Fracturas vertebrales causadas por reductores de velocidad o "lomos de burro" / Spinal fractures caused by speed bumps

Objetivo: Presentar una serie de casos de fracturas vertebrales en pasajeros de autobús asociadas al pasaje por reductores de velocidad. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de casos de lesiones vertebrales torácicas y lumbosacras sufridas por pasajeros a causa del impacto del vehículo con reductores de velocidad. Se incluyó a pacientes tratados en dos instituciones, entre el 1 de enero de 2012 y el 1 de enero de 2023. Resultados: Se registraron 23 pacientes con lesiones vertebrales de la columna toraco-lumbosacra, 14 mujeres (60,9%) y 9 hombres (39,1%), promedio de la edad 43 años (DE ± 12; rango 25-62). Casi todos eran pasajeros (n = 22; 95,7%) que viajaban sentados en la última fila del autobús (n = 20; 86,5%). Un solo caso correspondía a un conductor del vehículo. Se documentaron 29 lesiones vertebrales, 28 fracturas toracolumbares (de T10 a L2; 96,6%) y una fractura de coxis (3,4%). La vértebra más comprometida fue L1 (n = 16; 55%). Las fracturas más graves (A3/A4) se asociaron con tratamiento quirúrgico (p = 0,007) y una mayor mediana de días de internación (p = 0,005). Conclusiones: Las lesiones vertebrales asociadas al impacto vehicular con reductores de velocidad son fracturas causadas por un mecanismo de compresión axial, más frecuentes en pasajeros ubicados en la última fila de asientos del autobús. Comprometen predominantemente la charnela toracolumbar y la vértebra fracturada con más frecuencia es L1 y exclusivamente uno de los platillos vertebrales. Nivel de Evidencia: IV

Objective: To present a case series of spinal fractures in bus passengers caused by passing over speed bumps. materials and methods: A descriptive and retrospective study of a case series of thoracic and lumbosacral spinal injuries suffered by passengers as a result of vehicle impacts with speed bumps was conducted. Patients treated at two institutions from January 1, 2012 to January 1, 2023 were included. Results: 23 patients with vertebral injuries of the thoracolumbosacral spine were recorded: 14 women (60.9%) and 9 men (39.1%), average age 43 years (SD±12; range=25-62). Almost all of the patients were passengers (n=22, 95.7%) sitting in the last row of seats on the bus (n=20, 86.5%). A single case was documented involving the vehicle's driver. 29 spinal injuries were recorded, 28 thoracolumbar fractures (from T10 to L2; 96.6%) and 1 coccyx fracture (3.4%). The most frequently involved vertebra was L1 (n=16; 55%). The most severe fractures (A3/A4) were associated with surgical treatment (p=0.007) and a longer median hospital stay (p=0.005). Conclusions: Spinal injuries during vehicular impact with speed bumps are caused by an axial compression mechanism, with greater involvement of passengers who are located in the last row of seats. They primarily affect the thoracolumbar joint, with the L1 vertebra and exclusively one of the vertebral endplates being fractured most frequently. Level of Evidence: IV

Seguridad de la cirugía de luxofracturas vertebrales toracolumbares según la oportunidad quirúrgica / Safety of surgical treatment for thoracolumbar fracture-dislocations according to surgical timing

Introducción: Las luxofracturas vertebrales toracolumbares se producen por traumatismos de alta energía, representan el 10% de las lesiones traumáticas de la columna vertebral y se asocian frecuentemente con otras lesiones. El objetivo de este estudio fue comparar las complicaciones tempranas en pacientes con una luxofractura toracolumbar según la oportunidad quirúrgica, antes o después de las 24 h del trauma. Materiales y métodos: Estudio multicéntrico, analítico, observacional y retrospectivo de una cohorte de pacientes operados por una luxofractura toracolumbar, desde el 1 de enero de 2014 hasta el 1 de enero de 2023. Se inclu-yó a pacientes de ambos sexos, >18 años, operados por una luxofractura vertebral de alta energía. Se los agrupó según si habían sido operados de columna antes o después de las 24 h del trauma. Se registraron las complicaciones totales y agrupadas. Resultados: Se evaluó a 72 pacientes, 64 hombres (88,9%) y 8 mujeres (11,1%), con una edad promedio de 35.94 años. Predominaron las instituciones laborales (n = 60; 83,3%). El mecanismo de lesión más frecuente fueron los accidentes de tránsito (n = 42; 58,3%), seguidos de las caídas de altura (n = 26; 36,1%). El 86% sufrió una o más lesiones asociadas. Se registraron 283 complicaciones en 67 (93,1%) pacientes y 45 complicaciones quirúrgicas en 26 pacientes (36,1%). La mediana de complicaciones fue mayor en pacientes operados tardíamente (p = 0,004). Conclusiones:Los pacientes con luxofractura toracolumbar operados después de las primeras 24 h presentaron una mediana de complicaciones totales significativamente mayor que los operados precozmente. Nnivel de Evidencia: IV

