Efecto de la maniobra de fijación en línea en la clasificación de Cormack-Lehane / Effect of the in-line fixation maneuver on Cormack-Lehane classification

Resumen: Introducción: El manejo correcto de la vía aérea en los pacientes politraumatizados es crucial, ya que es necesario tener una vía aérea segura y proveer adecuada ventilación sin emperorar una probable lesión medular. Objetivo: Determinar el efecto de la maniobra de fijación en línea (MILS del inglés Manual In-Line Stabilisation) en la clasificación de Cormack-Lehane (CL), así como la correlación con el índice de masa corporal (IMC). Material y métodos: En un estudio descriptivo en el Centro Hospitalario del Estado Mayor Presidencial en la Ciudad de México se incluyeron 56 pacientes con estado físico ASA I a IV. El anestesiólogo realizó la laringoscopía directa bajo MILS y valoró el grado de CL. Inmediatamente después se reposicionó al paciente en posición de olfateo, se efectuó nueva laringoscopía directa y se revaloró de nuevo el grado de CL. Resultados: Los grados del CL fueron significativamente diferentes entre la posición MILS versus olfateo. Los grados de CL fueron en su mayoría altos cuando se posicionó al paciente en MILS (75% de los pacientes clasificados entre III y IV) y disminuyeron significativamente al ser cambiados a posición de olfateo. Conclusión: Se observa mejoría del CL cuando se cambia de posición MILS a olfateo.

Abstract: Introduction: Correct airway management of polytraumatized patients is crucial because of the necessity of securing the airway and providing adequate ventilation without worsening a probable spinal cord injury. Objective: Determine the effect of manual inline stabilization (MILS) on Cormack-Lehane classification and if there is any correlation with body mass index (BMI). Material and methods: In a descriptive study at the Centro Hospitalario del Estado Mayor Presidencial in Mexico City, we included 56 patients with ASA physical status I to IV. The anesthesiologist performed direct laryngoscopy while MILS was performed and observed the CL grade. Immediately after, the patient was repositioned into the sniffing position, direct laryngoscopy was performed, and the CL grade was observed again. Results: The CL grades observed were significantly different between MILS vs. Sniffing position. CL grades were mainly high when positioned in MILS (75% classified as grades III and IV) and diminished significantly when changed to the sniffing position. Conclusion: Improvement of CL grade was observed when changing from MILS to sniffing position.

Stuttering priapism post C-spine schwannoma excision: case report

Priapism is prolonged penile erection that persists beyond or is unrelated to sexual stimulation and this is associated with significant psychological, socioeconomic and physical morbidity. It is a urologic emergency as delayed intervention may result in penile fibrosis and consequent erectile dysfunction. The aim of this paper is to present our experience in the management of the rare occurrence of stuttering priapism in a 32 years old man following surgical excision of cervical schwannoma during the early postoperative period and review relevant literature on management of this urologic entity. Stuttering priapism may complicate cervical spine tumor excision but may demonstrate complete patient recovery.

Early fixation versus delayed fixation in cervical spine trauma patient with absent cough reflex in view of intensive care unit stay and cost effectiveness

Background: This study was conducted in GMC Jammu to evaluate ICU stay and cost effectiveness in patients with cervical spine trauma undergoing early fixation (within 24-72 hours after trauma) versus late fixation (delayed fixation after applying traction and waiting for return of cough reflex).Methods: Retrospective and prospective study was done by collecting data from admission register and patient follow-up during 2016-2019. 50 patients were admitted as cervical spine trauma, out of which 38 were operated upon and ten managed conservatively. 15 patients were operated within 72 hours of admission with absent cough reflex and 23 were put on cervical traction and operated upon after return of cough reflex.Results: Average ICU stay for 15 patients (4 females 11 males) immediately operated ranged from 10 to 15 days along with prolonged mechanical ventilation. Average ICU stay for 23 patients (16 males and 7 females) operated after returning of cough reflex ranged from 3-4 days with considerably decreased requirement of mechanical ventilation.Conclusions: Delayed fixation of cervical spine after returning of cough reflex shortens post-operative ICU stay and is considerably more cost effective than early fixation.

