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PubMed2006

Nonoperative management and treatment of spinal injuries.

STUDY DESIGN: Review of literature. OBJECTIVE: To delineate and discuss nonoperative treatment and treatment of spinal injuries. SUMMARY OF BACKGROUND DATA: Nonoperative methods have been a mainstay of care for spinal injuries since ancient Egypt. The vast majority of all spinal injuries should be treated in the nonoperative fashion. The indications and methods continue to evolve. METHODS: A PubMed search of the literature returned more than 1000 articles related to spine trauma. A total of 270 were references to nonoperative treatment, and 100 were thought to be relevant and included in this review. RESULTS: All spine injuries are treated in a nonoperative manner, at least initially. The vast majority of injuries are successfully and appropriately treated in a definitive manner with nonsurgical methods. Over the past 10-15 years, the advent of better rigid cervical fixation has decreased the use of halo vests as definitive treatment of many cervical injuries. In contrast, during the same time, more thoracolumbar injuries are being treated in a nonsurgical fashion because the outcomes have been shown to be similar or superior. CONCLUSIONS: As with all of medicine, the treatment of spine trauma will continue to evolve with time. It is paramount that the physician selects the treatment that will provide the best short-term recovery with the least impact on long-term function.

Emergency Treatment↗
PubMed2000

[Intensive care treatment concepts after traumatic spinal cord injury].

Spinal injuries are caused by strong traumatic impacts, followed not only by a local spinal reaction but also systemic involvement. The main problems in the early posttraumatic period are haemodynamic instability, pulmonary insufficiency and SIRS. In this period multiple risks of secondary injuries to the spinal cord or other organs exist and may develop towards life-threatening sepsis, ARDS and multi-organ failure. Optimum therapy for spinal injury patients is demanding and requires an experienced team for diagnosis as well as primary and secondary care. Close cooperation between intensive care and surgery is also important.

Critical Care↗
PubMed1984

National survey of spinal injuries in hockey players.

There has been an alarming increase in the number of spinal injuries in hockey players. Between 1976 and 1983, 42 were reported to the Committee on Prevention of Spinal Injuries due to Hockey. The median age of the injured players was 17 years. Of the 42 players 28 had spinal cord injuries, and 17 of them had complete paralysis below the vertebral level of the injury. Strikes from behind and collisions with the boards were common mechanisms of injury. Many of the players had suffered a burst fracture of the cervical spine following a blow to the top of the helmet when the neck was slightly flexed. The committee studied a number of possible etiologic factors and made several recommendations regarding prevention. League officials, coaches, players and equipment manufacturers can all play a role in prevention.

Adolescent↗
PubMed1993

Role of magnetic resonance imaging in the assessment of spinal injuries.

Magnetic Resonance Imaging (MRI) examination was carried out on 44 patients who had spinal injuries with neurological involvement. The technique provided valuable information about the nature of the injuries and, in particular, about the state of the spinal cord. The appearances of the cord on MRI ranged from normal, to oedema, to more severe damage such as cord haemorrhage or transection or, in later cases, myelomalacia. The appearance of the cord on MRI correlated strongly with both the severity of the neurological deficit and also the degree of subsequent recovery. In the assessment of the acute spinal injury, MRI has been shown to be a good prognostic indicator; it may also help to identify which patients are likely to benefit from early decompression.

Acute Disease↗
PubMed1975

Spinal injury after ejection in jet pilots: mechanism, diagnosis, followup, and prevention.

In order to contribute to the study of spinal injury after ejection., the author analyzed the results of 100 cases of ejections carried out by military and civil Italian jet pilots in a period of 20 years. Of this group, 47 successfully ejected from aircraft without injury; 11 ejections proved fatal. The remaining 42 pilots sutained vertebral fractures, while 27 sustained other traumatic injuries different from spinal fractures. There were 23 vertebral fractures in 15 pilots and the most frequently affected vertebrae were those of the thoraco-lumbar junction. Analysis was make of the pathology, the clinical and radiological profiles, the therapeutic treatment, and the relative aeromedico-legal aspects concerning the temporary unfitness for flying or permanent grounding of the personnel as well as the possible prevention of spinal injury after ejection

Accidents, Aviation↗
PubMed1984

Megadose corticosteroid therapy following experimental traumatic spinal injury.