Introduction: Thoracolumbar fracture-dislocations account for 10% of traumatic spinal injuries and typically occur in the context of high-energy trauma. Our objective is to compare early complications in patients with thoracolumbar fracture-dislocation based on surgical timing, either before or after 24 hours from the trauma.materials and methods: This is a multicenter, retrospective cohort study of patients surgically treated for thoracolumbar dislocations, from January 1, 2014 to January 1, 2023. We included adult patients (>18 years old) of any gender, surgically treated for high-energy thoracolumbar fracture-dislocations. Patients were grouped based on when they underwent spinal surgery: before or after 24 hours following trauma. Total and grouped complications were recorded. Results: Our sample comprised 72 patients, with 64 men (88.9%) and 8 women (11.1%) at an average age of 35.94 years. Occupational health care centers were predominant (n=60; 83.3%). Road traffic accidents (n=42; 58.3%) were the most frequent cause of injury, followed by falls from height (n=26; 36.1%). Furthermore, 86% of patients had one or more associated injuries. In total, 283 complications were recorded, with 67 patients (93.1%) suffering at least one complication, and 26 patients (36.1%) experiencing surgical complications. The median number of complications was significantly higher in late-operated patients (p=0.004). Conclusions: Patients with thoracolumbar dislocations who underwent surgery after the first 24 hours following trauma had a significantly higher median rate of complications than those who underwent early surgery. Level of Evidence: IV

Tratamiento de las fracturas cervicales aisladas de tipo "masa lateral flotante": serie de casos / Treatment of isolated "floating lateral mass" fractures of the cervical spine: A case series

Objetivo: Presentar una serie de casos de pacientes con fracturas cervicales de tipo "masa lateral flotante" con énfasis en describir el rol de la lesión discal en la potencial inestabilidad segmentaria. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de pacientes con fracturas facetarias de tipo "masa lateral flotante", aisladas, diagnosticadas entre el 1 de enero de 2016 y el 1 de enero de 2022. Se incluyeron pacientes con lesiones de tipo "masa lateral flotante" según la clasificación AO, diagnosticadas por tomografía computarizada y, al menos, 6 meses de seguimiento. Se excluyó a aquellos con fracturas patológicas, lesiones por fragilidad ósea y registros incompletos. Resultados: Se analizó a 16 pacientes (media de la edad 42.86; DE 12,396), con predominio del sexo masculino (81,25%). El 68,75% tenía una lesión del disco intervertebral en el segmento fracturado y el 18,75%, anterolistesis. A 11 pacientes se les propuso un tratamiento conservador durante 12 semanas. La fractura consolidó en el 45,4% y 6 (54,6%) evolucionaron con traslación. El fracaso del tratamiento conservador se asoció con lesión del disco intervertebral. Once pacientes fueron operados, en su mayoría, con artrodesis cervical anterior monosegmentaria. Conclusiones: En esta serie de casos, la presencia de una lesión asociada del disco intervertebral fue más frecuente cuando el tratamiento conservador fracasó y cuando se decidió una artrodesis como tratamiento inicial. La mayoría de las cirugías se realizaron por vía anterior con discectomía y artrodesis cervical anterior en un único nivel, y se lograron buenos resultados. Nivel de Evidencia: IV

Introduction: We report a series of patients with "floating lateral mass" cervical fractures, focusing on the role of disc injury in potential segmental instability. materials and methods: We conducted a descriptive and retrospective study on a case series of isolated floating lateral mass facet fractures diagnosed between January 1, 2016 and January 1, 2022. Patients with floating lateral mass lesions according to the AO classification, diagnosed by computed tomography, and at least 6 months of follow-up were included. Patients with pathological fractures, bone fragility injuries and incomplete records were excluded. Results: We included 16 cases, the average age was 42.86 (SD 12.396), and the majority were male (n=13; 81.25%). 68.75% (n=11) had intervertebral disc injury in the fractured segment, while 18.75% (n=3) had anterolisthesis. Conservative treatment was proposed for 12 weeks in 11 patients (68.75%), of whom 5 (45.4%) achieved fracture healing and 6 (54.6%) progressed to translation. Cases where conservative treatment failed were associated with intervertebral disc injury. Eleven patients were treated surgically, mostly with monosegmental anterior cervical arthrodesis. Conclusions: We report a series of cases in which the existence of an associated intervertebral disc injury was more frequent in patients with failed conservative treatment and in those initially treated with arthrodesis. Most of the surgical cases were treated using an anterior approach with discectomy and anterior cervical arthrodesis at a single level, with favorable outcomes. Level of Evidence: IV

