​Functional Analysis of Effectiveness of Short Segment with Index Vertebra Fixation as Compared with Long-segment Fixation in the Management of Thoracolumbar Spinal Injuries

Background: Dorsolumbar fractures are unstable mostly which requires surgical spinal stabilization to maintain anatomicalreduction and stability and also to promote early bony fusion and mobilization. Posterior short-segment pedicle screw fixation isusually done for burst fractures. Even though early clinical results of this surgery are usually satisfactory, a high failure rate andprogressive kyphosis remain a concern. To overcome this, in addition to short-segment fixation, the pedicle screw is insertedat the fracture site. Long-segment fixation is usually done for fracture dislocations.Materials and Methods: A total of 25 patients with dorsolumbar spinal injuries admitted in Government Rajaji Hospital andMadurai Medical College were selected for the study and followed for a period of 24 months. Of these, four patients were lostfollow–up, and hence, 21 cases were included in the study and followed for a period of 2 years.Results: A total of 25 patients were selected for the study. Our results showed good to excellent in long segment, 72.7% of thepatients were good (eight cases), and in short segment, 70% of the cases were good (seven cases). In long segment, 27.7%of the patients were fair (three cases), and in short segment, 30% of the cases were fair (three cases). In our study, the meanof Oswestry Disability Index in long segment is 32.31 and mean in short segment is 31.99. In our study, only one patient hadrod breakage, but the patient had no pain and no neurological deficit, and functional outcome is good.Conclusion: We conclude that short-segment fixation with index vertebra fixation provides as good results as long-segmentfixation with reduction in cost and time of surgery in the treatment of thoracolumbar spinal injuries.

A Safe Surgical Procedure for Old Distractive Flexion Injuries of the Subaxial Cervical Spine

STUDY DESIGN: Retrospective review. PURPOSE: To describe a safe and effective surgical procedure for old distractive flexion (DF) injuries of the subaxial cervical spine. OVERVIEW OF LITERATURE: Surgical treatment is required in old cases when a progression of the kyphotic deformity and/or persistent neck pain and/or the appearance of new neurological symptoms are observed. Since surgical treatment is more complicated and dangerous in old cases than in acute distractive-flexion cases, the indications for surgery and the selection of the surgical procedure must be carefully conducted. METHODS: To identify a safe and effective surgical procedure, the procedure selected, reason(s) for its selection, and associated neurological complications were investigated in 13 patients with old cervical DF injuries. RESULTS: No neurological complications were observed in nine patients (DF stage 2 or 3) who underwent the anterior-posterior-anterior (A-P-A) method and two patients (DF stage 1) who underwent the posterior method. It was initially planned that two patients (DF stage 2) who underwent the P-A method would be treated using the Posterior method alone; however, anterior discectomy was added to the procedure after the development of a severe spinal cord disorder. CONCLUSIONS: The A-P-A method (anterior discectomy, posterior release and/or partial facetectomy, reduction and instrumentation, anterior bone grafting) is considered to be a suitable surgical procedure for old cervical DF injuries.

Thoracolumbar Chance fracture during a professional female soccer game: case report / Fratura toracolombar tipo Chance durante jogo de futebol feminino profissional: relato de caso

ABSTRACT We report a rare case of an unstable flexion-distraction spine fracture with ligament involvement that occurred during a professional female soccer game. There were no neurological déficit. The patient had a painful midline gap which suggested ligamentar injury that was not immediately recognized. Despite that, proper immobilization and referral to hospital for further evaluation avoided additional spinal cord damage. The patient underwent a monosegmental posterior instrumentation spine fusion and after 6 months returned to professional soccer activities. This paper alerts to the possibility of occurrence of severe and unstable spine injuries during soccer practice and the importance of an adequate initial care at the game field in order to avoid iatrogenic neurological injuries.

