Vertebral Injury Research Articles

Aetiology and Imaging Findings in Traumatic Spine Injury among Patients Attending Muhimbili Orthopedics Institute in Dar es Salaam

Background: The main objective of the study was to determine etiology and imaging features of traumatic spine injury in spine injured patients attending Muhimbili orthopedics institute Methods: The study was a hospital based cross-sectional and consecutively included 87 with traumatic Spine Injury. Data was collected through a structured questionnaire. Statistical package for social science (SPSS 20) was used for data analysis. Results: Eight seven (87) patients with traumatic spine injury were studied. The age range was 4 to 81 years, with a mean age of 33 years. Males were more affected than females. Young individuals aged 16-30 years were the most affected. The commonest cause of spine trauma was motor traffic crashes. The commonest vertebral spine injury seen was compression wedge fracture (35.6%), followed by dislocation (18.4%). The most frequent spine level involved was lumbar spine (37.9%). Paraplegia (33.3%) and quadriplegia (10.3%) were the common clinical presentations. Fifty six percent of patients had associated injuries Conclusion: Traumatic spine injury is common at our settings. Young individuals below 30 years of age are most affected and the most common cause is motor traffic accident (MTA). The use of Computed Tomography (CT) in this study helped to identify several types of injuries especially injury to vertebral bodies and their effect unto neuro structures. MRI helped to identify patients with spinal cord injury which was not evident on CT. Key words : Spine trauma, vertebral fracture, Computed Tomography

Contact Isolation Precautions in Trauma Patients: An Analysis of Infectious Complications.

Victims of traumatic injuries represent a population at risk for a wide variety of complications. Contact isolation (CI) is a set of restrictions designed to help prevent the transmission of medically significant organisms in the healthcare setting. A growing body of literature demonstrates that CI can have significant implications for the individual isolated patient. Our goal was to characterize the use of contact isolation at our Level I trauma center and investigate the association of CI with infectious complications. An existing trauma database containing data on patients admitted at our Level I trauma center between January 1, 2011 and December 31, 2012, along with their contact isolation status, was queried. Demographics, injuries, and the presence of infections were collected. Diagnosis of pneumonia or UTI was based on clinical documentation in the patient's medical record. A chart review was performed to ascertain the reason for CI including specific organisms. Because of differences in patient demographics between the CI and non-CI groups, linear regression was performed to adjust for the effects of different variables. A total of 4,423 patients were admitted over this period. Of these, 4,318 (97.6%) had complete records and were included in the subsequent analysis. The CI was in place in 249 (5.8%) patients; 4,069 (94.2%) were not isolated. The number who had CI initiated for MRSA nasal colonization was 173 (69.5%). Twenty-two (8.9%) had no reason for CI documented. Pneumonia occurred in 190 (4.4%), 54 (21.7) in the CI group versus 136 (3.3%) in the non-CI group. Urinary tract infection (UTI) was diagnosed in 166 (3.8%), 48 (19.3%) in the CI group versus 118 (2.9%) in the non-CI group. Using logistic regression and excluding patients placed on contact isolation for the development of a new resistant nosocomial infection, CI, Injury Severity Score, gender, length of stay, and mechanical ventilation were identified as common covariates for pneumonia (PNA) and UTI. Chronic obstructive pulmonary disease COPD was specifically identified for PNA. Spinal cord injury, vertebral column injury and pelvic-urogenital injury were also significant for UTI. The development of pneumonia and UTI in patients with trauma was significantly associated with the use of CI. Because the majority of these patients had CI precautions in place for asymptomatic colonization, the CI provided them no direct benefit. Because the use of CI is associated with multiple negative outcomes, its use in the trauma population needs to be carefully re-evaluated.

The psychological trajectory in a patient with vertebral and spinal cord injury sequels

The paper considers the psychological factors that influence the course of vertebral and spinal cord injury (VSCI). The factors contributing to psychological growth include psychological stability, an internal locus of control, hope and optimism, low-grade depression, social involvement, good family relationships, and behavioral and cognitive coping. The formation of the optimal psychological trajectory in patients with VSCI assumes that a psychotherapist diagnosing and correcting this condition should participate fully in the rehabilitation process.