Spinal Cord Alignment in Patients with Thoracolumbar Burst Fracture / Alinhamento espinopélvico em pacientes com fratura toracolombar explosão

Abstract Objective To evaluate the spinopelvic alignment in patients with thoracolumbar burst fracture (TBF) without neurological deficit treated nonsurgically and surgically in a tertiary reference trauma hospital. Method Retrospective cross-sectional study of patients with single level, type A3 and A4 AOSpine TBF only of the thoracolumbar region. Analysis of clinical data, low back pain (visual analogue scale [VAS]), Denis Pain Scale, quality of life (SF-36), sagittal (TC, TLC, LL, SVA) and spinopelvic (IP, PV, SI, PI-LL) radiographic parameters of patients treated surgically and nonsurgically. Results A total of 50 individuals with an average age of 50 years old with a mean follow-up of 109 months (minimum of 19 and maximum of 306 months) were evaluated. There was a significant difference between treatments for the Denis Work Scale (p= 0.046) in favor of nonsurgical treatment. There was no significant difference between the treatments for lower back pain VAS and Denis Pain Scale (p= 0.468 and p= 0.623). There was no significant difference between treatments in any of the domains evaluated with the SF-36 (p> 0.05). Radiographic parameters were not different between the analyzed groups; however, all radiographic parameters showed significant difference between the population considered asymptomatic, except for pelvic incidence (p< 0.005). Conclusions The spinopelvic alignment was normal in patients with TBF without neurological deficit treated nonsurgically and surgically after a minimum follow-up of 19 months. However, they presented a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared with the reference values of the Brazilian population.

Resumo Objetivo Avaliar o alinhamento espinopélvico em pacientes com fratura toracolombar do tipo explosão (FTE) sem déficit neurológico tratados de forma não operatória e operatória em um hospital terciário de referência em trauma. Método Estudo transversal retrospectivo de pacientes com FTE apenas da região toracolombar, de nível único, do tipo A3 e A4 AOSpine. Análise de dados clínicos, dor lombar (escala visual analógica [EVA]), Escala de Denis, qualidade de vida (SF-36), parâmetros radiográficos sagitais (cifose torácica [CT], cifose toracolombar [CTL], lordose lombar [LL] e eixo vertical sagital [EVS]) e espinopélvicos (incidência pélvica [IP], versão pélvica [VP], inclinação sacral [IS] e a discrepância entre incidência pélvica e lordose lombar [IP-LL]) de pacientes tratados de forma operatória e não operatória. Resultados O presente estudo avaliou um total de 50 indivíduos com uma média de 50 anos de idade com acompanhamento médio de 109 meses (mínimo de 19 e máximo de 306 meses). Houve diferença significativa entre os tratamentos para Denis trabalho (p= 0,046) a favor do tratamento não operatório. Não houve diferença significativa entre os tratamentos para EVA dor lombar e Denis dor (p= 0,468 e p= 0,623). Não houve diferença significante entre os tratamentos em nenhum dos domínios avaliados do SF-36 (p> 0,05). Parâmetros radiográficos não se mostraram diferentes entre os grupos analisados; contudo, todos os parâmetros radiográficos mostraram diferença significante entre a população considerada assintomática, com exceção da incidência pélvica (p< 0,005). Conclusões O alinhamento espinopélvico foi normal em pacientes com FTE sem déficit neurológico tratados de forma não operatória e operatória, após acompanhamento mínimo de 19 meses. Entretanto, estes pacientes apresentaram maior média de versão pélvica e de discrepância entre lordose lombar e incidência pélvica quando comparados com os valores de referência da população brasileira.

Epidemiology of vertebral fractures evaluated at iot-fmusp from 2019 to 2022 / Epidemiologia das fraturas vertebrais avaliadas no iot-fmusp de 2019 a 2022 / Epidemiología de fracturas vertebrales evaluadas en iot-fmusp del2019 al 2022

ABSTRACT: Objective: To determine the epidemic profile of patients with spinal fractures referred for evaluation by Spine Group of IOT-HCFMUSP between 2019 and 2022. To enable the effect of the Covid-19 Pandemic on these epidemic profiles. Methods: We retrospectively analyzed the medical records of patients with spinal fractures referred by the São Paulo Center for the Regulation of Health Offers and Services (CROSS) to the Spine Group of IOT-HCFMUSP between 2019 and 2022. The epidemiological profile between the pre-pandemic Covid-19 period and the period of the Covid-19 pandemic until December 2022 in the city of São Paulo was compared. Results: The medical records of 427 patients were analyzed between March 2019 and December 2022. During the period, males accounted for 71.9% of cases, and the mean age was 46.7 years. Falls from heights were the most frequent trauma mechanism (63.7%), followed by motorcycle accidents (14.3%). The absence of neurological deficit occurred in 76.8% of the cases, and the most injured region was the lumbar region (39.3%). There were changes in the epidemiological profile during the Covid-19 pandemic compared to the pre-pandemic. Conclusions: A predominance of middle-aged males was observed, in addition to the trauma mechanism of falling from a height, as well as the absence of a neurological deficit in the initial evaluation. The lumbar and cervical regions were the most frequent sites of injury. The pandemic period interfered with the epidemiological profile presented and in the time interval between the injury and the evaluation at the IOT-HCFMUSP. Level of Evidence IV; Case Series.

