-eighty-two patients were included; 189 were in the early group (1.7 ± 0.5 days), and 93 were in the late (4.4 ± 2.1 days) group. The late group received enoxaparin more often than patients in the early group (41.9 % vs. 19 %, p < 0.001). Baseline characteristics, hospital course, and surgical management were similar between the groups. The rate of post-operative complications, including hematoma and VTE was similar between the groups. None of the patients in the early group had post-operative bleeding. ConclusionIn this retrospective cohort study, VTE prophylaxis timing was not associated with clinically significant post-operative spinal bleeding and VTE in trauma patients.

Patient-reported outcomes after posterior surgical stabilization for thoracolumbar junction fractures: A pilot study with combined patient-reported outcome measure methodology.

Thoracolumbar junction fractures (TLJFs) attract controversy for several parameters, including surgery versus conservative treatment, fusion versus stabilization, open versus percutaneous surgery, construct length, and downstream metalwork extraction. The aim of this pilot study was to assess the effectiveness of surgical treatment in patients with burst (AO Classification Type A4) TLJFs using patient-reported outcome measures (PROMs) and evaluate and compare different PROMs in this clinical scenario. Patient records of consecutive patients who underwent posterior stabilization surgery for TLJFs were retrospectively reviewed. Data were collected on demographics, medical and social history, neurological examination, and postoperative complications. Telephone interviews and a combined PROM methodology (Numerical Rating Scale [NRS], EuroQol [EQ]-5D-5L, and Oswestry Disability Index [ODI]) were utilized to assess the effectiveness of intervention. Descriptive statistics were used to analyze exposure variables and outcome measures. Spearman's rank correlation was used for the outcome measures. Thirteen patients were included. The mean age was 42 ± 16 years; the male: female ratio was 8:5; the mean follow-up was 18.9 ± 6.4 months. The mean NRS score was 3.3 ± 2.5, in line with a median score of 2 (2) on EQ-5D-5L pain/discomfort scale. Statistically significant correlations were found between several PROMs: pain-EQ-5D-5L and NRS (rs = 0.8, P = 0.002), pain-EQ-5D-5L and ODI (rs = 0.8, P = 0.001), usual anxiety/depression-EQ-5D-5L, and ODI (rs = 0.7, P = 0.008). A combined PROM methodology showed supportive evidence for safety and efficacy in the surgical stabilization of burst TLJFs. This alleviated significant pain and prevented neurological deficit and major disability. The preliminary widespread correlation between these PROMs supports further larger studies of their combined use in clinical practice, to measure the outcomes of spine trauma patients.

Canadian C-spine Rule versus NEXUS in Screening of Clinically Important Traumatic Cervical Spine Injuries; a systematic review and meta-analysis.

The Canadian C-spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) are two criteria designed to rule-out clinically important traumatic cervical Spinal Cord Injury (SCI). In this systematic review and meta-analysis, we reviewed the articles comparing the performance of these two models. Search was done in Medline, Embase, Scopus and Web of Science until June 2022. Observational studies with direct comparison of CCR and NEXUS criteria in detection of clinically important cervical SCI were included. Two independent reviewers screened the relevant articles and summarized the data. Certainty of evidence was assessed based on QUADAS-2. Data were recorded as true positive, true negative, false positive, and false negative. Then, using "diagma" package and applying weighted random effect model, area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic odds ratio (DOR) were calculated with 95% confidence interval (95% CI). We included 5 studies with direct comparison. Area under the ROC curve of NEXUS in screening of patients with clinically important cervical SCI was 0.708 (95% CI: 0.647 to 0.762). Pooled sensitivity and specificity of NEXUS criteria in screening of patients with clinically important cervical SCI were 0.899 (95% CI: 0.845 to 0.936) and 0.398 (95% CI: 0.315 to 0.488). The positive and negative likelihood ratios of NEXUS were 1.494 (95% CI: 1.146 to 1.949) and 0.254 (95% CI: 1.155 to 1.414), respectively. Diagnostic odds ratio of NEXUS was 5.894 (95% CI: 3.372 to 10.305). Furthermore, area under the ROC curve of CCR in screening of clinically important cervical SCI was 0.793 (95% CI: 0.657 to 0.884). Meta-analysis results showed that pooled sensitivity of CCR criteria in screening of patients with clinically important cervical SCI was 0.987 (95% CI: 0.957 to 0.996) and specificity was 0.167 (95% CI: 0.073 to 0.336). The positive and negative likelihood ratios of CCR were 1.184 (95% CI: 0.837 to 1.675) and 0.081 (95% CI: 0.021 to 0.308), respectively. Diagnostic odds ratio of CCR was 14.647 (95% CI: 3.678 to 58.336). Based on studies, both CCR and NEXUS were sensitive rules that have the potential to reduce unnecessary imaging in cervical spine trauma patients. However, the low specificity and false-positive results of both of these tools indicate that many people will continue to undergo unnecessary imaging after screening of cervical SCI using these tools. In this meta-analysis, CCR appeared to have better screening accuracy.