Subaxial Cervical Spine Injury Research Articles

Fracture-dislocations of the subaxial cervical spine

Fracture-dislocations of the subaxial cervical spine are rare yet potentially devastating injuries often associated with high-energy trauma. These inherently unstable injuries frequently lead to neurologic compromise, necessitating urgent operative intervention. This review provides a comprehensive overview of subaxial cervical spine fracture-dislocations, addressing their epidemiology, anatomy, and classification systems. Classification schemes including Allen and Ferguson, Cervical Spine Injury Severity Score (CSISS), Subaxial Cervical Spine Injury Classification System (SLIC), and AO Spine Subaxial Cervical Spine Injury Classification System are discussed. Prompt recognition and management of these injuries is critical in optimizing long-term functional and neurologic outcomes. Rates of neurologic injury can exceed 50 %, with distractive flexion injuries and bilateral facet injuries often presenting with higher ASIA grades and lower neurologic recovery potential. Minimizing time to reduction is the most important factor in optimizing neurologic outcomes in these injury patterns. We discuss both closed and open reduction methods, timing considerations, technical pearls, and potential complications associated with each strategy. We also discuss the diagnosis and management of concurrent acute disk herniations, the role of advanced imaging, and the debated utility of pre-reduction MRI. Many subaxial cervical fracture-dislocations necessitate surgical intervention, which can be approached from an anterior, posterior, or combined approach. Although no standard surgical treatment algorithm exists, we discuss surgical options and situations where a preferred approach may exist. Selection of the approach depends on injury characteristics and surgeon preference, and there are no clearly defined surgical recommendations based on injury pattern.

Safety of tranexamic acid in surgically treated isolated spine trauma.

Tranexamic acid (TXA), a synthetic antifibrinolytic drug, effectively reduces blood loss by inhibiting plasmin-induced fibrin breakdown. This is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine trauma. To assess the safety of TXA in isolated spine trauma. The primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion, respectively. This prospective observational study included patients aged ≥ 17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United Kingdom. We identified 67 patients: 26 (39%) and 41 (61%) received and did not receive TXA, respectively. Both groups were matched in terms of age, gender, American Society of Anesthesiologists grade, and mechanism of injury. A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score > 4 (74% vs 56%). All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min, compared with 24 patients (58%) in the non-TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 min. Among patients who received TXA, blood loss was < 150 and 150-300 mL in 8 (31%) and 15 (58%) patients, respectively. There were no cases of thromboembolic events in any patient who received TXA. Our study demonstrated that TXA is safe for isolated spine trauma. It is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel cases. Further, larger studies are necessary to explore the rate, dosage, and mode of administration of TXA.

Outcome and complications of operatively treated subaxial cervical spine injuries: A population-based retrospective cohort study

ObjectiveThe aim was to study the outcome and complications of operative treatment for subaxial cervical spine injuries with respect to injury morphology and surgical strategy. MethodsA population-based cohort of 271 consecutive patients treated at Kuopio University Hospital from 2003 to 2018 was retrospectively reviewed. ResultsThe mean age was 52.4 (range 12–90) years and 78.6% were male. The AOSpine morphological classification was C in 56.5%, B in 24.7% and A in 17.0% of cases. The surgical approach was anterior in 70.8%, posterior in 20.3% and combined in 8.9% of patients. Fixation alignment was maintained in 96.9% of patients. Instrumentation failures were observed only in patients operated anteriorly but no statistical difference was found between the surgical approaches. The American Spinal Injury Association Impairment Scale (AIS) grade improved in 22.1% of patients. Patients with preoperative AIS grade C had significant potential for neurological improvement (OR 10.44; 95% CI 1.77–61.56; p = 0.010). Postoperative, mostly mild, complications manifested in 22.5% of patients. The posterior approach was associated with fewer postoperative complications (OR 0.18; 95% CI 0.06–0.51; p = 0.001). Preoperative AIS grade A was a significant predisposing factor for complications (OR = 4.90; 95% CI = 1.49–16.10; p = 0.009). The perioperative (90-day) mortality rate was 3.3%. The mean follow-up period was 64.7 ± 25.9 (radiological)/136.7 ± 174.8 (clinical) days. ConclusionsOperative treatment is safe and effective but the surgical approach should be patient- and injury-specific. The prognosis for neurological recovery from spinal cord injury is superior in patients with partially preserved motor function.