RESUMO: Objetivos: Determinar o perfil epidemiológico dos pacientes com fraturas na coluna vertebral encaminhados para avaliação pelo Grupo de Coluna do IOT-HCFMUSP entre 2019 e 2022. Avaliar o efeito da Pandemia de Covid-19 sobre esse perfil epidemiológico. Métodos: Foram analisados retrospectivamente os prontuários dos pacientes com fratura na coluna encaminhados pela Central de Regulação de Ofertas e Serviços de Saúde (CROSS) de São Paulo ao Grupo de Coluna do IOT-HCFMUSP entre os anos de 2019 e 2022. Foi comparado o perfil epidemiológico entre o período pré-pandemia Covid-19 e o período de pandemia Covid-19 até dezembro de 2022 na cidade de São Paulo. Resultados: Analisou-se o prontuário médico de 427 pacientes entre março de 2019 e dezembro de 2022. No período o sexo masculino correspondeu a 71,9% dos casos, a média da idade foi de 46,7 anos. Queda de altura foi o mecanismo de trauma mais frequente (63,7%), seguido de acidentes de motocicleta (14,3%). A ausência de déficit neurológico ocorreu em 76,8% dos casos, bem como a região mais lesada foi a lombar (39,3%). Houveram mudanças no perfil epidemiológico durante a pandemia de Covid 19 em relação à pré-pandemia. Conclusões: Observado predomínio do sexo masculino de meia idade, além do mecanismo de trauma de queda de altura, bem como ausência de déficit neurológico a avaliação inicial. A região lombar e cervical foram os locais mais frequentes de lesão. O período pandêmico interferiu no perfil epidemiológico apresentado e nos intervalos de tempo entre a lesão e a avaliação no IOT-HCFMUSP. Nível de Evidência IV; Série de Casos.

RESUMEN: Objetivos: Determinar la epidemiología de los pacientes con fracturas vertebrales evaluadas por el Grupo de Columna IOT-HCFMUSP entre 2019 y 2022. Evaluar el efecto de la Pandemia Covid-19 sobre esta epidemiología. Métodos: Análisis retrospectivo de historias clínicas de pacientes con fracturas de columna remitidos por el Central de Regulação de Ofertas e Serviços de Saúde (CROSS) de São Paulo al Grupo de Columna IOT-HCFMUSP entre 2019 y 2022. Se comparó el perfil epidemiológico entre el periodo de la pre-pandemia de Covid-19 y el período de pandemia de Covid-19 hasta diciembre de 2022. Resultados: Serie de casos de 427 pacientes entre marzo de 2019 y diciembre de 2022. En el período, el sexo masculino representó el 71,9% de los casos, la edad promedio fue de 46,7 años. La caída de altura fue el mecanismo traumático más común (63,7%), seguido de los accidentes de motocicleta (14,3%). La ausencia de déficit neurológico se presentó en el 76,8% de los casos, siendo la región lumbar (39,3%) la región más lesionada. Hubo cambios en el perfil epidemiológico durante la pandemia de Covid-19 con relación a la prepandemia. Conclusiones: Hubo predominio del sexo masculino, caídas de altura como mecanismo traumático y ausencia de déficit neurológico en la evaluación inicial. La región lumbar y cervical fueron los sitios de lesión más frecuentes. El período pandémico interfirió con el perfil epidemiológico presentado y los intervalos de tiempo entre la lesión y la evaluación en el IOT-HCFMUSP.