Clinical and psychological aspects of rehabilitation in patients with vertebral and spinal cord injury

Rehabilitation in patients after vertebral and spinal cord injury (VSCI) is one of the most difficult problems in the global world health system. VSCI leads to severe, persistent functional impairment or disability, which causes clinical, psychological, social, and economic challenges faced by patients. The paper presents clinical and psychological ideas and information about adaptation problems in patients with VSCI. It describes in detail a stepwise rehabilitation system for these patients, the role of their personal traits, and social providers. The importance of interdisciplinary cooperation in patient's adaptation to disease is shown.

The crossed phrenic phenomenon.

The cervical spine is the most common site of traumatic vertebral column injuries. Respiratory insufficiency constitutes a significant proportion of the morbidity burden and is the most common cause of mortality in these patients. In seeking to enhance our capacity to treat specifically the respiratory dysfunction following spinal cord injury, investigators have studied the “crossed phrenic phenomenon”, wherein contraction of a hemidiaphragm paralyzed by a complete hemisection of the ipsilateral cervical spinal cord above the phrenic nucleus can be induced by respiratory stressors and recovers spontaneously over time. Strengthening of latent contralateral projections to the phrenic nucleus and sprouting of new descending axons have been proposed as mechanisms contributing to the observed recovery. We have recently demonstrated recovery of spontaneous crossed phrenic activity occurring over minutes to hours in C1-hemisected unanesthetized decerebrate rats. The specific neurochemical and molecular pathways underlying crossed phrenic activity following injury require further clarification. A thorough understanding of these is necessary in order to develop targeted therapies for respiratory neurorehabilitation following spinal trauma. Animal studies provide preliminary evidence for the utility of neuropharmacological manipulation of serotonergic and adenosinergic pathways, nerve grafts, olfactory ensheathing cells, intraspinal microstimulation and a possible role for dorsal rhizotomy in recovering phrenic activity following spinal cord injury

A Clinical Prospective Observational Cohort Study on the Prevalence and Primary Diagnostic Accuracy of Occult Vertebral Fractures in Aged Women with Acute Lower Back Pain Using Magnetic Resonance Imaging.

Background Elderly female patients complaints of acute low back pain (LBP) may involve vertebral fracture (VF), among which occult VF (OVF: early-stage VF without any morphological change) is often missed to be detected by primary X-ray examination. The current study aimed to investigate the prevalence of VF and OVF and the diagnostic accuracy of the initial X-ray in detecting OVF. Method Subjects were elderly women (>70 years old) complaining of acute LBP with an accurate onset date. Subjects underwent lumbar X-ray, magnetic resonance imaging (MRI), and bone mineral density (BMD) measurement at their first visit. The distribution of radiological findings from X-ray and magnetic resonance imaging (MRI) as well as the calculation of the prevalence of VF and OVF are investigated. Results The prevalence of VF among elderly women with LBP was 76.5% and L1 was the most commonly injured level. Among VF cases, the prevalence of OVF was 33.3%. Furthermore, osteoporotic patients tend to show increased prevalence of VF (87.5%). The predictive values in detecting VF on the initial plain X-ray were as follows: sensitivity, 51.3%; specificity, 75.0%; and accuracy rate, 56.7%. Conclusions Acute LBP patients may suffer vertebral injury with almost no morphologic change in X-ray, which can be detected using MRI.

Peculiarities of Reparative Osteogenesis of Injured Thoracic and Lumbar Vertebral Bodies at Different Terms after Trauma

The analysis of the results of morphologic examination of vertebral body bone tissue obtained intraoperatively from 43 patients (20 - 67 years) with thoracic and lumbar spine injuries at different terms after trauma was performed. All patients were operated on via anterior approach to create ventral fusion. In the examined serial samples of vertebral body structures the quality and regeneration potential of bone tissue were assessed. It was shown that cell differentiation during the osteogenesis process was closely associated with angiogenesis. In the zones with active growth of microcirculatory bed vessels the normal cycle of osteoblast and osteocytes took place while hypoxia and acidosis resulted in pathologic osteogenesis. In patients under 50 years, both males and females) the full value consolidation time averaged 5 months. In patients over 50 years, independently of the gender, the decrease of spongy structures volume and bone mineral density was observed. The recommendations on surgical treatment tactics of patients with thoracic and lumbar vertebral body injuries were given.

