Thoracolumbar Spine Injuries Research Articles

Reliability and reproducibility analysis of the AOSpine thoracolumbar spine injury classification system by Chinese spinal surgeons.

The objective of this study was to analyze the interobserver reliability and intraobserver reproducibility of the new AOSpine thoracolumbar spine injury classification system in young Chinese orthopedic surgeons with different levels of experience in spinal trauma. Previous reports suggest that the new AOSpine thoracolumbar spine injury classification system demonstrates acceptable interobserver reliability and intraobserver reproducibility. However, there are few studies in Asia, especially in China. The AOSpine thoracolumbar spine injury classification system was applied to 109 patients with acute, traumatic thoracolumbar spinal injuries by two groups of spinal surgeons with different levels of clinical experience. The Kappa coefficient was used to determine interobserver reliability and intraobserver reproducibility. The overall Kappa coefficient for all cases was 0.362, which represents fair reliability. The Kappa statistic was 0.385 for A-type injuries and 0.292 for B-type injuries, which represents fair reliability, and 0.552 for C-type injuries, which represents moderate reliability. The Kappa coefficient for intraobserver reproducibility was 0.442 for A-type injuries, 0.485 for B-type injuries, and 0.412 for C-type injuries. These values represent moderate reproducibility for all injury types. The raters in Group A provided significantly better interobserver reliability than Group B (P<0.05). There were no between-group differences in intraobserver reproducibility. This study suggests that the new AO spine injury classification system may be applied in day-to-day clinical practice in China following extensive training of healthcare providers. Further prospective studies in different healthcare providers and clinical settings are essential for validation of this classification system and to assess its utility.

Thoracolumbar Spine Injury at CT: Trauma/Emergency Radiology.

Thoracolumbar Spine Injury at CT: Trauma/Emergency Radiology.

Temporary Percutaneous Pedicle Screw Stabilization Without Fusion of Adolescent Thoracolumbar Spine Fractures

Pediatric spine trauma often results from high-energy mechanisms. Despite differences in healing potential, comorbidities, and length of remaining life, treatment is frequently based on adult criteria; ligamentous injuries are fused and bony injuries are treated accordingly. In this study, we present short-term results of a select group of adolescent patients treated using percutaneous pedicle screw instrumentation without fusion. An IRB-approved retrospective review was performed at a level 1 pediatric trauma center for thoracolumbar spine fractures treated by percutaneous pedicle screw instrumentation. Patients were excluded if arthrodesis was performed or if instrumentation was not removed. Demographics, injury mechanism, associated injuries, fracture classification, surgical data, radiographic measures, and complications were collected. Radiographs were analyzed for sagittal and coronal wedge angles and vertebral body height ratio and statistical comparisons performed on preoperative and postoperative values. Between 2005 and 2013, 46 patients were treated surgically. Fourteen patients (5 male, 9 female) met inclusion criteria. Injury mechanisms included 8 motor vehicle collisions, 4 falls, and 2 all-terrain vehicle/motorcycle collisions. There were 8 Magerl type A injuries, 4 type B injuries, and 2 type C injuries. There was 1 incomplete spinal cord injury. Implants were removed between 5 and 12 months in 12 patients and after 12 months in 2 patients. Statistical analysis revealed significant postoperative improvement in all radiographic measures (P<0.05). There were no neurological complications, 1 superficial wound dehiscence, and 2 instrumentation failures (treated with standard removal). At last follow-up, 11 patients returned to unrestricted activities including sports. Average follow-up was 9 months after implant removal and 19.3 months after index procedure. Adolescent thoracolumbar fractures present unique challenges and treatment opportunities different from the adult patient. We present a nonconsecutive series of 14 patients temporarily stabilized with percutaneous pedicle screw fixation for injuries including 3-column fracture dislocations and purely ligamentous injuries. Temporary fusionless instrumentation can provide successful management of select thoracolumbar spine injuries in pediatric trauma patients. Level IV-Retrospective case series.

Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community

Objective. The disruption of autonomic function following a spinal cord injury (SCI) is common and can negatively affect quality of life. The objective of this study was to describe the prevalence of bladder/bowel incontinence and sexual dysfunction in community-dwelling individuals with a thoracolumbar SCI and examine the impact on general physical and mental health status.Methods. Participants who sustained a traumatic SCI to the thoracolumbar region of the spinal cord and classified as American Spinal Injury Association Impairment Scale (AIS) A to D were recruited. Demographic, injury data, MRI classification and neurological data were collected on admission. At follow-up, the neurological data, a questionnaire collecting participant-reported secondary health conditions (SHCs) (e.g. bladder incontinence, depression etc.) following SCI and health status measured by Short Form-36 were obtained. Regression models determined the association of health status with demographic/injury-related data, types and number of SHCs.Results. Of the 51 participants, 58.8% reported bladder incontinence, 54.0% bowel incontinence, 60.8% sexual dysfunction and 29.4% had all three. The regression models demonstrated that age at injury, bowel incontinence, sexual dysfunction, presence of pain, motor score at follow-up and the number of SHCs were significant predictors of health status. The number of SHCs was more predictive than all other demographic and injury variables for health status.Conclusion. Results highlight the high prevalence of self-reported bowel/bladder incontinence and sexual dysfunction in the traumatic thoracolumbar SCI population and support the need for standardized assessments. Several demographic, injury-related and SHCs impacted health status and should be considered for the management of individuals living in the community.

Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury.

Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C‐fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex‐mediated simultaneous detrusor and sphincter contractions or detrusor‐sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease‐associated changes can impact on the quality of life and life expectancy of spinal‐injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.

Role of magnetic resonance imaging in acute spinal trauma: a pictorial review.

Magnetic resonance imaging (MRI) has been playing an increasingly important role in the spinal trauma patients due to high sensitivity for detection of acute soft tissue and cord injuries. More and more patients are undergoing MRI for spinal trauma in the emergency settings, thus necessitating the interpreting physicians to be familiar with MRI findings in spinal trauma. In this pictorial review, we will first describe the normal anatomy of various ligamentous structures. Indications of MRI in spinal trauma as well as the role of MRI in diagnosing spinal cord and soft tissue injuries will then be discussed. Illustrated cases are mainly of cervical spine trauma, but thoracolumbar spine injuries are also included where appropriate in our review.

Clinical and radiological factors affecting progressive collapse of acute osteoporotic compression spinal fractures

Osteoporotic compression spine fractures have a different clinical course and outcomes when compared to spinal fractures occurring in the younger population. Only a few studies have investigated the risk factors for progressive osteoporotic compression spine fractures. The purpose of this study was to investigate clinical and radiological factors related to progressive collapse following acute osteoporotic compression spine fractures. We retrospectively identified all patients treated for thoracolumbar fractures in our institution between January 2008 and July 2013. Included cases were examined by plain radiographs and CT scans. For each patient we classified the fracture according to the AOSpine Thoracolumbar Spine Injury Classification System. The difference between initial and final height loss and initial and final local kyphosis was documented as height loss difference and kyphotic angle difference. The presence of old fractures and intravertebral cleft were also documented. The study included 153 patients, comprising 102 women and 51 men. The mean patient age was 68.9years. The mean length of follow up was 15months. A statistically significant correlation was found between patient age, final height loss, height loss difference and kyphotic angle difference. Height loss difference and kyphotic angle difference were significantly correlated to type of fracture according to the AO classification system. The height loss difference was 18.1% in A1 type fractures, 27.1% in A2 type fractures, 24.2% in A3 type fractures and 25.7% in A4 type fractures. During a minimum 3-month follow up of conservative treatment for acute osteoporotic vertebral compression fractures, age and the AOSpine Thoracolumbar Spine Injury Classification System were predictive factors for progressive collapse.

Abstracts from The 34(th) Annual National Neurotrauma Symposium June 26-29, 2016 Lexington, Kentucky.