Retrospective analysis of spinal fracture cases in a tertiary hospital / Análise retrospectiva dos casos de fratura de coluna em um hospital terciário / Análisis retrospectivo de casos de fractura de columna en un hospital terciario

ABSTRACT: Objective: To evaluate the clinical and epidemiological profile of patients diagnosed with spinal fractures treated at Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ), from the municipality of São José/SC, from March 2020 to March 2021. Methods: An observational study was carried out with a cross-sectional design and analysis of secondary data obtained by reviewing electronic medical records of patients diagnosed with spinal fractures treated during the study period. Associations of categorical variables were tested using Pearson's chi-square test. The statistical significance level adopted was 5% (p<0.05). Results: 173 individuals participated in the study. There was a predominance of males, with 120 (70.5%) cases. The most frequent trauma was falling from a height (43.4%), followed by trauma from traffic accidents (37.6%). In the AO Classification, A1 was attributed in 35.8% of the cases, and the Frankel Scale had mostly E (90.8%). The approach to fractures was predominantly conservative (70.5%). The most injuries were in the lumbar spine (93). Conclusion: The risk group for spine fractures consists of young men, with a predominance of falls as a mechanism of trauma and lumbar involvement. It is necessary to establish preventive measures aimed at the public at risk. Since spine fractures are important determinants of morbidity and mortality in the population. Level of Evidence II; Type of study: Prognostic study.

RESUMO: Objetivo: Avaliar o perfil clínico e epidemiológico dos pacientes com diagnóstico de fratura de coluna atendidos no Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ), do município de São José/SC, no período de março de 2020 a março de 2021. Métodos: Foi realizado um estudo observacional com delineamento transversal e análise de dados secundários obtidos por meio da revisão de prontuários eletrônicos, dos pacientes com diagnóstico de fratura de coluna atendidos no período de estudo. As associações das variáveis categóricas foram testadas pelo teste de Qui-quadrado de Pearson. O nível de significância estatística adotado foi de 5% (valor de p<0,05). Resultados: Participaram do estudo 173 indivíduos. Obteve-se predomínio do sexo masculino com 120 (70,5%) dos casos. O trauma mais frequente foi o de queda de altura (43,4%), seguido por traumas provenientes de acidentes de trânsito (37,6%). Na Classificação AO, a A1 foi atribuída em 35,8% dos casos e a Escala de Frankel teve em sua maioria E (90,8%). A abordagem das fraturas teve predomínio por conduta conservadora (70,5%). Os maiores acometimentos de lesão foram em coluna lombar (93). Conclusão: O grupo de risco para fraturas de coluna constitui-se por homens jovens, com predomínio de quedas como mecanismo de traumas e acometimento lombar. É necessário que se estabeleçam medidas de prevenção voltadas para o público de risco. Nível de Evidência II; Tipo de estudo: Estudo prognóstico.

RESUMEN: Objetivo: Evaluar el perfil clínico y epidemiológico de los pacientes con diagnóstico de fractura de columna atendidos en el Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ), del municipio de São José/SC, de marzo de 2020 a marzo de 2021. Métodos: Se realizó un estudio observacional con diseño transversal y análisis de datos secundarios obtenidos a través de la revisión de historias clínicas electrónicas de pacientes con diagnóstico de fractura de columna atendidos durante el periodo de estudio. Las asociaciones de variables categóricas se probaron mediante la prueba de chi-cuadrado de Pearson. El nivel de significancia estadística adoptado fue del 5% (p<0,05). Resultados: 173 personas participaron en el estudio. Hubo predominio del sexo masculino con 120 (70,5%) de los casos. El traumatismo más frecuente fue la caída de altura (43,4%), seguido del traumatismo por accidente de tráfico (37,6%). En la Clasificación AO se atribuyó A1 en el 35,8% de los casos y la Escala de Frankel tuvo mayoritariamente E (90,8%). El abordaje de las fracturas fue predominantemente conservador (70,5%). La mayoría de las lesiones fueron en la columna lumbar (93). Conclusión: El grupo de riesgo para las fracturas de columna está formado por hombres jóvenes, con predominio de caídas como mecanismo de traumatismo y afectación lumbar. Es necesario establecer medidas preventivas dirigidas al público en riesgo. Nivel de Evidencia II; Tipo de estudio: Estudio pronóstico.

Lesiones vertebrales postraumáticas / Post-traumatic vertebral injuries

Introducción: Las lesiones raquídeas son frecuentes en hombres adultos jóvenes. Reconocer la cinemática ayuda a disminuir la tasa de diagnósticos tardíos, principalmente si hay trastornos de la conciencia. Las fracturas vertebrales pueden ser únicas o múltiples, y asociarse con lesiones extravertebrales. Los objetivos de este estudio fueron analizar la distribución de la lesión según el mecanismo de producción, caracterizar el cuadro neurológico, evaluar el patrón de lesión y la asociación con lesiones extra-vertebrales, y analizar el tratamiento. materiales y métodos: Estudio multicéntrico, prospectivo de pacientes con lesiones vertebrales postrauma, que ingresaron entre el 1 de julio de 2018 y el 30 de junio de 2020. Se analizaron los siguientes parámetros: edad, sexo, cinemática, cuadro neurológico, sector afectado, patrón de lesión, lesiones extravertebrales asociadas. Resultados: Se evaluó a 281 pacientes (60% hombres) con 400 lesiones vertebrales y 118 extravertebrales que, en 62 casos, conformaban un cuadro de politraumatismo; 147 con trauma por caída de altura y 98, por accidente de tránsito. El cuadro neurológico más observado fue ASIA E (8 casos), no determinado al ingreso. El sector T2-L5 fue el más afectado, en su mayoría, por lesiones por compresión. Las lesiones extravertebrales más frecuentes fueron el trauma de cráneo y de tórax; hubo un caso de SCIWORA y un óbito temprano. Conclusiones: Los sectores raquídeos más afectados fueron: el toracolumbar, el torácico y el lumbar; las lesiones suelen deberse a caídas de altura y suelen ser únicas, sin cuadro neurológico. El tratamiento se decide según la estabilidad y el cuadro neurológico. Nivel de Evidencia: IV

