Vertebral Injury Research Articles

Spinal gunshot wounds: A retrospective, multicenter, cohort study

Introduction and objectiveTo describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. Material and methodsRetrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. ResultsData on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. ConclusionsIn this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Nationwide Survey of the Surgical Complications Associated with Lateral Lumbar Interbody Fusion in 2015-2020.

Lateral lumbar interbody fusion (LLIF) has been introduced in Japan in 2013. Despite the effectiveness of this procedure, several considerable complications have been reported. This study reported the results of a nationwide survey performed by the Japanese Society for Spine Surgery and Related Research (JSSR) on the complications associated with LLIF performed in Japan. JSSR members conducted a web-based survey following LLIF between 2015 and 2020. Any complications meeting the following criteria were included: (1) major vessel, (2) urinary tract, (3) renal, (4) visceral organ, (5) lung, (6) vertebral, (7) nerve, and (8) anterior longitudinal ligament injury; (9) weakness of psoas; (10) motor and (11) sensory deficit; (12) surgical site infection; and (13) other complications. The complications were analyzed in all LLIF patients, and the differences in incidence and type of complications between the transpsoas (TP) and prepsoas (PP) approaches were compared. Among the 13,245 LLIF patients (TP 6,198 patients [47%] and PP 7,047 patients [53%]), 389 complications occurred in 366 (2.76%) patients. The most common complication was sensory deficit (0.5%), followed by motor deficit (0.43%) and weakness of psoas muscle (0.22%). Among the patient cohort, 100 patients (0.74%) required revision surgery during the survey period. Almost half of the complications developed in patients with spinal deformity (183 patients [47.0%]). Four patients (0.03%) died from complications. Statistically more frequent complications occurred in the TP approach than in the PP approach (TP vs. PP, 220 patients [3.55%] vs. 169 patients [2.40%]; p<0.001). The overall complication rate was 2.76%, and 0.74% of the patients required revision surgery because of complications. Four patients died from complications. LLIF may be beneficial for degenerative lumbar conditions with acceptable complications; however, the indication for spinal deformity should be carefully determined by the experience of the surgeon and the extent of the deformity.

Estrategias de tratamiento en la metástasis vertebral. Necesidad de comités multidisciplinarios desde la perspectiva del cirujano. Narración de la literatura

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increases. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life.The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment.The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis.In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.

The implementation of sport learning at school: Reality and Injury

A good sport learning planning could minimize injury risk in sports learning. The study aimed at finding out the preparation process of sport learning planning and the number of injury cases. It used a cross-sectional design with a quantitative approach. It was conducted in April-October 2022 at junior high schools in the Special District of Yogyakarta. Its samples were drawn from 20,401 students and 33 physical, sports, and health education teachers using a random sampling technique that gave 400 samples (171 males and 229 females). The validity test of the student questionnaire gave r-count r-table (0.235) and alpha Cronbach of 0.928 0.655, while the validity test of the teacher questionnaire gave r-count r-table (0.344) and alpha Cronbach of 0.737 0.655. Results: There were 158 students (39.50%) who got cervical vertebrae injuries, 193 students (48.25%) who got shoulder injuries, 133 students (33.25%) who got elbow injuries, 182 students (45.50%) who got wrist injuries, 163 students (40.75%) who got finger injury, 198 students (49.50%) who got waist injury, 170 students (42.50%) who got pelvis injury, 202 students (50.50%) who got knee injury, 170 students (42.50%) who got ankle injury, and 165 students (41.25%) who got toe injury. Concerning sports learning planning, there were 2 teachers (6.1%) who never planned sports learning, 8 teachers (24.2%) who rarely planned it, 13 teachers (39.4%) who occasionally planned it, 9 teachers (27.3%) who often planned, and 1 teacher (3.0%) who always planned it. Conclusion: Knee injury was the most common one and teachers have not well-planned sport learning. It was necessary to conduct further study of the correlation between sports learning planning and the injury

Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty

To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra ( r=0.493, P<0.001). The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.

Recent Progress in the Classification and Operation of Sacral Fractures.

