Vertebral Injury Research Articles

Pattern of spine fracture in Sub-Himalayan region: A prospective study

BackgroundThough spine trauma contributes to great functional, psychological, and economic loss, research regarding the demographic profile of patients according to different regions of our country are lacking.This study aims to identify the demographic pattern and clinical profile of patients with spinal fracture in the Sub-Himalayan region. MethodPatients with acute or subacute spine trauma presenting within 8weeks and involving fracture of cervical, dorsal, or lumbar vertebra, from July 2017 to December 2019 were included prospectively. Patients with osteoporotic or metastatic collapse, isolated transverse or spinous process fracture, penetrating trauma or ballistic injuries were excluded. ResultsOut of 280 enrolled patients, 180 were males and 100 were females. The maximum number of spine trauma patients was in 16–30 years age group. The most common mechanism of injury was fall from height (FFH, 42.5%)> road traffic accident (RTA, 38.6%). RTA was more common among males and FFH among females (p < 0.0001). Most common location of injury was at thoracolumbar junction (D10-L2) (37.5%) followed by cervical spine (25.3%). 58.2% of patients had AO type A facture morphology followed by AO types C (36.1%) and AO type B (5.7%). Spinal Cord Injury (SCI) was seen in 82.1% spine trauma patients with statistically significant association with male gender (p- 0.045). Complete paralysis was seen maximum in patients with cervical spine injury (67.3%, p < 0.0001). Complete neurological deficit (ASIA grade A) was seen maximum in AO type C fracture morphology (74.25%, p < 0.001) followed by AO type A4 (29.6%). Seasonal distribution showed increased incidence during summer and monsoon season. ConclusionYoung aged males in age group of 16–30 yrs were most commonly affected with fall from height as the most common mechanism of trauma. Association was found between gender and mechanism of injury (RTA in males and FFH in females). Most common vertebral injury level was thoracolumbar junction. AO type A was the most common fracture morphology. SCI seen in 82.1% of spine trauma. Statistically significant association was found between Complete SCI with Location of Injury (Cervical) and Fracture morphology (AO type C).

Spinal trauma in DISH and AS: is MRI essential following the detection of vertebral fractures on CT?

BACKGROUNDBoth ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) cause a rigid spine, but through different pathophysiology. Recent data has shown that characteristic fracture patterns may also differ following trauma since the posterior osseous and soft tissue elements are often spared in DISH. CT and MRI are important in diagnosing spine injury, but given the differences between AS and DISH, the utility of obtaining both studies in all patients warrants scrutiny. PURPOSETo assess the prevalence of posterior element injury on CT and MRI in DISH and AS patients with known vertebral body injury detected on CT; to determine whether MRI demonstrates additional injuries in neurologically intact patients presumed to have isolated vertebral body injuries on CT. STUDY DESIGNMulticenter, retrospective, case-control study. PATIENT SAMPLEDISH and AS patients presenting after spine trauma between 2007 and 2017. OUTCOME MEASURESReview of CT and MRI findings at the time of presentation. METHODSOne hundred sixty DISH and 85 AS patients presenting after spine trauma were identified from 2 affiliated academic hospitals serving as level 1 trauma and tertiary referral centers. A diagnosis of DISH or AS was verified by a board-certified emergency radiologist with 3 years of experience. Age, gender, mechanism of injury, fracture type, spine CT and MRI imaging findings, surgical intervention, and neurologic deficit were recorded. The CT and MRI studies were reviewed by the same radiologist for fracture location and type using the AO spine classification. No funding source or conflict of interest was present. RESULTSMedian age was 72 and 79 years old for the AS and DISH groups, respectively. Both were predominantly male (81%) and most presented after a low energy mechanism of injury (74% and 73%). Type C AO spine injuries were seen in 52% of AS patients but only 4% of DISH patients. In patients with known vertebral body injury on CT, additional injury to the posterior elements on CT or MRI in DISH patients was 51% versus 92% in AS patients. However, in patients with an isolated vertebral body fracture on CT and no neurological deficit, MRI identified posterior element injury in only 4/22 (18%) DISH patients compared to 5 of 7 (71%) AS patients. None of the MRI findings in the DISH patients were considered clinically important while all 5 AS patients eventually underwent operative treatment despite having no neurological deficit. Epidural hematoma on MRI was seen in 43% of AS patients as opposed to 5% of DISH patients. CONCLUSIONBased on our small sample size, CT alone may be adequate in DISH patients with isolated vertebral body fractures and no neurologic deficit, but an additional MRI should be considered in the presence of an unclear neurological exam or deficit. MRI should be strongly considered for any AS patient regardless of neurologic status.

