The National Interscholastic Cycling Association Mountain Biking Injury Surveillance System: 40,000 Student-Athlete-Years of Data.

ABSTRACT: A web-based injury surveillance system was implemented through a collaboration between University of Utah researchers and the National Interscholastic Cycling Association (NICA) to better understand injury characteristics in mountain biking. Data were collected from NICA leagues during the 2018 and 2019 seasons. Injuries were tracked in 41,327 student-athlete-years, identifying 1750 unique injuries during 1155 injury events. Rider-dependent and rider-independent variables were analyzed. The most commonly reported injuries were concussion (23.6%), injuries to the wrist/hand (22.3%), and shoulder (15.6%). Half of all injury events occurred on downhills. Men and women reported similar yet significantly different injury rates (2.69% and 3.21%, respectively; P = 0.009). Women sustained more lower-limb injuries (37.8% vs 28.3%; P = 0.003). Nearly 50% of crashes resulted in an emergency room visit. Youth mountain bike racing is a rapidly growing sport. Acute traumatic injuries are common. Injury surveillance system data are now being used to inform injury prevention strategies and direct future research.

A randomized prospective evaluation of 3 techniques of postoperative pain management after posterior spinal instrumentation and fusion.

STUDY DESIGN: Randomized prospective trial. OBJECTIVE: To compare the efficacy of intravenous analgesia with single and dual continuous epidural analgesia (CEA) in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion and instrumentation (PSIF). SUMMARY OF BACKGROUND DATA: Pain management after posterior spinal fusion (PSF) for patients with AIS is challenging. Although intravenous patient-controlled analgesia (PCA) is used most commonly, CEA has been found to be safe and effective. Recently, the use of 2 epidural catheters has been thought to be more effective than a single catheter, although the efficacy of using 2 catheters has not been directly compared with a single catheter. METHODS: Sixty-six patients with AIS were randomized into 3 groups prior to PSF; PCA, single CEA, and double CEA. Postoperative pain scores as well as side effects, complications, and use of breakthrough medication were collected. Recovery times were also recorded, including hospitalization, times to first bowel movement, and days to walk and climb stairs. Four patients were withdrawn due to the inability to maintain the pain management protocol. RESULTS: Pain intensity was most effectively controlled with a double CEA when compared with PCA (P < 0.05) and a single CEA (P < 0.05). Pain control was equivalent in both the PCA and single CEA groups (P = 0.21). The pain control method with the fewest side effects trended toward the single CEA, with an average of 2.55 side effects per patient. The majority of the side effects included pruritis, constipation, and nausea. Late onset neurological events were absent in all patients. CONCLUSION: These data document that the double CEA most effectively controls postoperative pain after surgery for AIS. The single CEA trended toward having the fewest side effects when compared with the other techniques. On the basis these findings, we now routinely use the double CEA technique for all patients having surgery for AIS.

Involvement of the spine in patients with multiple hereditary exostoses.

BACKGROUND: Extension of a vertebral exostosis into the spinal canal is rare, but many isolated cases have been reported in the literature. Three existing patients with multiple hereditary exostoses at our institution had development of neurologic findings and were found to have exostoses in the spinal canal. These findings led us to perform magnetic resonance imaging or computed tomographic scans for the remaining patients with multiple hereditary exostoses at our institution. METHODS: Forty-four patients at our institution (including twenty-six male patients and eighteen female patients) had multiple hereditary exostoses. Forty-three patients were evaluated with magnetic resonance imaging and one was evaluated with computed tomography to look for spinal column involvement. RESULTS: Thirty (68%) of the forty-four patients had exostoses arising from the spinal column, and twelve (27%) had lesions encroaching into the spinal canal. Thirty-six of the forty-four patients also had plain radiographs, but only six had radiographs that accurately identified the lesions and another six had radiographs that mistakenly identified lesions that were not confirmed with magnetic resonance imaging or computed tomography. Patients with lesions inside the spinal canal were typically asymptomatic and neurologically normal, with radiographs that did not demonstrate the lesion. Compared with female patients, male patients were more likely to have spinal lesions and more likely to have lesions encroaching into the spinal canal (p = 0.014). CONCLUSIONS: The risk that a patient with multiple hereditary exostoses has a lesion within the spinal canal is much higher than previously suspected (27%). Because the potential exists for serious neurologic injury to occur, we have begun to use magnetic resonance imaging to screen all patients who have multiple hereditary exostoses at least once during the growing years.