Abstracts from The 34(th) Annual National Neurotrauma Symposium June 26-29, 2016 Lexington, Kentucky.

Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study.

The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries. Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation. Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k=0.43±0.01 and 0.59±0.16, respectively, PLC: k=0.47±0.01 and 0.55±0.15, respectively), and fair to moderate reliability (k=0.29±0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k=0.59±0.01) and substantial intrarater reliability (k=0.68±0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems. Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.

The value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries.

Although imaging has a major role in evaluation and management of thoracolumbar spinal trauma by spine surgeons, the exact role of computed tomography (CT) and magnetic resonance imaging (MRI) in addition to radiographs for fracture classification and surgical decision-making is unclear. Spine surgeons (n=41) from around the world classified 30 thoracolumbar fractures. The cases were presented in a three-step approach: first plain radiographs, followed by CT and MRI images. Surgeons were asked to classify according to the AOSpine classification system and choose management in each of the three steps. Surgeons correctly classified 43.4% of fractures with plain radiographs alone; after, additionally, evaluating CT and MRI images, this percentage increased by further 18.2 and 2.2%, respectively. AO type A fractures were identified in 51.7% of fractures with radiographs, while the number of type B fractures increased after CT and MRI. The number of type C fractures diagnosed was constant across the three steps. Agreement between radiographs and CT was fair for A-type (k=0.31), poor for B-type (k=0.19), but it was excellent between CT and MRI (k>0.87). CT and MRI had similar sensitivity in identifying fracture subtypes except that MRI had a higher sensitivity (56.5%) for B2 fractures (p<0.001). The need for surgical fixation was deemed present in 72% based on radiographs alone and increased to 81.7% with CT images (p<0.0001). The assessment for need of surgery did not change after an MRI (p=0.77). For accurate classification, radiographs alone were insufficient except for C-type injuries. CT is mandatory for accurately classifying thoracolumbar fractures. Though MRI did confer a modest gain in sensitivity in B2 injuries, the study does not support the need for routine MRI in patients for classification, assessing instability or need for surgery.

Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas.

Necessity of imaging for symptom-free conscious patients presented to emergency department (ED) following traumatic thoracolumbar spine injuries has been a matter of debate. The present study was aimed to evaluate the diagnostic value of clinical findings in prediction of traumatic thoracolumbar injuries compared tocomputed tomography (CT) scan. The present diagnostic value study was carried out using non-random convenience sampling during the time between October 2013 and March 2014. All trauma patients > 15 years old underwent thoracolumbar CT scan were included. Correlation between clinical and CT findings was measured using SPSS 21.0 and screening performance characteristics of clinical findings in prediction of thoracolumbar fracture were calculated. 169 patients with mean age of 37.8 ± 17.3 years (rage: 15-86) were evaluated (69.8% male). All fracture patients had at least 1 positive finding in history and physical examination. The fracture was confirmed in only 24.6% of the patients with positive findings in history or physical examination. In 37.5% of patients the location of fracture, matched the area of positive physical examinations. Sensitivity, specificity, PPV, NPV, PLR, and NLR of clinical findings in comparison to thoracolumbar CT scan were 100 (95% CI: 89 - 100), 1.5 (95% CI: 0.2-6), 24.5 (95% CI: 18.3-31.9), 100 (95% CI: 19.7-100), 32.5 (95% CI: 24.6-43.03), and infinite, respectively. The results of the present study, show the excellent screening performance characteristics of clinical findings in prediction of traumatic thoracolumbar fracture (100% sensitivity). It could be concluded that in conscious patients with stable hemodynamic, who have no distracting pain and are not intoxicated, probability of thoracolumbar fracture is very low and near to zero in case of no positive clinical finding.