Adverse events after surgery for injuries to the subaxial cervical spine: analysis of incidence and risk factors.

To determine the incidence of severe surgical adverse events (sSAE) after surgery of patients with subaxial cervical spine injury (sCS-Fx) and to identify patient, treatment, and injury-related risk factors. Retrospective analysis of clinical and radiological data of sCS-Fx patients treated surgically between 2010 and 2020 at a single national trauma center. Baseline characteristics of demographic data, preexisting conditions, treatment, and injury morphology were extracted. Incidences of sSAEs within 60 days after surgery were analyzed. Univariate analysis and binary logistic regression for the occurrence of one or more sSAEs were performed to identify risk factors. P-values < .05 were considered statistically significant. Two hundred and ninety-two patients were included. At least one sSAE occurred in 49 patients (16.8%). Most frequent were sSAEs of the surgical site (wound healing disorder, infection, etc.) affecting 29 patients (9.9%). Independent potential risk factors in logistic regression were higher age (OR 1.02 [1.003-1.04], p = .022), the presence of one or more modifiers in the AO Spine Subaxial Injury Classification (OR 2.02 [1.03-3.96], p = .041), and potentially unstable or unstable facet injury (OR 2.49 [1.24-4.99], p = .010). Other suspected risk factors were not statistically significant, among these Injury Severity Score, the need for surgery for concomitant injuries, the primary injury type according to AO Spine, and preexisting medical conditions. sSAE rates after treatment of sCS-Fx are high. The identified risk factors are not perioperatively modifiable, but their knowledge should guide intra and postoperative care and surgical technique.

The Effect of Concomitant Spinal Cord Injury on Postoperative Health-related Quality of Life After Traumatic Subaxial Cervical Spine Injuries: A Nationwide Registry Study

ObjectiveTo evaluate the effect of spinal cord injury (SCI) on the health-related quality of life (HRQoL) in patients surgically treated for traumatic subaxial cervical spine injuries and investigate the agreement between objective neurologic outcomes and patient reported outcome measures (PROMs) in that context. Study DesignObservational study on prospectively collected multi-institutional registry data. SettingSweden. ParticipantsPatients with traumatic subaxial spine injuries identified in the Swedish Spine Registry (Swespine) between 2006 and 2016. InterventionsAnterior, posterior, or anteroposterior cervical fixation surgery. Main OutcomesPatient-reported outcome measures (PROMs) consisting of EQ-5D-3Lindex and Neck Disability Index (NDI). ResultsAmong the 418 identified patients, 93 (22%) had a concomitant SCI. In this group, 30 (32%) had a complete SCI (Frankel A), and the remainder had incomplete SCIs (17%) Frankel B; 25 (27%) Frankel C; 22 (24%) Frankel D. PROMs significantly correlated with the Frankel grade (P<.001). However, post hoc analysis revealed that the differences between adjacent Frankel grades failed to reach both statistical and clinical significance. On univariable linear regression, the Frankel grade was a significant predictor of a specific index derived from the EQ-5D-3L questionnaire (EQ-5D-3Lindex) at 1, 2, and 5 years postoperatively as well as the NDI at 1 and 2 years postoperatively (P<.001). Changes of PROMs over time from 1, to 2, and 5 years postoperatively did not reach statistical significance, regardless of the presence and degree of SCI (P>.05). ConclusionOverall, the Frankel grade significantly correlated with the EQ-5D-3Lindex and NDI and was a significant predictor of PROMs at 1, 2, and 5 years. PROMs were stable beyond 1 year postoperatively regardless of the severity of the SCI.

Is it true that treatment in patients with Subaxial Cervical Spine Injury Classification System (SLICS) 4 is the surgeon's choice?

