Type Of Spinal Injury Research Articles

Lesión medular asociada a hematoma epidural espinal espontáneo

IntroductionSpontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methodsIn order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). ResultsCases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. ConclusionSSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

Spinal injuries after ejection seat evacuation in fighter aircraft of the German Armed Forces between 1975 and 2021.

The ejection seat is one of the most important rescue tools for military aircrews. However, the high ejection speeds place high loads on the pilots, which is mainly absorbed by the pilot's spine. The differentiated evaluation of spinal injuries is of particular importance because this has a decisive influence on the further personal life and career of the affected aircrew members. Factors influencing the occurrence of a fracture as well as the impact of a spinal injury on military flight certification have not been addressed sufficiently to date. The authors conducted a retrospective evaluation of ejection seat evacuations in German Armed Forces combat aircraft accidents between 1975 and 2021. The total number of aviation accidents with ejection seat initiations and the survived ejections were collected. Accident-specific data and pilot-specific data were collected. In addition, it was evaluated whether aircrew members were recertified for military flight after the accident. The type of spinal injury and the location of the injury were evaluated. In addition to the descriptive statistics, two logistic regression models were developed to assess prediction values of accident- and pilot-specific factors for spine injuries. A total of 103 aircrew members were included in this retrospective analysis. The overall prevalence of spine injuries was 56.3%, and the overall prevalence of spine fractures was 33.0%. In the first regression model analysis, there was no association with pilot flight experience, age, height, weight, BMI, and being diagnosed with a spine fracture. Similarly, aircraft type, altitude, and airspeed were not associated with the occurrence of spine fractures. In the regression model analysis for predictors of rejection in military flight recertification after ejection seat evacuation, lumbar spine fractures were associated with higher odds of being rejected for recertification. Military aircraft crew members have a high risk of suffering from a spine injury after emergency evacuation using an ejection seat. In the subsequent medical workup, special attention should be paid to the spine, and ideally a consultation with a spine surgeon should be performed. Lumbar spine fractures may have major consequences for military flight certification, and therefore special attention should be paid to successful rehabilitation.

Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation.

Factors influencing the length of spinal instrumentation have been mostly evaluated in burst fractures, receiving more attention than other unstable thoracolumbar injuries. We aimed to evaluate clinical factors affecting surgical decision-making and associated complications. This was a multicentric retrospective cohort study. Outcomes of patients with AO Spine injury classification types B2, B3, and C operated through an open posterior-only approach were analyzed. Length of instrumentation was correlated with age, type of injury, comorbidities, level of injury, neurological status, and complications. Among 439 patients, 30.3% underwent short-segment fixation (SSF) and 69.7% underwent long-segment fixation (LSF). Type C injuries were treated with LSF in 89.4% of cases (P < 0.001). On multivariate analysis, age ≤39 years (OR: 2.06), AO spine type B2 (OR: 3.58), and type B3 (OR: 7.48) were statistically significant predictors for SSF, while hypertension (OR: 4.07), upper thoracic injury (OR: 9.48), midthoracic injury (OR: 6.06), and American Spinal Injury Association Impairment Scale A (OR: 3.14) were significantly associated with LSF. Patients with SSF had fewer overall complications (27.1% vs 50.9%, P < 0.001) and were less likely to develop pneumonia (6.0% vs 18.3%, P < 0.001) and urinary tract infections (6.8% vs 16.3%, P < 0.007). Unstable thoracolumbar injuries were mostly treated by LSF. Length of instrumentation was affected by the type of spinal injury, location of the injury, and neurological status. SSF was associated with lower rates of early complications than LSF. The decision on the length of fixation in the surgical treatment of unstable thoracolumbar injuries is affected by different factors, and it will impact the rate of postoperative complications.

