Retrospective study on the incidence of cats and dogs' spinal injuries by computed tomographic scan. Part I: Cervical and Cervicothoracic / Estudo retrospectivo sobre incidência de injúrias em coluna vertebral de cães e gatos por meio de exame tomográfico. Parte I: Cervical e Cervicotorácica

Injuries involving the spine are frequent in dogs and knowledge of them is important to define the patient's treatment and prognosis. The objective of this retrospective study was to describe the epidemiological profile of animals and lesions in the cervical (C1-5) and cervicothoracic (C6-T2) spine diagnosed through tomographic examination. Compilation of computed tomography (CT) reports for the referred regions was carried out in a diagnostic center between 01/04/2017 and 30/04/2020, with or without contrast, from the clinical routine, in order to relate the most common lesions and their locations, as well as the species, breeds and ages most affected. A total of 1164 CT scans were performed in the period, 57.56% (n=670/1164) for the spine, with 89.7% (n=601/670) reports accessed, where both regions referred to here totaled 26.95% of the studies (n=162/601). Male mixed-breed dogs (MBD) showed the most lesions. For the cervical spine, the most identified lesion was disk extrusion and the site was C3-C4, while the mean age for lesions was 8.09±3.55 years. As for cervicothoracic, disk mineralization was more frequent and the mean age for lesions was 6.96±2.93 years. It was concluded that the spine is the main target of CT scans, that lesions related to the intervertebral disk were the main ones identified, and older MBD animals are the main ones affected.

As lesões envolvendo coluna vertebral são frequentes em animais de companhia, podendo ocorrer à nível vertebral, medula espinal, disco intervertebral, meninges ou raízes nervosas, e o conhecimento das mesmas é importante para definir o tratamento e prognóstico do animal. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral cervical (C1-5) e cervicotorácica (C6-T2) diagnosticadas por meio de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina clínica, a fim de relacionar as lesões, raças e locais mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670/1164) para a coluna, com 89,7% dos laudos acessados (n=601/670), sendo que as regiões cervical e cervicotorácica somaram 26,95% dos estudos (n=162/601). Em ambas regiões, os cães sem raça definida (SRD) machos foram os que mais demonstraram lesões. Para a coluna cervical, a lesão mais identificada foi extrusão de disco e o local mais afetado foi C3-C4, enquanto a média de idade para lesões foi 8,09±3,55 anos. Já para cervicotorácica, a mineralização de disco foi mais frequente e média de idade para ocorrência de lesões foi de 6,96±2,93 anos. Concluiu-se que a coluna vertebral foi o principal alvo de tomografias, as lesões relacionadas ao disco intervertebral foram as mais identificadas, sendo animais SRD com idade avançada os mais acometidos.

Management of spinal gunshot wound injuries / Manejo das lesões por arma de fogo na coluna vertebral / Manejo de lesiones por arma de fuego en la columna

ABSTRACT Objectives Elaborate a care protocol for spinal gunshot wounds (GSWs), based on the experience of more than fifteen years of treating this type of injury. Methods A retrospective cross-sectional analysis of the electronic medical record data of a tertiary hospital related to the treatment of spinal GSWs between January 2002 and January 2018. Results The management proposed was applied to 700 patients. Epidemiological data collected describes the population served. Conclusions An easy-to-use treatment flowchart was developed that, according to factors related to the neurological condition, projectile location, lesion stability and additional criteria, allows the objective determination of the best treatment option for each case. Level of evidence II; Retrospective Study.

RESUMO Objetivos Elaborar um protocolo de atendimento para ferimentos por arma de fogo (FAF) na coluna vertebral, com base na experiência de mais de quinze anos de atendimento desse tipo de lesão. Métodos Realizou-se uma análise transversal retrospectiva dos dados do prontuário eletrônico de um hospital terciário referentes ao atendimento de FAF na coluna vertebral entre janeiro de 2002 e janeiro de 2018. Resultados O manejo proposto foi aplicado a 700 pacientes. Os dados epidemiológicos coletados mostram a população atendida. Conclusões Foi elaborado um fluxograma de tratamento de uso fácil que, de acordo com fatores relacionados com o quadro neurológico, a localização do projétil, a estabilidade da lesão e critérios adicionais, permite determinar objetivamente a melhor opção de tratamento para cada caso. Nível de evidência II; Estudo Retrospectivo.

RESUMEN Objetivos Desarrollar un protocolo de atención a las heridas por arma de fuego (HAF) en la columna vertebral, basado en la experiencia de más de quince años en la atención a este tipo de lesiones. Métodos Se realizó un análisis transversal retrospectivo de los datos de la historia clínica electrónica de un hospital terciario sobre la atención en casos de HAF en la columna vertebral entre enero de 2002 y enero de 2018. Resultados Se aplicó el tratamiento propuesto a 700 pacientes. Los datos epidemiológicos recopilados muestran la población atendida. Conclusiones Se desarrolló un diagrama de flujo de tratamiento de fácil de usar que, de acuerdo a factores relacionados con la condición neurológica, ubicación del proyectil, estabilidad de la lesión y criterios adicionales, permite determinar objetivamente la mejor opción de tratamiento para cada caso. Nivel de evidencia II; Estudio Retrospectivo.