The Subaxial Cervical Spine Injury Classification System (SLICS) is a commonly used algorithm for diagnosing and managing subaxial cervical spine trauma. A SLIC score 4 suggests either surgery or non-surgically treatment depending on the surgeon's experience and patient's conditions. Prognosis and treatment results were analyzed in patients with SLIC score 4. The patients with SLIC score 4 were retrospectively reviewed from 2012 to 2019. Forty-one patients were included and divided into two groups: non-surgically treated and surgically treated. Demographic data and radiographs were analyzed. Statistical analysis was performed to determine the difference between the two clinical groups. Twenty-two patients were non-surgically treated, and nineteen patients were surgically treated. There was no neurological deterioration in both groups. However, there was no statistically significant difference in the last follow-up AISA and Nurick grade (p> 0.05). There was no significant difference in the number of patients who showed improvement when comparing the initial and the last follow-up neurological status (p> 0.05). Regardless of the treatment method, the spinal cord injury patients with SLICS point 4 showed a relatively good prognosis. Patients with SLIC score 4 could be treated non-surgically or surgically based on the surgeon's experience and factors associated with the patient's acute health status and chronic comorbidities.

Treatment of Subaxial Cervical Spine Injuries at the University Hospital Center of Brazzaville, Congo

Background and Aim: Spinal cord trauma is a public health problem. The subaxial cervical spine is the most frequent seat of such injuries. This study aims to describe the treatment of subaxial cervical spine injuries at the University Hospital Center of Brazzaville, the Republic of Congo. Methods and Materials/Patients: This descriptive study was conducted for 7 years, from 2015 to 2021 in the Department of Multipurpose Surgery at the University Hospital Center of Brazzaville, Congo. The research included all patients hospitalized for subaxial cervical spine injury. The surgery was performed on 32 cases (53.3%). Results: A total of 90 cases with subaxial cervical spine injuries were reported with a frequency of 3.2% and included 60 cases. The median age was 37 years and the sex ratio (male/female) of 3.6. The trauma was because of a road accident in 68.3% of the cases. The affected vertebral level was C5-C6 in 18 cases (30%). It was a luxation in 30% and fracture luxation in 26.7% of the subjects. Surgery was indicated in 51 patients and 32(53.3%) were operated. The median time between admission and surgery was 288 hours. A total of 31(96.9%) cases were operated by the anterior approach alone. Anterior osteosynthesis was performed in all cases. Meanwhile, 18(56.3%) cases had a favorable evolution, 7(21.9%) had a worsening of the deficit, 5(15.6%) experienced a postoperative infection, 5(15.6%) showed deep pressure ulcers, and 7(22%) cases died. In both univariate and multivariate analysis, an unfavorable American Spine Injury Association score (between A and B) was associated with the occurrence of complications with a significant statistical difference (P&lt;0.05). Conclusion: Therapeutic care is delayed due to insufficient financial means for patients who lack health insurance. The surgery consists of neural decompression, arthrodesis then osteosynthesis, particularly by an anterior approach.

143. Evolution of patient-reported outcome measures beyond one-years after fixation surgery for subaxial cervical spine injuries

143. Evolution of patient-reported outcome measures beyond one-years after fixation surgery for subaxial cervical spine injuries

Timing of Surgery and Pre-operative Physiological Parameters as Clinical Predictors of Surgical Outcomes in Traumatic Subaxial Cervical Spine Fractures and Dislocations.

Objective To evaluate the risk factors and outcomes in patients surgically treated for subaxial cervical spine injuries with respect of the timing of surgery and preoperative physiological parameters of the patient. Methods 26 patients with sub-axial cervical spine fractures and dislocations were enrolled. Demographic data of patients, appropriate radiological investigation, and physiological parameters like respiratory rate, blood pressure, heart rate, PaO2 and ASIA impairment scale were documented. They were divided pre-operatively into 2 groups. Group U with patients having abnormal physiological parameters and Group S including patients having physiological parameters within normal range. They were further subdivided into early and late groups according to the timing of surgery as U early , U late, S early and S late . All the patients were called for follow-up at 1, 6 and 12 months. Results 56 percent of patients in Group S had neurological improvement by one ASIA grade and a good outcome irrespective of the timing of surgery. Patients in Group U having unstable physiological parameters and undergoing early surgical intervention had poor outcomes. Conclusion This study concludes that early surgical intervention in physiologically unstable patients had a strong association as a risk factor in the final outcome of the patients in terms of mortality and morbidity. Also, no positive association of improvement in physiologically stable patients with respect to the timing of surgery could be established.

