Spine Traumatic Injuries Research Articles

Cervical Spine Computed Tomography in Adolescent Blunt Trauma Patients: Are They Being Overutilized?

IntroductionCervical spine computed tomography (CSCT) scans are used to evaluate cervical spine traumatic injuries; however, recent evidence demonstrates that adult trauma centers (ATCs) overutilize CSCT when evaluating adolescent patients. This leads to unnecessary radiation exposure. The aim of this study is to review a level 1 ATC's use of CSCT in the adolescent blunt trauma population. MethodsA retrospective chart review was conducted of a level 1 ATC's trauma database. Blunt trauma patients between the ages of 11 and 18 who receive a CSCT between January 2015 to December 2019 were included. The primary outcome was the prevalence of positive findings on CSCT scans. Data were analyzed using Fischer-Exact analysis and multivariate logistic regression where appropriate. ResultsThree-hundred thirty-seven of 546 (61.7%) adolescent blunt trauma patients received CSCT. Of those, 68.2% (230) were male; the mean age was 16.6 ± 1.0 y old. Twenty-eight patients (8.3%) had a positive finding on CSCT. All patients with a positive CSCT failed the National Emergency X-Radiography Utilization study (NEXUS) criteria while 123 patients (36.5%) with a negative CSCT met NEXUS criteria. ConclusionsCSCT was overutilized in our trauma center. There is a low positive CSCT scan rate among adolescent patients, which aligns with the current literature. All patients with positive CSCT passed NEXUS criteria suggesting that a quality improvement project focusing on the use of the NEXUS criteria to assess the risk of cervical spine injury could potentially reduce the use of CSCT scans by nearly 40%.

Clinical aspects of cervical spine traumatic injury biomechanics

Cervical spine trauma is one of the most serious injuries of the human musculoskeletal system, as structural disorders of the cervical spine lead to neurological disorders due to damage to the spinal cord and/or its roots or create conditions when instability poses a significant potential threat to anatomical integrity and functional capacity of the spinal canal structures. A lot of classifications of traumatic injuries of the cervical spine have been developed, they are based on the biomechanics of injury, but none of them is generally accepted and universal. Failures to develop a system that could clearly determine the causal relationship between the effects of the traumatic agent and the traumatic bone changes are due to a number of causes. Extensive clinical material accumulated over the years of study of traumatic changes in the cervical spine allowed identifying the main criteria that determine the nature and degree of traumatic injuries. These include the parameters of traumatic action and individual characteristics of the victims, in particular physiological indicators and the presence of comorbidities. In this review, we present a brief description of the main clinical factors influencing the biomechanics of traumatic cervical spine injury (nature, direction and intensity of traumatic action, age of a patient, muscle condition and initial curvature of the cervical spine, as well as some comorbidities: degenerative changes of the spine, osteoporosis, connective tissue diseases, congenital malformations). These criteria are of practical importance that allows using the collected information not only in theoretical but also in applied aspects.

Pain type and intensity in long-term spinal cord injury

Background. Pain is one of the most common secondary symptoms seen in patients with spinal cord injury (SCI). Approximately 65 to 85 % of all SCI patients complaining of pain, with a third having severe/excruciating pain. Despite a large number of studies, some aspects that are fundamental for the choice of pain therapy remain practically unexplored. The purpose of our study was to determine the types, subtypes, and intensity of pain in subaxial cervical spine SCI patients. Materials and methods. We performed a retrospective analysis of the patients’ database admitted in Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine from 2010 to 2020 with subaxial cervical spine traumatic injury. The patients’ state was assessed within 12–18 months after the injury. We determined the functional class of neurological disorders using the ASIA scale. Pain sensation was characterized using International Spinal Cord Injury Pain Classification. The Numeric Rating Scale was the instrument for pain intensity assessment. Results. Persistent pain sensations in 12–18 months after subaxial cervical SCI are recorded in 86.42 % of 81 analyzed victims, whereas one subtype of pain is noted in 38.57 % of all patients with pain, two subtypes — in 40 % and three — in 21.43 % subjects. Elements of nociceptive pain were registered in 54.32 % of all patients, and neuropathic pain was recorded in 71.6 % of cases. When assessing pain subtypes, musculoskeletal pain was observed in 54.32 % (95% CI: 44.44–66.16) of all subjects, neuropathic pain at the trauma level in 51.85 % (95% CI: 41.98–63.77), and neuropathic pain below the trauma level was noted in 43.21 % patients (95% CI: 33.33–54.91). Nociceptive visceral and other neuropa-thic types of pain were reported sporadically — in 4.94 % (95% CI: 1.23–9.09) and 3.7 % (95% CI: 1.23–7.94) patients, respectively. When comparing the nature of pain and the ASIA functional class, we determined that the frequency pattern of the pain distribution statistically significantly correlates with the level of neurological disorders. The greatest intensity of pain was observed in patients with the ASIA functional class C of neurological disorders. Conclusions. The obtained results allowed us to reveal the regularities of the clinical picture in patients with different levels of neurological disorders, which is of practical importance for the development of optimal pharmacological treatment schemes.