Estimation of vertebral and spinal cord injury consequences using International Classification of Functioning, Disability and Health for sociomedical assessment

Introduction. International Classification of Functioning, Disability and Health (ICF) was adopted by WHO experts in 2001. Comprehensive ICF goal is to provide a unified standard language and define a framework for describing health indicators and indicators related to health. Purpose. To estimate efficiency of drafting type of functioning for patients and invalids with the consequences of vertebral-spinal trauma during the sociomedical assessment (SMA). Materials and methods. The study included 180 patients examined or treated in the department of Traumatology and Orthopedics (with neurosurgical beds) from 2012 to 2016. The age of the patients was 18–62 years old, on average (41±4.7) years. There were 146 (81%) male and 34 (19%) female patients. The determination of the method of profiling patients and disabled persons with consequences of vertebral, spinal injuries according to ICF is a part of scientific studies, performed by a group of medical and social expertise and rehabilitation of disabled persons with the consequences of trauma and orthopedic diseases combined with the disorders of the peripheral nervous system. Results and discussion. To highlight the profile of such patients functioning status there has been developed a concise set of domains (b152, b280, b525, b620, b640, b710, b730, b735, b810, s120, s430, s610, s760, s810, d230, d240, d410, d420, d445, d455, d465, d470, d520, d530, d550, e110, e115, e120, e150, e155, e310, e340, e355, e580). Conclusions. ICF is an important tool to assess all aspects of disability in a single “international language” both on the individual and the social level. A short profile for the evaluation of patients with vertebral and spinal injury developed and recommended for use by WHO experts and specialists from the International Union for Physical and Rehabilitation Medicine is the best and valid method to determine the functioning of the disabled patients in the long term. ICF allow more efficiently evaluate the patient’s state and his functioning status in the macro- and microcommunity for expert decisions. ICF allows us not only to determine the need and scope of rehabilitation measures, but also to evaluate their effectiveness.

Peculiarities of Reparative Osteogenesis of Injured Thoracic and Lumbar Vertebral Bodies at Different Terms after Trauma

The analysis of the results of morphologic examination of vertebral body bone tissue obtained intraoperatively from 43 patients (20 - 67 years) with thoracic and lumbar spine injuries at different terms after trauma was performed. All patients were operated on via anterior approach to create ventral fusion. In the examined serial samples of vertebral body structures the quality and regeneration potential of bone tissue were assessed. It was shown that cell differentiation during the osteogenesis process was closely associated with angiogenesis. In the zones with active growth of microcirculatory bed vessels the normal cycle of osteoblast and osteocytes took place while hypoxia and acidosis resulted in pathologic osteogenesis. In patients under 50 years, both males and females) the full value consolidation time averaged 5 months. In patients over 50 years, independently of the gender, the decrease of spongy structures volume and bone mineral density was observed. The recommendations on surgical treatment tactics of patients with thoracic and lumbar vertebral body injuries were given.

C-Myb acts in parallel and cooperatively with Cebp1 to regulate neutrophil maturation in zebrafish

AbstractNeutrophils are the key effectors for generating innate immunity in response to pathogenic infection and tissue injury in vertebrates. Dysregulation of neutrophil development and function is known to associate with various human disorders. Yet, the genetic network that orchestrates lineage commitment, differentiation, and maturation of neutrophils remains incompletely defined. Here, we present an in vivo study to delineate the genetic program underlying neutrophil development during zebrafish embryonic myelopoiesis. We show that loss of c-Myb function has no effect on macrophages but severely impairs neutrophil terminal differentiation, resulting in the accumulation of neutrophils with unsegmented nuclei and scant granule. This neutrophilic defect, which resembles the neutrophil-specific granule deficiency (SGD) caused by the mutations in CCAAT/enhancer-binding protein ε (C/EBPε) in humans, is attributed, at least in part, to the downregulation of the granule protein transcription. Likewise, genetic inactivation of Cebp1, the zebrafish functional homolog of mammalian C/EBPε, also leads to a similar SGD-like phenotype in zebrafish. Genetic epistasis and biochemical analysis further reveals that c-Myb and Cebp1 act in parallel and cooperatively to control neutrophil differentiation by directly regulating granule protein gene transcription. Our study indicates that c-MYB is an intrinsic master regulator for neutrophil terminal differentiation and a potential target in SGD patients.