Not Yet Time to Abandon Cervical Collars in Blunt Trauma

In the evidence-based summary by Serigano et al. (Ref 1.) published in this issue of Academic Emergency Medicine under the Brass Tacks series, the authors critically appraise the evidence for the long-standing practice of prehospital and emergency department cervical spinal motion restriction (SMR) in blunt trauma patients. They highlight the absence of class I data demonstrating a benefit and describe some of the potentially harmful side effects of cervical collars.

Incidence and characteristics of spinal injuries in the victims of intimate partner violence (IPV).

PurposeTo describe the incidence and patterns of the spinal injuries in the victims of physical IPV.Materials and methodsWith institutional review board (IRB) approval, we retrospectively reviewed patients referred to our institution’s domestic violence intervention and prevention program with a diagnosis directly related to physical abuse between January 2013 and June 2018. Electronic health records and radiology reports were reviewed for all patients.ResultsA total of 21/688 (3%) IPV patients with 41 vertebral injuries were identified. The study population comprised of 19/21 (90%) females. Median age of the included patients was 43 years with a range of 21–72 years. All vertebral injuries were AO type A spinal injuries. Upper lumbar spine (L1 and L2) was the most common level of injury followed by upper to mid-thoracic spine. The reported mechanism of the injury was IPV in 8/21 (38.0%), fall in 8/21(38.0%), and incidental in 5/21 (24.0%). Ten out of 21 (48%) patients had concomitant injuries, most commonly to the craniofacial region 5/21 (23%). Psychiatry history was positive in 17/21 (81%), and substance abuse was positive in 15/21 (71%) of the patients.ConclusionIncidence of spinal injuries is relatively low in IPV with morphologic AO type A injury being the most common type of injury and the upper lumbar spine being the most common level of injury.

A Case Report of Pediatric Laryngeal Fracture

Background: Laryngeal fractures are one of the complications of direct damage to the neck, which can lead to airway obstruction and life-threatening conditions. Other causes of laryngeal fractures include injuries during fights, sports injuries, hangings, and iatrogenic causes. In this study, we introduce a child with a laryngeal fracture following an accidental hanging. Case Report: A 9-year-old girl was presented to the emergency department with respiratory distress and inability to speak after being hanged by her scarf. We secured the cervical spine with a hard collar and provided two intravenous (IV) lines. Then, the patient was transferred to the radiology department to perform cervical and thoracic computerized tomography (CT) scans. In the cervical CT scan, the fracture of laryngeal cartilage was detected. We repaired the fracture by prolene sutures. Then the patient was transferred to the intensive care unit (ICU) ward. After 2 days, she was transferred to ward and discharged without any complications. Conclusion: The cervical trauma is a critical condition that must be managed carefully and urgently. For the rapid diagnosis of possible damage, imaging is necessary. Among all modalities, CT scan is the best choice for detection of the vertebral injuries and airway competence in emergent conditions.

Percutaneous intervertebral bridging cementoplasty for adjacent multilevel osteoporotic thoracolumbar fractures with vertebral endplate-disc complex injury: technical note