SPINE TRAUMA EPIDEMIOLOGICAL PROFILE IN A TERTIARY NEUROSURGERY HOSPITAL IN SOUTH BRAZIL

ABSTRACT Objective The aim of this paper is to analyze the epidemiological profile of a large series of spine trauma victims in the Southernmost state of Brazil. Methods A retrospective study including spine trauma patients was performed at a tertiary hospital from January 1st, 2013 to December 31st, 2018. The variables analyzed include demographic data, information related to the trauma (etiology, trauma mechanism, type of spine injury, number of vertebrae involved, vertebral segment involved), neurological status at hospital admission (Frankel scale), treatment performed and the outcome (number of days in hospital, neurological outcome, and mortality). Results A total of 808 patients were included. The mean age was 47.9 (±19.0), and the majority were male and Caucasian. The most frequent etiology was falls from height (N=508; 62.9%) followed by traffic accidents (N=185; 22.9%). The thoracolumbar segment was the spinal segment most frequently affected, occurring in 401 (52.1%) patients, followed by the cervical, thoracic and lumbar segments. The incidence of SCI was 16.7%. Non-operative treatment was indicated in 510 (63.1%) patients. Conclusion The authors presented the largest epidemiological profile regarding spine trauma in Latin America, analyzing a total of 808 patients, which represents an incidence of 134.6 cases/year. This paper fills a gap in the medical literature regarding the epidemiological profile of this disease in Latin America. Level of evidence II; Prognostic study.

Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population.

Thoracolumbar fractures are the most common kind of spine injury in children. Several types of spine injury can occur, and for this reason, treatment algorithms have been put in place for the management of these patients. At present, the thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AOSpine injury score (AOSpine score) aimed at providing treatment recommendations. We aimed to assess the reliability, in children, of the TLICS scoring and AOSpine scoring systems, and to define the superiority of one of the methods of scoring, to spread its use in routine clinical management in the pediatric spine trauma. A retrospective chart review of consecutive children admitted to a Level 1 trauma center for traumatic thoracolumbar fractures, between 2006 and 2019, was performed. We compared the management we performed in clinical practice in children with spine trauma, to the decisional algorithms based on the TLICS and AOSpine scores. According to these scores, surgical treatment should be performed when the TLICS score ≥ 5 and the AOSpine score > 5; and surgical or conservative treatment was considered reasonable when the TLICS score = 4 and the AOSpine score = 4 or 5. Surgical indications were based on the clinical status, the anatomy of the fracture, and the risk of sagittal imbalance of the growing spine. Fifty-four patients met the inclusion criteria. We demonstrated that both the AOSpine score and the TLICS scores had a significant correlation for surgical management decision of spine trauma (p < 0.0001). We found a high concordance between surgical decision making in the pediatric clinical practice and the TLICS score. In our pediatric cohort, there were significantly more patients with TLICS ≥ 5 (n = 47, 87%) than with AOSpine score > 5 (n = 26, 46%, p < 0.0001). There were significantly more patients with TLICS ≥ 4 (n = 53, 98%), than with AOSpine score ≥ 4 (n = 42, 77%, p = 0.001). ConclusionsThe TLICS score was significantly more appropriate than the AOSpine score, for the surgical treatment decision in children, especially when considering the future risk of sagittal imbalance.