Cirugía mínimamente invasiva en el tratamiento de fracturas tóracolumbares / Minimally invasive surgery in the treatment of thoracolumbar fractures

Objetivo: Analizar y describir una serie de fracturas tóraco-lumbares traumáticas tratadas con cirugía mínimamente invasiva. Material y métodos: Analizamos una serie de 26 pacientes con fracturas traumáticas tóraco-lumbosacras entre 2010-2017. Las imágenes pre-operatorias fueron clasificadas usando la clasificación AO. Analizamos en forma pre y post operatoria: escala visual analógica, volumen de pérdida sanguínea, duración de la hospitalización, complicaciones, cirugías asociadas en otros órganos, extracción de implantes en el largo plazo, estado neurológico pre y post quirúrgico y mortalidad.Los pacientes con historias clínicas completas, TAC pre-operatoria y un seguimiento mínimo de 12 meses fueron incluidos (18 hombres y 8 mujeres). La edad promedio fue de 28.7 años (21-84 años); seguimiento promedio de 28 meses (13-86 meses). Dieciocho pacientes fueron manejados con instrumentaciones percutáneas, 8 recibieron vertebroplastias, y en 5 casos se realizó además algún gesto de artrodesis. Resultados: La EVA mejoró 7 puntos promedio respecto al pre-operatorio; el promedio de sangrado fue de 40 mL, no observamos ningún caso de empeoramiento neurológico. La duración promedio de la hospitalización fue de 3.9 días. Cuatro enfermos necesitaron alguna cirugía en otro órgano producto de sus politraumatismos.Los tornillos percutáneos fueron removidos en 9 casos luego de la consolidación. Como complicaciones tuvimos: 1 hematoma retroperitoneal autolimitado, una fractura pedicular y una cánula de cementación rota adentro de un pedículo. Conclusión: La cirugía mínimamente invasiva en trauma espinal es una alternativa válida que permite estabilización, movilización precoz y logra buenos resultados en términos de control del dolor con baja tasa de complicaciones

Objective: To analyze and describe a series of trauma-related thoraco-lumbo-sacral vertebral fractures managed with minimally invasive surgery. Methods: We retrospectively review the charts and images of 26 patients with thoracolumbar spine fractures between 2010-2017. Pre-op images were assessed and fractures were classified according to the thoraco-lumbar trauma AO Spine classification. We analyzed pre and post-surgical visual analog scale (VAS), blood loss during surgery, hospital length of stay, complications, associated surgical procedures, long term post-op implant removal, pre and post neurological status and mortality.Patients with a complete case record, pre-op CT scans and minimum 12-month follow up were included (18 males and 8 females). Mean age was 28.7 years (21-84 years); mean post-op follow up was 28 month (13-86 months). Eighteen patients were managed with percutaneous instrumentation, 8 patients also received percutaneous vertebroplasty, and 5 patients underwent also some arthrodesis procedure. Results: VAS improved 7 points as compared to the pre-op score; mean blood loss was 40 mL, we did not observed any neurological deficit worsening. Mean hospital length of stay was 3.9 days. Four patients needed surgical procedures involving other organs due to politrauma. Percutaneous screws were removed in 9 cases after fracture consolidation. Complications were: one case of self-limiting retroperitoneal hematoma, one case of pedicle screw fracture and one cement broken cannula into the pedicle. Conclusion: Minimally invasive surgery in spine trauma is a valid option allowing stabilization, early mobilization, and leading to good outcomes in terms of pain control and a lower complication rate

Perfil epidemiológico dos pacientes com fratura da coluna cervical tratados cirurgicamente no serviço de neurocirurgia do Hospital de Base do Distrito Federal (Brasília, Brasil) / Epidemiological Profile of Patients with Cervical Spine Fractures Treated Surgically in the Neurosurgery Service at Hospital de Base do Distrito Federal (Brasília, Brazil)

Introdução As fraturas cervicais correspondem a um grande espectro de lesões. Em alguns trabalhos a coluna cervical é o segmento mais acometido nas fraturas vertebrais, representando cerca de 45-60% de todos os casos. Apresentamos o perfil epidemiológico de 48 pacientes com fratura traumática da coluna cervical tratados cirurgicamente no serviço de neurocirurgia do Hospital de Base do Distrito Federal. Métodos Trata-se de um trabalho retrospectivo, baseado na revisão de prontuários médicos, de pacientes com fratura da coluna cervical operados no período de julho de 2007 a julho de 2012. Resultados Predomínio do sexo masculino (89,5%); a faixa etária mais comum é de 20-40 anos (50%); idade média do sexo masculino é de 36,6 anos e do feminino, 19,8 anos (teste t: p » 0,04); vértebra mais fraturada: C5 (53,3%); 54,1% dos indivíduos apresentam algum déficit neurológico; fratura do tipo B é mais comum na coluna cervical (62,2%); mecanismos do trauma: acidente automobilístico (41,6%), queda de altura (20,8%), acidente motociclístico (12,5%), outros (25,1%); déficit neurológico da cervical alta (zero) e subaxial de 57,7% (p » 0,052); déficit neurológico masculino de 53,4% e feminino de 60% (p > 0,05); déficit neurológico do tipo A de 71,4%, do tipo B de 55,5%, e do tipo C de 54,5% (p > 0,05). Conclusão A maioria dos pacientes era do sexo masculino e da faixa etária entre 20 e 40 anos de idade, sendo as mulheres mais jovens que os homens. Cerca de 54,1% dos pacientes apresentavam déficit neurológico à admissão hospitalar e tinham C5 como principal vértebra fraturada. A fratura tipo distração (tipo B da AO) foi a mais encontrada. O principal mecanismo do trauma foram os acidentes de trânsito seguido pelas quedas de altura.