RESUMO Relatamos um caso raro de fratura instável da coluna vertebral com envolvimento ligamentar, ocorrida por mecanismo de flexão-distração, durante jogo de futebol feminino profissional. Não houve déficit neurológico. A paciente apresentava espaçamento doloroso dorsal na linha média, que sugeriu lesão ligamentar, a qual não foi reconhecida imediatamente. Apesar disso, realizaram-se imobilização adequada e encaminhamento para unidade hospitalar, fatos que evitaram a ocorrência de danos adicionais à medula espinal. A paciente foi submetida à fusão monossegmentar, com instrumentação e, após 6 meses, retornou à prática de futebol profissional. O presente estudo alerta para a possibilidade de ocorrência de lesões graves e instáveis na coluna durante a prática de futebol, e para importância da assistência inicial adequada ainda em campo, a fim de evitar lesões neurológicas iatrogênicas.

Treatment of unstable thoracolumbar fractures in pediatric patients / Tratamento das fraturas toracolombares instáveis em pacientes pediátricos / Tratamiento de fracturas toracolumbares inestables en pacientes pediátricos

Objective: To analyze the characteristics of unstable thoracolumbar fractures in the pediatric population. Methods: A retrospective cross-sectional study was conducted with pediatric patients (0 to 15 years) who presented with unstable thoracolumbar fracture with or without neurological damage. Twenty-four operated patients were analyzed: 13 male and 11 female. Results: Falls from height are the most common cause, being the thoracolumbar junction the anatomical site most frequently injured. Conclusion: The thoracolumbar fractures are rare in the pediatric population, as well as post-surgical instrumentation structural deformities.

Objetivo: Analisar as características das fraturas toracolombares instáveis na população pediátrica. Métodos: Estudo transversal retrospectivo com pacientes pediátricos (0 a 5 anos) que apresentaram fratura toracolombar instável com e sem dano neurológico. Foram analisados 24 pacientes operados: 13 homens e 11 mulheres. Resultados: Quedas de altura são a causa mais comum, sendo a junção toracolombar o local anatômico mais frequentemente atingido. Conclusão: As fraturas toracolombares são raras na população pediátrica, assim como as deformidades estruturais depois de instrumentação cirúrgica.

Objetivo: Analizar las características de las fracturas toracolumbares inestables en la población pediátrica. Métodos: Se realizo un estudio transversal retrospectivo de pacientes pediátricos (0 a 15 años) que presentaron fractura toracolumbar inestable con y sin daño neurológico. Se analizaron 24 pacientes operados: 13 masculinos y 11 femeninos. Resultados: Las caídas de altura son la causa más común, siendo la unión toracolumbar el sitio anatómico más frecuentemente lesionado. Conclusión: Las fracturas toracolumbares son raras en la población pediátrica, así como las deformidades estructurales posteriores a la instrumentación quirúrgica.

Evaluation of Traumatic Spine by Magnetic Resonance Imaging and Correlation with Neurological Recovery

STUDY DESIGN: Prospective study. PURPOSE: To compare magnetic resonance imaging (MRI) findings with clinical profile and neurological status of the patient and to correlate the MRI findings with neurological recovery of the patients and predict the outcome. OVERVIEW OF LITERATURE: Previous studies have reported poor neurological recovery in patients with cord hemorrhage, as compared to cord edema in spine injury patients. High canal compromise, cord compression along with higher extent of cord injury also carries poor prognostic value. METHODS: Neurological status of patients was assessed at the time of admission and discharge in as accordance with the American Spine Injury Association (ASIA) impairment scale. Mean stay in hospital was 14.11+/-5.74 days. Neurological status at admission and neurological recovery at discharge was compared with various qualitative cord findings and quantitative parameters on MRI. In 27 patients, long-term follow-up was done at mean time of 285.9+/-43.94 days comparing same parameters. RESULTS: Cord edema and normal cord was associated with favorable neurological outcome. Cord contusion showed lesser neurological recovery, as compared to cord edema. Cord hemorrhage was associated with worst neurological status at admission and poor neurological recovery. Mean canal compromise (MCC), mean spinal cord compression (MSCC) and lesion length values were higher in patients presenting with ASIA A impairment scale injury and showed decreasing trends towards ASIA E impairment scale injury. Patients showing neurological recovery had lower mean MCC, MSCC, and lesion length, as compared to patients showing no neurological recovery (p<0.05). CONCLUSIONS: Cord hemorrhage, higher MCC, MSCC, and lesion length values have poor prognostic value in spine injury patients.

