Epidemiology and Management of Spinal Trauma in Children and Adolescents <18 Years Old.

OBJECTIVE: This retrospective study reports the epidemiology, clinical aspects, and management of spinal trauma in children and adolescents. METHODS: Multicenter study of 215 cases of spinal trauma in individuals <18 years of age. All patients were submitted to preoperative and postoperative radiologic and clinical evaluation. The fractures were classified according to the AOSpine fracture classification. Neurological evaluation was performed using the Frankel scale at admission to hospital and at the last follow-up. RESULTS: Mean age was 14.7 (± 2.5) years and most of the patients were male (72.6%). Falls were responsible for 52.6% of the spinal trauma. Compression fracture was the most common type of fracture, observed in 48.4% of the cases. Most spinal fractures were located at the thoracic level (58.7%). Associated injuries were observed in 37.2% of the cases. The complication rates were 15.8%. Normal neurological examination was observed in 160 cases (74.4%) at the final follow-up. Neurological impairment was mostly observed due to shallow water diving, dislocation fractures types, and fractures located between the lower cervical spine and the thoracic spine. Surgical treatment was performed in 73.8% of the cases. Better neurological outcome was observed in fractures due to falls, fractures located in the upper cervical (C1-C2) and lower lumbar spine injuries (L3-L5). CONCLUSIONS: Surgical treatment is often necessary in children and adolescents after spinal trauma. Higher incidence of spinal cord injury was observed after shallow water diving, fractures located in the lower cervical spine and thoracic spine, and type B and C fractures.

Analysis of scientific output by spine surgeons from Japan: January 2000 to December 2013.

BACKGROUND: Over the last decade, the growing body of work on spine pathology has led to developments and refinements in the areas of basic science, diagnosis and treatment of a variety of spine conditions. Scientific publications have a global impact on the international scientific community as they share vital information that can be applied by physicians worldwide to solve their everyday medical problems. The historical background of scientific publication in journals in Japan on the subject of spine is unclear. METHODS: We performed a literature search for publications by Japanese spine surgeons regarding spine or spinal cord topics using an online database: Pubmed.gov (http://www.ncbi.nlm.nih.gov/pubmed/). The results were stored and analyzed at the Laboratory of Clinical Studies and Basic Models of Spinal Disorders of the University of Caxias do Sul. Results were limited to articles published from January 2000 to December 2013. The search terms used were "Japan" AND ("spine" OR "spinal diseases" OR "spinal cord" OR "spinal cord diseases" OR "vertebroplasty" OR "arthrodesis" OR "discectomy" OR "foraminotomy" OR "laminectomy" OR "denervation" OR "back injuries"). Japanese spine surgeons were defined as spine surgeons from orthopedic or neurosurgical specialties where the publication was affiliated with Japanese services. RESULTS: A total of 16,140 articles were identified by the Medline search. Most of the articles were excluded based on information provided in the title and abstract as they were not related to spine surgery. This study comprised 1768 articles published in the Medline database by Japanese spine surgeons from 2000 to 2013. The number of publications rose in a linear fashion, with the number of papers published increasing by 5.4 per year (p = 0.038). In recent years the publications were increasingly performed in conjunction with the neurosurgery and orthopedics specialties. CONCLUSIONS: This study showed a clear increase in publications (on Medline) by Japanese spine surgeons over the last 14 years. While this is a positive development, there is also cause for concern as there is some evidence that the number of young scientists is declining in Japan. Special attention to educating researchers and improving resources for research is crucial to further increase the number and quality of Japanese publications.