Introduction The cervical fractures represent a wide spectrum of injuries. In some works, the cervical spine is the segment most affected vertebral fractures, representing 45­60% of all cases.We present the epidemiological profile of forty-eight patients with traumatic cervical spine fracture surgically treated in the neurosurgery service at the Hospital of the Federal District. Methods This was a retrospective study, based on a review of medical records of patients with cervical spine fracture surgery from July 2007 to July 2012. Results Predominance of males (89.5%), the most common age group is 20­40 years (50%), mean age: males (36.6 years) and females (19.8 years) (t-test p » 0.04); fractured vertebra: C5 (53.3%), 54.1% of subjects have a neurological deficit, fracture type B is more common in the cervical spine (62.2%), mechanism of injury: motor vehicle accidents (41.6%), fall (20.8%), motorcycle (12.5%), other (25.1%), neurological deficit: high cervical 0 cases, subaxial 57.7% (p » 0.052); neurological deficit: male 53.4%, female 60% (p> 0.05); neurological deficit: 71.4% Type A, Type B 55.5% 54.5% Type C (p> 0.05). Conclusion Most patients were male and the age group between 20­40 years of age, with younger women than men. Approximately 54.1% of the patients had neurologic deficit on admission and had as main fractured vertebra C5. The distraction fractures (AO Type B) was found most frequently. The main mechanism of injury were traffic accidents followed by falls from height.

Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries / Avaliação do SLICS no tratamento das lesões da coluna cervical sub-axial

The SLICS (Sub-axial Cervical Spine Injury Classification System) was proposed to help in the decision-making of sub-axial cervical spine trauma (SCST), even though the literature assessing its safety and efficacy is scarce. Method We compared a cohort series of patients surgically treated based on surgeon’s preference with patients treated based on the SLICS. Results From 2009-10, 12 patients were included. The SLICS score ranged from 2 to 9 points (mean of 5.5). Two patients had the SLICS < 4 points. From 2011-13, 28 patients were included. The SLICS score ranged from 4 to 9 points (mean of 6). There was no neurological deterioration in any group. Conclusion After using the SLICS there was a decrease in the number of patients with less severe injuries that were treated surgically. This suggests that the SLICS can be helpful in differentiating mild from severe injuries, potentially improving the results of treatment. .

O SLICS (Sub-axial Cervical Spine Injury Classification System) foi proposto para auxílio na tomada de decisão no tratamento do traumatismo da coluna cervical sub-axial. Contudo, existem poucos trabalhos que avaliem sua segurança e eficácia. Método Realizamos estudo comparativo de série histórica de pacientes operados baseados na indicação pessoal do cirurgião com pacientes tratados baseados na aplicação do SLICS. Resultados Entre 2009-10, 12 pacientes foram incluídos. O SLICS escore variou de 2 a 9 pontos (média de 5,5) com dois pacientes com escore menor que 4. Entre 2011-13, 28 pacientes foram incluídos. O escore de SLICS variou de 4 a 9 pontos, com média de 6. Conclusão Observamos que após o uso do SLICS houve uma diminuição do número de pacientes operados com lesões mais estáveis. Isso sugere que o SLICS pode ser útil para auxiliar a diferenciação de lesões leves das graves, eventualmente melhorando os resultados do tratamento. .