Study of steffee fixation in spinal trauma

Background: The management of thoraco lumbar and lumbar injuries depends on the mechanical and neurological problems due to injury of bone, ligaments, disc and cord. The steffee system of transpedicular spinal stabilization, when used with correct operative technique and a sound knowledge of the morphology of pedicles at various levels is a good, cost effective implant which can be adapted for usage in all types of thoracolumbar injuries with minimal complications. Materials and Methods: In a prospective study conducted in the Postgraduate Department of Orthopaedics, Pudukkottai Government Medical College and Hospital, Tamilnadu over a period of 2 years. Fifty cases, both male and female in the age group of 20 to 60 years, who had undergone steffee fixation for various types of spinal injuries with neurological deficit were included. The results were analyzed according to neurological improvement as per Frankel's grading, the complications and the duration of hospital stay in both the groups. Results: In this series 80% of patients had spinal injuries at the thoraco lumbar [D12 – L1] level. Burst Fractures and fracture dislocation were the two most common types of fractures and accounted for about 90% of the spinal injuries in this study. Out of 50 cases, 44 patients the results were good. Of the remaining 6 patients screw breakage occurred in 2 patients after the injured vertebrae had fused. Implant backing out was seen in two patients, but the K angle was maintained and the injured vertebrae had fused. Only in one patient the result was poor as there was screw breakage in the first month which led to loss of spinal stabilization. Conclusion: The steffee system of transpedicular spinal stabilization, when used with correct operative technique and a sound knowledge of the morphology of pedicles at various levels is a good, cost effective implant which can be adapted for usage in all types of thoracolumbar injuries with minimal complications.

Spinal Manifestations of Neurofibromatosis: An Update

Background and Aim: Neurofibromatosis-1 (NF1) is a common genetic condition in children. It is becoming increasingly recognized that in neurofibromatosis, there might be anomalous development of bone with or without any local anomaly of neuroectodermal basis. This review was conducted to highlight the different features of spinal disorders in this congenital disease. Methods and Materials: Different search engines were used in this research. After going through the results and discarding the repeated ones, 2 reviewers began to inspect the studies independent of one another. In case of any disagreements between the reviewers over the inclusion of certain research material into the study, the final decision was made by the senior author. In the end, accepted research materials were used as needed in categorizing different types of spinal injuries. Results: Skeletal defects are among the most effective complications on the quality of life of patients. Bone deformities, osteoporosis, osteopenia, reduction of bone mass density, and spinal osteopathy such as scoliosis among such defects. Although the relative prevalence of spinal defects in neurofibromatosis type 1 is not clear, scoliosis can be considered the most common type of spinal deformity in this illness to the point it is present in 10 to 71% of cases. Thus, spine surgeons may face numerous common challenging conditions in NF1 patients like scoliosis, spondylolisthesis, and dural ectasia. Conclusion: As NF1 distresses several organ systems, radiologic spine screening is important in patients with NF1 and patients are likely to profit most from a multidisciplinary treatment policy.

Missed manubriosternal dislocation in patient with thoracolumbar fracture, a case report

BackgroundSpine fractures combined with sternal injury are most commonly occur in the thoracic region. Lower cervical and thoracolumbar injuries have also been reported, especially for the patients with manubriosternal dislocation. The type of spine injury is easily recognized in initial presentation, but we may miss the sternal fracture and manubriosternal dislocation.Case presentationA 23-year-old male patient complained with chest, right ankle, and lumbar pain after a fall at ground level, with diagnosis of right distal tibial fracture, sternal fracture, calcaneus fracture, and L2 vertebral fracture. However, neurologically he was completely normal. He underwent the operation for his lower extremity and spine, but we missed his manubriosternal dislocation after discharged. After one month, he came to the clinic with complained of chest pain, the imaging exams showed anterior dislocation of manubriosternal joint. We chose conservative treatment for manubriosternal dislocation. He was followed up at monthly intervals and radiographs along with computerized tomography showed satisfactory in fracture healing of lumber and the sternal fracture. However, the manubriosternal dislocation was malunioned. The patient had appearance deformity of the manubriosternal joint.ConclusionThis case supports the concept of the existence and clinical relevance of the thoracic cage theory, the thoracolumbar vertebrae should also be included in the thoracic cage theory.