Introduction: Spinal injuries are common among young adult men. Recognizing kinematics can help reduce the number of late diagnoses, especially if there are consciousness disorders. Vertebral fractures can be single or multiple, and they are often associated with extravertebral injuries. Objectives: To examine the distribution of the lesion based on the mechanism of production, to characterize the neurological condition, to evaluate the lesion pattern and its relationship with extravertebral lesions, and to analyze the treatment. materials and methods:This was a multicenter, prospective study of patients admitted with post-trauma vertebral injuries between July 1, 2018 and June 30, 2020. Age, gender, kinematics, neurological condition, affected sector, pattern of injury, and associated extravertebral injuries were all examined. Results: There were 281 patients (60% men) evaluated, with 400 vertebral and 118 extravertebral lesions. The causes were as follows: polytrauma in 62 cases, falls from great heights in 147 patients, and traffic accidents in 98. ASIA E was the most frequently observed neurological picture (8 cases), which was not determined at admission. The T2-L5 sector was the most affected, mostly by compression injuries. Head and chest trauma were the most common extravertebral injuries; there was one case of SCIWORA and one early death. Conclusions: The most commonly affected spinal sectors were thoracolumbar, thoracic, and lumbar; the injuries are typically caused by falls from great heights and, in general, are isolated, with no neurological injuries. The treatment is determined by the stability and neurological condition. Level of Evidence: IV

Análisis de pacientes con lesiones vertebrales por proyectil de arma de fuego según el retorno laboral / Analysis of patients with vertebral gunshot injuries according to return to work

Introducción: Las lesiones vertebrales por arma de fuego representan el 13-17% de las lesiones vertebrales traumáticas con presentación clínica variable. El objetivo de este estudio fue comparar las características demográficas y clínico-terapéuticas de pacientes que sufrieron lesiones vertebrales por arma de fuego en el contexto de accidentes laborales, según la posibilidad de retorno laboral. materiales y métodos: Estudio analítico, observacional y retrospectivo de pacientes con lesión vertebral por arma de fuego en accidentes de trabajo, entre enero de 2012 y marzo de 2022. Se registraron variables sociodemográficas y relacionadas con el siniestro, la atención inicial, la lesión vertebral, el tratamiento, la evolución y el retorno laboral. Resultados: Se evaluó a 22 pacientes (15 hombres y 7 mujeres; media de la edad 32.5 años). El 54% eran trabajadores de fuerzas de seguridad; no obstante, el 82% de los accidentes se había producido in itinere. El 90% tenía lesiones asociadas. Doce (55%) requirieron cirugía y 10 (45%), tratamiento conservador. El 81% sufrió complicaciones. Doce (54%) regresaron al trabajo, un tercio fue recalificado y 9 requirieron la baja laboral. Se halló una asociación estadística entre pacientes con baja laboral permanente y topografía torácica (p = 0,005), daño neurológico severo (p = 0,004), incidencia transfixiante o penetrante (p = 0,005), requerimiento de tratamiento psiquiátrico crónico (p = 0,012) y más días de incapacidad laboral temporaria (p = 0,001). Conclusión: La baja laboral permanente se asoció con lesiones torácicas, transfixiantes o penetrantes, compromiso neurológico severo y requerimiento de tratamiento psiquiátrico clínico-farmacológico crónico. Nivel de Evidencia: IV