Personal injury recovery cost of pedestrian–vehicle collisions in New South Wales, Australia

ABSTRACTBackground: There is a need for routine estimates of injury recovery costs from pedestrian collisions using hospital separation records for economic evaluations.Objective: To estimate the cost of injury recovery following pedestrian–vehicle collisions using the personal injury recover cost (PIRC) equation using key demographic and injury characteristics.Method: An estimation of the costs of on-road pedestrian–vehicle collisions involving individuals who were injured and hospitalized in New South Wales (NSW), Australia, from 2002 to 2011 using the PIRC equation. The PIRC estimates individual injury recovery costs and does not include costs associated with property damage, vehicle repair, or rescue services. Individual recovery costs associated with severe traumatic brain injury (TBI) were estimated. The injured individual's mean, median, and total injury recovery costs are described for key demographic, injury, and crash characteristics.Results: There were 9,781 pedestrians who were injured, costing an estimated total of $2.4 billion in personal injury recovery costs, an annual cost of $243 million. Males had a total injury recovery cost 1.7 times higher than females. The median injury recovery cost decreased with increasing age. TBI ($248,491) and spinal cord and vertebral column injuries ($264,103) had the highest median injury recovery costs for the body region of the most severe injury. TBI accounted for 22.6% of the total injury recovery costs for the most severe injury sustained. Just over one third of pedestrians sustained 4 or more injuries, with a median cost of $243,992, which was 1.6 times higher than the cost for a pedestrian who sustained a single injury ($153,682).Conclusions: Personal injury recovery costs following pedestrian–vehicle collisions where a pedestrian is injured are substantial in NSW. The PIRC equation enables the economic cost burden of road traffic injury to be calculated using hospital separation data. The PIRC enables comprehensive personal injury recovery costs to be estimated and would aid in economic evaluations of preventive strategies in road safety.

A novel technique for unstable Hangman’s fracture: lag screw-rod (LSR) technique

The goal of the study was to describe the lag screw-rod (LSR) technique for the treatment of unstable Hangman's fracture as an attempt to pull C2 vertebral body back to posterior elements easily and immobilize C2 relative to C3 simultaneously. Twenty-one patients with unstable Hangman's fracture were treated with the LSR technique from January 2008 to October 2014. The clinical and radiological records were reviewed retrospectively. The angulation and displacement of C2 on C3 were evaluated. Complications, neck pain, neurological improvement, and fusion rate were assessed. The LSR technique was used for C2-C3 pedicle fixation and fusion in all the patients. The C2 vertebral body was pulled back to posterior elements successfully. The angulation and displacement of C2 on C3 were rectified obviously. No intra-operative or post-operative spinal cord or vertebral injury was observed. Visual analogue scale (VAS) scores for neck pain decreased gradually after operation. The patients with spinal cord injury were recovered at final following up. All patients achieved bony fusion without internal fixation failures. The LSR technique is an effective and reliable treatment for unstable Hangman's fractures. The technique has the advantages of pulling back the C2 vertebral body back to posterior elements easily and immobilizing C2 relative to C3 simultaneously.

Gunshot Wound to the Atlantoaxial Spine Associated with Vertebral Artery Occlusive Injury

Atlantoaxial spine injuries due to firearm are uncommon. However, civilian gunshot wounds are becoming more frequent in modern society. The authors report a case of a middle age man with a penetrating neck gunshot wound; discuss the complexity of this type of trauma and its management.