The Value of CT and MRI in the Evaluation and Management of Patients with Thoracolumbar Spinal Injuries

Introduction Although imaging has a major role in evaluation and management of thoracolumbar spinal trauma, the exact role of CT and MRI in addition to radiographs for fracture classification and management is unclear. We conducted an online survey base study to evaluate the added value of computed tomography (CT) and magnetic resonance imaging (MRI) in classification, evaluation of stability and management of thoracolumbar injuries. Methods Spine surgeons ( n = 41) from around the world classified 30 thoracolumbar fractures. The cases were presented in a three step approach: first plain radiographs, followed by CT and MRI images. Surgeons were asked to classify according to the AO Spine Classification System, evaluate fracture stability and choose management. Results Surgeons correctly classified 43.4% of fractures with plain radiographs alone; after additionally evaluating CT and MRI images, this percentage increased by further 18.2% and 2.2% respectively. Instability was diagnosed in 68.5% cases with plain radiographs and this percentage increased to 79.3% after CT ( p &lt; .0001) but did not increase significantly after MRI. AO Type A fractures were identified in 51.7% of fractures with radiographs while the number of type B fractures increased after CT and MRI. The number of type C fractures diagnosed was constant across the three steps. Agreement between radiographs and CT was fair for A-type (k=0.31), poor for B-type (k=0.19), but it was excellent between CT and MRI (k &gt; 0.87). CT and MRI had similar sensitivity in identifying fracture sub types except that MRI had a higher sensitivity (56.5%) for B2 fractures ( p &lt; 0.001). Conclusion For accurate classification, radiographs alone were insufficient except for C type injuries. CT is mandatory for accurately classifying thoracolumbar fractures. Though MRI did confer a modest gain in sensitivity in B2 injuries, the study does not support the need for routine MRI in patients without spinal cord injury for classification, assessing instability or need for surgery.

Influence of PMMA Screw Augmentation on the Primary Stability of an Anterolateral Plating System in Osteoporotic Vertebrae

Introduction Expandable anterolateral plates facilitate the reduction of posttraumatic deformities of thoracolumbar spine injuries and are commonly used in cases of unstable injuries or compromised bone quality. In this human cadaver study, the craniocaudal yield load of the bony fixation of an anterior angle stable plating system and the influence of Polymethyl Methacrylate (PMMA) augmentation on the primary stability of the screw–bone interface during kyphosis reduction was evaluated in twelve osteoporotic thoracolumbar vertebrae. Material and Methods The anterolateral stabilization device used for this study is comprised of two swiveling flanges and an expandable midsection. It facilitates the controlled reduction of kyphotic deformities in situ with a geared distractor. Single flanges were attached to twelve thoracolumbar vertebrae. Six specimens were augmented with PMMA by means of cannulated bone screws. The constructs were subjected to static, displacement controlled craniocaudal loading to failure in a servohydraulic testing machine. Results The uncemented screws cut out at a mean of 393 +/− 66 N, whereas the cemented screws demonstrated significantly higher yield load of 966 +/− 166 N ( p &lt; 0.02). No significant correlation between bone mineral density and yield load was detected in this setting. Conclusion The results of this study indicate that PMMA augmentation is an effective method to increase two- to 3-fold the primary stability of the screw–bone interface of an anterolateral spine stabilization system in osteoporotic bone. We recommend the system in cases of severely compromised bone quality to reduce the risk of screw loosening during initial kyphosis correction and to increase long-term construct stability.

Development of a Universal Disease-Specific Outcome Instrument for Spine Trauma: The AOSpine Clinician Reported Outcome Spine Trauma (AOSpine CROST)