Introduction: Firearm spinal injuries account for 13-17% of all traumatic spinal injuries, with varying clinical manifestations. The goal of this study was to examine the demographic and clinical-therapeutic characteristics of patients who suffered spinal injuries as a consequence of gunshots in the context of workplace incidents, based on how soon they could return to work. materials and methods: An analytic, observational, and retrospective study of patients with spinal injuries caused by firearms in workplace incidents between January 2012 and March 2022 was conducted. Variables associated with the incident, initial assessment, spinal injury, treatment, progression, and return to work were recorded. Results: Twenty-two individuals were evaluated (15 men and 7 women; mean age 32.5 years). 54% were law enforcement officers, yet 82% of the accidents happened on the job. 90% had associated injuries. Twelve (55%) required surgery, while ten (45%) required conservative treatment. 81% had complications. Twelve patients (54%) returned to work, one-third were requalified, and nine needed sick leave. Patients on permanent sick leave had a statistically significant relationship with chest topography (p = 0.005), severe neurological damage (p = 0.004), transfixing or penetrating injuries (p = 0.005), the need for chronic psychiatric treatment (p = 0.012), and more days of temporary incapacity for work (p = 0.001). Conclusion: In our series, permanent sick leave was associated with thoracic, transfixing, or penetrating injuries, severe neurological compromise, and the need for chronic clinical-pharmacological psychiatric treatment. Level of Evidence: IV

Columna vertebral flotante y otras variantes de la asociación de múltiples fracturas vertebrales inestables simultáneas / Floating spine and other types of associated multiple simultaneous unstable spinal fractures

ntroducción: El objetivo de este estudio fue evaluar a una serie de pacientes con la asociación de múltiples fracturas vertebrales inestables (tipo B o C) simultáneas. Materiales y métodos: Estudio descriptivo de pacientes con trauma vertebromedular de alta energía y asociación de múltiples fracturas vertebrales inestables simultáneas entre enero de 2015 y enero de 2021. Se incluyó a pacientes con fracturas vertebrales múltiples tipo B (asociación de lesión ligamentaria) o tipo C (evidencia de subluxación/luxación). Se excluyó a pacientes con registros incompletos de historias clínicas, fracturas por osteoporosis o patológicas y seguimiento <3 meses. Resultados: Se constataron 5 pacientes (1 mujer y 4 hombres) con dos fracturas vertebrales inestables simultáneas, con 4 casos (80%) de fracturas no contiguas y 3 casos (60%) con 2 luxofracturas simultáneas no contiguas ("columna flotante"); 2 (40%) pacientes presentaron la asociación de una fractura tipo B con una tipo C. La mediana de la edad era de 35 años. Todos tenían traumatismos de alta energía con lesiones asociadas. Los pacientes fueron operados por vía posterior convencional, con reducción y artrodesis larga. Se constató la recuperación neurológica en 2 pacientes. Conclusión: Presentamos una serie de casos de múltiples fracturas vertebrales inestables (tipo B o C) y simultáneas por traumatismos de alta energía. Esta asociación de lesiones es poco frecuente y tiene una elevada morbilidad relacionada con el trauma vertebral, sistémico y neurológico. Nivel de Evidencia: IV

ntroduction: We intend to present a series of patients with associated multiple and simultaneous unstable spinal fractures (Type B or C). materials and methods: A descriptive analysis of patients with high-energy spinal cord injuries and associated multiple unstable and simultaneous spinal fractures from January 2015 to January 2021 was conducted. Patients with type B (ligament injury) and/or type C (subluxation/dislocation) multiple spinal fractures were included. Patients with incomplete medical records, osteoporotic or pathological fractures, or fewer than 3 months of follow-up were excluded. Results: We included 5 patients (1 woman and 4 men) with two simultaneous unstable spinal fractures, including 4 cases (80%) of non-contiguous fractures and 3 (60%) with two simultaneous non-contiguous fracture dislocations ("floating spine"); 2 (40%) cases had a type B fracture associated with a type C fracture. The median age was 35 years. High-energy trauma with associated injuries occurred in all cases. All patients were surgically treated with a conventional posterior approach, reduction, and long arthrodesis. In two patients, neurological recovery was confirmed. Conclusion: A case series of multiple simultaneous unstable spinal fractures (type B or C) caused by high-energy trauma is presented. This is a rare injury association with significant morbidity associated with spinal, systemic, and neurological trauma. Level of Evidence: IV

Trauma no accidental de columna toracolumbar en un niño de 10 meses / Non-accidental trauma to the thoracolumbar spine in a 10-month-old child

Presentamos el caso de un niño de 10 meses con fractura-subluxación inveterada de la columna toracolumbar, sin daño neurológico, a causa de un trauma no accidental por mecanismo desconocido. Para evaluar la estabilidad espinal se utilizó el sistema de clasificación de la gravedad de las lesiones toracolumbares de Vaccaro. Se realizó una osteosíntesis pedicular segmentaria. Se analizó y comparó el caso presentado con otros publicados. Se actualizaron los datos registrados por Unicef sobre violencia infantil en la República Argentina, no sin antes definir claramente el tema, el marco legal y realizar una sucinta reseña histórica. Nivel de Evidencia: IV