The Experience of Eggshell Technique during Kyphoplasty to Prevent Cement Leakage in Treatment of Osteoporotic Vertebral Fracture

Introduction Osteoporosis is the big problem in the aging human. Among these osteoporotic related fractures, vertebral compression commonly is the main one. Pain and disability pose major problems in these patients. To restore the vertebral height for driving physical stiffness, and loading bearing toward normal limited and control the pain, kyphoplasty with variable filling materials (PMMA, CPC etc.) have been used for the treatment. For decreasing the rate of PMMA leakage in various wall injuries in vertebral compression fracture, we performed kyphoplasty with modified eggshell technique in different characteristics of vertebral wall. Material and Methods Twenty-four symptomatic vertebral fractures were enrolled. Visual Analogue Scale, the Oswestry Disability Index and Vertebral Wall Injury Score were assessed. The vertebral height loss and changes of kyphotic angle were also recorded by plain X-ray. Three-dimensional CT will be arranged for evaluating the condition of deficiency vertebral wall and central body collapse if need. After creating cavity by percutaneous bipedicular balloon device, PMMA was injected into weak wall site according the pre-operative evaluation or intra-operative finding. The balloon was once again introduced into the created cavity and inflated to achieve the PMMA shield (regional egg-shell method). Then the PMMA or other materials as CPC materials will be continuously to be fill into the left space. Outcome, fill materials leakage condition, X-ray and CT were reviewed postoperatively. Results Symptomatic cement extravasation related complications or leakage on X-ray were not observed in follow up. Only one adjacent compression fracture was happened in one month. Improvement in vertebral height and the mean kyphotic angle was also noted. The mean VAS and ODI decreased significantly from pre-operation to post-operation ( p < 0.05). The Vertebral Wall Injury Score reviews also told us the eggshell technique is fit for multiple conditions of wall injury Conclusion It's always concerned for the leakage of PMMA during spine surgery. There are many options of new implant for decreasing the rate of leakage. Greene introduces the eggshell technique in 2007, they used the eggshell idea to cover the possible leakage site. They had only 7 patients and those possible cortical defects were noted over superior endplate or lateral wall in their paper. According to our experiences in kyphoplasty with this regional eggshell technique in our 24 patients with various wall injuries. The technique is a safe and significantly functional works for decreasing the leakage of PMMA in various wall injury conditions with experienced surgery operator.

Weight change after spinal cord injury

Objectives: To study the patterns of weight change after spinal cord injury (SCI) and identify associated risk factors.Study design: Cohort study.Setting: Sixteen Spinal Cord Injury Model Systems (SCIMS), USA.Participants: One thousand and ninety-four individuals with an SCI who were entered into the SCIMS and had a 1-year follow-up between October 2006 and November 2012.Intervention: Not applicable.Outcome measure: Change in body mass index (BMI) during the first year of injury. Height and weight were assessed during inpatient rehabilitation and 1 year after injury.Results: Mean BMI decreased from 26.3 to 25.8 kg/m² during the first year after SCI (mean change: −0.5 kg/m² (standard deviation: 3.58)). Weight loss was mainly observed among individuals classified as overweight or obese during rehabilitation (n = 576) with a BMI decrease of 1.4 kg/m², which varied significantly by sex, education, neurological level, and the presence of vertebral injury. Weight gain was noted among individuals classified as underweight or normal weight during rehabilitation (n = 518) with a BMI increase of 0.5 kg/m², with the greatest increase among individuals of Hispanic origin (1.2 kg/m²), other marital status (1.2 kg/m²), age group 31–45 years (1.1 kg/m²), with less than high school education (1.1 kg/m²), without spinal surgery (0.9 kg/m²), and with motor functionally incomplete injury (0.8 kg/m²).Conclusion: Our findings suggest that strategies for weight management should be addressed after a SCI to ameliorate the potential for unhealthful weight change, particularly among at-risk groups.