This paper describes a minimally invasive technique of percutaneous intervertebral bridging cementoplasty (PIBC) to augment the fractured vertebrae and immobilize the intervertebral space with endplate-disc complex injury simultaneously. Thirty-two patients with adjacent multilevel osteoporotic thoracolumbar fractures (AMOTLFs) and vertebral endplate-disc complex injury (EDCI) treated by PIBC were retrospectively reviewed. The PIBC technique was a combination of puncture, balloon expansion and bridging cementoplasty. The clinical and radiological assessments were reviewed. The operation time was 82.8 ± 32.5 min, and blood loss was 76.9 ± 31.7 mL. A cement bridge was connected between the two fractured vertebrae across the injured intervertebral space. VAS at three time points including pre-operation, post-operation 1 day and final follow-up was 6.9 ± 0.9, 2.9 ± 0.8 and 1.7 ± 0.8, respectively; ODI at three time points was (71.1 ± 7.8)%, (18.4 ± 5.7)%, and (10.3 ± 5.7)%, respectively; Cobb angle at three time points was 46.0° ± 10.4°, 25.9° ± 8.5°, and 27.5° ± 7.1°, respectively. Compared with pre-operation, VAS, ODI and Cobb angle were significantly improved at post-operation 1 day and final follow-up (P < 0.05). Clinical asymptomatic cement leakage was observed in thirteen patients. No vessel or neurological injury was observed. PIBC may be an alternative way of treatment for AMOTLFs with EDCI. The technique is a minimally invasive surgery to augment the fractured vertebrae and immobilize the injured intervertebral space simultaneously.

The Effects of Lockdown During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Neurotrauma-Related Hospital Admissions

BackgroundThe response to the global severe acute respiratory syndrome coronavirus 2 pandemic culminated in mandatory isolation throughout the world, with nationwide confinement orders issued to decrease viral spread. These drastic measures were successful in “flattening the curve” and maintaining the previous rate of coronavirus disease 2019 infections and deaths. To date, the effects of the coronavirus disease 2019 pandemic on neurotrauma has not been reported.MethodsWe retrospectively analyzed hospital admissions from Ryder Trauma Center at Jackson Memorial Hospital, during the months of March and April from 2016 to 2020. Specifically, we identified all patients who had cranial neurotrauma consisting of traumatic brain injury and/or skull fractures, as well as spinal neurotrauma consisting of vertebral fractures and/or spinal cord injury. We then performed chart review to determine mechanism of injury and if emergent surgical intervention was required.ResultsCompared with previous years, we saw a significant decline in the number of neurotraumas during the pandemic, with a 62% decline after the lockdown began. The number of emergent neurotrauma surgical cases also significantly decreased by 84% in the month of April. Interestingly, although the number of vehicular traumas decreased by 77%, there was a significant 100% increase in the number of gunshot wounds.ConclusionsPopulation seclusion had a direct effect on the frequency of neurotrauma, whereas the change in relative proportion of certain mechanisms may be associated with the psychosocial effects of social distancing and quarantine.

Continuous Optical Monitoring of Spinal Cord Oxygenation and Hemodynamics during the First Seven Days Post-Injury in a Porcine Model of Acute Spinal Cord Injury.

One of the only currently available treatment options to potentially improve neurological recovery after acute spinal cord injury (SCI) is augmentation of mean arterial blood pressure (MAP) to promote blood flow and oxygen delivery to the injured cord. However, to optimize such hemodynamic management, clinicians require a method to monitor the physiological effects of these MAP alterations within the injured cord. Therefore, we investigated the feasibility and effectiveness of using a novel optical sensor, based on near-infrared spectroscopy (NIRS), to monitor real-time spinal cord oxygenation and hemodynamics during the first 7 days post-injury in a porcine model of acute SCI. Six Yucatan miniature pigs underwent a T10 vertebral level contusion-compression injury. Spinal cord oxygenation and hemodynamics were continuously monitored by a minimally invasive custom-made NIRS sensor, and by invasive intraparenchymal (IP) probes to validate the NIRS measures. Episodes of MAP alteration and hypoxia were performed acutely after injury, and at 2 and 7 days post-injury to simulate the types of hemodynamic changes SCI patients experience after injury. The NIRS sensor demonstrated the ability to provide oxygenation and hemodynamic measurements over the 7-day post-SCI period. NIRS measures showed statistically significant correlations with each of the invasive IP measures and MAP changes during episodes of MAP alteration and hypoxia throughout the first week post-injury (p < 0.05). These results indicate that this novel NIRS system can monitor real-time changes in spinal cord oxygenation and hemodynamics over the first 7 days post-injury, and has the ability to detect local tissue changes that are reflective of systemic hemodynamic changes.