The state of the sagittal balance of the injured cervical spine depending on the nature of the damage to the subaxial level

Background. Three main interrelated principles form the basis for modern surgery of traumatic cervical spine injuries, namely decompression, reconstruction and stabilization. Restoration of the sagittal profile is one of the basic tasks of the reconstructive stage. Currently, there are no clear recommendations for surgical management in traumatic injuries depending on the degree of deformation, and the state of sagittal balance of the injured cervical spine in the preoperative period has practically not been studied. The purpose of the work is to study the state of the sagittal profile and the degree of segmental deformation of the cervical spine following traumatic injury at the subaxial level, to determine the relationship between them and the type of injury. Materials and methods. We performed a retrospective analysis of X-ray data from 140 patients with subaxial cervical spine traumatic injury who were hospitalized at the Department of Spinal Cord Pathology of the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine in the period from 2008 to 2018. We calculated indicators of segmental kyphosis and general cervical lordosis and determined the type of damage according to AO Spine Subaxial Cervical Spine Injury Classification System. Results. We found that the type of the damage affects the degree of segmental deformation (p < 0.001). Type A1, A2 and C injuries show the maximum kyphotic angulation: 13.51° (8.18; 20.07), 21.8° (20.12; 22.96) and 20.01° (17.52; 21.99), respectively. Injuries of type A2 and C statistically significantly differ from other types of lesions. We registered maximum values of deviations from the normal sagittal circuit in patients with injuries types A2 and C: ‒26.77° (‒32.78; ‒20.91) and ‒26.70° (‒36.30; ‒16.77), respectively. The parameters of segmental kyphosis and general cervical lordosis reveal high interdependence (r2=0.766, p < 0.001). We found maximum correlation in type A3, A4 and B3 injuries: ‒0.93, ‒0.91 and ‒0.97, respectively (p < 0.001). And types A1 and A2 injuries demonstrated statistically insignificant relationship (p > 0.05). Conclusions. The results show that traumatic injury of the subaxial cervical spine is characterized by a wide range of kyphotic segmental angulation values, which is largely determined by the type of injury. General cervical lordosis tends to flatten in most cases, but the degree of physiological curvature loss correlates with local deformation to some extent.

The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: an international validation study.

PurposeTo evaluate the AOSpine Thoracolumbar Spine Injury Classification System and if it is reliable and reproducible when applied to the paediatric population globally.MethodsA total of 12 paediatric orthopaedic surgeons were asked to review MRI and CT imaging of 25 paediatric patients with thoracolumbar spine traumatic injuries, in order to determine the classification of the lesions observed. The evaluators classified injuries into primary categories: A, B and C. Interobserver reliability was assessed for the initial reading by Fleiss’s kappa coefficient (kF) along with 95% confidence intervals (CI). For A and B type injuries, sub-classification was conducted including A0-A4 and B1-B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff’s alpha (αk) along with bootstrapped 95% CIs. A second round of classification was performed one-month later. Intraobserver reproducibility was assessed for the primary classifications using Fleiss’s kappa and sub-classification reproducibility was assessed by Krippendorff’s alpha (αk) along with 95% CIs.ResultsIn total, 25 cases were read for a total of 300 initial and 300 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF = 0.74; 95% CI 0.71 to 0.78) across all observers. Sub-classification reliability was substantial (αk= 0.67; 95% CI 0.51 to 0.81), Adjusted intraobserver reproducibility was almost perfect (kF = 0.91; 95% CI 0.83 to 0.99) for both primary classifications and for sub-classifications (αk = 0.88; 95% CI 0.83 to 0.93).ConclusionThe inter- and intraobserver reliability for the AOSpine Thoracolumbar Spine Injury Classification System was high amongst paediatric orthopaedic surgeons. The AOSpine Thoracolumbar Spine Injury Classification System is a promising option as a uniform fracture classification in children.Level of EvidenceIII