Corticosteroids are frequently used in the treatment of spinal trauma, although neither experimental nor clinical evidence to support their use is persuasive. Recently there have been claims that extremely high doses ("megadoses") of corticosteroids (equivalent to 15 to 30 mg/kg of methylprednisolone) improve neurological recovery compared to results with traditional steroid doses. The authors have compared the effect of megadose dexamethasone and methylprednisolone therapy to that of saline treatment following traumatic cervical spinal injury in the cat. During 6 weeks postinjury, neurological recovery did not differ significantly in corticosteroid-treated and saline-treated animals. Moreover, histopathological changes in the spinal cord were similar in methylprednisolone- and saline-treated cats. Corticosteroid-treated animals had a higher mortality rate than did control animals, with the predominant cause of death being neurogenic pulmonary edema. It is concluded that megadose corticosteroid treatment does not improve neurological recovery in this experimental model of spinal injury, and is associated with increased mortality.

Animals↗
PubMed1990

Spinal injuries in children.

We reviewed 47 children with spinal injuries. Three distinct patterns of injury were observed: subluxations and dislocations without a fracture (type 1), spinal cord injury without radiographic abnormality (type 2), and spinal fractures which may be associated with subluxation or dislocation (type 3). The neurological recovery was poor in complete lesions associated with type 2 injuries.

Adolescent↗
PubMed1994

[Treatment of spinal injuries].

The treatment of spinal column injuries relies on the well founded knowledge in functional spinal anatomy. An exact diagnosis is based on a thorough clinical and neurological examination. X-rays, CT-scan and eventually an MRI examination. A fracture classification is imperative for further conservative and operative treatment. Fractures and fracture dislocations of the thoracic and lumbar spine are generally classified in groupings based on the three column theory of Dennis. The whiplash injury is the most common soft tissue injury of the cervical spine. The initial therapy of this trauma intends to achieve a fast reduction of pain and inflammatory tissue reactions. Of all fractures regarding the human beings the spinal column is affected in about one percent. The most common fracture localisation is the thoraco-lumbar spine. Fractures of the atlas (Jefferson fracture) and odontoid fractures type Anderson I and Anderson III are usually treated by a halo west for 8-12 weeks. Odontoid fractures type Anderson II are stabilised by screw fixation. Fractures below C 2 require an operative stabilisation in most cases. Ventral, dorsal and combined ventral-dorsal spondylodeses are performed. Fractures of the thoracic and lumbar spine are treated conservatively in about 80-90% of our cases. Fractures of the upper thoracic spine usually require no external fixation, functional treatment is possible. Fractures below Th 11 are treated by reduction and casting for 12 weeks. Within the last 15 years the operative treatment of these fractures continually increased. Dorsal stabilisation with pedicle implants prevailed in the last years. The aftercare of spinal trauma patients consists in an intensive physical therapy for at least three months.

Diagnostic Imaging↗
PubMedDate not supplied

Reduction, stability, and strength provided by internal fixation systems for thoracolumbar spinal injuries.

Anterior, posterior, and combined thoracolumbar spinal injuries were simulated in human cadaver specimens and then stressed in flexion, before and after stabilization, with Weiss Springs, Roy-Camille plates, vertebral body plates, and Harrington compression and distraction rods. The reduction, stability, and strength were determined for each implant-injury combination. For posterior ligamentous injuries, the Harrington compression system on the laminae gave reduction in extension, stability to that of the intact spine, and failure at 87.6 Nm bending load with 14.1 J energy absorption. For anterior vertebral body fracture, Harrington distraction rods from three vertebrae above to three below the injury gave a reduction in extension with stability similar to that of the intact spine. Failure occurred at 81.6 Nm load, one-third greater than with rods two levels above to two below, and 14.0 J energy absorption, twice that for the short rod. The more unstable combined anterior and posterior injury was satisfactorily reduced only by the long distraction system, which failed at 44.1 Nm load, twice that for the short rod, and 5.7 J energy absorption. By accurately determining what structures have been injured, and appropriate fixation device can be selected and the strength of the stabilized spine estimated. A thorough understanding of the biomechanics of the spine is essential for successful clinical utilization of these experimental data.

Aged↗
PubMed1993

Etiology of children's spinal injuries at Rancho Los Amigos.