Teachability of lower cervical spine injury classifications

ObjectivesTo compare the teachability of the Allen–Ferguson, Harris, Argenson, AOSpine, Subaxial Cervical Spine Injury Classification (SLIC), Subaxial Cervical Spine Injury Classification (CSISS) and to identify the classification that a group of residents and junior neurosurgeons find easiest to learn. MethodsWe used data from 64 consecutive patients. Answers of nine residents and junior neurosurgeons and four experienced surgeons in two assessment procedures were used. Six raters (workshop group) participated in special seminars between assessments. Three other raters formed the control group. Experienced surgeon's answers were used for comparison. Teachability was measured as the median value of the difference (ΔK) in the interrater agreement on the same patients by the same pairs of subjects. ResultsMedian Δ K for the Allen–Ferguson, Harris, Argenson and AOSpine classifications were: (1) 0.01, 0.02, 0.29, and 0.39 for the workshop group; (2). 0.09, −0.03, 0.06 and 0.04 for the control group, respectively. Between numerical scales, median ΔK was higher for SLIC but did not exceed 0.16. Interrater consistency with expert's opinion was increased in the workshop group for Allen–Ferguson, Argenson and AOSpine and did not differ in either group for SLIC and CSISS. ConclusionThe AOSpine classification was the most teachable. Among numeric scales, SLIC demonstrated better results. The successful application of these classifications by residents and junior neurosurgeons was possible after a short educational course. The use of these scales in educational cycles at the stage of residency can significantly simplify the communication between specialists, especially at the stage of patient admission.

An international validation of the AO spine subaxial injury classification system

PurposeTo validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions.MethodsA live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (ƙ = 0–0.20), fair (ƙ = 0.21–0.40), moderate (ƙ = 0.41–0.60), substantial (ƙ = 0.61–0.80), or excellent (ƙ = > 0.80) as determined by the Landis and Koch classification.ResultsA total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (ƙ = 0.87), while fracture subtype (ƙ = 0.80) and facet injury were substantial (ƙ = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (ƙ = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (ƙ = 0.76).ConclusionThe AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.

The Role of Riluzole in Acute Traumatic Cervical Spinal Cord Injury with Incomplete Neurological Deficit: A Prospective, Randomised Controlled Study.

Riluzole, a benzothiazole sodium channel blocker is acknowledged as a neuroprotective agent in spinal cord injury (SCI). Most of this evidence is based on pre-clinical studies and its effectiveness in clinical setting is undetermined, heretofore. A prospective, randomised-controlled study was conducted between April 2019 and March 2020 at a tertiary-level centre. Patients aged 18-65years with sub-axial cervical spine injury, who presented within 72h of injury with incomplete neuro-deficit, were included. They were randomised into groups A (riluzole was administered) and B (no adjuvants). All patients were followed up at 6weeks/3/6/12months, and clinical [ASIA motor/sensory scores/grade, SCIM3, and NRS (neuropathic pain)] and radiological evaluation was performed. Twenty-three and 20 patients were included in groups A and B. Two in group A were females, while others were males (p = 0.49). Mean age in groups A and B was 47.7 ± 14.8 and 51.2 ± 14.1years (p = 0.44). Five patients died prior to 6th-week follow-up. Among the others, there was significant improvement in all neurological parameters in both groups (post-injury vs 1-year; motor score: p < 0.001, sensory score: p < 0.001, SCIM3: p < 0.001, NRS: p < 0.001). In both groups, initial significant improvement was noticed even at the 6th-week follow-up, which further continued until the end of 1year. There was no statistically significant difference between groups A and B with respect to these neurological parameters (motor: p = 0.15, sensory: p = 0.39, SCIM3: p = 0.68, NRS: p = 0.06). Administration of riluzole did not significantly improve neurological outcome/neuropathic pain in our cohort. Nevertheless, both our groups demonstrated an overallimprovement inneurological outcome at 1year, as compared with immediate post-injury status.