Neuropathic pain as a predictor of neurological disorders regression in patients with spinal cord traumatic injury

Background. Neuropathic pain is one of the principal secondary complications of spinal cord injury. The biological role of neuropathic pain has not been established yet. This type of pain is formed directly in the area of the spinal cord injury; therefore, it can be assumed that its intensity may characterize both degenerative and reparative processes. The aim of this work is to assess the possible relationship between the intensity of neuropathic pain in patients with spinal cord injury at cervical subaxial spine and the dynamics of neurological disorder regression. Materials and methods. We have performed a retrospective analysis of patients referred to outpatient department of the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine in the period from 2010 to 2020 after a surgical treatment of subaxial cervical spine traumatic injury. The extent of neurological disorders and the intensity of neuropathic pain were assessed within 5–7 and 11–13 months after surgery. Results. All 102 patients selected for analysis were divided into three groups depending on the intensity of the registered pain sensations: 1) absence of constant pain sensations — 19.6 % of subjects, 2)moderate pain— 56.9 %, 3) severe neuropathic pain — 23.5 %. In the first group, the regression of neurological disorders was 3.5 (95% confidence interval (CI) 2.15–6.15), in the second — 25.0 (95% CI 24.14–29.58), in the third — 13.0 (95% CI 10.87–16.55). The differences are statistically significant (χ2 = 60.4, df = 2, p < 0.0001). In patients with severe neurological disorders, the dynamics of recovery did not correlate with the pain intensity. With ASIA B, the dynamics of group 1 was 8.5 (95% CI 10.56–27.56), of group 2— 15.0 (95% CI 13.41–18.41), of group 3 — 10.5 (95% CI 7.45–14.89). With ASIA C functional class, the difference is even more pronounced: in group 1, the median was 8.0 (95% CI 0.83–20.83), in group 2 — 32.0 (95% CI 25.41–36.86), in group 3 — 15.5 (95% CI 10.27–27.4). With ASIA D, a similar trend was observed. Conclusions. The worst regression of neurological disorders is observed in patients without clinically significant pain, the best results of neurological dysfunction recovery are found in patients with mode rate neuropathic pain.

The classifications of subaxial cervical spine traumatic injuries. Part 6. Ben L. Allen biomechanical classification

Traumatic injuries of subaxial cervical spine are characterized by a wide range of possible pathomorphological changes that depend not only on the direction and intensity of the traumatic force impact, but also on the initial position of cervical spine at the moment of exposure. One of the most detailed classifications of cervical spine traumatic injuries, in which the integrated approach to assessing the type of injury considering the mechanism of injury is used, is the system developed by Ben L. Allen and published with co-authors in 1982. It is also known as the Allen-Ferguson classification and despite long history of existence, still has not lost its relevance. In the classification when characterizing the type of traumatic injury, not only visually detected signs, but also inevitably accompanying changes are given. In total, 6 types of damage were classified: compression-flexion, vertical compression, distraction-flexion, compression-extension, distraction-extension and lateral-flexion, which were divided into stages depending on the severity of pathomorphological changes. The authors of the classification note a pronounced correlation between the nature of damage to anatomical structures and neurological disorders in all patterns of damage. When writing this review, a detailed analysis of the original publication was carried out, highlighting the basic biomechanical aspects that underlie the classification and still have not lost their relevance . It is noted that the schematic images of damages found in modern literature often do not correspond to the description proposed by Ben L. Allen et al., Therefore, when preparing the illustrative material, we relied solely on the data of the original article. Along with the description of morphology, for each type and stage of injury, modern data on possible methods of treatment, both conservative and surgical are given. The complex analysis suggests that the classification developed by Ben L. Allen is a convenient tool for assessing pathomorphological changes and allows choosing the optimal method of treating the patients in each specific clinical situation.