Lesiones de la columna lumbar en el deportista / Lumbar spine injuries in athletes

El dolor lumbar es relativamente común en deportistas. Su etiología es variada y está determinada por múltiples factores que incluyen la edad, nivel y cargas de entrenamiento y condición física. Existen disciplinas que imponen un riesgo particularmente alto de lesión y adicionalmente los atletas pueden presentar alteraciones que afecten por igual a la población no deportista. Esta revisión se centra en las causas más habituales de dolor lumbar en deportistas y aborda las bases de la rehabilitación y la prevención de nuevas lesiones.

Low-back pain is relatively common in athletes and sports enthusiasts. Etiology is varied and is determined by multiple factors, including age, level of training, training loads and personal body constitution. Although athletes can suffer from lumbar ailments present in the non-athletic population, some disciplines pose a particular risk for specific injury. This review focuses in the more frequent causes of back pain in athletes and in the basics of physiotherapy treatment and prevention of re-injury.

Accuracy of "funnel technique" in the thoracic pedicle screw instrumentation: experimental and clinical study / 中华创伤杂志

Objective To evaluate the accuracy of thoracic pedicle screw placement using the "funnel technique" and investigate its consistency in experimental study and clinical application.Methods The clinical data of three human cadavers and 11 patients with the installation of at least one thoracic pedicle screw at T1 -T12 from August 2006 to July 2008 were retrospectively analyzed. One junior spine surgeon lack of experience were responsible for placing these screws with the "funnel technique".The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing postoperative CT scans. Results The mean follow-up time was 23.1 months,which showed no vascular or visceral complications, or iatrogenic neurological injury. The rate of unintended cortex perforations was 14% (10/72) in cadavers and 15% (8/55) in patients, respectively.The critical perforation occurred in two screws (3%) in cadavers and one screw (2%) in patients. There was no statistical difference between the percentage of cortex perforations in cadavers and patients. Of all the 11 patients, screw violation occurred laterally in six ( 11% ), medially in one ( 2% ) and superiorly in one (2%). No violations occurred inferiorly or anteriorly. For all patients, only one screw needed revision. The perforations made by the junior spine surgeon occurred in six screws in the first cadaver, three in the second cadaver and one in the third cadaver. Conclusions The "funnel technique" is a simple,safe, accurate and cost-effective technique for pedicle screw placement. The result of the experimental study is consistent with that of the clinical application. "funnel technique" is helpful for junior spine surgeons to master the technique of thoracic pedicle screw placement.

Diagnosis and treatment for distractive extension injuries of the cervical vertebrae / 中华急诊医学杂志

Objective To study the diagnosis and treatment for distractive extension injuries of the cervical vertebrae.Method From 2000 to 2005.the clinical and image data of fifty-six patients in the Second Affiliated Hospital of Zhejiang University College of Medicine with distractive extension injuries of the cervical vertebrae were studied and treated with anterior discectomy or subtotal vertebrectomy in the second affiliated Hospital of zhejiang university collegeof medicine,bone grafting and internal fixation with plate.Results The follow-up period was six to seventeen months in fourty-eight patients.The neurological recovery was found after operation in five of nine case with complete spinal cord injuries and thirteen patient had complete recovery.Neck pain completely disappeared in 6 patients with oboslete injury and neurological recovery was improved in 4 patients.Condusions MRI examination is the essential approach to diagnoze distractive extension injuries of the cervical vertebran,and early operation,including anterior discectomy,bone graftillg and internal fixiation with plate,is a best choice of surgical interrention to achieve cervical stabilization and neurological improvement.