P152. Is short segment fracture fixation appropriate for AO spine type B and C injuries?

<h3>BACKGROUND CONTEXT</h3> The AO Spine Classifications are associated with a hierarchical injury severity score. "Type A" fractures represent the most stable injuries and "Type C" represent the most severe and unstable injuries. "Three column" subaxial cervical spine and thoracolumbar injuries are designated as Type B (tension band) and Type C (fracture dislocation). Although the load sharing classification describes burst type fractures, Type B and C injuries are often minimally comminuted but grossly unstable due to "three-column" disruption. Therefore, the load sharing classification may not be appropriate to guide short- or long-segment fixation. <h3>PURPOSE</h3> To identify if construct length affects the rate of surgical complications or instrumentation revision following Type B and C subaxial or thoracolumbar injuries. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> All patients with cervical or thoracolumbar Type B and Type C injuries between 2006-2021 were identified from a prospectively collected database. Only patients who underwent operative intervention were included. <h3>OUTCOME MEASURES</h3> Surgical complications (persistent cerebrospinal fluid leak, wound dehiscence, epidural hematoma, surgical site infection) and reoperations (instrumentation revision and/or exchange). <h3>METHODS</h3> Patients were divided based on the number of levels instrumented above and below the injured level (>2 levels (long-segment) versus < 2 levels (short-segment)). Patient demographics, surgical characteristics and clinical outcomes were collected and compared. Independent t-tests or Mann-Whitney U tests compared continuous variables, while Pearson's chi-square tests compared categorical variables. Bivariate logistic regression measured the effect of fixation construct length (long-segment fixation) on the likelihood of having a surgical complication and reoperation for instrumentation revision and/or exchange. Alpha was set at P<0.05. <h3>RESULTS</h3> A total of 180 patients representative of 187 fractures were included. Of the 187 injuries, 69 (36.9%) underwent long-segment fixation. Patients who underwent long-segment fixation were older (61.1 vs 51.5 years, p=0.005), were more likely to have comorbid ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperosteosis (DISH) (47.8% vs 21.2%, p<0.001), and were more likely to have an injury that involved a thoracic vertebra (53.6% vs 30.5%, p=0.008). Further, patients who underwent long-segment fixation were more likely to undergo posterior-only fixation (85.5% vs 60.2%, p<0.001) in comparison to anterior-only and combined anterior-posterior fixation. There was no significant difference in the proportion of long-segment versus short-segment constructs that included bilateral, unilateral or no pedicle screws within the injured vertebrae (p=0.371). Bivariate logistic regression demonstrated that a long-segment fixation construct had a non-significant increase in complication rates (OR=2.08, p=0.176) and reoperations for instrumentation revision or exchange (OR=2.99, p=0.142). We subanalyzed the 58 fractures with AS/DISH compared to the 129 fractures without AS/DISH. Injuries with AS/DISH had a mean 2.57+ 1.01 and 2.34 + 0.81 levels instrumented above and below the injury compared to injuries without AS/DISH, mean 1.97 + 1.04 and 1.90 + 0.96 levels instrumented above and below the injury (p<0.001), respectively. However, there was no difference in the rate of surgical complications (8.62% vs 7.75%, p=0.780) or instrumentation revision (6.90% vs 3.10%, p=0.256) between the two groups based on construct length. <h3>CONCLUSIONS</h3> Long-segment fixation of Type B or C subaxial cervical spine or thoracolumbar spine injuries resulted in a non-significant increase in complications and spine reoperations for instrumentation revision. Instrumentation technology has improved since the load sharing classification. This exploratory study suggests short segment fixation may be appropriate even for unstable spine fractures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Operative Outcomes After Cervical Diffuse Idiopathic Skeletal Hyperostosis Fracture in the Elderly.