The classifications of subaxial cervical spine traumatic injuries. Part 5. Facet joint and lateral mass lesions

Traumatic injury to the cervical spine accompanied by a wide range of possible changes in its osteo-ligamentous apparatus. One of the basic criteria to determine the treatment strategy is the assessment of injury stability which depends on the condition of the spine supporting columns. Most of the modern and widely used classifications of subaxial cervical spine traumatic injuries quite sufficiently characterize the state of the anterior support column. At the same time, much less attention is paid to the assessment of the degree and nature of traumatic changes in lateral masses, facet joints, as well as possible dislocations. Literature analysis reveals the absence of a generally accepted scheme that would allow one to unambiguously and comprehensively characterize the damage to the facets / lateral masses and choose the optimal surgical or conservative treatment method. This review provides well known assessment schemes: classification of traumatic changes of facet joints by Marcel F. Dvorak et al., variants of traumatic displacement of the cervical vertebrae by V.P. Selivanov, variants of lateral mass traumatic injury by Y. Kotani et al. and Posterior Ligament-Bone Injury Classification and Severity Score. The advantages and disadvantages of anterior, posterior or combined approach for the treatment of traumatic injuries of posterior support complex are considered that is of critical importance for obtaining better clinical results. It is noted that the choice of the optimal treatment method is currently a controversial issue. Although good surgical results can be obtained using a variety of methods, there are certain situations in which one technique may be better than others. The accumulated clinical experience and current research on the injured spine biomechanics demonstrate the advantage of surgical treatment in most patients, since such injuries are usually unstable or potentially unstable.

The classifications of subaxial cervical spine traumatic injuries. Part 4. AOSpine Subaxial Classification System

Cervical spine injuries are a fairly common consequence of mechanical impact on the human body. The subaxial level of the cervical spine accounts for approximately half to 2/3 of these injuries. Despite the numerous classification systems that exist for describing these injuries, the recommendations for treatment strategy are very limited, and currently none of them is universal and generally accepted. Consequently, treatment decisions are based on the individual experience of the specialist, but not on evidence or algorithms. While the classification system based on the mechanism of trauma originally proposed by B.L. Allen et al. and subsequently modified by J.H. Harris Jr et al., was comprehensive, but lacked evidence, which to some extent limited its clinical applicability. Similarly, the Subaxial Injury Classification System proposed by the Spine Trauma Group, had no distinct and clinically significant patterns of morphological damage. This fact hindered the standardization and unification of tactical approaches. As an attempt to solve this problem, in 2016 Alexander Vaccaro, together with AO Spine, proposed the AO Spine subaxial cervical spine injury classification system, using the principle of already existing AOSpine classification of thoracolumbar injuries. The aim of the project was to develop an effective system that provides clear, clinically relevant morphological descriptions of trauma patterns, which should contribute to the determination of treatment strategy. The proposed classification of cervical spine injuries at the subaxial level follows the same hierarchical approach as previous AO classifications, namely, it characterizes injuries based on 4 parameters: (1) injury morphology, (2) facet damage, (3) neurological status, and (4) specific modifiers. The morphology of injuries is divided into 3 subgroups of injuries: A (compression), B (flexion-distraction), and C (dislocations and displacements). Damage types A and B are divided into 5 (A0-A4) and 3 (B1-B3) subtypes, respectively. When describing damage of the facet joints, 4 subtypes are distinguished: F1 (fracture without displacement), F2 (unstable fracture), F3 (floating lateral mass) and F4 (dislocation). The system also integrates the assessment of neurological status, which is divided into 6 subtype). In addition, the classification includes 4 specific modifiers designed to better detail a number of pathological conditions. The performance evaluation of AOSpine SCICS showed a moderate to significant range of consistency and reproducibility. Currently, a quantitative scale for assessing the severity of classification classes has been proposed, which also, to a certain extent, contributes to decision-making regarding treatment strategy.

Factors influencing the pedicle screw fixation stability in patients with unstable lumbar and thoracolumbar spine injuries