Most sacral fractures are caused by high-energy, violent injuries, often accompanied by lumbosacral plexus injuries, which can cause instability of the posterior pelvic ring or lumbosacral junction in severe cases. Currently, the most commonly used clinical classification methods are Denis classification, Tile classification, Isler classification, and Denis II classification. In recent years, lumbosacral vertebral injury classification and injury degree scoring systems have often been applied clinically as the choice of treatment methods. At present, the internal fixation and implantation methods of sacral fracture are developing in the direction of positive, efficient, safe, and minimally invasive. But different fixation methods have their own indications, which should be strictly followed. This article reviews the classification of sacral fractures and the latest progress in surgical treatment.

Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction

BackgroundThere has been widespread use of short-segment posterior fixation (SSPF) for traumatic thoracolumbar burst fractures. The relationship between the destruction of the vertebral endplate and adjacent disc and postoperative correction loss has been studied in only a few studies. This study investigated the risk factors for correction loss following SSPF.MethodsForty-eight patients (mean age 35.0 years) who underwent SSPF for thoracolumbar burst fractures were enrolled. The mean follow-up period was 25.7 months (12–98 months). The neurological status and postoperative back pain were assessed by the medical records. Segmental kyphotic angle (SKA) and anterior vertebral body height ratio (AVBHR) were measured radiographically to assess indirect vertebral body reduction and local kyphosis. Preoperative Sander’s traumatic intervertebral disc lesion (TIDL) classification and AO classification were used to evaluate the severity of disc and vertebral endplate injury. The corrective loss was considered present if ΔSKA was ≥10°. A multivariate logistic regression analysis was performed to identify the risk factors associated with postoperative loss of correction.ResultsThe fracture distribution was as follows: 10 at T12, 17 at L1, 10 at L2, 9 at L3, and 2 at L4. Vertebral fractures were classified in the following way: A3 in 13 patients, A4 in 11, B1 in 11, and B2 in 13. In 47 patients (98%), a union of the fractured vertebrae was achieved. SKA and AVBHR improved significantly after surgery from 11.6° to 3.5° and from 67.2 to 90.0%, respectively. However, the correction loss at follow-up was 10.4° and 9.7%, respectively. Twenty patients (42%) had severe TIDL (grade 3). Postoperative ΔSKA and ΔAVBHR were significantly higher in patients with TIDL grade 3 than with TIDL grade 0–2. The presence of cranial TIDL grade 3 and older age were significant risk factors for ΔSKA ≥10° on multivariate logistic regression analysis. All patients could walk at follow-up. TIDL grade 3 and ΔSKA ≥10° were associated with severe postoperative back pain.ConclusionsRisk factors for loss of correction after SSPF for thoracolumbar burst fractures were severe disc and endplate destruction at the time of injury and older age.

Demographics, Mechanism of Injury, and Outcomes for Acute Upper and Lower Cervical Spinal Cord Injuries: An Analysis of 470 Patients in the Prospective, Multi-Center, North American Clinical Trials Network Registry.

There is a paucity of data comparing the demographics, mechanism of injury, and outcomes of upper versus lower cervical spinal cord injuries (cSCI). The study objective was to define different clinical manifestations of cSCI. Data were collected prospectively through centers of the North American Clinical Trials Network (NACTN). Data was collected on 470 patients (21% women, mean age 50 years). Cervical vertebral level was analyzed as an ordinal variable to determine a natural demarcation to classify upper versus lower cSCI. For continuous variable analysis, falls were associated with C3 more than C4 vertebral level injuries (60% vs. 42%; p = 0.0126), while motor vehicle accidents were associated with C4 more than C3 (40% vs. 29%; p = 0.0962). Motor International Standards for Neurological Classification of Spinal Cord Injury scores also demonstrated a natural demarcation between C3 and C4, with C3 having higher median American Spinal Injury Association (ASIA) motor scores (40 [4-73] vs. 11 [3-59], p = 0.0227). There were no differences when comparing C2 to C3 nor C4 to C5. Given the significant differences seen between C3 and C4, but not C2 and C3 nor C4 and C5, upper cSCI was designated as C1-C3, and lower cSCI was designated as C4-C7. Compared with a lower cSCI, patients with an upper cSCI were more likely to have a fall as their mechanism of injury (54% vs. 36%; p = 0.0072). Patients with an ASIA C cSCI were likely to have an upper cervical injury: 23% vs. 11% (p = 0.0226). Additionally, patients with an upper cSCI were more likely to have diabetes prior to injury: 37% versus 22%, respectively (p = 0.0084). Lower cSCI were more likely injured through sports (19% vs. 8%, p = 0.0171) and present with ASIA A (42% vs. 25%, p = 0.0186) neurological grade. Patients with lower cSCI were also significantly more likely to have complications such as shock, pulmonary embolism, and pleural effusion. In conclusion, there appears to be a natural demarcation of injury type between C3 and C4. Upper cSCI (C1-C3) was more associated with falls and diabetes, whereas lower cSCI (C4-C7) was more associated with sports, worse ASIA scores, and more complications. Further research will be needed to understand the mechanistic and biological differences between these two groups and whether different treatments may be appropriate for each of these groups.