Long Term Follow-Up Results of Spinal Concussion Cases: Definition of Late Injuries of the Spinal Cord

This study aims to evaluate the long-term clinical and radiologic findings of cases diagnosed with spinal concussion and to describe the spinal cord injuries that are detected in the later course. Data obtained from 91 cases, who had been diagnosed with spinal concussion, were retrospectively evaluated. These were placed in 2 groups according to the type of trauma (axial forces or vertical forces). Magnetic resonance imaging scans taken >6 months after the trauma were inspected. Axial and vertical forces result in different types of spine injuries. The effect of vertical forces on the spinal cord can involve longer segments and the effect of axial forces remains limited to a few segments. Vertical forces usually result in the development of syringomyelias in the late period, whereas axial forces may cause cavitation and stretch injuries to the spinal cord. Although patients with spinal concussion manifest complete recovery in the early period after the trauma, findings related to the spinal cord may appear in the later course. The direction of the forces that the spinal cord is subjected to may result in different cord injuries in the late period.

SPINE TRAUMA

Objectives: To determine the etiology and level of spine trauma in patientspresenting in tertiary care hospital of Pakistan. Study Design: Descriptive, cross-sectional study.Setting: This study was conducted at the Department of Neurosurgery, Pakistan Institute ofMedical Sciences (PIMS), Islamabad, from September 20th, 2014 to March 20th, 2015. Subjects:The patients in the study were of both genders, between 15 to 80 years of age (N=315, meanage 38.17 years, SD 17.31). Materials and Methods: All 315patientsbetween 15 to 80 yearsof age with spine trauma presenting to the Neurosurgery department of PIMS, Islamabadconsented to participate in the study. All these patients had underwent thorough history andphysical examination after stabilization and initial emergency management. X-ray spine wascarefully reviewed and patient details, bio-data, etiology of trauma, spinal injury type, level,neurological status and diagnosis were recorded. Results: The most frequently affected agegroup presenting with spine trauma were young and between 15 to 30 years of age (17.1%).The most frequent etiologies seen for spine injury were falls; 158 (50.2%) followed by RTA’s;129 (41%). The most common level of spine trauma presentation was at the lumbar spine;142 (45.1%) followed by thoracic spine fractures; 80 (25.4%). Conclusion: Lumbar spine andyounger male people are more prone to spinal injuries in Pakistan. The most frequent reasonfor the trauma was due to falls followed by road traffic accidents.

ETIOLOGY AND FRERQUENCY OF SPINE TRAUMA; PATIENTS PRESENTED IN A TERTIARY CARE HOSPITAL OF PAKISTAN

Objectives: To determine the etiology and level of spine trauma in patientspresenting in tertiary care hospital of Pakistan. Study Design: Descriptive, cross-sectional study.Setting: This study was conducted at the Department of Neurosurgery, Pakistan Institute ofMedical Sciences (PIMS), Islamabad, from September 20th, 2014 to March 20th, 2015. Subjects:The patients in the study were of both genders, between 15 to 80 years of age (N=315, meanage 38.17 years, SD 17.31). Materials and Methods: All 315patientsbetween 15 to 80 yearsof age with spine trauma presenting to the Neurosurgery department of PIMS, Islamabadconsented to participate in the study. All these patients had underwent thorough history andphysical examination after stabilization and initial emergency management. X-ray spine wascarefully reviewed and patient details, bio-data, etiology of trauma, spinal injury type, level,neurological status and diagnosis were recorded. Results: The most frequently affected agegroup presenting with spine trauma were young and between 15 to 30 years of age (17.1%).The most frequent etiologies seen for spine injury were falls; 158 (50.2%) followed by RTA’s;129 (41%). The most common level of spine trauma presentation was at the lumbar spine;142 (45.1%) followed by thoracic spine fractures; 80 (25.4%). Conclusion: Lumbar spine andyounger male people are more prone to spinal injuries in Pakistan. The most frequent reasonfor the trauma was due to falls followed by road traffic accidents.