Background. One of the reasons for the lack of standardized approaches for treatment of lumbar and thoracolumbar spine traumatic injuries is inconclusive information on relative contribution of various factors to pedicle screw fixation stability.Objective. To determine risk factors that influence pedicle screw fixation stability in patients with unstable traumatic injuries of a lumbar spine and thoracolumbar junction.Material and methods. This was a retrospective evaluation of 192 spinal instrumentations. Patients with type А3, A4, B1, B2 and C injuries of lumbar and thoracolumbar spine were enrolled. Pedicle screw fixation was used either as a stand-alone technique or in combination with anterior column reconstruction. If required, decompression of nerve roots and spinal cord was performed. Cases with pedicle screw fixation failure were registered. Logistic regression analysis was used to assess predictive significance of potential risk factors. Results. Complication rate growth was associated with a decrease in bone radiodensity, posterior decompression extensiveness, lumbosacral fixation and residual kyphotic deformity. Anterior column reconstruction and additional pedicle screw installation led to a decline in complication rate while anterior decompression and fixation length did not influence fixation stability. Conclusion. In most cases, pedicle screw fixation system failure is associated with altered bone quality; however, surgical approach may also impact complication rate and should be taken into account planning surgical intervention. Anterior column reconstruction and additional pedicle screw installation are associated with the decline in complication rate; the influence of those options is comparable. Anterior decompression does not influence pedicle screw fixation stability; consequently, it is preferable in cases with considerable risk of pedicle screw fixation failure.

The classifications of subaxial cervical spine traumatic injuries. Part 3. The Cervical Spine Injury Severity Score (CSISS)

The classifications of subaxial cervical spine traumatic injuries. Part 3. The Cervical Spine Injury Severity Score (CSISS)

ETHNIC AND AGE-RELATED PECULIARTIES OF LIPID PEROXIDATION AND ANTIOXIDATIVE PROTECTION

The relevance of this research is determined by a number of factors including Chernobyl tragedy, enforced usage of computer technologies and telecommunication, environmental problems, unhealthy diet poor in poor in vegetables and fruits. This promotes the condition for increased free radical production by the body and antioxidant system emaciation. Alzheimer’s and Parkinson’s diseases, lateral amyotrophic sclerosis and cataract, stroke, brain and spine traumatic injuries have been reported as rapidly growing worldwide. Less common diseases with ethio-pathogenetic mechanisms mentioned above include peroxisomal biogenesis disorders (X-linked adrenoleukodystrophy, Zellweger syndrome), Friedreich ataxia, Niemann-Pick diseases, neurodegeneration accompanied with brain iron accumulation, infantile neuroaxonal dystrophy, ferritinopathy, aceruloplasminemia. Intensive production of free oxygen species underlies the emergence of the diseases, therefore studying their ethiology, pathogenesis, clinical courses and the approaches in their early detection, treatment and prevention is one of the priority directions for genetics, biology, theoretical and applied medicine in order to determine important ethnic and age-related differences. This is of quite significance as many diseases known before as age-related now are affecting more and more of young population. Some diseases are traditionally more prevalent in some populations identified as races due to their common ancestry. It also includes altered prevalence and patterns in different ethnic groups. But nowadays the population of many countries is become more and more ethnically mixed. This is critical in diagnosing and managing some diseases as cardiovascular diseases, some autism forms with epilepsy, ischemic-hypoxic encephalopathy in children. The authors highlight lately determined mechanisms of the impairment in pro-oxidative-antioxidative status as well as some modern medicines and approaches for the correction for some pathological conditions.

The classifications of subaxial cervical spine traumatic injuries. Part 2. The Subaxial Injury Classification and Severity Scale (SLIC)

Cervical spine trauma remains one of the most severe musculoskeletal injuries with high mortality and disability. The majority of injuries of this location occur at the subaxial level — more than 65 % of fractures and 75 % of dislocations. The complex anatomical structure of the cervical spine, its high mobility, the multiplicity of injury variants, as well as the potentially catastrophic consequences of incorrect therapy, determine correct tactics to be a difficult clinical task, even for specialists with extensive practical experience. Despite the impressive amount of scientific research and clinical achievements, the classification and approaches to treating fractures and dislocations of the cervical spine remain quite controversial.This review describes one of the first clinical classifications of traumatic injuries of the cervical spine at the subaxial level. The Subaxial Injury Classification and Severity Scale were developed by spinal injury study group in 2007, and currently, it is one of the most common, simple, clinically-oriented tools for unifying damage and treatment tactics. One of the indisputable advantages of the presented systematization is the point-based assessment of the injury severity, a sufficiently developed therapeutic and tactical algorithm and a significant evidence base.The classification considers three main groups of criteria that are fundamental in making clinical decisions regarding the management of patients with traumatic injury: the morphology of injury; integrity of the disco-ligamentous complex; neurological status.The article provides a detailed analysis of principles of classification cases construction, as well as the main surgical approaches, depending on the nature and extent of damage to various anatomical structures. Even though the described tactical principles are certainly purely recommendatory, nevertheless, therapy based on the specified scale is highly clinically argued.