Introduction The AOSpine Knowledge Forum Trauma initiated a project to develop and validate universal disease-specific outcome instruments for adult spine trauma patients. Besides a patient reported outcome measure, the objective is to develop and validate a clinician reported outcome (AOSpine CROST) for this specific patient population. The AOSpine CROST is needed to formalize the most relevant clinical and radiological assessment parameters as a simple, reliable and quick to administer tool that is completed by the treating surgeons, and enables them to evaluate and predict the clinical and functional outcomes of spine trauma patients on the short term (3 months-2 years) and long term (≥2 years) time periods post-trauma, independent of the patient reported outcome. To identify relevant parameters, 2 separate surveys were conducted. Material and Methods The 2 international cross-sectional web-based surveys were conducted among highly experienced spine surgeons from the 5 AOSpine International world regions, consisting of members of AOSpine International and International Spinal Cord Society (ISCoS). The first survey focused on identifying relevant parameters for the thoracic and lumbar spine (TL-survey), the second survey on the subaxial cervical spine (C-survey). Participants were asked to give their opinion on the relevance of a compilation of parameters on a 5-point scale. Those parameters were based on a systematic review, the recently developed AOSpine Subaxial Cervical Spine and Thoracolumbar Spine Injury Classification Systems, as well as expert interviews. In total, 16 parameters were included in the TL-survey, and 21 in the C-survey. Furthermore, participants were asked to indicate the age that may have an influence on patients' outcome. The responses were analyzed using descriptive statistics, frequency analysis and Kruskal-Wallis test. Results Out of the 279 invited spinal surgeons, 118 (42.3%) participated in the TL-survey and 108 (38.7%) in the C-survey. Combining the results of both surveys, 5 parameters were identified as relevant by at least 70% of the participants for all spine regions and time periods post-trauma. Neurological status was identified as the most relevant parameter. In contrast, 5 parameters were not deemed relevant. Pain and mobility of the spine were more relevant for the thoracolumbar- and lumbar spine region, while 3 parameters were more relevant for the cervical spine. Five parameters were identified as relevant for the short term, while bony fusion was the only identified parameter for the long term. The identified missing parameter was bone quality. No large differences were observed for the age that may have an influence on patients' outcome (mean range: 50.1–58.2 years). Only minor differences were observed in the response patterns between the world regions, or spine surgeons' degree of experience. Conclusion These studies identified clinical and radiological assessment parameters considered as most relevant by a worldwide panel of highly experienced spine surgeons to evaluate and predict outcomes of spine trauma patients. After formalizing these parameters and conducting pilot tests, a final version of the AOSpine CROST has been developed, consisting of 10 items. Once subjected to further validation, the AOSpine CROST will be a helpful tool in research and clinical practice.

Influences of MOTOmed training on motor function of patients with thoracolumbar spinal cord injury

Objective To explore the influences of MOTOmed training on functional independence of patients with thoracolumbar spinal cord injury. Methods A total of 60 patients with thoracolumbar spinal cord injury admitted from January 2009 to August 2013 were divided into observation group and control group by random number, each with 30 cases. Conventional methods of rehabilitation were used in the control group; while MOTOmed training was conducted in the observation group on the basis of conventional training. Muscle strength of lower limbs, range of motion (ROM) of hips and knees, scores of motor function (score of motor function in FIM) were recorded before rehabilitation, 2 courses and 4 courses after rehabilitation. Score of muscle strength was in accordance with ASIA motor score, and with manual muscle test (MMT). Protractor was used to measure active bending degree. Motor function score was in accordance with FIM evaluation scale. Results After 2 courses and 4 courses after rehabilitation in the observation group, compared with the control group, muscle strength scores were (18.93±3.84), (29.36±4.29)(P<0.05); range of motion of hips were (65.83±15.26)°, (100.17±7.37)° (P<0.05); range of motion of knees were respectively (45.00±9.10)°, (66.50±11.68)°, (P<0.05); scores of motor function were respectively (62.43±12.06), (100.10±8.70) (P<0.01). Conclusions Adding MOTOmed training to conventional rehabilitation training can better improve motor function of patients with thoracolumbar spinal cord injury. Key words: Rehabilitation; Spinal cord injury; Muscle strength; Joint range of motion; Motor function; Motor training; MOTOmed

Patients Immobilized with a Long Spine Board Rarely Have Unstable Thoracolumbar Injuries