Imaging in paediatric spinal injury

Background Paediatric spinal injury is rare and exhibits many unique features. Attending clinicians and radiologists often lack knowledge, expertise and experience in dealing with a potential injury to the paediatric spine. Within the paediatric age range itself there are different age-dependent mechanisms that can injure the paediatric spine. Moreover, the anatomical features and degree of osseous maturity of the developing paediatric spine determine the biomechanical characteristics which promote unique patterns of spinal injury in each paediatric age group. Methods An expert illustrated narrative review of the literature. Results Multiple factors make the imaging interpretation of the injured paediatric spine challenging. Each imaging modality has strengths and weaknesses in depicting spinal anatomy which vary with the type of spinal injury and age of the paediatric patient. Conclusions Attending doctors need to be familiar with the imaging appearances of the normal paediatric spine, its normal variants as well as the imaging features characteristics of paediatric spinal injury seen on radiographs, computed tomography and magnetic resonance imaging.

Clinical research on the accuracy of cervical pedicle screws

Objective To evaluate the clinical effect of a self-developed technique of manual placement of pedicle screw in cervical spine based on anatomical research. Methods Data of 105 patients who had cervical pedicle screw placement within seven years (from April 2007 to April 2013, and April 2013 to April 2016) were retrospectively analyzed, including 60 male and 45 female, aged from 20 to 76 years (51.7±14.5 years). Five main types of spinal injury were included: traumatic spinal injury (61 cases), degenerative cervical injury (19 cases including 12 ossification of posterior longitudinal ligament and 7 cervical spondylosis), cervical cancer (16 cases including 9 schwannoma, 4 meningioma, and 3 cases of cervical vertebral tumor), cervical deformity (6 cases including 3 kyphosis and 3 congenital malformation), and intervertebral space infection (3 cases). All the patients had X-ray, CT scan and MRI imaging pre-operatively, and X-ray and CT scan were also performed post-operatively to assess the accuracy of the position of screws. The accuracy of pedicle screws placement and screw leaning degree were analyzed according to the Lee standard. Grade 0: no penetration; Grade I: pedicle penetration within 25% of the pedical screw diameter; Grade II: pedicle penetration between 25% to 50% of the pedical screw diameter; Grade III: pedicle penetration beyond 50% of the pedical screw diameter. Grade II and III were considered as misplacement. In patients of Grade II and/or III, complications of blood vessels and nerve injury, etc. were observed. American spinal injury association (ASIA) was used to classify spinal injury among patients with trauma, while Japanese Orthopaedic Association Scores (JOA) was used to evaluate neural function improvement within patients without trauma. Results A total of 510 screws were placed by manual placement in 105 patients. Among 99 valid patients (6 without post-operative CT scan were excluded) with 497 screws (including 201 in upper cervical spine, and 296 in lower cervical spine), the results were shown as following: (1) Screw placement accuracy: 486 screws of Grade 0, 8 screws of Grade I, 3 screws of grade II, and 0 screws of Grade III. (2) 11 screws were penetrated pedical cortex with 8 of Grade I and 3 of Grade II (2 penetrated into cortical paries medialis and 1 penetrated into paries lateralis, but no screw penetrated into upper or inferior border). The accuracy of screw placement was 97.79% (Grade 0), the total misplacement rate was 0.6% (Grade II and III). According to post-operative follow up in 12 to 30 months (average 20.6±5.2 months), no complication of spinal, nerve root, or vascular injury was found. No screw loosening or fracture occurred, and all bones were healed properly. Follow up in the 6 months after operation showed that patients with trauma had significantly improvement in ASIA grading, while patients without trauma had better JOA scores. Conclusion Based on the study, the technique of manual placement of pedicle screw in cervical spine is considered to be safe and reliable. Considering its wide indication, it’s a technique worthy of clinical application. Key words: Cervical vertebrae; Spinal fusion; Bone screws; Tomography, X-ray computed

Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management.

Background:High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients.Materials and Methods:All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded.Results:During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients.Conclusion:Prolonged bradycardia was associated with significantly higher incidence of asystole. Endotracheal suctioning and positioning of HSCI patients were significant provocative factors for prolonged bradycardia; hypotension on admission, pneumonia and tracheostomy were the risk factors for the development of prolonged bradycardia in these patients.