Current Outcomes of Blunt Vertebral Artery Injuries

There is no consensus on the treatment of blunt vertebral artery injuries, and studies are limited to small case series. We assessed the natural history and current management of these injuries. We performed a retrospective study of a prospectively collected registry at a level I trauma center over a 5-year period. Additional information was gathered from patient charts and imaging review from electronic medical records. We analyzed demographics, mechanism of injury, Glasgow Coma Score, mortality, length of stay, associated injuries, Denver grading scale, neurological findings, level and laterality of injury, delay in diagnosis, treatment, and follow-up imaging. There were 13,080 trauma admissions during this time period yielding 141 patients with blunt vertebral artery injuries from 2013 to 2018 (1.1% incidence). Mean injury severity score (ISS) was 22 with a 30-day mortality of 14 (9.9%). An ISS of greater than 15 is associated with polytrauma and increased mortality. There were 112 (79.4%) associated cervical fractures. C6 and C7 were both equally the most common locations. There was one symptomatic injury manifesting as a cerebellar ischemic infarct. The degree of arterial injury was classified by the Denver grading scale. There were 61 (43.3%) instances of Denver grade I injuries, followed by grade IV at 36 (25.5%), grade II at 34 (24.1%), grade III at 8 (5.7%), and grade V at 1 (0.7%). The level of injury was recorded as follows: V2=67 (47.5%), V3=56 (39.7%), V1=48 (34%), V4=14 (9.9%). Medical therapy included aspirin in 93 patients (66%), 31 patients (22%) received systemic anticoagulation with heparin drip, and 2 patients (1%) were administered therapeutic Lovenox. A total of 15 patients (11%) received no medical treatment. There was one intervention in our series. Our only grade V injury was coil embolized. A total of 118 patients (84%) had follow-up imaging. Seventy-eight patients (96%) with grade I and grade II injuries did not worsen, and complete radiographic resolution was found in 50 patients (62%). Grade IV injuries persisted in 22 patients (75.9%). Median time to resolution for grade I and grade II injuries was 7 and 8days, respectively. Most follow-up scans for grade I and II injuries occurred within 50days. Posterior circulation stroke due to blunt vertebral artery injury is rare. In our experience, the natural course of blunt vertebral artery injury was benign and neither delay in medical treatment nor choice of antithrombotic had a significant impact on outcomes. In our series, only 3 (3.7%) grade I and II injuries worsened and were without any clinical sequelae. We suggest that routine serial imaging in grade I and II blunt vertebral injuries is not warranted.

Traumatic Spinal Injuries: An Autopsy Study at Tertiary Health Care Center of Rajasthan During the Year 2017-18

Introduction: India is a developing country with traumatic fatalities is on the rise. Accurate injury profiles are helpful in prevention strategies as well as clinical and community services for persons suffering trauma especially of spinal region. Aim &amp; Objectives Aim: To study the pattern of traumatic spinal injuries observed in medico-legal autopsies at S.M.S. Hospital, Jaipur during the study period 2017-18 Objectives To observe the pattern of traumatic spinal injuries. To observe survival pattern among the patients with soinal injuries To observe the demographic data of traumatic spinal injuries. Material &amp; Method: Descriptive type of observational study of autopsy conducted at Mortuary of Department of Forensic Medicine, SMS Hospital, Jaipur from 1st April, 2017 to 31st March, 2018among Bodies with spinal injuries brought for medicolegal study during study period Observations: a total number of 150 autopsy cases were included in the study. Out of 150 cases of traumatic spinal injuries, there were 132 males (88%) and 18 females (12%). Maximum numbers of fatalities with spinal injuries were observed in 21-30 years age group (24.66%), there were 75.33% cases from rural regions unemployed (50.67%). Majority of cases suffered fatality in one to seven days after the traumatic episode (41.33% cases). Road traffic accidents were the major offenders (44.00%) in the present study followed by falls. Level of spinal injury Mid cervical 53 (35.33%). Associated vertebral injuries seen along with spinal injuries as fractures of vertebrae in 49.33% cases and fractures along with dislocations in another 49.33% cases. Suggestions:- Male of earning age group should be target group for education and awareness of spinal injuries prevention education. Mid cervical protection modalities should be deployed