Cervical diffuse idiopathic skeletal hyperostosis (DISH) fractures are frequently unstable and carry significant risk of neurologic injury and death. Most patients with DISH fractures are elderly (>70 years) with significant comorbidities. We assessed factors that contribute to outcomes in elderly patients with cervical DISH fractures. Elderly patients with cervical DISH fractures from 2008 to 2017 were included in this retrospective multi-institutional cohort study. Predictor variables included injury level, surgical approach, preinjury comorbidities, American Society of Anesthesiologists (ASA) score, American Spinal Injury Association (ASIA) impairment scale grade, preoperative anticoagulation status, and the subaxial cervical spine injury classification system (SLIC) score. Univariate and multivariate analyses were utilized to identify factors associated with 30-day mortality and ambulatory status at discharge. A total of 48 patients, mean age 74.7 years old (range 60-96), underwent cervical fixation for DISH fractures. Average SLIC score was 6.30 ± 1.2 (range 5-8), and most frequent fracture level was at C6 to -C7 (31.3%) followed by C7-T1 (25.0%). Forty (83.3%) patients underwent posterior fixation, 7 (14.6%) with anterior fixation, and 1 (2.1%) had combined approach. Ten (20.4%) patients died within 30 days of surgery. Multivariate analysis demonstrated that poorer preoperative ASIA grade (OR 2.35, P = 0.003, CI = 1.33-4.14) and ASA score >3 (P = 0.027) had increased risk of being nonambulatory at discharge. Higher SLIC score was associated with increased 30-day mortality (P = 0.021, CI = 1.20-9.60). Cervical DISH fractures can be highly unstable, for which instrumentation and fixation are indicated. Surgical decision-making should focus on preoperative ASIA grade, SLIC score, and ASA score. The study is relevant due to an aging poulation predisposed to cervical DISH fractures.

Posterior surgical approach for the treatment of lower cervical spine injury with spinal cord paralysis: high postoperative mortality in resource-scare setting.

This report aimed to characterize clinical and imaging characteristics and outcomes of the patients with lower cervical spine injury combined with spinal cord paralysis who underwent posterior cervical spine surgery. Between January 2019 and December 2020, a retrospective evaluation of prospectively collected data at one institution was conducted. We included all patients who were diagnosed with subaxial cervical spine injuries (C3-7), had spinal cord paralysis, and underwent posterior cervical spine surgery. Clinical profile, preoperative characteristics, intraoperative data, and postoperative outcomes were retrieved from prospective patients' medical records and computerized database. Among 70 selected patients, most were male (66, 94.29%) and the average age was 48.41 ± 14.33 years. Most of them worked in agriculture (90.4%). Clinical symptoms included neck pain (58, 82.86%), cervical radiculopathy (50, 71.43%), loss of sensation (44, 62.86%), and decreased sensation (21, 30.00%). The most frequent cervical spinal injuries involved C5 (28.57%), followed by C7 (14.29%). Circular muscle dysfunction was present in 65 (92.86%) patients. Early complications included respiratory failure (12.85%), pneumonia (11.42%), bedsores (8.57%), and urinary tract infection (7.14%). Common late complications included movement disorder (48.21%), muscle weakness and stiffness (37.50%), sensory disturbances (32.14%), urinary tract infection (17.86%), bedsores (16.07%), and pneumonia (5.36%). Patients after surgery and at follow-up had a significant improvement compared to preoperative assessment according to the AIS classification, and recovery of smooth muscle. Three patients died within 1 month following surgery, 3 within 1-3 month(s), 2 within 3-6 months, and 1 case beyond 6 months. In hospital-based clinical condition with limited practice approach, our study indicated specific clinical and imaging characteristics of Vietnamese patients with lower cervical spine injury combined with spinal cord paralysis. With high postoperative mortality rate, commonly late complications after posterior cervical spine surgical approach were pain and difficulty in neck movement, muscle weakness and stiffness, and nerve root pain.

Epidemiology and Surgical Outcome of Traumatic Sub Axial Cervical Spine Injuries in a Tertiary Care Hospital of KPK, Pakistan

Objective: The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Materials and Methods: This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion. Results: 80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale. Conclusion: Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern.