Non-Contiguous Spinal Injury in Cervical Spinal Trauma: Evaluation with Cervical Spine MRI

OBJECTIVE: We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries. MATER AND METHODS: Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18-81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury. RESULTS: Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.3%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance (p > 0.05). CONCLUSION: Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the non-contiguous CTJ or upper thoracic spinal injury.

The evaluation of Fat Saturation Fast Spin-Echo T2WI for Patients with Acute Spinal Trauma

PURPOSE: To determine the usefulness of fat saturation fast spin-echo T2WI for patients with mild acute trauma of the spine. MATERIALS AND METHODS: Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2WI, and additional fat-saturation fast spin-echo T2WI were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. RESULTS: The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2WI than at conventional T2WI. CONCLUSION: Fat-saturation fast spin-echo T2WI is useful for the evaluation of patients with mild acute spinal trauma without neurological impairment.

Facet Joint Injuries in Acute Cervical Spine Trauma: Evaluation with CT and MRI

PURPOSE: To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. MATERIALS AND METHODS: From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. RESULTS: The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. CONCLUSION: Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.

Clinical Analysis and Treatment of Cervical Spine Injury

This study analyzed 88 patients who sustained a cervical spine injury during the past 4 years(Jan, 1993-May, 1996) in whom had 33 anterior, 21 posterior interventions were underwent and 34 remaining patients recieved conservative treatment with halovest. In 45 cases of upper cervical injuries, 16 operations were done. Among these, anterior approach was used in 3 patients and posterior approach in 13 patients. In 43 cases of lower cervical injuries, 39 operations were done. The anterior approach was used in 30 patients, posterior approach in 9 patients, and bilateral approached in remaing 4 cases. For patients with a predominent posterior ligamentous or osteoligamentous lesion, we selected anterior approach, when closed reduction was possible. Whenever the facet joint remained interlocked, a posterior approach was chosen. This report does not mentioned priority of anterior procedure at any case. Although clinical experience does not support the experimental data, we examined the reliability of anterior approach with use of internal fixation.

MR Manifestations of Vertebral Artery Injuries in Cervical Spine Trauma

PURPOSE: To assess the diagnostic efficacy of magnetic resonance (MR) imaging in the detection of a vertebralartery injury occurring from major cervical spine trauma. MATERIALS AND METHODS: Conventional MR findings of 63patients and 63 control subjects were compared to detect a possible change in the vertebral arteries resulted fromtrauma. Plain films, CT and clinical records were also reviewed to correlate the degree of cervical spine injurywith vascular change. RESULTS: Nine cases of absent flow signals in vessel lumen were observed in eight patientsand one was observed in the control group. Patients more frequently demonstrated other abnormalities such asintraluminal linear signals (n=3) or focal luminal narrowing (n=9) but there was no statistical significance. There was a close relationship between degree of cord damage and occlusion of the vertebral artery. CONCLUSION: Conventional MR imaging is useful in the detection of vertebral artery occlusion resulting from cervical spinetrauma.

Clinical Analysis of Cervical Spine Injured Patients in Military Services

The authors had analyzed the cases of 40 patients in military services with traumatic cervical spine injuries retrospectively. Among the 40 patients, 20 patients underwent surgical treatment. The results were summarized as follows: 1) The causes of injury were traffic accidents(45.5%), falling down(32.5%), and sports injuries(17.5%). 2) The common mechanisms of injury were flexion, vertical compression and extension. 3) Fifty percent of these patients had surgical intervention by anterior approach(10), posterior approach(8), combined anterior/posterior approach(1), and anterior approach after posterior approach(1). 4) As for the final outcome, there was no statistical difference in Frankel's neurological grade between patients treated with and without surgical stabilization procedures(p>0.005) 5) Except for the cases with progressive neurological deficits by bony fragments, disc protrusion, hematoma or other irreducible lesions, delayed surgical treatment(after 10 days)was recommended.