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At least 199 records · Page 11Linked to original sources
PubMed2003

Distribution of spinal fractures in children: does age, mechanism of injury, or gender play a significant role?

BACKGROUND: The distribution of fractures in the spine reported in the literature is quite variable. Application of such data to the pediatric population needs to take into account differences between children and adults, including overall decreased fracture frequency in children, developmental and physiological differences, and mechanism of injury. Knowledge of specific regions of injury may alter search patterns and protocols. OBJECTIVE: To determine if the distribution of spinal injuries in pediatric patients is related to age, mechanism of injury, or gender. PATIENTS AND METHODS: All pediatric patients (<18 years old) referred to our trauma service over a 5-year period were retrospectively reviewed. All patients with vertebral fracture and/or neurological injury were included. The levels of the spinal fractures were tabulated. Correlation was then made with age, gender, and mechanism of injury (motor vehicle accident versus non-motor vehicle accident). RESULTS: Of the 2614 pediatric patients, 84 sustained vertebral fracture and 50 had neurological injury without radiographic abnormality. A total of 164 fractures were identified. The thoracic region (T2-T10) was most commonly injured, accounting for 47 fractures (28.7%) followed by the lumbar region (L2-L5) with 38 fractures (23.2%), the mid-cervical region with 31 fractures (18.9%), the thoracolumbar junction with 24 fractures (14.6%), the cervicothoracic junction with 13 fractures (7.9%), and the cervicocranium with 11 fractures (6.7%). There was no relationship to gender or mechanism of injury. CONCLUSIONS: Regardless of gender or mechanism of injury, the thoracic spine (T2-T10) is the most common region of fracture in pediatric trauma patients.

Accidents, Traffic↗
PubMed2001

[Nocturnal spinal fracture--first manifestation of epilepsy].

A 54-year-old patient suffered overnight a double thoracic burst-fracture. One week later during the investigation for a metabolic or endocrinological cause, a witnessed seizure led to an unstable fracture of the humerus and the scapula. The neurological work-up revealed a cerebral astrocytoma as the epileptogenic focus. Forces generated during a tonic-clonic seizure can result in axial skeletal trauma, including thoracic and lumbar burst fractures. Vertebral fractures unrelated to an exogenous trauma are therefore always suspicious of an underlying epileptic disease.

Astrocytoma↗
PubMed1993

Cotrel-Dubousset rods in surgical stabilization of spinal fractures.

Cotrel-Dubousset instrumentation (CDI) was used to stabilize thoracolumbar fractures in 48 consecutive patients at the Lucerne Spinal Center. The results of these patients were reviewed with respect to completion of healing, change in neurologic status, medical or hardware complications, and follow-up radiographic parameters. Twenty patients were braced and 28 were not braced after operation, depending on certain criteria. Two elderly patients died at 1 and 6 months after their injury, of medical complications. One other patient was lost to follow-up after 6 months. Of the remaining 45 patients, all were evaluated at follow-up ranging from 12 to 47 months (mean, 21 months). Forty-two of the 45 patients (93%) developed a solid stable fusion with the initial procedure. Ten patients of 45 required additional surgical procedures for a complication rate of 22%, as follows: there were two early hardware failures requiring revision and one late failure that did not require revision. Five patients required late rod removal because of pain. One patient required late syrinx drainage without removal of hardware, and another adolescent patient required extension of her fusion because of late scoliosis development below the injury site. There were no infections or neurologic complications. Cotrel-Dubousset instrumentation rods have been found to be an excellent device for thoracolumbar fracture stabilization.

Adolescent↗
PubMed1994

Spinal canal restoration by posterior distraction or anterior decompression in thoracolumbar spinal fractures and its influence on neurological outcome.

Thirty consecutive patients who had suffered unstable fractures and dislocations of the thoracolumbar spine mostly associated with neurologic impairment and bony encroachment on the spinal canal were treated either with Harrington distraction rods combined with sublaminar wires or with the Zielke-VDS device. These patients were subsequently assessed for neurologic outcome, spinal canal clearance, sagittal and coronal spinal deformity correction preoperatively and postoperatively with a minimum follow-up of 26 months. In the follow-up evaluation, the patients who underwent surgery with Harrington rods showed an overall improvement of their neurologic function of 90.9%, whereas all patients who underwent the Zielke operation improved. Preoperatively, positive correlations were found between the level of injury and Frankel grades; the cord lesion tended to demonstrate more severe neurologic deficit when compared with cauda equina ones (P < 0.001). Furthermore, dislocation accompanying the injury resulted in a more severe neurological deficit (P < 0.05). Harrington rods and Zielke device offer sufficient initial correction of the frontal spinal deformity but did not significantly either restore or maintain sagittal plane alignment. The Harrington series showed an overall improvement of the segmental kyphosis of 26% (NS), with a subsequent loss of correction of 7.38% (NS) on the follow-up observation. The Zielke device produced an immediate, much better correction of the segmental posttraumatic kyphosis of 45% (NS), but a loss of correction of 22.9% (NS) was measured in the follow-up evaluation. Correction of the anterior and posterior vertebral height was shown to be better for the Zielke patient group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Spinal fractures in adults in bob-sled accidents].

A case study of two adults who sustained severe burst fractures of the thoracolumbar spine (T12, L1) after trivial accidents using plastic sledges. In one case a transient conus medullaris lesion was encountered. The fractures were reduced indirectly by internal fixation as well as by direct anteposition of the fragments from the spinal canal after laminectomy. The fracture mechanism is probably a result of hyperflexion combined with very little shock absorbtion from this sledgetype. Plastic sledges seem particularly hazardous for adults.

Adult↗
PubMed1984

[Indications for operative stabilization of spinal fractures].

Absolute indications are seen in lesions of the spinal cord; increase of an incomplete paralysis, paralysis after free interval or after a primarily good restitution and in case of an ascending complete paralysis. The decompression depends on the actual site of compression. If there is an anterior compression not laminectomy but only the anterior approach will be successful. Relative indications are instability, especially disco-ligamentious ones. Late results with permanent instability, pseudarthrosis of the dens axis and marked angulation (40 degrees) of the vertebral body.

Fractures, Open↗
PubMed1984

Spinal fractures: results and experience with computer tomography.

Our results and experience with computer tomography (CT) were analyzed with respect to 41 patients with fresh bone injuries in both the cervicothoracic and the lumbar region of the vertebral column. Besides differentiated representation of the involvement of various parts of the vertebral body, the arch, transverse and spinous processes in 46 fractures, and four luxation fractures, bone fragments were found in the spinal cavity in 12 patients. Two patients displayed spinal bleeding and 3 showed a traumatic vertebral disc protrusion; 5 patients had paravertebral hematomas. Comparison of the CT-verified computer-tomographic fractures with the results of conventional X-ray diagnosis in two planes, as well as partial a.p. or lateral tomography (n = 12), revealed that in 13 patients even the detection of the fracture remained uncertain. Post-traumatic CT investigation (n = 9) showed syringomyelia in 3 patients, dense necrosis in 1 patient, and spinal channel stenoses as well as radicular irritations which could be explained by overshoot bone neogenesis at the intervertebral foramina. New technological developments in CT instruments of the most recent generation (digital radiography, sagittal and coronary image reconstruction) have made CT the most effective method in the diagnosis of spinal trauma. This necessitates a reorientation in the diagnostic procedure in patients with traumatic lesions of the spine.

Adolescent↗