Spinal injury in major trauma: Epidemiology of 1104 cases from an Italian first level trauma center

IntroductionTraumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management. Patients and methodsRetrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures. ResultsPatients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died. ConclusionsIn Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.

Correlation between presence of traumatic disco-ligamentous injuries as an MRI finding with the results of management of thoracolumbar and lumbar injuries

Introduction: Radiographic study plays an important role in diagnosis of acute vertebral injuries and helps in proper management of those patients. Magnetic resonance imaging (MRI) is the modality of choice for evaluation of ligamentous and other soft tissue structures, disc, spinal cord and occult osseous injuries. Due to high cost, it is necessary to detect the best use of this technique in the evaluation of thoracolumbar spinal injuries. The purpose of this study was to evaluate the importance of MRI as indicators for vertebral ligamentous injuries and intervertebral disc injuries or herniation in management of thoracolumbar and lumbar fractures. Methods: Retrospective study using radiological measurements. Seventy-two patients with thoracolumbar and lumbar fractures were included. Radiographic parameters detected were percentage of compression, kyphosis angle, vertebral translation and scoliosis angle. Computed tomography was used to detect the degree of spinal canal narrowing, MRI was used to evaluate the condition of posterior ligamentous complex and intervertebral disc injury or herniation. American Spinal Injury Association score was recorded. Results: There were 83% AO spine type A, 6% AO spine type B and 11% AO spine type C. Correlation between fracture type and neurological status with the posterior ligamentous complex injury was found to be significant: ( P = 0.0143 and P = 0.0344, respectively). Degree of vertebral body compression, kyphosis and scoliosis angles, vertebral body translation and spinal canal narrowing were found to be insignificant in correlation with posterior ligamentous complex injuries. Correlation of the above-mentioned parameters with disc injury or herniation was found to be insignificant except for kyphotic angle that was found to be significant in correlation with posttraumatic disc herniation ( P = 0.0219). Conclusion: MRI finding is of great value in management plan of thoracolumbar and lumbar fractures. Injury of posterior ligamentous complex is significantly correlated with fracture severity and the neurological function. But the intervertebral disc injury or herniation was not correlated to them except that the disc herniation was significantly correlated to kyphosis angle.

Evaluation of patients applying for disability determination procedures in terms of spine injury

Vertebral are not easily injured due to both the strength of the bone structure and the anatomical protection of the soft tissues. Traumas that cause damage to the vertebral column are often high-energy traumas such as traffic accidents. In our study, vertebral fractures seen in patients who applied for a report for disability determination; were aimed to evaluate the fracture site in terms of its sequelae and its provisions in the disability determination charts. In our study, the reports of the cases that were examined by us after applying for disability assessment in Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Forensic Medicine between the years 2019-2021 were examined. Cases with vertebral injuries were included in the study and were examined in terms of age, gender, spine region, additional traumatic findings, sequelae, treatment method, how many points they got from which disability scale, and duration of incapacity. As a result of joint range of motion examinations, in cervical vertebral fractures, limitation of cervical extension movement, in thoracic vertebral fractures, limitation of thoracic flexion movement, in lumbar vertebral fractures, it was determined that the limitation of lumbar extension movement was observed mostly. In our study, vertebral injuries were seen in 17% of the patients who applied for disability detection procedures after a traffic accident. In addition, vertebral injuries are important injuries in terms of public health and health expenditures, as well as important causes of disability and incapacity to work. Vertebral injuries resulting from traffic accidents can cause significant limitations and adversely affect people's lives.

