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PubMed2004

Spinal injuries in children.

BACKGROUND/PURPOSE: Traumatic spinal injury (TSI) is an uncommon source of morbidity and mortality in children. The aim of this study was to describe childhood TSI in a single level 1 urban pediatric trauma center. METHODS: The authors retrospectively analyzed all children younger than 14 years with TSI, treated at a level I pediatric trauma center between 1991 and 2002 (n = 406, 4% total registry). All children were stratified according to demographics, mechanisms, type and level of injury, radiologic evaluations, associated injuries, and mortality. RESULTS: The mean age was 9.48 +/- 3.81 years. The most common overall mechanism of injury was motor vehicle crash (MVC; 29%) and ranked highest for infants. Falls ranked highest for ages 2 to 9 years. Sports ranked highest in the 10 to 14 year age group. Paravertebral soft tissue injuries were 68%. The most common injury level was the high cervical spine (O-C4). The incidence of spinal cord injury without radiologic abnormality (SCIWORA) was 6%. Traumatic brain injury (37%) was the most common associated injury. Overall mortality rate was 4% in this urban catchment. CONCLUSIONS: TSI in children requires a different preventive and therapeutic logarithm compared with that of adults. The potential devastating nature of TSI warrants that the health care team always maintains a high index of suspicion for injury. Future prospective studies are needed to further elucidate injury patterns.

Accidental Falls↗
PubMed2002

Double noncontiguous cervical spinal injuries.

BACKGROUND: Double noncontiguous spinal injuries in the same patient, the first at the cervical level and the second at the thoracic or thoracolumbar level are not uncommon. On the other hand the incidence of double noncontiguous cervical injuries in low and these injuries imply complex mechanisms. This study investigates the cases of double noncontiguous cervical lesions in 342 cases of acute cervical injuries. METHOD: An analysis of 342 patients with cervical injuries found 67 multiple cervical injuries and only 11 cases of double noncontiguous cervical lesions. FINDINGS AND INTERPRETATION: Double noncontiguous cervical injuries have a frequency of 3.2% in this study and in three cases there were pre-existing benign cervical lesions. A possible spinal biomechanical behaviour during injury can be that the first lesion appears because of the traumatic impact and there is a uniform transmission of the remaining traumatic strain all along the spine. It seems that the propagated force finds a spinal zone where the spinal resistance is diminished and the second spinal lesion can occur. Spinal vulnerability for the second lesion in the same trauma can be caused by a pre-existing benign spinal lesion or by a biomechanical discontinuity because of a particular posture at the traumatic moment. The second lesion in double noncontiguous cervical lesions can appear through a single great impact in pre-existing lesions, double impacts at the same time with injuries at two cervical levels or repeated cervical impacts in very quick succession in the same trauma.

Adolescent↗
PubMed2002

Spinal injuries.

The pre-hospital care of patients with suspected spinal injuries involves early immobilisation of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disruption. Early ventilation and differentiation of haemorrhagic from neurogenic shock are the key elements of pre-hospital resuscitation specific to spinal injuries. Falls from a significant height, high-impact speed road accidents, blast injuries, direct blunt or penetrating injuries near the spine and other high energy injuries should all be regarded as high risk for spinal injury but clinical examination should determine whether the patient requires full, limited or no spinal immobilisation. Although there is little conclusive evidence in the literature that supports pre-hospital clinical clearance of the spine, the similarities between pre-hospital immobilisation decisions and in-hospital radiography decisions are such that it is likely that clinical clearance will be effective for selected patients. This decision can be made at the scene provided the patient has no evidence of: Altered level of consciousness or mental status Intoxication Neurological symptoms or signs A distracting painful injury (e.g. chest injuries, long bone fracture) Midline spinal pain or tenderness. Where there is evidence to support spinal immobilisation, then the full range of devices and techniques should be considered. In the remote or operational environment where pre-hospital times are prolonged, full immobilisation, analgesia and re-assessment may allow localisation of the injury and a reduction in the degree of immobilisation. Common reasons for missing significant spinal injuries include failing to consider the possibility of spinal injuries in patients who are either unconscious, intoxicated or uncooperative (54,55). The application of the decision rule discussed here will ensure that no clinically significant spinal injuries are missed in pre-hospital care.

