Penetrating Aortic Injury due to Broken Ribs and Preventive Measures.

We herein report two cases of patients that underwent prophylactic operations to prevent aortic injuries in association with fractured ribs. Penetrating aortic injuries induced by fractured ribs remain fatal. Prophylactic operations appear effective. However, the indication for such operations should be clarified further in the future.

Posterior Insertion of a Lateral Lumbar Interbody Fusion Cage for the Treatment of Osteoporotic Vertebral Fracture with Kyphotic Deformity: A Case Report.

Introduction: Stable fixation with a wide-foot-plate expandable cage and lateral lumbar interbody fusion (LLIF) cage has been reported as the ideal treatment for vertebral pseudarthrosis or deformity after an osteoporotic vertebral fracture. (OVF). The procedure requires anterior surgery, which may be associated with unique complications. Therefore, we performed a novel procedure consisting of posterior vertebral column resection (PVCR) using a lateral lumbar interbody fusion LLIF cage. Case Presentation: In 2020, we prospectively studied three patients (one male and two female patients; mean age, 75.1 years) who underwent posterior insertion of a lateral lumbar interbody fusion LLIF cage for kyphotic deformity due to osteoporotic vertebral fractures. OVFs. The affected levels were L1, T12, and T11 in patients one, two, and three, respectively. The cage trajectory was confirmed by simulating the procedure using PowerPoint® software. Radiological outcomes were assessed using the angle of local kyphosis pre-preoperatively and postoperatively, and the clinical outcomes and neurological complications were reviewed. We inserted the cage smoothly and optimally in all three patients without sacrificing the nerve root, consistent with our pre-operative simulations. The mean operation time was 405 min (range, 368-433 min), and the mean blood loss was 845 mL (range, 800-865 mL). The mean local kyphotic angle was 46.3° preoperatively and 16.3° two2 weeks postoperatively. The pre-operative low back pain disappeared in all the patients. Post-operative neurological complications occurred in two of the patients, but did not interfere with walking rehabilitation. Conclusion: The present study is the first to demonstrate that posterior insertion of a lateral lumbar interbody fusionLLIF cage is feasible in patients undergoing posterior vertebral column resection.PVCR.

Effect of Early vs Delayed Surgical Treatment on Motor Recovery in Incomplete Cervical Spinal Cord Injury With Preexisting Cervical Stenosis: A Randomized Clinical Trial.

Importance: The optimal management for acute traumatic cervical spinal cord injury (SCI) is unknown. Objective: To determine whether early surgical decompression results in better motor recovery than delayed surgical treatment in patients with acute traumatic incomplete cervical SCI associated with preexisting canal stenosis but without bone injury. Design, Setting, and Participants: This multicenter randomized clinical trial was conducted in 43 tertiary referral centers in Japan from December 2011 through November 2019. Patients aged 20 to 79 years with motor-incomplete cervical SCI with preexisting canal stenosis (American Spinal Injury Association [ASIA] Impairment Scale C; without fracture or dislocation) were included. Data were analyzed from September to November 2020. Interventions: Patients were randomized to undergo surgical treatment within 24 hours after admission or delayed surgical treatment after at least 2 weeks of conservative treatment. Main Outcomes and Measures: The primary end points were improvement in the mean ASIA motor score, total score of the spinal cord independence measure, and the proportion of patients able to walk independently at 1 year after injury. Results: Among 72 randomized patients, 70 patients (mean [SD] age, 65.1 [9.4] years; age range, 41-79 years; 5 [7%] women and 65 [93%] men) were included in the full analysis population (37 patients assigned to early surgical treatment and 33 patients assigned to delayed surgical treatment). Of these, 56 patients (80%) had data available for at least 1 primary outcome at 1 year. There was no significant difference among primary end points for the early surgical treatment group compared with the delayed surgical treatment group (mean [SD] change in ASIA motor score, 53.7 [14.7] vs 48.5 [19.1]; difference, 5.2; 95% CI, -4.2 to 14.5; P = .27; mean [SD] SCIM total score, 77.9 [22.7] vs 71.3 [27.3]; P = .34; able to walk independently, 21 of 30 patients [70.0%] vs 16 of 26 patients [61.5%]; P = .51). A mixed-design analysis of variance revealed a significant difference in the mean change in ASIA motor scores between the groups (F1,49 = 4.80; P = .03). The early surgical treatment group, compared with the delayed surgical treatment group, had greater motor scores than the delayed surgical treatment group at 2 weeks (mean [SD] score, 34.2 [18.8] vs 18.9 [20.9]), 3 months (mean [SD] score, 49.1 [15.1] vs 37.2 [20.9]), and 6 months (mean [SD] score, 51.5 [13.9] vs 41.3 [23.4]) after injury. Adverse events were common in both groups (eg, worsening of paralysis, 6 patients vs 6 patients; death, 3 patients vs 3 patients). Conclusions and Relevance: These findings suggest that among patients with cervical SCI, early surgical treatment produced similar motor regain at 1 year after injury as delayed surgical treatment but showed accelerated recovery within the first 6 months. These exploratory results suggest that early surgical treatment leads to faster neurological recovery, which requires further validation. Trial Registration: ClinicalTrials.gov Identifier: NCT01485458; umin.ac.jp/ctr Identifier: UMIN000006780.

Analysis of patients with bodyboarding injuries transported by physician-staffed emergency helicopter.

CONTEXT: There have been no reports that have studied the characteristics specific to bodyboard injuries. AIMS: To clarify characteristics to bodyboard injuries. SETTINGS AND DESIGN: A retrospective medical chart review. MATERIALS AND METHODS: A medical chart review was retrospectively performed for all patients with spinal cord injuries transported via physician-staffed emergency helicopters between January 2009 and October 2013. The subjects were divided into two groups based on whether they had a spinal cord injury induced by bodyboarding (Bodyboard group, n = 14) or not (Control group, n = 14). STATISTICAL ANALYSIS USED: Using a χ(2)-test, Mann-Whitney U-test and non-paired Student's t-test. RESULTS: All but one of the subjects had spinal canal stenosis. The age of the patients in the Bodyboard group was younger than that of the Control group. The ratio of males and Glasgow Coma Scale of the Bodyboard group were higher than those on the Control group. The spinal cord injury induced by bodyboarding typically occurred after impacts of the head or face with the sea bottom while the subject was being buffeted by the waves. The severity of the spinal cord injury in the Bodyboard group was lower than that in the Control group. CONCLUSION: Bodyboarding tended to induce spinal cord injuries after the head or face collided with the sea bottom, and was more common in middle-aged males during the summer season, and was associated with a favorable outcome.

Acute posterior neck pain in adult: a case series.

Calcification around the cervical spine is thought to be relatively rare case, among these conditions the calcification at the longus colli muscle is called retropharyngeal tendinitis and only several cases were reported in the literature. In this disease, the three characteristic clinical features are acute severe posterior neck pain without any trigger, severely restricted range of motion, and odynophagia. The radiographic findings include swelling of the retropharyngeal space and amorphous calcification anterior to C1-C2 in lateral view of the cervical spine. Diagnosis is established by sound history taking coupled with computed tomography (CT) scan of the affected area, treatment is the administration of oral non-steroidal anti-inflammatory drugs (NSAID), for a few weeks and/or oral steroid. We present a new 3 cases (27, 35, and 24 years old, male) and review of literature.