Neurosurgical Outcome of Combined Anterior-Posterior Approaches for Sub-Axial Cervical Spine Injury: A Retrospective Analysis

Neurosurgical Outcome of Combined Anterior-Posterior Approaches for Sub-Axial Cervical Spine Injury: A Retrospective Analysis

Beach Breaking Waves and Related Cervical Spine Injuries: A Level One Trauma Center Experience and Systematic Review

To analyze cervical spine injuries resulting from recreational activity in shallow ocean water amid high-energy breaking waves. Single-center 10-year review of patients who sustained cervical injuries at the beach in Long Island, New York, USA. A systematic review following the PRISMA guidelines was also performed. Nineteen patients (age 17-79 years) sustained cervical injury from high-energy breaking waves while in shallow beach water. Six patients dived into a wave; 6 patients were struck by a large wave while standing upright; and 7 tumbled in the waves while engaged in nonspecified recreational activity. All 7 patients with subaxial cervical AO Spine Injury Score (AO-SIS) >10 had cervical spine injury with cord signal change and required operative management. Diving mechanism, AO-SIS >10, and cord signal change all predicted significant disability or death at 12 months (P < 0.01). The present study and 7 additional studies reporting on 534 patients (mean age, 45.4 years) were analyzed. Within the reported literature, most patients (94.2%) sustained a spinal cord injury. On long-term follow-up, an estimated 64.8% of patients had permanent neurologic injury and 12.5% had permanent quadriplegia. We offer the first description of cervical injuries sustained in water-related recreational activity using the AO-SIS. The morphology of injuries varied significantly and seemed to depend on body position and wave kinetic energy. Patients presenting with cervical injury in this setting and yielding AO-SIS >10 are likely to have poor functional recovery.

Observational retrospective study of subaxial cervical spine trauma at tertiary care centre

The aim of this study is to compare between various treatment modalities available for treatment of subaxial cervical spine injuries due to trauma A total of 172 patients of subaxial cervical spine injuries were assessed retrospectively about their mode of injury, clinical course, definitive treatment given and its outcome. As the study was Descriptive and retrospective in nature involving only patient case files, statistical test is not applied to the study In our study 44 patients suffered from vertebral body fracture while 108 patients had spinal canal compromise due to other injuries. 16 patients had quadriplegia, 24 patients had grade 4 power in upper and lower extremities, and roots were involved in 46 patients. In 44 patients complete corpectomy was performed with placement of tricorticate graft taken from fibula, this graft was fixed in place with titanium plate and four screws.From this study it can be concluded that Patients treated with anterior approach had better outcome in relation to the fixation and fusion of the spine, reconstruction is more better in anterior approach.

Approach and considerations for surgery in subaxial cervical spine injury: A narrative review

Subaxial cervical spine injuries are common and encompass a spectrum of injuries ranging from a minor ligamentous sprain to fracture dislocation with spinal cord injury. These injuries are often missed in the initial evaluation, and a high index of suspicion is needed to evaluate and diagnose these injuries, which otherwise could lead to spinal cord injury. Computed tomography scans are the gold standard in the evaluation of fractures as plain radiographs have limited sensitivity. Magnetic resonance imaging (MRI) is necessary to identify injury to the disco-ligamentous complex and to assess cord injury. The principles of the treatment of cervical spine injuries include early immobilization to prevent secondary neurological injury, achieving alignment by reduction and stabilization of the unstable injured segment and decompression of the cord in the presence of cord injury. Owing to a broad spectrum of injuries, there is no unified approach, and the management plan depends on the morphology of injury, the extent of structures damaged, and the presence of neurological impairment. Various classifications grade and help assess the severity of the injury. Minor injuries are conservatively managed with cervical orthoses, and unstable injuries require stabilization either anterior, posterior, or combined approaches, depending on the injury morphology. Controversy exists over the safety of closed reduction in facetal subluxations, need for pre-reduction MRI, and the ideal approach for each injury. This review presents the current evidence and guidelines on the management of subaxial cervical spine injuries.