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Non-contiguous spinal fractures.

A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-contiguous spine fractures. Seventy-three per cent of the non-contiguous injuries were comprised of combinations of injuries in the cervical and thoracic regions or in the thoracic and lumbar regions. Forty-five per cent of fractures were a combination of compression fractures, 40% a combination of a compression fracture and a major spine fracture (i.e., one more likely to cause a neurologic deficit), and 15% a combination of major fractures.

Fractures, Bone↗

[Spinal fractures in children and adolescents].

A follow-up study of more than hundred spinal fractures in children and adolescents pointed out that treatment and prognosis depends on the injury involving the growth-plate. In compression fractures without injury of the growth-plate spontaneous correction can be expected during further growth, especially if the wedge-shaped compression was in the sagittal plane alone. Spinal fractures with damage of the growth plate always result from a severe accident. These compound fractures, luxations and luxation-fractures require an exact repositioning and stable fixation to avoid growth disturbances such as progressive scoliosis and kyphosis originating from the unreduced fracture. Reposition and fixation can be managed by modern surgical methods more carefully, more exactly and with greater stability than with conservative methods. Furthermore surgical procedure allows removal of mechanical obstructions within the spinal channel. The origin, clinical appearance and treatment of apophyseal tearing out from the vertebral body are discussed.

Adolescent↗

Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation.

STUDY DESIGN: Introduction of a posterior approach for internal fixation of fractures of the ankylosed cervical spine. OBJECTIVES: To evaluate the clinical outcome of patients with ankylosing spondylitis and cervical spinal fractures treated with posterior instrumentation and a collar orthosis. SUMMARY OF BACKGROUND DATA: Cervical spinal fractures in patients with ankylosing spondylitis almost always extend completely across the vertebral segment to include both anterior and posterior elements. Treatment with immobilization alone is often inadequate. Generalized spinal rigidity and exaggerated thoracic kyphosis may hinder anterior exposure. Posterior approaches have been described but generally require postoperative halo immobilization. In the authors' technique for patients whose spinal alignment is relatively well preserved, a posterior exposure is used that achieves three-point internal fixation along multiple segments. The complications associated with halo immobilization are avoided. METHODS: Seven patients with ankylosing spondylitis and fractures of the cervical spine were stabilized with posterior instrumentation. Patients were immobilized after surgery with either a cervical collar or a sternal occipital mandibular immobilizing brace and observed for neurologic outcome, radiographic evidence of bony fusion, and complications. RESULTS: No patient experienced neurologic deterioration with surgery. Two patients died at acute rehabilitative facilities after discharge. Radiographic evidence of fusion was observed in the five patients available for follow-up. CONCLUSIONS: Patients with ankylosing spondylitis and cervical spinal fractures can be adequately treated with lateral mass plating and interspinous wiring of autologous rib graft. Adequate postoperative immobilization can be attained with a cervical collar and does not require a halo vest.

Adult↗

Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures?

Encroachment upon the spinal canal, separation of the pedicles, associated fractures of the laminae are assumed to be related to dural lacerations consequent to burst fractures of the thoracolumbar spine. Owing to the possible occurrence of early or delayed complications of meningeal discontinuations, the predictive value of these signs has been analyzed in a consecutive series of 50 patients, who were submitted to surgery. Dural tears were found to occur at a rate of 60%, without any statistically significant relation with any of the examined signs. The results were not consistent with the thesis that lacerations of the dura can be predicted on the basis of radiological signs.

Dura Mater↗

Hemothorax--an unusual presentation of spinal fracture in ankylosing spondylitis.

Patients with ankylosing spondylitis are susceptible to spinal fractures. In many cases there is no history of associated trauma or only minor trauma. The instability of such fractures and complicating neurologic sequelae are well documented. We describe an unusual complication of ankylosing spondylitis, hemothorax secondary to spinal fracture, that to our knowledge has not been previously reported. Further, we reemphasize that the instability of such fractures may lead to significant paravertebral soft tissue and vascular injuries.

Fractures, Bone↗

[Selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures].

OBJECTIVE: To investigate the selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fracture. METHODS: Twenty-two consecutive procedures were performed in 17 aged patients with osteoporotic spinal compression fractures from April 2002 to June 2004. The signal changes in different sequences were confirmed by magnetic resonance imaging before the procedures. This operation involved the percutaneous insertion of two inflatable bone tamps into a fractured vertebral body transpedicularly under fluoroscopic guidance. Every patient was treated individually, according to the results of radiography and CT scan before operation. Preoperative and postoperative complications, visual analogue scale, and radiographic findings such as vertebral height and Cobb angle were recorded and analyzed. RESULTS: All patients tolerated the procedure well with immediate relief of their back pain in 24 hours. There was no leakage of cement into the epidura. The mean loss percent of the anterior and middle vertebral heights were (35.32 +/- 13.15)% and (27.53 +/- 12.61)% before operation, and (14.21 +/- 12.43)% and (16.2 +/- 7.5)% after operation. The height restoration of vertebra was confirmed by X-ray after the procedure (P < 0.01). The mean kyphosis was improved from (25.3 +/- 4.2) degrees to (8.6 +/- 5.1) degrees. No complications occurred. No patient had nerve injury. The patients were allowed to walk next day after the procedure. CONCLUSION: The selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures has satisfactory short-term clinical efficacy. It is also an effective way to prevent complications.

Aged↗

Vertebral end-plate failure in porcine and bovine models of spinal fracture instrumentation.