Analysis of Traumatic Vertebral Artery Injury Outcomes: Medical Management Is Safe Despite Severity of Injury

Management of traumatic vertebral artery injury (VAI) remains under debate. Traditional teaching reserves surgical management for high-grade injury to prevent stroke. We sought to evaluate the factors that influence posterior fossa stroke outcomes of traumatic VAI. A search of the prospectively maintained PROspective Observational Vascular Injury Treatment (PROOVIT) trauma registry of patients older than 18 years with a diagnosis of VAI was performed at a level I trauma center from 2013 to 2019. Patients’ demographics, type of injury, timing of presentation, Biffl classification of cerebrovascular injury grade, medical management, procedural interventions, and stroke outcomes were analyzed. VAIs from 59 surviving trauma patients were identified. There were more blunt VAIs than penetrating VAIs (91.5% vs 8.5%, respectively). Nine patients presented with clinical posterior circulation strokes visible on imaging. The average Biffl classification grade was similar between the stroke and nonstroke groups (2.0 vs 1.5; P = .39). The average Injury Severity Score (ISS) between the stroke and nonstroke groups was also similar (9.0 vs 14.0; P = .35). All nine patients in the stroke group declared their neurologic change on average within 21.2 hours of presentation. In the nonstroke group, 47 patients (94.0%) underwent medical management and 3 patients (6.0%) underwent medical management and non-vertebral artery endovascular intervention (ie, carotid angiography and embolization). Once patients safely passed through the initial 21.2-hour window from VAI, none had vertebral artery aneurysmal degeneration or experienced a new neurologic deficit secondary to the index vertebral injury (followed up to 9.7 months on average). The severity of VAI or ISS does not predict future stroke outcome. Medical management of VAI appears safe regardless of ISS in the trauma population. Neurologic changes on arrival were most predictive of eventual stroke outcomes. Conservative medical management was sufficient to protect from vertebral artery aneurysmal degeneration or secondary neurologic deficit regardless of index vertebral injury.

RISK FACTORS FOR THE DEVELOPMENT OF MALADAPTIVE REACTIONS TO DIFFERENT TYPES OF PHYSICAL LOAD IN MIDDLE-AGED MEN

Aim. The article is aimed at assessing the risks for developing pathological reactions to different types of physical activity in middle-aged men. Materials and methods. A comprehensive study of 34 men was conducted, of which 19 people performed strength exercises and 15 people practiced sport in swimming groups. The following data were studied: official data of the clinical examination, indicators of an electrocardiographic study of the cardiovascular system, data of functional tests, anthropometric indicators, data of magnetic resonance imaging. All participants underwent an annual medical examination. Functional tests were performed on a treadmill (Matrix USA) with parallel ECG recording (Cardiovit AT-101, Schiller, Switzerland). The development of physical qualities was assessed at three control points: at the beginning of the study, at 6 and 9 months of the study. Statistical processing was carried out using standard methods of variation statistics (Statistica 10.0 USA). Result. Almost the entire sample had pathological changes in the cardiovascular and musculoskeletal system, which created a significant risk of maladaptation to physical activity. Strength exercises in some cases provoked an increase in blood pressure (BP) to maximum values, resulted in pain in the vertebral region and injuries of the capsular ligamentous structures. The training sessions in the swimming groups were characterized by the absence of a risk to the regulatory adaptive systems of the body, which allowed to increase the reserves of the cardiorespiratory system. Conclusion. Strength exercises for middle-aged men impose significant risks to health, while swimming is an effective means for developing physical qualities and increasing the functional reserves of the respiratory and cardiovascular systems.

An odontoid fracture and vertebral artery injury in fast-track.

While CT scans without IV contrast are obtained commonly to evaluate vertebral injuries, CT angiography scans should be considered whenever a fracture site approaches known vasculature.

The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care.

Study designDescriptive study.ObjectivesThe aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR).SettingSCI community in Iran.MethodsThe NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry.ResultsThe final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity.ConclusionThe NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals.