Management of Spinal Injuries Secondary to Rockfall in Traditional Mines

Introduction: Spinal injuries represent the whole of the mechanisms responsible for vertebral, disco-ligamentary and spinal cord injuries. Spinal cord injury is life-threatening and is responsible for functional consequences that make the subsequent socio-economic integration of victims difficult. In developing countries, spinal injuries in traditional gold mining are becoming more and more frequent. Purpose: The purpose of this study was to describe the anatomopathological aspects and the results of surgical treatment of spinal injuries secondary to traditional mine collapses at the University Hospital of Kati. Patients and Methods: This was a prospective, descriptive study over 18 months, from November 2017 to May 2019. Included in this study were patients operated on for spinal trauma secondary to rockfall in traditional mines. The neurological status was assessed in each patient since admission to the department using the Fr&#228nkel score. Decompression by laminectomy combined with titanium device placement was preferred in lumbar, thoracic and thoraco-lumbar surgery. We performed an anterior cervical spine approach with SENEGAS plate placement in cervical injuries. Motor physiotherapy was associated whenever recovery was not complete. At a minimum follow-up of 6 months, all our patients were re-evaluated by the Fr&#228nkel score. Results: The mean age was 31 years with extremes of 10 and 49 years. The majority of patients were men, 95%. Twenty patients underwent surgery. According to the spinal segments, the cervical spine was affected in 05 cases, the thoracic spine in 08 cases and the lumbar spine in 17 cases. The neurological examination revealed tetraplegia (n = 5), paraplegia (n = 12) and paraparesis (n = 3). According to the types of lesions, we collected 12 cases of fractures, 4 cases of fracture-luxations and 04 cases of pure luxations. According to the site, the fracture was uni-articular (n = 3), corporal (n = 15) and transverse apophyseal (n = 1). According to the type of line, the fracture was simple (n = 6), with compression (n = 11) and comminuted (n = 2). The dislocation was anterior in all 08 cases. The spinal cord injuries were concussion (n = 3), contusion (n = 6) and transection (n = 11). Sphincter disorders such as leakage or retention of urine were present in all our patients. At a minimum follow-up of 6 months, all our patients classified as Fr&#228nkel D and C had a complete motor recovery. Of the 5 patients classified as Fr&#228nkel B, 2 had complete motor recovery and one had partial recovery. Of 12 patients classified as Fr&#228nkel A, one patient had partial recovery. Conclusion: The severity of the neurological lesions in spinal injuries due to rockfalls in traditional gold mining is certain. These traumas are of high velocity and provide extensive spinal cord injuries. The dorsolumbar hinge is the most affected segment. Fractures of the first lumbar vertebra and the twelfth thoracic vertebra are the most frequent. Settling fractures are by far the most frequent fracture types. T12-L1 dislocation is the most frequent. Early osteosynthesis by spinal stabilization after reduction improves the Fr&#228nkel score. This study shows the need for public awareness of the dangers of traditional gold panning.

EFFECTS OF COMBINATION THERAPY WITH VIBEGRON FOR ANTICHOLINERGIC-RESISTANT PEDIATRIC NEUROGENIC BLADDER

(Objective) We report the effectiveness of combination therapy with vibegron in pediatric patients with neurogenic bladder inadequately responding to anticholinergic agents. (Subjects and methods) This retrospective study involved 13 pediatric patients with neurogenic bladder treated with anticholinergics at our department from November 2019 to January 2021 who had an inadequate response and received combination therapy with vibegron. Changes in the volume of urinary incontinence before and after the use of vibegron reported during interviews from the 13 patients were compared. In addition, bladder capacity at the end of examination, bladder capacity at the end of examination/expected bladder capacity (EBC), and bladder compliance were compared using the Wilcoxon signed rank test in 9 patients for whom urodynamics (UDS) or video urodynamics (VUDS) was performed before and after introduction of vibegron. (Results) The 13 patients comprised 8 boys and 5 girls. The median age was 13 years (range, 5-18 years). Underlying diseases included 9 cases of spina bifida, 1 case of Hinman syndrome, 1 case of cervical vertebra injury, 1 case of idiopathic cervical epidural hematoma combined with spina bifida, and 1 case of spinal cord infarction. Eight of the 13 patients experienced decrease in urinary incontinence after the introduction of vibegron. All 9 patients who underwent UDS or VUDS before and after introduction of vibegron displayed significant differences in bladder capacity at the end of the examination, bladder capacity at the end of the examination/EBC, and bladder compliance, indicating improvement. (Conclusion) Combination therapy with vibegron is effective for pediatric patients with neurogenic bladder who have inadequately responded to anticholinergic agents.