One year experience of emergency service in patients with penetrating head trauma due to firearm

Objective: We aimed to share the features of 45 patients with firearm injuries related head traumas and our experiences in their treatments. Methods: Our cases consisted of 36 males 45 patients in total between the ages of 18-65, who were brought to the emergency service of our hospital due to firearm injuries. For this retrospective study, it was accessed to the patient data from the archival records of our hospital. The demographical data of the patients like age and gender, and the records such as type of injury, injured area in head, diagnosis, treatment and follow ups were reviewed. Results: There were sinus injury related epidural haemorrhages in 8 of patients who underwent urgent surgical intervention (17.8%). In 18 of the patients (39.95%) who underwent surgery had supratentorial injuries and 7 (15.55%) had infratentorial injuries. All these 25 patients (55.50%) who underwent surgery had multiple intracranial injuries (compression fracture + subdural haemorrhage + contusion + pneumocephalus + SAH + brain edema). Four of these 6 patients with multiple injuries had abdominal injuries. Two patients had haemopneumothorax. There were vertebra and extremity injuries in 2 patients with abdominal injuries. Conclusions: Brain injuries occurring with the firearm head injuries are seen as multiple injuries and their rate of mortality is quite higher.

The experience with the early rehabilitation of the children presenting with the vertebral cerebrospinal injury

This article was designed to report the experience with the provision of early rehabilitation care to the children suffering from a spinal-cord injury (SCI) that was gained at the Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology. The authors have developed and describe the combined multidisciplinary approach making it possible to promote the recovery of the children presenting with SCI at the first stage of the rehabilitative treatment. They distinguish three basic periods in the early rehabilitation of the children with this condition, defined the main goals of rehabilitation and the role of each specialist in their achievement. The results of the work provided the basis for the development of a stepwise approach for the extension of the rehabilitation measures and the solution of the tasks facing rehabilitation of the patients with vertebral cerebrospinal injuries. The correction of nutritive losses was found to be a most important component of the early stage of the rehabilitation process preceding the full-scale rehabilitative treatment. The role of various technical devices designed for the patients' re-education in functional motor activities, development and acquisition of the sustained self-service skills, enhancement of the patient's mobility, and improvement of his/her quality of life is discussed. The importance of the early beginning of the rehabilitation measures for the children suffering from a vertebral cerebrospinal injury has been confirmed.

Liver as a Target Organ for Eco-Toxicological Studies

A range of contaminants including carcinogens, metals, bio-toxins, and persistent organic pollutants injure livers of fishes, and although some mechanisms of liver injury are unique to fish, most of the hepatic injury in these aquatic vertebrates arises from mechanisms similar to those observed in mammals [2]. An understanding of chemical hepato-toxicity requires an appreciation of anatomic and physiologic features of the liver. With respect to fish liver, although fish and mammalian liver are same in many features, there are some different futures between fish and mammals that may influence its interpretation [3].

Dorso-Lumbar Burst Fractures Secondary to a Peculiar Tipper Truck Injury: A Report on Two Cases

Spinal injury is a disabling event. Disability primarily depends on the degree of cord injury. Vertebral bone injuries are a frequent accompaniment. Burst fracture of the vertebral body indicates a high-impact nature of injury. Among the various causes of burst fractures with cord injury, road traffic accidents are the most common mode of injury. We report two cases of fractures of dorsolumbar junction in a peculiar truck accident. Both the patients had burst fractures, and presented and continued to have paraplegia despite surgery. The authors want to highlight this peculiar spinal injury and at the same time want to educate the neurosurgeons about this mode of injury. This type of injury has not been reported earlier.

Complications associated with anterior cervical surgery

Fortunately, the incidence of major complications associated with anterior cervical spine surgery is low. Surgeons should remain cognizant of the possible intraoperative and postoperative complications, along with methods of prevention and treatment. This review briefly discusses the complications of esophageal, vertebral, and neurological injury, along with spinal fluid leak and hematoma. In general, anterior cervical spine procedures are highly successful with infrequent complications. However, the range of associated morbidity (and mortality) can be broad with each potential complication. Knowledge of potential complications is essential, including associated risk factors, methods of prevention, and treatment. This review briefly discusses intraoperative and immediate postoperative complications.