Emergency Medical Services↗
PubMed1992

[Complications in surgical management of spinal injuries].

Operative treatment of spinal injuries requires an accurate surgical technique and biochemical know-how to avoid complications due to mistakes in device handling, operative technique, and indication. Device failures are caused by loosening of locking clamps or fracture of Schanz screws, followed by loss of angle stability and early loss of reduction. Maldisplacement of pedicle screws may involve irritation of neurovascular structures or loss of correction as well as insufficient transpedicular bone reduction and bone grafting. In burst fractures with destruction of the vertebral body and loose canal fragments, the posterior approach is less efficient than a combined procedure.

Biomechanical Phenomena↗
PubMed2001

Clinical features, patterns of referral and out of hospital transport events for patients with suspected isolated spinal injury.

BACKGROUND: Prehospital diagnostic accuracy and risks of transportation associated neurological deterioration for patients with spinal injury remain imprecise. METHODS: Retrospective review of medical records for patients with suspected spinal injury assessed and escorted by medically staffed team. RESULTS: One hundred and ninety six patients had follow up for spinal injury, 61% with actual injury. Of the 196 patients, 93% involved helicopter transport, 3.5% road vehicle and 3.5% fixed wing transports. Fifty one percent were interhospital transfers. Medical team's scene diagnostic accuracy of spinal injury was 31%. Scene medical interventions were those consistent with current paramedical skills. Of interhospital transferred patients, 19% had no injury. Cervical injuries as part of mixed injuries were the most often missed injuries. Abnormal neurological findings occurred equally amongst patients with and without spinal injury. Transport related incidents were documented for 15%. Interhospital transport patient related incidents occurred for 12% helicopter and 36% road vehicle transports (P=0.094). No transport related neurological injury or other morbidity was documented. CONCLUSION: Prehospital diagnosis of spinal injury, even by medical teams remains imprecise. Choice of helicopter transport, based purely upon the suspected presence of spinal injury could not be supported.

Adolescent↗
PubMed2005

Aetioepidemiological profile of spinal injury patients in Eastern Nepal.

This is a retrospective case series of 233 spinal injury patients admitted to the orthopaedic ward of BPKIHS from May 1997 to April 2001. The inpatient records were analysed. In all, 40.3% of spinal injuries resulted from falls from trees while cutting leaves for fodder, and 27.9% resulted from falls from first/second floors. More than 75% of total spinal injuries are largely preventable. Overall, 46.8% of our spinal injury patients had complete cord transection at the level of injury. All adolescents and adults, irrespective of age or sex, should be the target groups for community education and intervention programmes for prevention of spinal injury.

Accidental Falls↗
PubMed1998

Psychosocial job factors, physical workload, and incidence of work-related spinal injury: a 5-year prospective study of urban transit operators.

STUDY DESIGN: Five-year prospective cohort study of 1449 transit operators. OBJECTIVES: To investigate psychosocial job factors as predictors of work-related spinal injuries, controlling for current and past physical workload. SUMMARY OF BACKGROUND DATA: The association between psychosocial job factors and spinal disorders may be confounded by physical workload. A 1991 prospective study of Boeing workers found psychosocial but not physical factors to be associated with spinal injuries. However, data on physical workload were limited. Recent cross-sectional studies of transit drivers showed both physical and psychosocial factors to be independently associated with back and neck pain. This study was designed to test these findings prospectively. METHODS: Spinal injuries were ascertained from workers' compensation records, employment history from company records, and psychosocial factors from questionnaires. Logistic regression models adjusted for age, gender, height, weight, vehicle type, and current and past physical workload. RESULTS: During follow-up, 320 drivers reported a first spinal injury. Spinal injury was predicted by psychological job demands (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.33-1.95); job dissatisfaction (OR, 1.56; 95% CI, 1.09-2.23); and the frequency of job problems (OR, 1.52; 95% CI, 1.02-2.26). Marginally significant associations were found for low supervisor support (OR, 1.30; 95% CI, 0.99-1.72) and female gender (OR, 1.49; 95% CI, 0.95-2.32). Compared with full-time work, part-time work was associated with a 2.7-fold reduced risk for spinal injury (OR, 0.37; 95% CI, 0.15-0.93). Cable car crews performing the heaviest physical labor had a threefold increased risk of spinal injury compared with bus drivers (OR, 3.04; 95% CI, 1.85-5.00). CONCLUSIONS: Physical workload and psychosocial job factors both independently predict spinal injury in transit vehicle operators.

