Cervical spine injuries

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of cervical spine injuries

Epidemiologia urazów kręgosłupa w materiale własnym Pogotowia Ratunkowego we Włocławku: Badania retrospektywne

Background. Spine injuries are serious medical and social problem, especially when it happens together with the defect of spinal cord, causing very often serious dysfunctions and permanent disability to the end of life.Aim. Purpose of researches was the evaluation of frequency of back bone injuries occurrence on patients covered by care of the Emergency Service in Włocławek within years 2006–2009.Materials and methods. Researches were performed based on documentation analysis of the archives of the Emergency Service Station in Włocławek within years 2006–2009. Applied research method was the retrospective analysis of medical documentation, and applied technique was quantitative analysis of documents. Population residing on area covered by activity of Emergency Service Station in Włocławek was included in the research. From the researched population, group of 244 people were selected, who suffered spine injuries, and then they were subjected to statistical analysis.Results. Statistically significant were the dependencies between the reasons of spine injuries and: gender, backbone section, age, alcohol consumption. Statistically insignificant result referred to the dependence between the reason of spine injuries and season of the year and place of residence.Conclusions. The most often reason of spine injury were traffic accidents. The most often the injury concerned the section of cervical spine. Men were subjects of spine injuries much more often than women. Spine injuries happened more often in municipal environment than in rural areas. Spine injuries occurred the most often in group 21-40 years. Spine injuries happened more most often in summer time. Number of spine injuries increases after consumption of alcohol. (PNN 2012;1(3):109-118)Wprowadzenie. Urazy kręgosłupa to poważny problem medyczny i społeczny, zwłaszcza gdy towarzyszy mu uszkodzenie rdzenia kręgowego, powodujące bardzo często poważne dysfunkcje i trwałe kalectwo do końca życia.Cel. Celem badań była ocena częstości występowania urazów kręgosłupa u pacjentów objętych opieką Pogotowia Ratunkowego we Włocławku w latach 2006–2009.Materiał i metody. Badania przeprowadzono w oparciu o analizę dokumentacji archiwum Stacji Pogotowia Ratunkowego we Włocławku w latach 2006–2009. Zastosowaną metodą badawczą była analiza retrospektywna dokumentacji medycznej a techniką ilościową analiza dokumentów. Badaniami objęto populację zamieszkałą na terenie objętym działalnością Stacji Pogotowia Ratunkowego we Włocławku. Z badanej populacji wyłoniono grupę 244 osób, które doznały urazów kręgosłupa, a następnie poddano analizie statystycznej.Wyniki. Istotne statystycznie okazały się zależności między przyczyną urazu kręgosłupa a: płcią, odcinkiem kręgosłupa, wiekiem, spożyciem alkoholu. Wynik nieistotny statystycznie dotyczył zależności między przyczyną urazu kręgosłupa a porą roku i miejscem zamieszkania.Wnioski. Najczęstszą przyczyną urazów kręgosłupa były wypadki drogowe. Najczęściej uraz dotyczył odcinka szyjnego kręgosłupa. Mężczyźni zdecydowanie częściej ulegali urazom kręgosłupa niż kobiety. Do urazów kręgosłupa częściej dochodziło w środowisku miejskim niż wiejskim. Najczęściej urazy kręgosłupa występowały w grupie wiekowej 21–40 lat; najczęściej dochodziło do nich latem. Wzrasta ilość urazów kręgosłupa po spożyciu alkoholu. (PNN 2012;1(3):109-118

A study on functional outcome following surgical fixation for lower spine injuries

Background: Cervical spine injuries are one of the common causes of serious morbidity mortality following trauma. 6% of trauma patients have spine injuries of which >50% is contributed by a cervical spine injury. The aim of the study was to determine the functional outcome following surgical fixation for sub-axial cervical spine.Methods: this prospective study involving 17 patients who were all admitted with sub-axial cervical spine injuries and amenable to intervention in our department of orthopedics and traumatology, government Theni medical college, Tamil Nadu, India in the year 2019-2020. Duration of 6 months from December 2019 to may 2020.Results: Most of the injuries presented within 24 hours of injury. Most of the patients presented with an incomplete neurological deficit. C5-C6 subluxation with disc bulge was the most common spinal injury. 5 patients were operated on more than 2 levels. The rest of the patients were operated on at 2 levels.Conclusions: We consider that the anterior decompression and fusion with a locking compression plate is a viable procedure in sub-axial cervical spine injuries

AO Spine Upper Cervical Injury Classification System: A Description and Reliability Study.