Posttraumatic vertebral disc alterations after B and C type spinal injuries in childhood-Clinical and radiological 10-year results for two cases

Pediatric traumatic vertebral injuries usually present as stable A (AOspine classification) fractures, whereas B and C injuries are relatively uncommon. In contrast to adults the appropriate treatment strategy in children remains an issue of debate.The data from two pediatric patients admitted with B and C type spinal injuries in 2007 and 2008 were retrospectively analyzed. The initial diagnostics were performed via computed tomography (CT) and an additional magnetic resonance imaging (MRI) was carried out in one case.The clinical and radiological follow-up controls were carried out after 77 and 66 months as well as 123 and 112 months, respectively. In both cases thoracolumbar MRI scans revealed degenerative alterations of the ventral half of the L1/L2 disc with aregular disc signal in the dorsal segment at the first follow-up and aprogressive disc degeneration in one patient at the second follow-up.Surgical treatment of pediatric B and C type injuries via open reduction and temporary monosegmental posterior screw and rod instrumentation results in satisfactory clinical and radiological outcomes. In the absence of vertebral burst fractures, the function and stability of discoligamentous injuries in children can be restored without any additional osseous fusion.

Role of Magnetic Resonance Imaging in Evaluation of post traumatic Vertebral Column

Abstract Background Trauma of the vertebral column is potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that purely evaluate the role of MR imaging after spinal trauma. Aim of the work Hence, this study was undertaken to assess the ability of MRI in identifying traumatic injuries to the tissue structures of the spine. Methods The study performed over 20 cases after spinal vertebral traumatic injuries then underwent MR imaging in the period 2016 till March 2018. The osseous and non-osseous structures namely; Para vertebral tissues, Vertebrae, Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament and the Spinal Cord were evaluated. The data were classified to; patient's age, sex, mode of trauma, region of imaging, main findings, associated findings and others. The statistically significant and non-significant relations between primary data and different post-traumatic findings of MRI were thus calculated. Results Of the 20 patients, 85% of patients were male, common ages affected were 20-30 and &amp;gt;40 years with 30% for each. The site of injury was the cervical spine (30%) and thoracolumbar spine was the next highest in occurrence with 25%. L1 was the commonest level exposed to fracture (30%). Cord compression was the commonest MRI main finding in post trauma (60 %), but syrinx was (5%). In associated findings; the spinal muscles spasm was the commonest (40%) and ligamentum flavum injury comprised (15%). Bone marrow edema was the highest (35%) as other findings. There were statically significant relations between age and T12 vertebral fracture and between mode of trauma and facet joint affection. Conclusion MRI was found to be the best modality in detecting injuries to the spinal cord and the ligaments and as well as for detection of vertebral fractures and also bone marrow edema. Though more studies required for further highlight the advancing ability of the MRI.

Pediatric blunt cerebrovascular injuries: A national trauma database study

BackgroundThe incidence of blunt cerebrovascular injuries (BCVIs) in children is unknown. We aimed to determine the rate and consequences of BCVIs in pediatric blunt trauma patients. MethodsWe queried the National Trauma Data Bank (NTDB) for all blunt trauma patients between 2007 and 2014. BCVI patients were identified by ICD-9 codes. Demographic, emergency room, and concomitant injury data were analyzed. ResultsThere were 732,702 blunt trauma patients, and 1682 BCVIs were identified (0.23%). 791 (47%) sustained carotid artery injuries (CAIs), 957 (57%) had vertebral artery injuries (VAIs), and 4% of patients sustained both. A majority of the injuries occurred in white patients (61%) and in motor vehicle accidents (53%). The average age was 12.1 ± 5.4 years. CAIs had more skull base fractures (55% vs 35%, p < 0.0001), and cervical spine fractures were more common in VAIs (26 vs 11%, p < 0.0001). Intensive care length of stay was longer in the CAI patients (9.2 vs 7.9 days, p = 0.03), as was length of stay (12.5 vs 9.7 days, p = 0.0002). 5% of CAI patients were coded for stroke, versus 2% of VAIs (p = 0.002). ConclusionsBCVIs are rare in children. Vertebral injuries are more common. Carotid injuries are associated with a longer length of stay and higher stroke rates. Type of StudyRetrospective cohort study. Level of EvidenceIII

Steinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in PuppySteinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in Puppy

Background: Acute spinal traumas can lead to irreversible damage associated with vascular and inflammatory changes in neural tissue. Since spine and spinal cord traumas have an unfavorable prognosis in small animals, and reports of the use of Steinmann pins and polymethylmethacrylate repair of lumbar vertebra fracture-luxation in puppies are rare in the literature, the present paper aimed to report the surgical treatment of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment by using Steinmann pins and polymethylmethacrylate in a 7-month-old Labrador Retriever male dog.Case: A 7-month-old intact male Labrador Retriever dog, weighing 24.0 kg was attended at School Veterinary Hospital with a history of hit by car and paraplegia of the hind limbs. On neurological examination was observed no proprioception and no deep pain sensitivity on the both pelvic limbs. The lumbar spinal palpation showed intense pain, and the motor function and patellar reflexes were reduced. The values of haematological and biochemical analysis remained within the reference values for the species. Radiographs revealed a transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment, and was decided to perform a surgical treatment by open reduction and internal fixation of the fracture. The dog was positioned in ventral recumbency for surgery, and a dorsal midline incision was made from the second lumbar vertebra to the sixth lumbar vertebra. Two crossed 1.5 mm Kirschner wires were placed through the caudal articular facets of the fourth lumbar vertebra to provide initial stability. Two 2.0 mm Steinmann pins were placed at 60° angle of the bodies of the second and fifth lumbar vertebrae, and third and fourth lumbar vertebrae. This procedure was repeated on the other side of the vertebral bodies. Sixty grams of polymethylmethacrylate bone cement was applied and the fixation was checked for stability. Muscular, subcutaneous tissue and skin was closed routinely. The dog was paraplegic without any pain and used a wheelchair to assist in locomotion, although it still had urinary and faecal incontinence; no tail control; and the implants were not removed.Discussion: Lumbar vertebral injuries, as in the present case frequently, occur secondary to severe trauma (e.g. hit by car) and seem to have a characteristic fracture pattern. The patient became paraplegic due to spinal cord injury and failure of sensitivity and elimination of urine and feces which can be associated with progressive destruction of neuronal tissue due to secondary vascular and inflammatory events. The radiographic exam was used to confirm the spinal injury and determine whether by conservative or surgical treatment. The treatment choice is related to the number of fractured compartments, and the presence or not of compression. Fractures in two or more compartments are indicative of surgical treatment, similar as the present case. Use of Steinmann pins was to make a rigid fixing system compared with block plates used for the same function. Use of polymethylmethacrylate may also become a complication due to the infection, for this reason was prescribed an antibiotic for 15 days. This procedure proved to be effective since the dog showed no signs of infection. According to the characteristics of the present case report, the use of Steinmann pins and polymethylmethacrylate for repair of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment provided an effective and practical means of stabilisation, promoting decompression, and thus, improving the patient's quality of life.

Evaluation of the relationship between the level of spinal vertebra injuries due to traffic accidents and additional injuries

Vertebral injuries are mostly seen in patients with multiple trauma. Because of high energy trauma, especially in young patients, it is associated with additional injuries. It was observed that there are not enough studies on this subject in our country. In this study, we aimed to explain the incidence of vertebral injuries and the characteristics of both concomitant and vertebral injuries and contribute to the literature by investigating the presence of additional injuries in patients with vertebral injuries resulting from traffic accidents. Data were recorded on the age, sex, type of trauma, spinal injury level, additional organ injury, GCS, neurological deficits, intensive care admittance, and mortality status of all patients. The data used in the study were obtained from the hospital’s automation system and patients’ files. The mean age of the 166 spinal trauma patients included in the study was 36.7±15.4 (Median:35; 95% Cl:34.1-38.7) years and 65.7% of the patients were male. Mortality rate in emergency department was 0.6%, mortality frequency was not associated with additional organ injury, trauma cause and spinal level but the results were not statistically significant (p> 0.05). The presence of additional injury increased the frequency of intensive care admission, the results were statistically significant (p

Inhibition of pain or response to injury in invertebrates and vertebrates

Inhibition of pain or response to injury in invertebrates and vertebrates