Accidents, Occupational↗
PubMed1991

The value of magnetic resonance imaging (MRI) in the follow-up management of spinal injury.

Twenty-seven patients with spinal injury have been studied with follow-up Magnetic Resonance Imaging (MRI). MRI has helped (a) to determine the extent of cord injury; (b) to detect continuing compression to the spinal cord; (c) to discover unexpected pathologies and most importantly (d) to detect the development of post traumatic syrinx. MRI was most valuable in patients with post-traumatic syrinxes to evaluate any changes in the size, and, in those who had a shunting procedure, to assess the efficacy of the procedure. MRI also aided in planning complicated one stage operations by giving a 'complete' picture of the injury inflicted to the vertebrae, soft tissue structures and the spinal cord. As well as advantages in clinical audit it makes financial sense. It provides more information than CT myelography and is non-invasive. When compared to the cost of neurological deterioration it is much more cost effective to follow-up spinal injury patients with MRI. It is the authors' contention that after the acute phase all patients with spinal injury should have at least one MRI.

Adolescent↗
PubMed2001

Spinal injuries in snowboarders: risk of jumping as an integral part of snowboarding.

BACKGROUND: The purpose of this study was to clarify the occurrence rate and characteristics of spinal injuries caused by snowboarding that were sustained at the Okumino skiing area in Gifu Prefecture, Japan, from 1988 to 2000. METHODS: This study was a retrospective review of 13,490 cases of snowboard- or ski-related injury treated at Sumi Memorial Hospital over this period. RESULTS: A total of 7,188 patients sustained snowboard-related injuries, and 238 of these had spinal injuries caused by snowboarding (3.3%), whereas 6,302 patients sustained ski-related injuries, and 86 of these had spinal injuries caused by skiing (1.4%). Although there were no significant differences in the difficulty of slope, location of vertebral fracture, or spinal cord injury between snowboarders and skiers, the incidence of transverse process fractures was significantly higher in snowboard-related than in skiing-related injury (p < 0.05). In addition, there was a significantly higher incidence of spinal injury among beginner snowboarders than among beginner skiers (p = 0.04). Furthermore, intermediate or expert snowboarders were more likely to be injured because of jumping than beginners (p < 0.001), whereas about 70% of spinal injuries caused by skiing resulted from a simple fall. CONCLUSION: Spinal injuries sustained while snowboarding are increasing considerably in incidence and are characterized as complex injuries. We must educate young snowboarders of the risk of this sport, to prevent these serious injuries.

Adolescent↗
PubMed2001

Prophylaxis of thromboembolism in spinal injuries--results of enoxaparin used in 276 patients.

OBJECTIVE: To evaluate the results of thromboembolic prophylaxis using enoxaparin in acute spinal injury patients. BACKGROUND: Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in patients with acute spinal injuries. A wide range of thromboprophylactic measures have been proposed. The present study describes the outcome of a regime of enoxaparin and antithromboembolic stockings in acute spinal injuries irrespective of neurological damage. SETTING: Scotland, UK. METHODS: Eighteen-month retrospective review of acute spinal injury patients admitted to a national spinal injuries unit. A thromboembolic prophylactic regimen of early mobilisation, use of antithromboembolic stockings, and subcutaneous administration of enoxaparin 40 mg once a day until patients could be mobilised for more than 4 h per day, was used. Patients with clinical suspicion of deep venous thrombosis or pulmonary embolism were investigated as appropriate. RESULTS: Out of 146 (53% of total) patients with spinal injuries with no neurological deficit only one patient (0.4%) developed clinical evidence of pulmonary embolism and out of 130 (47% of total) with spinal cord injury two (0.7%) developed clinical evidence of deep venous thrombosis while still on enoxaparin. Four patients (1.5%) developed deep venous thrombosis and one (0.4%) pulmonary embolism after discontinuing enoxaparin. There were no fatal pulmonary emboli and one suspected intraspinal bleeding. CONCLUSIONS: The present study suggests that, in addition to physical and mechanical measures, low molecular weight heparin in the form of enoxaparin 40 mg administered once daily compares favourably with previous studies for thromboprophylaxis in acute spinal injuries.

