Emergency,spine trauma,acute spinal cord injury

Acute thoracolumbar fractures are commonly diagnosed by clinical symptoms and X-ray plain films. Computed tomography (CT) is used to assess vertebral body damage, posterior wall canal intrusion, and posterior column injury. Both of these imaging tools have helped to develop classifications systems that aid the clinician in differentiating stable versus unstable spinal injuries. Multidetector CT has become the standard of care in polytrauma patients. It provides superior evaluation of bony anatomy and has been reported to be more cost effective than X-ray plain films, particularly in the cervicothoracic junction and in thoracolumbar unstable burst fractures...

Prior pre-clinical and clinical studies indicate that early decompression of the spinal cord (≤ 24 h post-trauma) may have benefits regarding clinical outcomes and neurological recovery after spinal cord injury (SCI). This study examines the benchmarking of management of patients with acute traumatic cervical SCI in order to determine the potential barriers and ideal timelines for each step to early surgical decompression. We reviewed patient charts and the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS) forms regarding the time and reasons for delay of each step in the management of patients with SCI...

The radiation examination of 728 victims of acute spinal column and cord injuries, admitted to Omsk City Emergency Medicine Hospital One in the period 2008-2011, was analyzed. The main cause of spinal column injuries was catastrophe (68.7%), vehicle-related trauma (22.3%), and others (9%). Injuries to the cervical segments of the spinal cord constituted 10.5%. The 5th and 6th cervical vertebrae were most commonly damaged. Spinal cord injuries were multifocal in about 46.2% of cases. The diagnostic algorithm of instrumental studies in the acute period of spinal injury was performed in the following sequence: spondylograms in two projections (77%), those in special positions (3%), multislice spiral computed tomography (75%), and magnetic resonance imaging (22%)...

The emergency care of patients who may have spinal injuries has become highly ritualised. There is little scientific support for many of the recommended interventions and there is evidence that at least some methods now used in the field and emergency department are harmful. Since prospective clinical trials are not likely to resolve these issues I propose a reconceptualisation of spinal trauma to allow a more rational approach to treatment. To do this I analyse the basic physics, biomechanics and physiology involved...

The purpose of this ambispective cohort study is to describe the emerging role of intra-operative cone-beam CT (O-arm®, Medtronic, Minneapolis, MN, USA), frequently coupled with stereotactic navigation (StealthStation®, Medtronic), in the surgical management of acute spinal trauma. All patients with acute spinal trauma between May 2009 and May 2011 who were treated with the use of the O-arm were identified from a prospectively collected spine database and retrospectively analyzed to characterize indications and outcomes...

BACKGROUND AND PURPOSE: The provision of appropriate spinal imaging in cases of acute injury as a consequence of trauma or tumour is becoming ever more challenging. This study assessed the use of multimodal radiological investigations in the management of spinal cord compression as a result of trauma and metastatic cancer in all major Irish hospitals. METHODS: We conducted a questionnaire of thirty four hospitals in an effort to assess the provision of these services to patients with possible spinal cord compromise...

STUDY OBJECTIVE: We aim to determine the prevalence and factors associated with cervical discoligamentous injuries detected on magnetic resonance imaging (MRI) in acute, alert, neurologically intact trauma patients with computed tomography (CT) imaging negative for acute injury and persistent midline cervical spine tenderness. We present the cross-sectional analysis of baseline information collected as a component of a prospective observational study. METHODS: Alert, neurologically intact trauma patients presenting to a Level I trauma center with CT negative for acute injury, who underwent MRI for investigation of persistent midline cervical tenderness, were prospectively recruited...

A wide spectrum of cervical spine injuries, including stable and unstable injuries with and without neurologic compromise, account for a large percentage of emergency department visits. Effective treatment of the polytrauma patient with cervical spine injury requires knowledge of cervical spine anatomy and the pathophysiology of spinal cord injury, as well as techniques for cervical spine stabilization, intraoperative positioning, and airway management. The orthopaedic surgeon must oversee patient care and coordinate treatment with emergency department physicians and anesthesia services in both the acute and subacute settings...

BACKGROUND AND IMPORTANCE: Intraspinal synovial cysts are uncommon causes of back and radicular leg pain. Usually associated with degenerative spinal disease, these juxtafacet cysts are usually located in the lumbar spine and may rarely undergo intracystic hemorrhage. The pathogenesis of these cysts are unclear, and risk factors that may contribute to hemorrhagic complications are largely unknown. CLINICAL PRESENTATION: A 68-year-old man presented to the clinic 4 months after a fall on ice with persistent back pain and lumbar radiculopathy...