BACKGROUND CONTEXT Prior upper cervical spine injury classification systems have focused on injuries to the craniocervical junction (CCJ), atlas, and dens independently. However, no previous system has classified upper cervical spine injuries using a comprehensive system incorporating all injuries from the occiput to the C2-3 joint. PURPOSE To (1) determine the accuracy of experts at correctly classifying upper cervical spine injuries based on the recently proposed AO Spine Upper Cervical Injury Classification System (2) to determine their interobserver reliability and (3) identify the intraobserver reproducibility of the experts. STUDY DESIGN/SETTING International Multi-Center Survey PATIENT SAMPLE: A survey of international spine surgeons on 29 unique upper cervical spine injuries OUTCOME MEASURES: Classification accuracy, interobserver reliability, intraobserver reproducibility METHODS: Thirteen international AO Spine Knowledge Forum Trauma members participated in two live webinar-based classifications of 29 upper cervical spine injuries presented in random order, four weeks apart. Percent agreement with the gold-standard and kappa coefficients (ƙ) were calculated to determine the interobserver reliability and intraobserver reproducibility. RESULTS Raters demonstrated 80.8% and 82.7% accuracy with identification of the injury classification (combined location and type) on the first and second assessment, respectively. Injury classification intraobserver reproducibility was excellent (mean, [range] ƙ = 0.82 [0.58-1.00]). Excellent interobserver reliability was found for injury location (ƙ = 0.922 and ƙ= 0.912) on both assessments, while injury type was substantial (ƙ=0.689 and 0.699) on both assessments. This correlated to a substantial overall interobserver reliability (ƙ = 0.729 and 0.732). CONCLUSION Early phase validation demonstrated classification of upper cervical spine injuries using the AO Spine Upper Cervical Injury Classification System to be accurate, reliable, and reproducible. Greater than 80% accuracy was detected for injury classification. The intraobserver reproducibility was excellent, while the interobserver reliability was substantial

The validity of thoracolumbar injury classification and biomechanical approach in the clinical outcome of operative and non-operative treatments

In the United States, the incidence of thoracolumbar injures is approximately 15,000 per year due to highenergy trauma resulting mainly from a motor vehicle accident in younger patients. Most commonly, thoracolumbar (TL) injuries occur at the T10 to L2 level, which is the most common site afflicted by trauma. Numerous classification systems for thoracolumbar spine injuries have established. Currently, there is no universal acceptance of a classification system for thoracolumbar spine injuries that facilitates proper communication between treating physicians and helps to standardize approaches to treatment

Rugby and cervical spine injuries

At the time of writing, a Cape newspaper reported on a 21-year-old rugby player who died on the field following a presumed spine injury. This highlights the ongoing concerns regarding safety in this contact sport. Although the physicality of rugby is a large part of its attraction, both to spectators and players, no one wishes serious harm. Two papers in this issue of SAMJ review rugby-related injuries to the spine and spinal cord

Patients with Blunt Traumatic Spine Injuries with Neurological Deficits Presenting to an Urban Tertiary Care Centre in Mumbai: An Epidemiological Study