The use of mature porcine and immature bovine spines as models for the assessment of spinal fracture instrumentation is commonplace. By comparing the load-displacement characteristics of these spine segments and observing the fracture type, this study investigated the tendency of immature bovine spines to fail prematurely at the vertebral physis, disrupting biomechanical evaluation of spinal fracture fixation devices. Load to failure of the spines was determined using the Instron Universal Testing Machine and a specially designed endcap. In axial compression, the 10-16-week-old calf spines failed at 12,845 +/- 1,466 N, compared with mature pig spines at 17,300 +/- 5,170 N (p less than 0.05). Axial compression with flexion caused consistent failure through an end-plate in both species: 995 +/- 156 N for the calf spines and 2,025 +/- 575 N for the porcine spines (p less than 0.005). It was concluded that the tendency for immature bovine spines to fail more readily at the cartilaginous end-plate makes the calf spine a less desirable model.

Aging↗

Thoracic spinal fracture in a rugby league footballer.

PURPOSE: The report describes the mechanisms and sequelae of the first case of thoracic vertebral fracture to be reported in a rugby league footballer. CASE SUMMARY: The injury was sustained as the result of a legal shoulder tackle. The player exhibited no sign other than dorsal midthoracic tenderness and paraspinal muscle spasm. Investigations commenced the next day because of persistent pain. CT and MRI revealed complex T6/7 fractures not evident on plain x-ray. The player was managed conservatively with analgesia and rest and has made a full recovery. DISCUSSION: Football is the most common cause of cervical spinal fractures in sport, whereas thoracic spinal fractures are very rare. Although in this case significant damage occurred to the posterior elements of the column, there were no neurological complications. RELEVANCE: The anatomical and physiological bracing of the thoracic spine accounts for the rarity of fractures in contact sport and favors conservative management.

Adolescent↗

Spinal fractures resulting from the 1995 Great Hanshin Earthquake of the Kobe-Osaka area of Japan.

One of the worst earthquakes hit the Hanshin area between Kobe and Osaka, in the early morning at 5:46 AM on January 17th 1995. The destructive force with MG 7.2 severely damaged buildings, houses, roads and railways, leaving 6500 dead, and 34,900 injured. Hyogo College of Medicine located in this area was also severely damaged, thus there was a major challenge to provide post-quake medical support. A post-quake investigation in this area was done by 50 affiliated hospitals. More than 15,000 victim-patients were treated at these hospitals during the first 3 days after the quake. Major injuries were spinal fractures, and other trunk fractures, including rib or pelvis fractures, but fractures of long bones were uncommon, because the quake hit this area in the early morning when most people were asleep. In this study, the mechanisms of these major injuries were analysed by direct interview soon after the quake, with 230 victim-patients who had 140 spinal fractures, and 100 with rib or pelvis fractures. Most of those who had a spinal fracture had either sat up or stood up on their 'Futon' mattresses without bed frames and were struck on their backs by falling furniture or ceilings. On the other hand, patients who had fractures of the ribs or the pelvis had been lying in the supine or lateral position and were hit on their chest or pelvis. This characteristic lifestyle pattern of the Japanese people to lie down on the floor directly beside furniture, resulted in these injuries. From these results, we will emphasize the following precautions:- If an earthquake occurs during sleeping hours at home, do not stand up or sit up. The best position is to crouch on the 'Futon' mattress.

Adult↗

Hook-rod with pedicle screw fixation for unstable spinal fracture. Technical note.

A technique is described in which spinal fracture repositioning, decompression, and stabilization are achieved by a combination of hook-rod and pedicle screw fixation. This straightforward technique is useful for performing acute decompression in patients with partial neurological deficits and multisystem injuries. A laminectomy allows for placement of a stiffer fixation system, and it improves the insufficient canal clearance obtained when performing annulotaxis alone.

Adult↗

Urgent surgical stabilization of spinal fractures in polytrauma patients.

STUDY DESIGN: A prospective, longitudinal study of multiply injured patients treated with segmental instrumentation for spinal fractures with a minimum 2-year follow-up. OBJECTIVES: To determine whether urgent stabilization of spinal fractures in severely injured patients increases the risk of surgery compared with early treatment and historical results. SUMMARY AND BACKGROUND DATA: Opinion in clinical studies is divided about whether operative treatment offers an advantage over nonoperative treatment in isolated spine fractures. Concomitant trauma is rarely discussed relative to decision making or surgical timing. Urgent stabilization of long-bone fractures improves survival and outcome in polytrauma patients. To date, urgent treatment of spine fractures in polytrauma patients has not been considered in the literature. METHODS: Seventy-five consecutive patients treated with segmental instrumentation for spinal trauma were observed prospectively to assess perioperative and longterm outcome. Twenty-seven patients with severe polytrauma (injury severity score, > 26) were separately analyzed. Perioperative and postoperative results were analyzed relative to timing of surgery, injury severity score, and surgical approach. Urgent treatment was defined as that provided within 24 hours of the spinal injury, and early treatment was defined as that provided between 24 and 72 hours after injury. RESULTS: Twenty-five patients (93%) sustained two or more major injuries in addition to the spine fracture, and 17 of 27 (63%) had neurologic injury. The mean injury severity score approached or exceeded the LD50 (50% expected mortality) in each group--36.0 for the early-treatment group and 42.0 for the urgent group--but only one patient in each group died. There were no deep venous thromboses, pulmonary emboli, neurologic injuries, decubiti, deep wound infections, or episodes of sepsis in either group. Blood loss for anterior procedures was significantly higher in the urgent group, but estimated blood loss for posterior procedures was similar for both groups. At 49 months' mean follow-up, no revisions were necessitated by the urgent spinal treatment. CONCLUSIONS: Urgent spinal stabilization is safe and appropriate in polytrauma patients when progressive neurologic deficit, thoracoabdominal trauma, or fracture instability increase the risks of delayed treatment.

Accidents, Traffic↗