Vertebroplastia percutánea guiada por tomografía para el manejo del dolor en pacientes con fractura del cuerpo vertebral / CT-guided Vertebroplasty for Painful Vertebral Fractures

Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada. Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga. Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0a7dondeel 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes. Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.

Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography. Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS). Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space. Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.

Spine gunshot wounds at the central military hospital in Mexico / Feridas por projétil de arma de fogo na coluna vertebral no hospital central militar de México / Heridas por proyectil de arma de fuego en la columna vertebral en el hospital central militar de México

ABSTRACT Objective: To compare the measurement of the Cobb angle in printed radiographs and digitalized radiographs displayed with the "PixViewer" tool. Methods: Pre-operative radiographs of 23 patients were performed in printed films and using the software "PixViewer". The same evaluator, a spine surgeon, chose the proximal and distal end vertebrae at the limit of the main curve in printed radiographs without identifying patients, and measured the Cobb angle based on these parameters. The same parameters and measurements were performed in digitalized radiographs. The measurements were compared, as well as the choice of end vertebrae. Results: The average change in the Cobb angle between the methods was 1.48±1.73°. The intraclass correlation coefficient (ICC) was 0.99, demonstrating excellent reproducibility. Conclusion: The Cobb method can be used to evaluate scoliosis through the "PixViewer" tool with the same reliability of the classic method on printed radiographs.

RESUMO Objetivo: Comparar a aferição do ângulo de Cobb em radiografias impressas e em radiografias digitalizadas visualizadas com a ferramenta "PixViewer". Métodos: Foram avaliadas as radiografias pré-operatórias de 23 pacientes em filmes impressos e com o software "PixViewer". O mesmo avaliador, cirurgião da coluna, elegeu a vértebra limite proximal e distal da curva principal nas radiografias impressas, sem identificação dos pacientes, e realizou a aferição do ângulo de Cobb baseado nesses parâmetros. Os mesmos parâmetros e aferições foram realizados nas radiografias digitalizadas. As aferições foram comparadas, assim como a escolha das vértebras limite. Resultados: A variação média do ângulo de Cobb entre os métodos foi de 1,48 ± 1,73°. O coeficiente de correlação intraclasse (CCI) foi de 0,99, demonstrando replicabilidade excelente. Conclusão: O método de Cobb pode ser utilizado para avaliação da escoliose com a ferramenta "PixViewer" com a mesma confiabilidade que através do método clássico em radiografias impressas.

RESUMEN Objetivo: Comparar la medición del ángulo de Cobb en radiografías impresas y en radiografías digitalizadas visualizadas con la herramienta "PixViewer". Métodos: Se evaluaron las radiografías preoperatorias de 23 pacientes en películas impresas e con el software "PixViewer". El mismo evaluador, cirujano de columna, eligió la vértebra límite proximal y distal de la curva principal en las radiografías impresas, sin identificar a los pacientes, y se realizó la medición del ángulo de Cobb con base en estos parámetros. Los mismos parámetros y mediciones se realizaron en las radiografías digitalizadas. Las mediciones fueron comparadas, así como la elección de las vértebras límite. Resultados: La media del cambio en el ángulo de Cobb entre los métodos fue de 1,48 ± 1,73°. El coeficiente de correlación intraclase (CCI) fue de 0,99, demostrando excelente reproducibilidad. Conclusión: El método de Cobb puede ser utilizado para evaluación de la escoliosis con la herramienta "PixViewer" con la misma fiabilidad del método clásico con radiografías impresas.

Application of spiral CT reconstruction in the forensic identification of atlantoaxial injuries / 法医学杂志

OBJECTIVE@#To evaluate diagnostic value of spiral CT reconstruction in atlantoaxial injuries.@*METHODS@#The images of 25 cases of spiral CT reconstruction were analyzed and compared with images of CT scan and X-ray.@*RESULTS@#In 7 cases of odontoid process fracture, X-ray demonstrated 4 cases and CT demonstrated 5 cases, whereas the spiral CT reconstruction diagnosed 7 cases, which could display the displacement of fracture clearly. The X-ray and CT showed asymmetric space between left and right gaps of atlantoaxial joint in 6 cases, while spiral CT reconstruction showed normal and excluded the possibility of atlantoaxial dislocation. There was one case of lateral atlantoaxial joint dislocation, which was demonstrated by the spiral CT reconstruction clearly but not by the X-ray and CT scan. There were 3 cases of atlantoaxial congenital deformity (1 case of absence of both posterior arch of atlas and odontoid process and 2 cases of maldevelopment of the odontoid process), which were displayed clearly by spiral CT reconstruction, but misdiagnosed as odontoid process fracture and atlantoaxial subluxation by X-ray and CT scan.@*CONCLUSION@#Spiral CT reconstruction can provide the most accurate and integrity imaging information and is very useful in the diagnosis of atlantoaxial injuries and deformity.