Applicability of Thoracolumbar Injury Classification and Severity Score to Criteria of Korean Health Insurance Review and Assessment Service in Treatment Decision of Thoracolumbar Injury

OBJECTIVE: For improving the drawbacks of previous thoracolumbar spine trauma classification, the Spine Trauma Study Group was developed new classification, Thoracolumbar Injury Classification and Severity Score (TLICS). The simplicity of this scoring system makes it useful clinical application. However, considering criteria of Korean Health Insurance Review and Assessment Service (HIRA), the usefulness of TLICS system is still controversial in the treatment decision of thoracolumbar spine injury. METHODS: Total 100 patients, who admitted to our hospital due to acute traumatic thoracolumbar injury, were enrolled. In 45, surgical treatment was performed and surgical treatment was decided following the criteria of HIRA in all patients. With assessing of TLICS score and Denis's classification, the treatment guidelines of TLICS and Denis's classification were applied to the criteria of Korean HIRA. RESULTS: According to the Denis's three-column spine system, numbers of patients with 2 or 3 column injuries were 94. Only 45 of 94 patients (47.9%) with middle column injury fulfilled the criteria of HIRA. According to TLICS system, operation required fractures (score>4) were 31 and all patients except one fulfilled the criteria of HIRA. Conservative treatment required fractures (score<4) were 52 and borderline fracture (score=4) were 17. CONCLUSION: The TLICS system is very useful system for decision of surgical indication in acute traumatic thoracolumbar injury. However, the decision of treatment in TLICS score 4 should be carefully considered. Furthermore, definite criteria of posterior ligamentous complex (PLC) injury may be necessary because the differentiation of PLC injury between TLICS score 2 and 3 is very difficult.

Clinical complications in patients with severe cervical spinal trauma: a ten-year prospective study / Complicações clínicas em pacientes com trauma raquimedular cervical grave: estudo prospectivo de dez anos

OBJECTIVE: To determine the complications due to severe acrescentar sigla após o nome (CST). METHODS: Between 1997 and 2006, 217 patients (191 men and 26 women) were prospectively evaluated. The mean age was 36.75±1.06 years. RESULTS: Forty-five percent of the patients had medical complications. The most important risk factor was alcoholic beverage use. The most important associated injury was head trauma (HT). Patients with American Spine Injury Association (ASIA) A or B had a 2.3-fold greater relative risk of developing complications. Thirty-three patients (15.2%) died. Patients with neurological deficit had a 16.9-fold higher risk of death. There was no influence of age and time between trauma and surgery on the presence of complications. CONCLUSIONS: Of the patients, 45% had clinical complications and 7.5% had associated injuries; pneumonia was the most important complication; patient age and time between trauma and surgery did not influence the development of medical complications; neurological status was the most important factor in determining morbidity and mortality.

OBJETIVO: Identificar complicações decorrentes do trauma raquimedular cervical grave. MÉTODOS: Avaliação prospectiva de 217 pacientes (191 homens e 26 mulheres) entre 1997 e 2006, com média de idade de 36,75±1,06 anos. RESULTADOS: Houve complicações em 45% dos pacientes. O fator de risco mais importante foi ingestão de bebida alcoólica. Trauma craniano foi a associação mais frequente. Pacientes com classificação A ou B da American Spine Injury Association (ASIA) tiveram 2,3 vezes maior chance de complicações. Faleceram 33 pacientes (15,2%), sendo a chance de óbito 16,9 vezes maior naqueles com déficit neurológico. Não houve influência da idade ou do tempo decorrido entre o trauma e a cirurgia. CONCLUSÕES: Dos pacientes, 45% apresentaram complicações e 7,5% apresentaram traumas associados; pneumonia foi a principal complicação clínica; a idade dos pacientes e o tempo entre o trauma e a cirurgia não influenciaram na frequência de complicações; o status neurológico após o trauma foi o fator de risco mais importante na determinação de morbidade e mortalidade.

Diagnostic Accuracy of Clinical Examination in Cervical Spine Injuries in Awake and Alert Blunt Trauma Patients

STUDY DESIGN: Observational, case series. PURPOSE: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi. OVERVIEW OF LITERATURE: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny. METHODS: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of their trauma workup were included. The X-rays were read by a radiologist not aware of the history of the patients. We recorded demographic data along with mechanism of injury, associated neck signs or symptoms whether present or not, cervical spine range of motion, associated injuries and X-ray findings. The history and examination were carried out by the on-call neurosurgery team member. The sensitivity and specificity along with negative and positive predictive value of the clinical examination were calculated. Data were analyzed using SPSS ver. 16.0. RESULTS: Of 50 patients with positive signs and symptoms, 4 (8%) had positive X-rays while only 1 out of 324 (0.3%) with no associated signs and symptoms had positive X-ray findings. CONCLUSIONS: The clinical examination is 80% sensitive and 73.98% specific in detecting true cervical spine injuries as compared to C-spine X-rays in alert and awake patients with blunt trauma.