Acute Disease↗
PubMed1986

Logistics of early management of head and spinal injuries.

The logistics of early management have been studied in a series of 1161 patients with head and/or spinal injuries, who were admitted to hospital in NSW in 1977-78. Special attention has been given to three subgroups: 336 head injuries with records of impaired consciousness before first hospital admission, 355 head injuries later transferred because of deterioration, and 202 serious spinal injuries. It was found that in at least 18% of unconscious head injuries, and a similar percentage of spinal injuries, first aid and transport to hospital were provided by ambulances recorded to have only one trained staff member. In country areas, 41% of unconscious head injuries reached hospital after periods of time exceeding 1 h. For administrative as well as geographic reasons, more than 80% of initially unconscious head injuries and spinal injuries were first admitted to hospitals without neurosurgical and/or spinal services; the majority of cases in both groups, therefore, had to be transferred to other hospitals, often within 6 h of first admission. In the subgroup of cases transferred because of deterioration, mortality increased with distance from a neurosurgical unit. These findings are related to the concept of an integrated regional trauma service.

Ambulances↗
PubMed1994

The prevention of spread of methicillin resistant Staphylococcus aureus in a spinal injuries centre.

The National Spinal Injuries Centre (NSIC) is a tertiary referral centre. It accepts most of its patients from other hospitals in the UK and overseas. The severity of injury, the presence of a tracheostomy, urinary catheter and pressure sores predisposes this group of patients to colonisation or infection with Methicillin resistant Staphylococcus aureus (MRSA). The NSIC uses simple but strict protocols for hygiene, screening for MRSA, and source isolation of known or suspected MRSA carriers in single room accommodation to control the spread of MRSA in the centre. A retrospective search of microbiology and patient records revealed that in 4 years there had been 24 admissions with MRSA, with a total of 1421 isolation days. There was only one outbreak of MRSA. This involved three patients. Hygiene, screening of potential MRSA carriers together with single room isolation can limit the spread of MRSA.

Cross Infection↗
PubMed2004

Speed and spinal injuries.

Road traffic accidents (RTA) are a significant cause of spinal trauma. On the 31st of October 2002 a new penalty system for speed related driving offences was introduced in Ireland. Our intention was to assess the effects of the introduction of this system on the activity of the National Spinal Injuries Centre (NSIC) with a retrospective review of all admissions from November 1998 until October 2003. The number of new acute admissions to the spinal injury unit during the study period was 831. In the first 6 months of the new system the number of RTA related admissions fell significantly to 17 compared to an average of 33 in the preceding 4 years. However, this effect was not maintained in the second 6 months. The fall in spinal injuries following RTA in the first 6 months of the new system parallels the pattern of road death reduction in this period. This suggests that driving behaviour can be modified with direct benefits in reducing spinal injuries. However, this effect has not persisted in the second 6 months of the new system suggesting that to maintain this change the perception and familiarity of a penalty are important factors in its impact.

Accidental Falls↗
PubMed1998

High incidence of occult neurogenic bladder dysfunction in neurologically intact patients with thoracolumbar spinal injuries.