Spontaneous reduction of a traumatic L2-L3 subluxation without fracture in a 14-year-old boy

To report a rare case of lumbar vertebral subluxation associated with spontaneous reduction in an adolescent treated conservatively. A 14-year-old male victim of a snowboard accident, which caused a lumbar spinal injury, was referred to the emergency room with significant lumbar pain. Neurologic examination was normal. Radiographic assessment at admission showed a unilateral left lateral subluxation of the L2-L3 vertebrae without associated fractures. These findings were confirmed by CT scan and a surgical management was decided. The preoperative MRI performed 24 h after the accident, however, revealed the spontaneous reduction of the subluxation, and an associated tear of the quadratus lumborum and the psoas muscles on the right side at the level of L2, L3 and L4. Following these findings conservative treatment with a plaster brace for 2 months was carried out. The brace was removed after 2 months. The patient had no pain and the range of motion of his lumbar spine was normal. Three months after injury, sports activities were resumed. At follow-up of 24 months, the patient was free of pain and radiographs showed a right positional bending without rotational or translation anomaly. To date, this is the first case of subluxation without fracture in a child, presenting without neurological deficit and where spontaneous reduction occurred. In this case, conservative treatment was effective and the outcome at 2-year follow-up was excellent

Management for traumatic injuries of cervical spine in Aleppo University Hospital

The study included 72 patients reviewed the Aleppo University Hospital between 1998-2004. The youngest patient was 10 years old, and the oldest was 60 years old, and the median age was 29.5 years. There was 54 males [75%] and 18 females [25%]. The radiologic procedures were plain X-ray to all of the patients, CT scan to only 39 patients and MRI to 8 patients only. The injuries divided into three groups: The pure fractures contained: 41 cases 30 males and 11 females. The pure dislocations contained: 23 cases. 17 males and 6 females The fractures-dislocations contained: 7 cases. 6 males and 1 female. And one [male] patient had oedema in the cervical spinal cord. The most cause of the injuries was road accidents [62.5%] then swimming accidents [16.6%]. In the pure fractures cases, the most injured levels was C5 [37.7%], then C6 [23.2%]. In the pure dislocation cases, the most injured levels was C5C6 [30%], then C6-C7 [23.2%]. The most age groups injured was 10-20 years [43%]. Types of injuries was: unstable 60 cases [83.3%] Stable 12 cases [16.7%]. The methods of treatment contained 3 ways: orthosis Traction [skin, skeletal traction]. Surgical treatment. The most common complications were: respiratory problems [38.5%], bed sores [26.4%], urinary infections [20.8%]. The mortality was 23 cases [3 1.9%]. The results of this study was approximately similar to the results of Dr.Ashkar [was also done in Aleppo University Hospital] between 1992-1996, and were compared also with other international studies. Finally we recommended: Improvement of the road states. Enforcement of the traffic laws. Supply the hospitals with equipments and operative rooms for spinal operations. Rehabilitation of the patients and improvement of life style

Role of computed tomography in spinal trauma.

Twenty patients admitted for spinal trauma were studied with computed tomography (CT) scan. All the patients had initial routine plain radiographs in the anteroposterior and lateral views. Ten patients sustained injury due to fall from height, 7 suffered road side accident, 2 had injury due to fall of weight on back and one suffered due to slip on floor. Twelve patients had injury at multiple levels. Twenty-four vertebral bodies were involved in 20 patients, 10 had fracture of posterior elements only. Neurological deficit occurred in 16 patients. CT scan provided more information than plain radiography, which missed vertebral body fracture in 2 out of 24 instances and spinal canal compromise in 7 out of 12 patients. CT scan detected posterior element injuries better and in greater detail in all cases.

Les traumatismes de la colonne cervicale

La desorganisation et le sous-equipement qui caracterisent notre societe font que la prise en charge des traumatises du rachis est souvent aleatoire. Dans cet article sont revues les notions elementaires liees au traumatisme cervical: les mecanismes et types de lesions; les differentes atteintes neurologiques; la clinique; le bilan radiologique; le traitement conservatif et chirurgical y sont discutes. Cette approche tient compte des conditions locales de travail

Diagnostic et traitement des lesions traumatiques instables du rachis cervical inferieur sans complication neurologique au Gabon

23 lesions traumatiques instables du rachis cervical inferieur (C3-C7) sans signe de deficit neurologique ont ete traites sur une periode de 8 ans. Le traitement a ete conservateur (6 cas) ou chirurgical (5 cas); 2 patients sont decedes sous traction cranienne avant le traitement definitif. Une fois; des complications neurologiques transitoires sont survenues en post-operatoire immediat. Une re-intervention a ete necessaire dans un cas. Dans l'ensemble; on a observe une consolidation osteoligamentaire satisfaisante. La discussion porte sur l'importance du bilan radiologique et les indications operatoires