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Spinal fracture in a young Depo-Provera user.
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Treatment of spinal fractures with paraplegia.
Of 206 patients with vertebral fractures in the thoraco-lumbar spine with spinal cord injuries, an antero-lateral decompression with stabilization of the injured segment of the vertebral column was undertaken in 56 cases. In all these cases there was a compression of the spinal cord from the front. 8 patients made a complete recovery, 31 a good recovery, and 6 were improved. In 8 patients no improvement was noted. 2 patients developed pressure sores later and 1 patient died one year after the operation of uraemia. 22 patients out of 55 got a normal function of the bladder and 25 patients out of 54 a normal function of the anal sphincter. 16 patients out of 17 made a complete or good recovery after removal of a displaced rotated vertebral bony fragment from the spinal canal, and 7 patients out of 9 with wedge shaped fractures. In our clinic today, in cases of vertebral fractures with neural involvement, reduction and internal fixation with Harrington rods and fusion of the injured segment is undertaken as soon as possible, also during the night. If narrowing of the neural canal and compression of the spinal cord are verified, a decompression operation with interbody fusion is undertaken during the next days.
Spinal fractures in patients with ankylosing spondylitis.
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Haemothorax and thoracic spinal fracture. A case for early stabilization.
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[Vertebral deformity as an index of osteoporosis-induced spinal fracture--an external validity construct based on bone density data].
BACKGROUND: In order to test the validity of vertebral morphometry for the assessment of prevalent vertebral osteoporotic fractures, we examined the association between vertebral deformities and bone mineral density (BMD). METHOD: The study population consisted of 595 postmenopausal women and 581 men aged 50 to 82 years who participated in the baseline survey of the European Vertebral Osteoporosis Study (EVOS) in Germany and received BMD measurements by dual-X-ray-absorptiometry (DXA) at the femur and the lumbar spine. RESULTS: In both sexes only vertebral deformities defined by more stringent morphometric criteria (McCloskey; Eastell 4 SD criterion) were significantly and inversely related to BMD (odds ratios 1.42 to 3.21 for a 1 SD [standard deviation] reduction in BMD; p < 0.05). The strength of the association depended on the stringency of the morphometric algorithm applied, and on the site of BMD measurement. The strongest associations were observed with femoral neck BMD in women and with BMD at the lumbar spine in men. In contingency analyses between vertebral deformities and osteoporosis (WHO criteria; European young female BMD reference values), vertebral deformities proved to be highly specific by all methods, even slightly more so in men (87.8 to 97.5%) than in women (86.3 to 96.7%). The predictive value of a positive test with respect to vertebral osteoporosis reached a maximum value of about 50% in both sexes. It further increased up to 72%, when the definition of osteoporosis was based on low BMD values at either the spine or the femoral neck, but only in women. CONCLUSIONS: In conclusion, for both men and women the likelihood of vertebral deformities to be related to osteoporosis increases with the stringency of the morphometric method, with a similar probability of major deformities to represent vertebral osteoporotic fractures in men as in women. Nevertheless, even the most stringent morphometric criteria are not sufficiently valid instruments for the assessment of the prevalence of vertebral osteoporotic fractures in epidemiological studies.
[SERM for early osteoporosis therapy. Risk for first spinal fracture reduced to half].
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Anesthesia case of the month. Complications during surgery for a spinal fracture in a dog.
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What is your diagnosis? Spinal fractures.
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Spinal fractures in intensively-fed yearling cattle.
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Radiographic diagnosis: thoracic spinal fracture resulting in kyphosis in a horse.
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Immobilisation of spinal fractures in patients with ankylosing spondylitis. Two case reports.
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[Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years].
Non-operative treatment of thoracolumbar fractures remains the standard treatment option for stable and slightly unstable spinal injuries at the level of the lower thoracic and lumbar spine. The purpose of the present retrospective study was to determine the outcome and long-term results of patients treated conservatively using either one of the two major non-operative treatment modalities: (1) functional, or (2) closed reduction and immobilisation by cast. The average follow-up time for the 43 patients reviewed was 16.3 years. They showed a radiologic increase in the average kyphosis angle of 5.2 degrees compared to the time of injury. No difference was noted between early functional therapy and treatment with closed reduction and immobilisation by cast. Patients with initial neurologic impairment showed a significant improvement ( P<0.05) in their neurologic status during the follow-up period. Results of validated psychometric questionnaires (SF-36, FSR, VAS-Spinescore) showed the characteristic pattern of a population with chronic back pain. In conclusion, a radiologic increase in the traumatic kyphotic deformity in patients with a non-operative treatment protocol has to be expected. Measurable negative physical and social long-term consequences can be anticipated after sustaining a type-A fracture of thoracolumbar vertebral bodies. Any correlation between radiologic and functional results has not been observed.