Profile of Blunt Abdominal Injuries: An Autopsy Study

Background: Many vital organs (Liver, spleen, kidney, etc) and also vital vessels like the aorta and many major veins are in the abdominal cavity, so injuries to the abdominal cavity are mostly fatal in the form of hemorrhagic shock or neurogenic shock. Blunt or sharp objects may cause these types of injuries. Which are due to any mode of death. aims: To study the epidemiological aspect of fatal blunt abdominal injuries. material and method: In this study 140 cases of abdominal injuries by blunt objects are studied for their various aspect. results: Most cases are of road traffic accidents (RTA) or any other form of accidents. Most of them are young males between 20-40 years of age. Though the majority of them died within in 1-2 hrs, on the spot or on the way. The nature of injuries is correlated with the history and incident. Involvement of the spleen and liver shows multiple lacerations. Kidney and retroperitoneal were also involved in a significant number of cases. Vertebral, bladder, and uterine injuries were rare. conclusion: Most of the fatal blunt abdominal injuries were off-road traffic accidents majority of them have liver or spleen and hemorrhagic shock is the cause of death in almost all cases.

Characteristics, Determinants, and Outcomes of Traumatic Vertebral and Spinal Injuries: A Retrospective Study in the Al-Qassim Region of Saudi Arabia.

Background In Saudi Arabia, traumatic vertebral and spinal injuries (TVSIs) are well-recognized injuries with long-term morbidity and mortality. Al-Qassim is among the five regions in the kingdom with the highest number of TVSIs. Little is known about the characteristics of and outcomes for patients with a TVSI in the Al-Qassim region, and we aimed to explore these further. Methodology Electronic medical records of patients with a TVSI admitted to Buraidah Central Hospital between January 1, 2017, and December 31, 2019, were examined. Characteristics, outcomes, and length of stay (LOS) in the hospital acute care were reported for the patients, along with their scores (A through E) on the American Spinal Injury Association (ASIA) impairment scale at admission and at discharge. Results The sample included 243 patients with a TVSI (median age 35 years). The majority of the participants were Saudi (70%), admitted due to road traffic accidents (67%), and had an ASIA score of E at admission (83%). The median (interquartile range [IQR]) LOS in acute care was 10.0 (4-18) days. Determinants of a prolonged hospital stay included being non-Saudi, having an ASIAscore of A through D at admission, and having associated orthopedic injuries. An ASIA score of A through D at admission was the only significant determinant of having an ASIAscore ofA through D at discharge. Conclusions Road traffic accidents accounted for the majority of TVSIs in Al-Qassim. Not having a normal and preserved function at admission (i.e., ASIAscore of A through D) was associated with a prolonged hospital stay.

Cervical Spine Injuries Most Commonly Occur in Traffic Accidents

The spine is made up of vertebrae, ring-shaped bones that line up in a row to form the spinal canal. Inside the spinal canal is the spinal cord - a bundle of nerve fibers and cells that conduct nerve impulses from the brain to various parts of the body and vice versa. The individual nerves that exit the spinal canal are separated from the spinal cord. In vertebral fractures, bone fragments can injure the spinal cord, leading to partial or complete muscle loss and loss of sensation below the level of the injury. The spinal cord can be damaged at the very moment of the vertebral injury, but also later when moving and carrying the injured person. Injuries occur when direct physical force damages the vertebrae, ligaments or discs of the spine, causing crushing, crushing or rupture of brain tissue, and penetrating brain injuries. Such injuries can also lead to vascular damage leading to ischemia or hematoma causing additional damage. All types of injuries can cause brain edema which further reduces blood flow and oxygenation