A review of 277 patients under the age of 16 years admitted to the pediatric spinal injury unit at Rancho Los Amigos Medical Center from 1960 to 1989 showed that 70% of the patients were male; complete and incomplete injuries were about equal; and the average age was 8.8 years. The cause of spinal injury by time period revealed that earlier time periods had etiologies similar to those reported in previously published series. Although the incidence of these traditional causes remained constant, violent injuries by gunshot steadily increased with time. In the most recent 5-year period, gunshot wounds equaled motor vehicle injuries as the most frequent cause of a child's spinal injury admitted to this hospital. Gunshot wound victims averaged 12 years old, 80% were male, and most were thoracic level paraplegics. Half of the 50 adolescents (12-16 years old) injured during the last 5 years were gunshot victims.

Accidents, Traffic↗
PubMed1980

Spinal injury in children: a review of 156 cases seen from 1950 through 1978.

We reviewed 156 cases of spinal injury sustained by children aged 14 years and younger. Analysis included the following: categorizing injury as an orthopedic (112), a neurologic (2), or a combined (42) problem; site along spinal column at which injury occurred; cause of injury (most commonly automobile accident and fall); referral pattern and hospital stay; immediate and rehabilitative therapy; complications; and deaths. The frequency of spinal injury in children increases with age. The mode of injury in urban and rural environments varies. Spinal injury is a serious problem and has an associated high mortality and a high complication rate. Most of the spinal injuries are preventable, and the incidence of complications can be lessened when special attention is given during the initial hospitalization to respiratory and urinary tract infections, decubiti, and behavior of the children.

Adolescent↗
PubMed1994

Non-contiguous spinal injury: clinical and imaging features, and postulated mechanism.

In an attempt to identify possible mechanisms for remote or non-contiguous spinal injury, clinical records and magnetic resonance (MR) images were analysed in 71 consecutive patients admitted for management of acute cervicothoracic spinal trauma. Seven patients (10%) were identified with clinical or MR evidence of non-contiguous spinal injury, and either more than one neurological level, or a cord lesion remote from the imaging abnormality. Five of these had radiographic and MRI findings suggesting that the second lesion was due to cord stretching, following local tethering at the first level, including three patients with a small extramedullary haematoma at the site of the distant cord lesion. The other two patients had underlying multilevel degenerative spinal canal stenosis, explaining the second cord lesion. Non-contiguous spinal injury is an infrequent manifestation of acute spinal trauma, and, in contrast to most forms of cord injury associated with spinal trauma, which are due to cord compression, this entity may represent the sequel of cord stretching.

Adult↗
PubMed2005

The influence of posterior instrumentation on adjacent and transfixed facet joints in patients with thoracolumbar spinal injuries: a morphological in vivo study using computerized tomography osteoabsorptiometry.

STUDY DESIGN: Subchondral mineralization of adjacent and transfixed facet joints was analyzed in patients with thoracolumbar spinal injuries, both before posterior instrumentation and after removal of the spinal implant. OBJECTIVE: To examine the influence of posterior instrumentation on content and distribution of subchondral mineralization as a correlate of the long-term load acting on the adjacent and transfixed zygapophysial joints. SUMMARY OF BACKGROUND DATA: Posterior stabilization plays an important role in the treatment of spinal injuries and is a standard technique for the treatment of thoracolumbar spinal fractures. Studies have shown that stress and motion in the adjacent segments are altered in the presence of instrumentation. METHODS: Twenty-three patients with thoracolumbar spinal injuries had computerized tomography (CT) during the course of routine posttraumatic diagnostics and subsequently received bisegmental posterior fixation with an internal fixator. Second CT were obtained after removal of the fixation device, which was performed on an average of 9.4 months after the trauma. Patients were divided into 2 groups with follow-up CT taken within either less than 3 months (group A: average 7.3 days, 15 patients) or 6 and more months (group B: average 17 months, 8 patients) after the internal fixator had been removed. Quantitative and qualitative CT osteoabsorptiometry were used to assess changes in subchondral mineralization, reflecting the altered load acting on the adjacent and bridged zygapophysial joints. RESULTS: There was a significant difference between preoperative and postoperative calcium values (P < 0.001) for the whole patient group. Mineralization decrease was significantly more often found than increase (P < 0.001). A separate analysis of the 2 groups of patients revealed significant differences between group A and B (P < 0.001). In group A, a mineralization decrease was found in 61.3% and an increase in 11.0% of the facet joints, while in group B, a mineralization decrease was shown in 21.9% and an increase in 41.0%. No significant differences between adjacent and transfixed facets were found except in group B, in which the suprajacent joints showed a significantly higher mineralization increase than the transfixed joints (P = 0.030). CONCLUSIONS: Decrease in subchondral mineralization indicates reduced load acting on the examined zygapophysial joints. This finding in patients with early follow-up CT seems to be caused by reduced activity in most of the patients until removal of the spinal implant. In patients with longer intervals between removal of the fixator and second CT, higher loads acting on the adjacent and bridged joints are shown morphologically. Whether or not these changes lead to spondylarthritis has to be studied in a long-term follow-up.