[Surgical treatment of thoracolumbar spinal fractures with internal fixator and transpedicular spongiosa-plasty].
We report on 30 unstable fractures of the thoracolumbar spine which were operatively treated between 1987 and 1992 with the AO Internal Fixator and transpedicular bone grafting. There were 26 flexion-compression fractures, 2 flexion-distraction injuries and 2 fracture-dislocations. Follow-up ranged from 2 to 5 years. All patients were examined and their histories reviewed. New radiographs were obtained and a standardized questionnaire on pain and on functional and economical status was answered. The radiographical analysis included measurement of the vertebral, segmental and local kyphosis and of the sagittal index. The preoperative vertebral kyphosis averaged +17 degrees and was corrected to +7 degrees at follow-up with the sagittal index improving from 0.59 to 0.86. The segmental respectively local kyphosis was reduced from +15 degrees respectively +8 to +5 degrees respectively -3 degrees. The fractured vertebra remained stable. We registered an average postoperative loss of correction of 4 degrees in the upper disc space due to collapse of the injured disc. The lower disc space was frequently overcorrected which was neutralized postoperatively due to a process of reequilibration of less than 3 degrees. The loss of correction occurred both before and after removal of the implant. There was no significant change of the sagittal plane apart from a successful realignment of the flexion-distraction injuries. Five out of 8 patients with neurological symptoms improved by at least 1 Frankel grade. We had no case of neurological deterioration. The results of the questionnaire were good or very good in 70%. At follow-up, the average back pain score was 3 out of 10, 10 being unbearable pain.
Mediastinitis and neck abscess following cervical spinal fracture.
Neck abscess and mediastinitis are rare complications of cervical spinal injury. Often there is a delay in diagnosis because the physical and laboratory signs of abscess are falsely attributed to the vertebral injury. Prognosis is directly related to the expediency of recognition of infection and surgical drainage. Three cases of neck abscess with mediastinitis that were seen over a four-year period at the spinal cord unit at Northwestern Memorial Hospital are reviewed.
Traumatic intrauterine fetal spinal fracture following seat belt use: a case report.
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[Back pain and neurological deficits in osteoporotic spinal fractures].
Generally osteoporotic compression fractures of the spine cause only localized pain and kyphosis without other significant complications. These fractures usually heal without difficulty by conservative treatment. However, it becomes to be accepted as a general concept that a small number of patients with osteoporotic fracture of the thoracolumbar spine result in delayed vertebral body collapse with neural compromise. We analyzed our series of osteoporotic-posttraumatic vertebral collapse. We had treated 51 consecutive patients with posttraumatic vertebral collapse following osteoporotic compression fractures of the thoracolumbar spine between Jan. 1987 and June 1994. Surgery consisted of anterior spinal reconstruction by strut grafting using a bioactive ceramic vertebral prosthesis (A-WGC) and autogenous rib in combination with the Kaneda device after resecting the collapsed vertebral bodies. After surgery, 80% of the patients with initial neurological deficits showed remarkable neurological recovery. The causes of neural compression were retropulsion of the posterior part of the collapsed vertebral body into the spinal canal and unstable kyphosis. The collapsed portion of the resected vertebral bodies was always less bloody or ischemic. Histology confirmed ischemic necrosis of the collapsed portion. The collapse would be resulted in by the compromised healing process due to repeated micro-traumas to the fragile trabecular bone following osteoporotic vertebral fracture. Autogenous iliac bone as well as fibula cannot be used as another alternative strut graft because of the fragility of the graft and grafted site. The anterior reconstruction with a bioactive ceramic vertebral prosthesis and the Kaneda device has been useful in osteonecrotic-posttraumatic vertebral collapse of the thoracolumbar spine.
[Radiation diagnosis of uncomplicated compression spinal fractures in children].
Experiments on rabbits compared the X-ray, morphological, and magnetic resonance imaging of compression fractures of the vertebral body. Edema of the bone marrow of the vertebral body was ascertained to be a basic morphological substrate that evokes a modified MR signal. The data on 178 children with suspected compression fracture of the vertebral body were used to consider the potentialities of MRI and X-ray study in this pathology. The MRI semiotics of uncomplicated compression fractures of vertebral bodies is presented. The sensitivities of MRI and spondylography in the diagnosis of compression fractures of vertebral bodies were 100 and 62.5%, respectively.