Toward developing a specific outcome instrument for spine trauma: an empirical cross-sectional multicenter ICF-based study by AOSpine Knowledge Forum Trauma.

Empirical cross-sectional multicenter study. To identify the most commonly experienced problems by patients with traumatic spinal column injuries, excluding patients with complete paralysis. There is no disease or condition-specific outcome instrument available that is designed or validated for patients with spine trauma, contributing to the present lack of consensus and ongoing controversies in the optimal treatment and evaluation of many types of spine injuries. Therefore, AOSpine Knowledge Forum Trauma started a project to develop such an instrument using the International Classification of Functioning, Disability and Health (ICF) as its basis. Patients with traumatic spinal column injuries, within 13 months after discharge from hospital were recruited from 9 trauma centers in 7 countries, representing 4 AOSpine International world regions. Health professionals collected the data using the general ICF Checklist. The responses were analyzed using frequency analysis. Possible differences between the world regions and also between the subgroups of potential modifiers were analyzed using descriptive statistics and Fisher exact test. In total, 187 patients were enrolled. A total of 38 (29.7%) ICF categories were identified as relevant for at least 20% of the patients. Categories experienced as a difficulty/impairment were most frequently related to activities and participation (n = 15), followed by body functions (n = 6), and body structures (n = 5). Furthermore, 12 environmental factors were considered to be a facilitator in at least 20% of the patients. Of 128 ICF categories of the general ICF Checklist, 38 ICF categories were identified as relevant. Loss of functioning and limitations in daily living seem to be more relevant for patients with traumatic spinal column injuries rather than pain during this time frame. This study creates an evidence base to define a core set of ICF categories for outcome measurement in adult spine trauma patients. 4.

Toward the Development of an International Disease-Specific Outcome Instrument for Spinal Trauma

Introduction There is no specific measure available for patients with spinal trauma to apply in comparative effectiveness analyses, which contributes to the present lack of consensus and ongoing controversies regarding the optimal treatment and evaluation of many types of spinal injuries. Therefore, the AOSpine Knowledge Forum on Spinal Cord Injury and Trauma initiated a project to develop and validate such an instrument, which includes both the patients' and health professionals' perspective. The International Classification of Functioning, Disability and Health (ICF) is used as the basis. The preparatory phase of this project focused on identifying all potentially meaningful ICF categories for patients with spinal trauma, excluding patients with complete paralysis and patients with polytrauma, from three different perspectives: research, expert, and patient perspective. The results of these studies created the necessary background for a consensus meeting during which a selection of core categories was decided. Material and Methods The research perspective was covered by a systematic literature review, from 2000 to June 2013, identifying outcome measures focusing on the functioning and health of patients with spinal trauma. The content of these outcome measures was linked to the ICF using established linking rules. The expert perspective was explored through an international cross-sectional web-based survey among spine surgeons from the five AOSpine International world regions. The surgeons were asked to give their opinion on the relevance of a compilation of 143 ICF categories for patients with spinal trauma. The patient perspective was investigated in an international empirical cross-sectional multicenter study, using the general ICF Checklist of 128 categories as a reference. Results Of 6,415 screened references, 217 were included in the systematic review, and 15 frequently used outcome measures were identified. The content of these measures was linked to 57 different ICF categories. A total of 150 AOSpine International members participated in the expert survey. Of 143 ICF categories included in the survey, 13 were identified as “definitely relevant” by ≥ 80% of the participants. The empirical study, including 187 patients from nine trauma centers in seven countries, yielded 38 ICF categories as the most important for ≥ 20% of the patients. Combining these results, the list of ICF categories presented at the consensus meeting included 157 different ICF categories at the first or second level (44 on the component body functions, 16 on body structures, 64 on activities and participation, and 33 on environmental factors). Overall, 11 experts from six countries attended the consensus meeting. Ultimately, a total of 25 ICF categories were selected for outcome measurement in adult spinal trauma patients. This core set included 9 categories from the component body functions, 14 from activities and participation, and 2 from environmental factors. Conclusion A formal consensus process integrating evidence and expert opinion led to a core set of ICF categories for outcome measurement in patients with spinal trauma. In future studies, the Patient Reported Outcome under development will be subjected to further validation and cross-cultural adaptation.