PURPOSE: We determine the relationship between lower urinary tract function and somatic neurological status after thoracolumbar fracture. MATERIALS AND METHODS: Within 72 hours of thoracolumbar vertebral fracture we evaluated 44 consecutive patients, including 30 men and 14 women 17 to 84 years old (mean age 38.7), with occult neurogenic bladder dysfunction following incomplete thoracolumbar spinal injuries (American Spinal Injury Association impairment classifications C to E). The neurological level and degree of injury were established, and testing for perianal pinprick sensation and bulbocavernosus reflex was done. Video urodynamic evaluation was then performed between 3 and 14 days after injury but before spinal surgery. RESULTS: Urodynamics revealed neurogenic lower urinary tract dysfunction in all 10 patients with classification C, 82% with D and 41% with E (otherwise completely intact neurologically) impairment. Although pinprick sensation deficiency and decreased bulbocavernosus reflex correlated with injury classification, lower urinary tract dysfunction was present in 62% of the patients with intact pinprick sensation and in 59% with intact bulbocavernosus reflex. CONCLUSIONS: Neurologically intact patients with thoracolumbar spinal injuries may have neurogenic lower urinary tract dysfunction on urodynamics. Pinprick sensation and bulbocavernosus reflex are specific but not sensitive indicators of lower urinary tract dysfunction after spinal cord injury. Although these indicators, which demonstrate somatic nerve function, were absent in all patients with detrusor areflexia, intact pinprick sensation and bulbocavernosus reflex are not sensitive for predicting lower urinary tract function, which depends on autonomic nerve function. Urodynamic evaluation is mandatory for the complete evaluation of patients with incomplete lumbosacral spinal injuries.

Adolescent↗
PubMed1994

Epidemiology of spinal injuries in Romania.

Retrospective and prospective epidemiological studies in Bucharest indicated a high rate of spinal injuries (about 28.5 per million population per year) in Romania. Most patients were poor, male, manual workers. Half of them were aged less than 40. Falls, particularly from horse-drawn carts, and road traffic accidents were the most frequent causes of injury. In summer, diving accidents were a common cause of spinal injuries. Sixty per cent of the patients had cervical injuries. Pressure sores became less frequent as staff and relatives were trained to turn and position patients. Because gastroduodenal bleeding and deep vein thrombosis were rare, the systematic use of drugs to prevent these conditions was deemed to be unnecessary, given the financial constraints. A shortage of beds and facilities made it difficult to manage associated injuries in a neurosurgical clinic in Bucharest or to admit all patients for rehabilitation. Thirty-nine per cent of all patients admitted with spinal injuries had spinal surgery (61% of those with neurological impairment). Bone grafting was the most common procedure for cervical injuries; surgical stabilisation was not commonly performed due to the shortage of plates and screws. The mortality rate in the early days post injury decreased from 22% (1985-1991) to 10.1% (1992) as medical management improved and the relatives helped with care in the acute phase. A programme is needed in Romania to prevent the accidents that cause spinal injuries and to improve clinical management. As a result of this study, three films were made to aid the prevention of accidents and to train staff and relatives in the care of those with spinal cord injuries.

Adolescent↗
PubMed2006

[Analysis on body impairment assessment upon 447 thoracolumbar, spinal injury cases in traffic accidents].

OBJECTIVE: To discuss the relation between degree of body impairment and that of thoracolumbar spinal injuries resulting from road traffic accidents, and sum up the experiences in body impairment assessment and its regularity. METHODS: For comprehensive body impairment assessment, 477 cases of thoracolumbar spinal injuries in road accidents have been sorted out, reassessed and rediagnosed. In addition, analyses have been undertaken about their treatment, the assessment of the degree of their thoracolumbar dysfunction,nerve dysfunction and the relations between injuries and sequelaes. RESULTS: The analyses show that the degree of thoracolumbar dysfunction and that of the post-injury nerve dysfunction don't necessarily depend on the quantity and degree of spinal injuries. However, the position suffering from the thoracolumbar spinal injuries has an immense impact on the thoracolumbar dysfunction, and the nerve impairment result mainly from the T1-1L spinal injuries. The research also shows that there has been a high misdiagnosis rate in hospital about the spinal injuries. CONCLUSION: In body impairment assessment, the cause and effect relations between the injury and degree of injury extent should be analyzed, the injury extent should be employed as principal evidence, and the degree of spinal dysfunction should be taken into greater consideration.

Accidents, Traffic↗