The classifications of subaxial cervical spine traumatic injuries. Part 1. General principles

Cervical spine and spinal cord injury is a significant medical and socio-economic problem of modern society. Ongoing urbanization, the development of high-speed modes of transport and the intensification of military conflicts lead to a progressive increase in the number of victims with this pathology. At the same time, unlike several other socially significant diseases, the category of the most employable population suffers from spinal injuries. Achievements of modern medicine to a much greater extent contribute to reducing the mortality of patients, rather than regression of neurological disorders. The usage of new diagnostic methods for neuroimaging and expensive surgical instruments, the continuous improvement of rehabilitation treatment of patients with spinal cord injury determine the progressively increasing costs for medical and social life support expenses. A large number of experimental and clinical studies, improvement of methods for surgical correction and stabilization of the damaged vertebral motor segment undoubtedly dictate certain changes in the tactics of treatment. The classification of traumatic spinal injuries is of key importance in determining the approaches, timing and volume of surgical intervention. Following the care algorithms helps to minimize the negative effects of traumatic damage to both the spine and the spinal cord and contributes to the maximum possible recovery of neurological functions. The last few decades have been characterized by the gradual replacement of the previously widely used “morphological” classifications of traumatic injuries of the cervical spine to “clinical” ones, based on an analysis of some heterogeneous factors determining treatment tactics. The first part of the review deals with a detailed description of the main criteria used in developing modern “clinical” classifications of subaxial cervical spine traumatic injuries. Besides, modern views on imaging methods and algorithms for determining the need to perform diagnostic procedures at primary hospitalization in patients with suspected cervical spine traumatic injury are presented.

Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 27. The utility of in-hospital postoperative radiographs following surgical treatment of traumatic cervical spine injuries

BACKGROUND CONTEXT Postoperative radiographs are routinely obtained following the surgical treatment of traumatic cervical spine injuries. Previous studies have evaluated the utility of postoperative radiographs following elective cervical spine surgery for degenerative conditions, but there has been no study evaluating this exclusively in the trauma population. This routine imaging comes at a financial cost to the health care system in addition to exposing the patient to an increased radiation dose. We hypothesized that routine postoperative X-ray imaging following surgical treatment of cervical spine traumatic injuries are unwarranted in the absence of changes in clinical findings. PURPOSE To assess the utility of routine in-hospital postoperative radiographs following surgical treatment of traumatic cervical spine injuries. STUDY DESIGN/SETTING Retrospective study. PATIENT SAMPLE All patients who underwent surgical treatment of traumatic cervical spine injuries over an eight-year period between January 2008 and December 2016 at a Level I trauma center. OUTCOME MEASURES Requirement of revision surgery. METHODS A retrospective chart review of the patients who underwent surgical treatment of traumatic cervical spine injuries over an eight-year period between January 2008 and December 2016 at a Level I trauma center was performed. Prior to discharge, postoperative upright AP and lateral radiographs were obtained and reviewed by one of the surgeons as per standard protocol. Those patients who subsequently required revision surgery were identified and further analyzed to identify if the results of the radiographs obtained led to the subsequent intervention or if other indications for surgery were present. RESULTS A total of 295 patients (177 males and 118 females) were identified with a mean age of 57.4 years (range, 18-94) between January 2008 and December 2016 with mean follow up of 284 days. All had routine postoperative upright X-ray imaging as well as during follow-up visits. There were two occipito-cervical fusions, 128 C1-2 posterior spinal fusions (PSFs), 50 subaxial cervical PSFs, seven odontoid screws, 81 anterior cervical discectomy and fusions (ACDFs), four anterior cervical corpectomy and fusions (ACCFs) and eight 360° fusions. Ten patients required subsequent surgeries: five for wound complications, two for neurological decline requiring decompression, one for recurrent subluxation, and two for non-union or mal-union. Four other patients were noted to have broken/loose hardware that were managed conservatively. Advanced imaging (CT/MRI) was ordered in 13 patients, nine of which required additional surgery: In the cases requiring additional surgery, the postoperative radiographs added no value in guiding treatment in the absence of clinical findings. Every patient who underwent additional surgery had clinical findings (ie, wound breakdown, new-onset radiculopathy or continued pain) that were of concern. Cervical radiographs alone added an additional $545,868 of health care cost during the study period. CONCLUSIONS Routine in-hospital and postoperative radiographs following surgical treatment of traumatic cervical spine injuries are of little value, especially in the absence of changes in examination or symptoms. In our experience, only 2.3% (7/295) patients had hardware-related complications, four of which were asymptomatic and three of which required subsequent surgery. With today's increasing emphasis on cost efficiency and evidence-based practice, we recommend against obtaining routine postoperative imaging in the absence of new clinical findings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Comparison of dynamics of neurological disorders regression in postoperative period in patients with subaxial cervical spine injury depending on constructive fusion system type