INTRODUCTION: Traumatic spine injuries are on the rise. The literature is sparse regarding epidemiology of patients with traumatic spine injuries from this part of the world. OBJECTIVES: To analyse the following in patients with traumatic spine injuries with neurological deficits: demographic and social profile, common modes of injury, pre-hospitalisation practices, region of spine affected, severity of neurological deficit and the lay individuals’ awareness about traumatic spine injuries. METHODS: The study sample comprised 52 adult patients with traumatic spine injuries with neurological deficits. We collected data on demographic and social characteristics, mode of injury, pre-hospitalisation treatment, interval between injury and presentation, spine region affected and severity of neurological deficits and patient's knowledge about such injuries. RESULTS: The average patient age was 31.32y. The male: female ratio was 2.25:1, and the most common modes of injury were fall from height, followed by traffic accident. More than half of the patients suffered cervical spine injuries, followed by dorsolumbar spine injuries. Only 9.61% of patients received pre-hospitalisation treatment. All patients understood there could be complete functional recovery after treatment for traumatic spine injuries. CONCLUSION: There is a growing need to improve railway and roadway safety equipment and to make it accessible and affordable to the susceptible economically weaker population. Attempts should be made to increase awareness regarding traumatic spine injuries

An Investigation of the Effect of Trunk Musculature on the Lumbar Spine Injury During a High-Speed Frontal Central Crash

Motor vehicle crashes have been a leading cause of fatalities and injuries worldwide. Owing to new protection systems, the occurrence of injuries has been decreasing in recent years. On the contrary, the incidence of lumbar spine injuries in frontal crashes has been increasing as a function of the vehicle model year. However, only a few studies focused on lumbar spine injuries in vehicle crashes. Therefore, the mechanism of lumbar spine injuries has not been understood thoroughly. Muscle contraction is one of the factors that influence the risk of lumbar spine injuries as occupants tend to brace their muscles during a vehicle crash. Greater muscle contraction, especially anticipatory muscle contraction, may contribute to bony injury. This study aimed to investigate the effect of lumbar muscle activation and the timing of muscle activation on the lumbar spine injury risk during a high-speed frontal central crash by utilizing a finite element human body model. The study implemented lumbar musculature on two versions of the validated models against the experimental results from a previous study. Sixteen simulations with 8 of each version were set up. These 8 simulations included: fully activated at 0ms, 40ms, and 80ms; half activated at 0ms, 40ms, and 80ms; no activation and no muscle. The model was seated in a simplified vehicle seat extracted from a common vehicle model and was in a frontal pole/tree (central) crash scenario with an initial speed of 56km/h. Each simulation ran for 150ms and forces on vertebrae L1, L3 and L5 were collected. The results showed the lumbar spine forces increased with the muscle activation level and decreased with the timing of the muscle activation. This suggested that the anticipatory powerfully braced lumbar muscles had a higher risk to induce lumbar spine injuries. Since it is impossible to train occupants to avoid bracing in anticipation of a frontal crash, this study focuses the attention on enhanced protection for the lumbar region of vehicle occupants in the future

Association of Head and Cervical Injuries in Pediatric Occupants Involved in Motor Vehicle Collisions

The leading cause of death for children in the age group of 1-14 years is accidental injury. Motor vehicle accidents make up 63% of all accidental injury deaths in this age category. Furthermore, traumatic brain injury causes the highest number of deaths among children involved in motor vehicle collisions. Although cervical spine injuries are less frequent, they do cause death in children. Using a retrospective database, the objective of this pilot study was to determine whether there was a relationship between head injuries and cervical spine injuries and if cervical spine injuries had a higher frequency in younger pediatric passengers. Data were gathered on the types of injuries in passengers and pedestrians from postmortem and police reports for children 12 years and under involved in motor vehicle collisions. The influence of age and gender on the frequency of sustaining a head and spine injury was analyzed. The results showed that the younger individuals of both sexes had higher odds of sustaining head injuries and lower odds of sustaining neck injuries. This study also showed that head and neck injuries were relatively independently related for all sample groups tested suggesting different factors were involved in their causation. By understanding the relationship between head and spine injuries in different age and gender groups, the variables responsible for these injuries must be further defined prospectively when designing motor vehicle research protocols and safety regulations and investigating child deaths in motor vehicle collisions. Serious head and neck injuries and deaths in children can be reduced by preventative safety measures which address the etiologic factors responsible for these injuries in motor vehicle collisions