Towards the development of an outcome instrument for spinal trauma: an international survey of spinal surgeons.

International web-based survey. To identify the most relevant aspects of human function and health status from the perspective of health care professionals involved in the treatment of spinal trauma patients. There is no universally accepted outcome instrument available that is specifically designed or validated for spinal trauma patients, contributing to controversies related to the optimal treatment and evaluation of many types of spinal injuries. Therefore, the AOSpine Knowledge Forum Trauma aims to develop such an instrument using the International Classification of Functioning, Disability, and Health (ICF) as its basis. Experts from the 5 AOSpine International world regions were asked to give their opinion on the relevance of a compilation of 143 ICF categories for spinal trauma patients on a 3-point scale: "not relevant," "probably relevant," or "definitely relevant." The responses were analyzed using frequency analysis. Possible differences in responses between the 5 world regions were analyzed with the Fisher exact test and descriptive statistics. Of the 895 invited AOSpine International members, 150 (16.8%) participated in this study. A total of 13 (9.1%) ICF categories were identified as definitely relevant by more than 80% of the participants. Most of these categories were related to the ICF component "activities and participation" (n = 8), followed by "body functions" (n = 4), and "body structures" (n = 1). Only some minor regional differences were observed in the pattern of answers. More than 80% of an international group of health care professionals experienced in the clinical care of adult spinal trauma patients indicated 13 of 143 ICF categories as definitely relevant to measure outcomes after spinal trauma. This study creates an evidence base to define a core set of ICF categories for outcome measurement in adult spinal trauma patients.

Biomechanical evaluation of bending strength of spinal pedicle screws, including cylindrical, conical, dual core and double dual core designs using numerical simulations and mechanical tests

Pedicle screws are used for treating several types of spinal injuries. Although several commercial versions are presently available, they are mostly either fully cylindrical or fully conical. In this study, the bending strengths of seven types of commercial pedicle screws and a newly designed double dual core screw were evaluated by finite element analyses and biomechanical tests. All the screws had an outer diameter of 7mm, and the biomechanical test consisted of a cantilever bending test in which a vertical point load was applied using a level arm of 45mm. The boundary and loading conditions of the biomechanical tests were applied to the model used for the finite element analyses. The results showed that only the conical screws with fixed outer diameter and the new double dual core screw could withstand 1,000,000 cycles of a 50–500N cyclic load. The new screw, however, exhibited lower stiffness than the conical screw, indicating that it could afford patients more flexible movements. Moreover, the new screw produced a level of stability comparable to that of the conical screw, and it was also significantly stronger than the other screws. The finite element analysis further revealed that the point of maximum tensile stress in the screw model was comparable to the point at which fracture occurred during the fatigue test.

Ischemic stroke after cervical spine injury: analysis of 11,005 patients using the Japanese Diagnosis Procedure Combination database