Most Emergency Medical Services (EMS) protocols require spine immobilization with both a cervical collar and long spine board for patients with suspected spine injuries. The goal of this research was to determine the prevalence of unstable thoracolumbar spine injuries among patients receiving prehospital spine immobilization: a 4-year retrospective review of adult subjects who received prehospital spine immobilization and were transported to a trauma center. Prehospital and hospital records were linked. Data was reviewed to determine if spine imaging was ordered, whether acute thoracolumbar fractures, dislocations, or subluxations were present. Thoracolumbar injuries were classified as unstable if operative repair was performed. Prehospital spine immobilization was documented on 5,593 unique adult subjects transported to the study hospital. A total of 5,423 (97.0%) prehospital records were successfully linked to hospital records. The subjects were 60.2% male, with a mean age of 40.6 (SD = 17.5) years old. An total of 5,286 (97.4%) subjects had sustained blunt trauma. Hospital providers ordered imaging to rule out spine injury in 2,782 (51.3%) cases. An acute thoracolumbar fracture, dislocation, or subluxation was present in 233 (4.3%) cases. An unstable injury was present in 29 (0.5%) cases. No unstable injuries were found among the 951 subjects who were immobilized following ground level falls. Hospital providers ordered at least one spine x-ray or CT in most patients, and a thoracolumbar imaging in half of all patients immobilized. Only 0.5% of patients who received prehospital spine immobilization had an unstable thoracolumbar spine injury.

Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury.

Literature examining magnetic resonance imaging (MRI) in acute spinal cord injury (SCI) has focused on cervical SCI. Reproducible systems have been developed for MRI-based grading; however, it is unclear how they apply to thoracic SCI. Our hypothesis is that MRI measures will group as coherent multivariate principal component (PC) ensembles, and that distinct PCs and individual variables will show discriminant validity for predicting early impairment in thoracic SCI. We undertook a retrospective cohort study of 25 patients with acute thoracic SCI who underwent MRI on admission and had American Spinal Injury Association Impairment Scale (AIS) assessment at hospital discharge. Imaging variables of axial grade, sagittal grade, length of injury, thoracolumbar injury classification system (TLICS), maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were collected. We performed an analytical workflow to detect multivariate PC patterns followed by explicit hypothesis testing to predict AIS at discharge. All imaging variables loaded positively on PC1 (64.3% of variance), which was highly related to AIS at discharge. MCC, MSCC, and TLICS also loaded positively on PC2 (22.7% of variance), while variables concerning cord signal abnormality loaded negatively on PC2. PC2 was highly related to the patient undergoing surgical decompression. Variables of signal abnormality were all negatively correlated with AIS at discharge with the highest level of correlation for axial grade as assessed with the Brain and Spinal Injury Center (BASIC) score. A multiple variable model identified BASIC as the only statistically significant predictor of AIS at discharge, signifying that BASIC best captured the variance in AIS within our study population. Our study provides evidence of convergent validity, construct validity, and clinical predictive validity for the sampled MRI measures of SCI when applied in acute thoracic and thoracolumbar SCI.

Reliability of the evaluation of posterior ligamentous complex injury in thoracolumbar spine trauma with the use of computed tomography scan.

The AOSpine thoracolumbar (TL) spine injury classification system is based mainly on computed tomography (CT). The main purpose of this study was to evaluate the reliability of CT scan in the diagnosis of posterior ligamentous complex (PLC) injury in thoracolumbar spine trauma (TLST). We performed a cross-sectional study of 43 patients with TLST. CT scans were evaluated independently by three spine surgeons on two separate occasions, 2 months apart. The reliability of PLC injury parameters was assessed by the Kappa coefficient (κ) and the average percentage of these parameters was established. Injuries were classified according to the AOSpine classification as type A (compression), B (anterior and/or posterior tension band injuries) or C (dislocation) injury and the reliability of the classification was calculated. On average, PLC injury was identified in 91.4% of type B or C injuries. Tension band injury and dislocation were found in 90.5% of type B and 93.2% of type C injuries. The intraobserver reliability for the PLC injury parameters ranged from 0.518 to 1.000, except for increased interspinous distance (IID). Interobserver reliability ranged from 0.303 to 0.688. When the patients were evaluated as a whole, dislocation showed the highest κ (0.656 and 0.688). When type A or B injuries were assessed, the highest κ were found for IID (0.533 and 0.511) and tension band injury (0.486 and 0.452). The κ for AOSpine classification was 0.526 and 0.645 in both assessments. In this study, the use of CT scan as the only diagnostic tool could identify PLC injury in most cases and demonstrated satisfactory reliability. Dislocation could satisfactorily diagnose type C injury, while IID was the best parameter to differentiate between type A and B injuries.