Adolescent↗
PubMed2005

Follow-up imaging of the urinary tract in spinal injury patients: is a KUB necessary with every ultrasound?

STUDY DESIGN: Prospective study of 100 consecutive patients. OBJECTIVES: To evaluate the diagnostic usefulness of the urinary tract (KUB) radiograph routinely performed as part of spinal injury patient urinary tract screening with ultrasound (US) and the KUB radiograph. SETTING: Orthopaedic and District General Hospital with spinal injuries unit, UK. METHODS: Prospective study of the urinary tract of 100 consecutive routine follow-up spinal injury patients with KUB (kidneys, ureters, bladder) radiograph and US of the urinary tract. The percentage of the visualised area of kidneys and urinary bladder and relevant abnormal findings were recorded. Relevant patient history was recorded. RESULTS: In all, 80 men 20 women were examined (average age 46 years, average time since injury 11 years). A total of 199 kidneys and 99 urinary bladders were examined. On average, less than 50% of the renal area and about 70-75% of the urinary bladder area were visualised. Five patients had renal stones identified on the KUB radiograph, and of these two were seen on US. There were no stones seen on US only. The patient history was not helpful to identify patients with renal stones. Significant further renal abnormalities were identified with US in 14 patients, and with the KUB radiograph in 0 patients. Significant urinary bladder abnormalities were identified with US in 20 patients, and with the KUB radiograph in 0 patients. CONCLUSION: On average, less than 50% of the kidney area is visualised on the KUB due to overlying bowel markings making the KUB radiograph a poor tool to assess the kidneys. The KUB radiograph and US are poor tools to assess urinary tract stones. In the absence of a therapeutic consequence, the KUB radiograph does not seem justified in the routine follow-up of the urinary tract in spinal injury patients.

Adult↗
PubMed2005

Post-traumatic syringomyelia: a review of the cases presenting in a regional spinal injuries unit in the north east of England over a 5-year period.

STUDY DESIGN: Retrospective study of the management of patients with a confirmed diagnosis of post-traumatic syringomyelia (PTS) in a regional spinal injuries unit. OBJECTIVES: To investigate the incidence of PTS in a regional spinal injuries unit, and to assess mode of presentation, management, and subsequent outcome. SUMMARY OF BACKGROUND DATA: Majority of patients male, mean age 44 years (range 33-60 years), with thoracic spinal cord injury (SCI). Most PTS developed within 5 years after injury (range 6 months to 25 years) and presented with reduced sensation. Fifty percent had surgical intervention at the time of SCI, and 50% managed conservatively. Four patients had additional spinal injury pathology not corrected at time of surgery. METHODS: Retrospective analysis of the case notes of all patients with a confirmed diagnosis of PTS (n = 16). Demographic details obtained and details of the original injury and subsequent clinical course and management noted. RESULTS: Incidence of PTS = 0.02%. Magnetic resonance imaging scanning performed in 56% with PTS. The majority of PTS developed around the site of the original lesion. The most common method of management was insertion of a syringoperitoneal shunt (44%). Thirty-one percent improved after surgery, 31% remain stable. One patient died. The symptoms of 3 patients continue to deteriorate slowly despite surgical intervention. CONCLUSIONS: Incidence of PTS are lower in our study than that quoted in the literature. Benefits of initial surgical management of SCI in reducing development of PTS are unclear. Benefits of surgical management of PTS are unclear. Additional studies are required as this may influence future management of spinal cord injured patients.

Adult↗
PubMed1980

Spinal injuries from swimming and diving treated in the spinal department of Royal Perth Rehabilitation Hospital: 1956-1978.

Over the past 23 years, 67 patients have been admitted with spinal cord injuries resulting from swimming and diving. These numbers comprise 10.5 per cent of all traumatic spinal cord injuries received, and 20.6 per cent of all cervical spine injuries received. Ninety-five per cent of these patients were male, and more than three-quarters were young males under the age of 30 years. Two-thirds of these patients had permanent residual disability with an early mrotality rate of 4.4 per cent.

Accidents, Traffic↗