Introduction. Two types of constructive solutions for fusion of subaxial cervical spine traumatic injury are possible. The first is an independent combination of interbody implant and anterior plating, the second one is the single telescopic implant that combines both principles. Objective. To analyze the dynamics of regression of neurological disorders in patients with subaxial cervical spine traumatic injury who underwent anterior decompression-fusion surgery with different constructive type of fixation. Materials and methods. Clinical material was presented by 25 patients with subaxial cervical spine traumatic injury, divided into two groups depending on the type of fusion system used during the operation. The dynamics of neurological disorders recovery was assessed using the International Standards for Neurological Classification of Spinal Cord Injury. Results. The findings revealed a statistically significant difference in the intensity of neurological disorders recovery in patients at 3 and 6 months’ follow-up with a decisive advantage of single fusion system usage. Conclusions. The usage of a telescopic implant for anterior interbody subaxial cervical fusion is clinically approved, since it indirectly provides more pronounced regression of neurological disorders.

AOSpine subaxial cervical spine injury classification system.

This project describes a morphology-based subaxial cervical spine traumatic injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes. A subaxial cervical spine injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1month apart. Kappa coefficients (κ) were calculated for intraobserver and interobserver reliability. The classification system is based on three injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all injury subtypes (κ=0.75 and 0.64, respectively). The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.

A case of successful surgical treatment of thoracic spine traumatic injury with TX vertebra unstable penetrating compression-comminuted fracture

A case of successful surgical treatment of thoracic spine traumatic injury with TX vertebra unstable penetrating compression-comminuted fracture

Traumatic injuries to the craniovertebral junction: a review of rare events

The craniovertebral junction is a specific region of the spine with unique anatomical and biomechanical properties that yields a wide variety of injury patterns. Junctional traumatic fractures and/or dislocations are widely reported in clinical practice, but we could identify only a subgroup of upper cervical spine traumatic injuries with very few cases reported in the literature, and for this reason may be considered rare. In some of these cases, the absence of spinal biomechanical instability, in association with moderate clinical symptoms (neck stiffness and pain) and the difficulty in fracture identification through standard cervical radiographs, leads to a high percentage of missed injuries. In other cases, traumatic events have been commonly described only in autopsy series due to the high degree of spinal biomechanical instability. Herein, we have summarized all the relevant literature concerning this issue and also included our cases, with the aim of emphasizing prompt diagnosis and correct management. We provide a guide for correctly identifying "rare" craniovertebral junction traumatic injuries.

Application of epidural electrostimulation method in renewing surgical treatment of patients with consequences of cervical spine traumatic injury

Working out of new methods of surgical treatment, aimed to renew spinal cord function and to improve life quality of patients with consequences it’s traumatic injury, is one of the most perspective directions of modern neurosurgery development.The results of epidural electrostimulation application at 59 patients with consequences of cervical spine injury are given. Movements renewing was estimated according to ASIA and Frankel scales. Pain syndrome intensity was estimated by VAS and NRS scales, the spasticity — by Ashworth.Renewing and improvement of movements in upper limbs was observed at 56 (94.9%) patients, renewing of movements in lower limbs — at 6 (10.2%), their improvement — at 7 (11.9%). The ability to walk was renewed at 5 (8.5%) patients, was improved — at 2 (3.4%). Positive results in neuropathic pain syndrome correction were obtained at 6 (85.7%) of 7 patients, in spasticity — at 9 (81.8%) patients of 11, bladder function was improved at 39 (66.1%).Results of spinal cord functions renewing using epidural electrostimulation are directly proportional to trauma severity and duration of injury existence.