Effects of Balanced Ligamentous Osteopathic Technique over LV in low back pain

Due to the high incidence of non-specific low back pain in the world population that don′t present a response with conventional tools, a quantitative register is sought, through a Balanced Ligamentous Osteopathic Technique, that responds to its effectiveness on the ligaments iliolumbar elongated by the vertebral injury, that is, the correction of a second-degree injury of the 5th lumbar. The purpose of this study was to determine if there is a decrease in local pain and an increase in trunk flexion movement in Lumbosacral Hinge after applying the Balanced Ligament Osteopathic Technique on the transverse apophysis of the 5th lumbar and to emphasize the importance of the treatment of ligament structures in the specific biomechanical integration of the entire spine. This design consisted of two groups, an experimental one that received the treatment detailed in the present work, while the second group was the control group, which received a placebo intervention. It was made up of two groups, one of an experimental type, of 72 participants, who received the treatment detailed in the present work, while the second group of other 72 participants, was the control group, which received a placebo intervention. Quantitative pain values were taken through the Algometer (local pain) and the ground finger test to record the presence of the limits that pain generates for the trunk flexion movement. The ground finger test resulted in an increase of 62,6 % for the experimental group and 6.7% for the control group, before and after the intervention. The same occurred in the Algometer record before and after the intervention, giving a 133 % increase in tolerance to pressure in the experimental group and in the control group it did not exceed 1 %.

Being an Expert Does Not Mean You Know Everything

Being an Expert Does Not Mean You Know Everything

Enhanced magnetic resonance imaging manifestations of paediatric intervertebral disc calcification combined with ossification of the posterior longitudinal ligament: case report and literature review

BackgroundSince the first description of paediatric intervertebral disc calcification (IDC) by Báron in 1924, only approximately 400 cases have been reported in the literature. Paediatric IDC combined with ossification of the posterior longitudinal ligament (OPLL) is an even rarer condition, with only 8 cases described in detail to date. In this paper, we present a review of the disease characteristics described in the relevant English language literature and discuss the possible mechanisms of lesion enhancement in contrast-enhanced magnetic resonance imaging (MRI).Case presentationIn May 2020, a 6-year-old Han nationality girl presented with the chief complaint of neck pain that had lasted for a week. She did not report a history of trauma or a past illness. On admission, there was no personal and family history, congenital diseases, or non-specific infections such as tuberculosis, among others. Further physical examination revealed that the movement of her cervical spine was limited. Computed tomography (CT) and MRI revealed ossification of the intervertebral discs and posterior longitudinal ligament (PLL) at the C4/5 levels and an absence of obvious spinal cord compression. When contrast-enhanced MRI was performed, significant enhancement was observed in the intervertebral discs and PLL at the C4/5 level. We adopted a non-interventional approach and performed an imaging re-examination 8 months later. Both the plain and contrast-enhanced MRI scans indicated swelling in the C4/5 intervertebral discs and disappearance of the previously observed enhancement in the nucleus pulposus (NP) and PLL at the corresponding levels; CT examination revealed that the ossified lesions had been completely resorbed.ConclusionObvious lesion enhancement in contrast-enhanced MRI is an extremely rare manifestation of paediatric IDC combined with OPLL. However, the exact mechanisms of this phenomenon remain unclear. We surmise that it may be caused by a series of biophysical changes related to vertebral endplate injury and repair, but further research will be required for in-depth investigation.

Severe Vertebral Body Fracture-Dislocation as a Result of Chest Compressions: A Case Report

BackgroundAlthough high-quality chest compressions are an essential, lifesaving component of cardiopulmonary resuscitation, injuries are common with both manual and mechanical chest compressions. Case ReportWe discuss the case of a 77-year-old woman who sustained thoracic vertebral fractures after cardiopulmonary resuscitation involving both manual and mechanical chest compressions. Why Should an Emergency Physician Be Aware of This?Routine post-cardiac arrest care should include evaluation for chest compression-related injury. If a patient has back pain, focal vertebral tenderness, or paraplegia after chest compressions, imaging to evaluate for vertebral fracture should be performed. If unable to assess for back pain or tenderness, consider imaging to evaluate for vertebral fracture in patients with kyphosis or osteopenia, as these patients are at higher risk for chest compression vertebral injury.