A simplified method of walking track analysis to assess short-term locomotor recovery after acute spinal cord injury caused by thoracolumbar intervertebral disc extrusion in dogs

The purpose of this study was to evaluate a simplified method of walking track analysis to assess treatment outcome in canine spinal cord injury. Measurements of stride length (SL) and base of support (BS) were made using a ‘finger painting’ technique for footprint analysis in all limbs of 20 normal dogs and 27 dogs with 28 episodes of acute thoracolumbar spinal cord injury (SCI) caused by spontaneous intervertebral disc extrusion. Measurements were determined at three separate time points in normal dogs and on days 3, 10 and 30 following decompressive surgery in dogs with SCI. Values for SL, BS and coefficient of variance (COV) for each parameter were compared between groups at each time point.Mean SL was significantly shorter in all four limbs of SCI-affected dogs at days 3, 10, and 30 compared to normal dogs. SL gradually increased toward normal in the 30 days following surgery. As measured by this technique, the COV-SL was significantly higher in SCI-affected dogs than normal dogs in both thoracic limbs (TL) and pelvic limbs (PL) only at day 3 after surgery. BS-TL was significantly wider in SCI-affected dogs at days 3, 10 and 30 following surgery compared to normal dogs. These findings support the use of footprint parameters to compare locomotor differences between normal and SCI-affected dogs, and to assess recovery from SCI. Additionally, our results underscore important changes in TL locomotion in thoracolumbar SCI-affected dogs.

Thoracolumbar spine clearance

The purpose of this study was to prospectively assess the sensitivity of clinical examination to screen for thoracolumbar spine (TLS) injury in awake and alert blunt trauma patients with distracting injuries. From December 2012 to June 2014, all blunt trauma patients older than 13 years were prospectively evaluated as per standard TLS examination protocol at a Level 1 trauma center. Awake and alert patients with Glasgow Coma Scale (GCS) score of 14 or greater underwent clinical examination of the TLS. Clinical examination was performed regardless of distracting injuries. Patients with no complaints of pain or tenderness on examination of the TLS were considered clinically cleared of injury. Patients with distracting injuries, including those clinically cleared and those with complaints of TLS pain or tenderness, underwent computed tomographic scan of the entire TLS. Patients with minor distracting injuries were not considered to have a distracting injury. A total of 950 blunt trauma patients were entered, 530 (56%) of whom had at least one distracting injury. Two hundred nine patients (40%) with distracting injuries had a positive TLS clinical examination result, of whom 50 (25%) were diagnosed with TLS injury. Three hundred twenty-one patients (60%) with distracting injuries were initially clinically cleared, in whom 17 (5%) TLS injuries were diagnosed. There were no missed injuries that required surgical intervention, with only four injuries receiving TLS orthotic bracing. This yielded an overall clinical clearance sensitivity for injury of 75% and sensitivity for clinically significant injury of 89%. In awake and alert blunt trauma patients with distracting injuries, clinical examination is a sensitive screening method for significant TLS injury. Radiologic assessment may be unnecessary for safe clearance of the asymptomatic TLS in patients with distracting injuries. These findings suggest significant potential reduction of both health care cost and patient radiation exposure. Diagnostic study, level IV; therapeutic/care management study, level IV.