The evaluation and management of cervical spine injuries is a core component of the practice of emergency medicine. This article focuses on evaluation and management of blunt cervical spine trauma by the emergency physician. Pertinent anatomy of the cervical spine and specific cervical spine fractures are discussed, with an emphasis on unstable injuries and associated spinal cord pathology. The association of vertebral artery injury with cervical spine fracture is addressed, followed by a review of the most recent literature on prehospital care...

In spite of the prevalence and impact of spinal trauma, significant controversy surrounds many of the topics in the field. The role and timing of surgical intervention after spinal trauma remains one of the most contested topics. This focus issue contains 3 studies, which respectively attempt to define the appropriate timing of surgery in the context of acute spinal cord injury, central cord syndrome, and spinal injuries in the poly-trauma patient. Each of these studies is discussed in detail and directions for future work are suggested...

The evaluation of patients with suspected spine trauma is controversial. This document addresses several pertinent issues: (1) which patients need imaging, (2) how much imaging is necessary, and (3) exactly what sort of imaging is to be performed. This subject is important, because conservative estimates indicate that more than 1 million blunt trauma patients, who have the potential for sustaining spine injuries, are seen annually in emergency departments in the United States. Adult patients who satisfy any of several "low-risk" criteria for cervical spine injury need no imaging...

BACKGROUND: The purpose of this article is to report experience gained over three years of the use of a protocol for patient selection and timing of operation for acute thoracic and lumbar fractures. METHOD: At admission, all patients underwent neurological and imaging exams. All patients with a spinal cord lesion scored as ASIA A at any level inferior to T10 and as ASIA B, C or D at any level, were categorized as emergency and operated on within eight hours from trauma...

Most traumatic spinal injuries result from a high-energy process and are accompanied by other injuries. Following the CCSPR study, the presence of all low-risk factors (simple trauma mechanism, fully conscious, ambulatory at any time since trauma, neck rotation exceeding 45 degrees bilaterally) obviates the need to acutely image the cervical spine. Imaging is indicated in all other patients. Emergency spiral CT should be performed as the first imaging method in high-risk and moderate-risk patients; only in low-risk patients should conventional radiography be performed and trusted as the sole modality...

Assessing a patient with clinical signs of acute spinal cord trauma is an emergency. A radiological work-up is crucial in determining management, and magnetic resonance imaging (MRI) is the modality of choice. It should therefore be performed immediately, preferably within 3 hours, even when plain radiography does not show an abnormality. By choosing an appropriate imaging protocol, it is possible to assess the spinal cord, joints, muscles, ligaments and bone marrow of the spine. Moreover, early MRI findings assist in determining functional prognosis...

Subaxial cervical spine injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracture-dislocation with bone and ligament failure, resulting in severe spinal cord injury. Understanding the epidemiology, anatomy, biomechanics, and classification of subaxial cervical spine injuries is important. Emergent management of such injuries is based on obtaining an accurate clinical history, careful physical examination, and organized radiographic evaluation. Attaining a unified approach to the wide spectrum of subaxial cervical injuries is difficult...

OBJECTIVE: The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period. METHODS: Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury...

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the frequency of stable and unstable cervical spine fractures after gunshot wounds to the head or neck; to identify potential risk factor(s) for an unstable versus stable cervical spine fracture. SUMMARY OF BACKGROUND DATA: Cervical spine fractures after gunshot wounds to the head and neck are common. Because of the nature of their injuries, patients often present with concomitant airway obstruction and large blood vessel injury that can necessitate emergent procedures...

STUDY DESIGN: Retrospective review of current literature regarding neuroprotection and axonal regeneration therapies for acute spinal cord injury. OBJECTIVES: To provide an update for spine clinicians of the emerging therapeutic strategies for promoting neural repair and regeneration after spinal cord injury. SUMMARY OF BACKGROUND DATA: The neuroscientific community has generated a number of novel potential treatments for spinal injuries, some of which have entered clinical trials...

Knowledge of trauma is as old as mankind and survived a long way to reach new technologic developments. Being a multisystemic disease, trauma is an important social and financial problem especially in developing countries. Anesthesists possess important roles in the multisystemic management of trauma patients. In our country prehospital life support for trauma victims is primarily realized and arranged by the emergency help and rescue team 112 which belonged to the Ministry of Health. Several courses are arranged for the team especially about endotracheal intubation and resuscitation in the field...