Clinical Analysis of Spinal Cord Injury in Sichuan Earthquake: 198 case report / 中国康复理论与实践

@#Objective To analyze the constituent ratio and clinical characteristics of spine trauma and spinal cord injury of the survivors in the Sichuan earthquake.Methods198 cases wounded in the Sichuan earthquake were divided into four groups according to age for collecting the type of fracture, nerve damage, spinal fractures combined injuries of data from multiple sites, analyzing their clinical characteristics.ResultsFracture types are most common compression fractures (49.3%), followed by the burst fractures (45.9%). 105 of them had spinal cord injury, ASIA grade: A grade: 20 cases, B Grade: 18 cases, C grade: 25 cases, D Grade: 42 cases. 41 cases had combined injury. T12, L1, and L2 vertebral fractures were common types.ConclusionCompression fractures and burst fractures as spinal injuries occurred commonly in Sichuan earthquake mainly in the 18～65 years old, and spinal cord injury accounted for 53.03% spinal injury.

Rescue of Patients with Spinal Cord Injury in Earthquake / 中国康复理论与实践

@#Earthquake can result in a large number of patients with spinal cord injury(SCI).The unique characteristic of spine trauma with SCI leads to challenges in the search-and-rescue phase and early trauma care for these patients.Rescue workers should be aware of the importance of spinal immobilization in people who is suspected of SCI.Special considerations are indicated for children less than 7 years old.The ABCs should be implemented as a primary resuscitative effort.Acute respiratory and hemodynamic failure after SCI should also require careful management at the scene.All efforts are aimed primarily at reducing the morbidity associated with acute SCI and increasing the survival rate of patients with SCI.

Spinal Cord Injury by Ruptured Disc Particles in Cervical Spinal Trauma

The incidence and definite criteria of posttraumatic cervical disc herniation is still uncertain. Not infrequently, ruptured posttraumatic cervical disc particles play important role on the cervical cord injury. In a prospective study, 23 patients of cervical spinal cord injury were evaluated preoperatively by magnetic resonance imaging(MRI) to reveal the incidence, developing mechanism, and radiographic results of posttraumatic cervical disc herniation, and severity of spinal cord damage by ruptured disc particles and usefulness of preoperative cervical MRI. All of the patients, who showed abnormal neurological signs consistent in cervical spinal cord inury, were evaluated preoperatively by cervical MRI within 24 hours after trauma. MRI was also taken after reduction in patients with cervical dislocation. The criteria for identifying posttraumatic disc herniation was limited to ruptured disc. Diffuse buldging disc or degenerated cervical stenosis was not considered as posttraumatic disc herniation. MRI demonstrated 7 patients(30%) with spinal cord compression by ruptured disc particles. Compressed spinal cord showed intramedullary swelling and localized high signal intensity by T2-weighted images. All of the patients with ruptured disc particles were operated by anterior approach and intervertebral fusion as soon as possible. Preoperatively, 6 patients showed incomplete spinal cord injury(Frankel's grade B-D); 5 patients showed one Frankel's grade improvement postoperatively. No patients worsened after reduction of cervical dislocation. These results suggest that ruptured disc particle is one of the main causes of cervical spinal cord injury which can be easily identified by MR imaging. It is author's opinion that early removal of ruptured particle compressing the spinal cord can be important factor to improve the neurologic status. The aurthor recommends prompt preoperative MR imaging study for the patient with suspected acute cervical spinal cord injury.

Clinical Analysis of Management of Spine-injuried Patients: Experince in the Suburban

The incidence of spine trauma has been increasing. To investigate the incidence, characteristics, and difficulty in management of the acute spine-injuried patients in suburban area we analyzed 50 cases treated conservatively or by operative fusion over a recent one-year period. This study comprised of 26 females and 24 males, between 23 and 83 years old patients with injury of whole column of spine. The most frequent cause of injury was traffic accident. The most common lesion was the compression fracture of the first lumbar spine. Most patients complained neck or back pain on admission. In 3 cases, neurological deficits were noted. For six patients, surgical treatment were performed and 44 patients has been conservatively managed with halo brace, neck collars, and thoracolumbar orthoses. The average period of admi-ssion and immobilzation for the conservatively treated patients was 6 weeks. During which time a few complications such as progressive kyphosis, hypoalbuminemia, thrombophlebitis, urinary tract infection, paralytic ileus, bed sore, and alcohol withdrawal syndrome were aroused. In most cases, good outcomes were achieved. Most of geriatric patients, concomitant systemic diseases with cardiovascular and pulmonary dysfunction were usually present and absence of the insight on spine injury made difficulties in managment. On the basis of these results we concluded that most elderly patients with spine fracture coulde be effectively treated by conservative methods, and also careful and systemic management with adequate education for patients and their families were required.