Background contextThe incidence and relevant risk of ischemic stroke after cervical spine trauma remain unknown. PurposeTo examine the incidence of ischemic stroke during hospitalization in patients with cervical spine injury, and analyze the impact of different types of cervical spine injuries on the occurrence of ischemic stroke. Study designRetrospective analysis of data abstracted from the Diagnosis Procedure Combination database, a nationally representative database in Japan. Patient sampleWe included all patients hospitalized for any of the following traumas: fracture of cervical spine (International Classification of Diseases, 10th Revision codes: S120, S121, S122, S127, S129); dislocation of cervical spine (S131, S133); and cervical spinal cord injury (SCI) (S141). Outcome measuresOutcome measures included all-cause in-hospital mortality and incidence of ischemic stroke (I63) during hospitalization. MethodsWe analyzed the effects of age, sex, comorbidities, smoking status, spinal surgery, consciousness level at admission, and type of cervical spine injury on outcomes. ResultsWe identified 11,005 patients with cervical spine injury (8,031 men, 2,974 women; mean [standard deviation] age, 63.5 [18] years). According to the types of cervical spine injury, we stratified the patients into three groups: cervical fracture and/or dislocation without SCI (2,363 patients); cervical fracture and/or dislocation associated with SCI (1,283 patients); and cervical SCI without fracture and/or dislocation (7,359 patients). Overall, ischemic stroke occurred in 115 (1.0%) patients during hospitalization (median length of stay, 26 days). In-hospital death occurred in 456 (4.1%) patients. Multivariate analyses showed that ischemic stroke after cervical spine injury was significantly associated with age, diabetes, and consciousness level at admission. The highest in-hospital mortality was observed in patients with cervical fracture and/or dislocation associated with SCI (7.6%), followed by cervical SCI without fracture and/or dislocation (4.0%), and cervical fracture and/or dislocation without SCI (2.6%). Unlike mortality, risks of stroke did not vary significantly among the three groups. ConclusionsThis analysis revealed that ischemic stroke after cervical spine injury was not uncommon and was associated with increased mortality and morbidity. Occurrence of ischemic stroke was significantly associated with age, comorbidities such as diabetes, and consciousness level at admission, but not with the type of spine injury.

Spinal Fracture-Dislocations and Spinal Cord Injuries in Motor Vehicle Crashes

Purpose: This study estimated the annual count of spinal cord injuries (SCIs) in motor vehicles crashes by type and seat belt use using 18 years of NASS-CDS data. It determined the rate for SCI and fracture-dislocation of the spine.Methods: 1994–2011 NASS-CDS was used to estimate the annual occurrence of spinal injuries in front seat occupants involved in motor vehicle crashes. Crashes were grouped by front, side, rear, and rollovers, and the effects of belt use were investigated. Light vehicles were included with model year 1994+. Spinal injuries were classified as minor (Abbreviated Injury Scale [AIS] 1), moderate (AIS 2), serious (AIS 3), fracture-dislocations, and SCI (AIS 4+). The annual count and rate for different types of spinal injury were estimated along with standard errors. The results were compared to estimates of head injuries. NASS-CDS electronic cases of SCIs in rear impacts were investigated.Results: There were 5,592 ± 1,170 fracture-dislocations of the spine and 1,046 ± 193 AIS 4+ SCI per year in motor vehicle crashes. Most of the injuries occurred in rollovers and frontal crashes and the least occurred in rear impacts. The rate of SCI was 0.054 ± 0.010%. The highest rate was 0.220 ± 0.056% in rollover crashes and the lowest rate was 0.032 ± 0.009% in frontal crashes. The highest rate for spinal fracture-dislocation was 1.552 ± 0.455% in rollovers and the lowest was 0.065 ± 0.021% in rear impacts. The rate for SCI was 0.027 ± 0.005% in belted and 0.145 ± 0.028% in unbelted occupants giving 81% effectiveness of belt use in reducing SCI. The cervical spine was associated with 66.3 ± 11.3% of the AIS 4+ SCI with 30.5 ± 7.4% in the thoracic spine and 3.2 ± 1.3% in the lumbar spine. Severe head injuries occurred 13.3 times more often than SCIs.Conclusions: Spinal cord injury occurred in one out of 1,860 front seat occupants in tow-away crashes. The rate was highest in rollover crashes and was reduced by seat belt use. Fracture-dislocation of the spine occurred about 5.3 times more often than SCIs and was also prevented by seat belt use.