We present the case of a 10-month-old boy with a chronic thoracolumbar spine fracture-subluxation without neurological damage caused by an unknown mechanism of non-accidental trauma. To assess stability, we used the scoring system for thoracolumbar injuries according to Vaccaro et al. We performed a segmental pedicle osteosynthesis. We analyzed and compared our case with others in the available literature. We updated UNICEF data on child violence in Argentina, but not before clearly defining the subject, and the legal framework, and providing a brief historical review. Level of Evidence: IV

Impact of covid-19 on spine surgeries in a high complexity emergency hospital / Impacto do covid-19 nas cirurgias de coluna em um hospital de urgências de alta complexidade / Impacto del covid-19 en las cirugías de columna en un hospital de urgencias de alta complejidad

ABSTRACT: Objective: To study the impact of the COVID-19 pandemic on spine surgeries at a Reference Center for High Complexity Urgencies in Goiás. Methods: A retrospective, observational study was carried out based on data from medical records of patients undergoing spine surgery between September 2017 and September 2021. Volunteers were divided into two groups: before and during the pandemic, considering April 2020 as a starting point. The following was extracted from the medical records: age, gender, education, etiology, neurological deficit, region of the spine addressed, mechanism of trauma, fractured vertebrae, type of fracture, length of stay in the ICU, COVID test (PCR), and deaths. Student t, chi-square, and Fisher's exact statistical tests were used to compare the preand post-pandemic profiles. In addition, Spearman's correlation test was applied to verify the correlation between variables, considering p<0.05. Results: 388 medical records were analyzed, showing a 15% increase in spine surgeries during the pandemic. There was a significant difference in the etiology of surgeries (p=0.05), with lumbar trauma being more prevalent in men and also more cases of neurological deficits (p=0.001). There was also a reduction in the length of stay in the ICU (p=0.0001), which was lower during the pandemic. Conclusion: The COVID-19 pandemic did not directly impact the number of surgeries performed at a Reference Hospital in High Complexity Urgencies in Goiás, but there was a prioritization of emergency surgeries. Level of Evidence II; Retrospective Study.

RESUMO: Objetivo: Estudar o impacto da pandemia de COVID-19 nas cirurgias de coluna em um Centro de Referência em Urgências de Alta Complexidade em Goiás. Métodos: Foi realizado um estudo retrospectivo, observacional a partir de dados de prontuários médicos de pacientes submetidos à cirurgia de coluna entre setembro de 2017 a setembro de 2021. Os voluntários foram divididos em dois grupos: antes da pandemia e durante a pandemia, considerando abril de 2020 como marco de início. Foram extraídos dos prontuários: idade, gênero, escolaridade, etiologia, déficit neurológico, região da coluna abordada, mecanismo de trauma, vértebras fraturadas, tipo de fratura, tempo de internação em UTI, teste de COVID (PCR) e óbitos. Utilizou-se os testes estatísticos T de Student, Qui quadrado e exato de Fisher para realizar a comparação entre o perfil pré e pós-pandemia. Além disso, foi aplicado o teste de correlação de Spearman para verificar a correlação entre as variáveis, considerando p<0,05. Resultados: Foram analisados 388 prontuários, constatando um aumento de 15% nas cirurgias de coluna durante a pandemia. Houve diferença significativa na etiologia das cirurgias (p=0,05), sendo mais prevalentes traumas lombares em homens e também mais casos de déficits neurológicos (p=0,001). Notou-se também uma redução no tempo de internação na UTI (p=0,0001), que foi menor durante a pandemia. Conclusão: A pandemia de COVID-19 não impactou diretamente na quantidade de cirurgias realizadas em um Hospital de Referência em Urgências de Alta Complexidade em Goiás, mas verificou-se uma priorização das cirurgias emergenciais. Nível de Evidência II; Estudo Retrospectivo.

RESUMEN: Objetivo: Estudiar el impacto de la pandemia de COVID-19 en las cirugías de columna en un Centro de Referencia para Urgencias de Alta Complejidad en Goiás. Métodos: Se realizó un estudio observacional retrospectivo a partir de datos de historias clínicas de pacientes operados de la columna entre septiembre de 2017 y septiembre de 2021. Los voluntarios se dividieron en dos grupos: antes de la pandemia y durante la pandemia, considerando abril de 2020 como punto de partida. De las historias clínicas se extrajo: edad, sexo, escolaridad, etiología, déficit neurológico, región de la columna abordada, mecanismo del trauma, vértebras fracturadas, tipo de fractura, tiempo de estancia en la UCI, test COVID (PCR) y fallecidos. Se utilizaron las pruebas estadísticas t de Student, chi-cuadrado y exacta de Fisher para comparar el perfil pre y postpandemia. Además, se aplicó la prueba de correlación de Spearman para verificar la correlación entre las variables, considerando p<0,05. Resultados: se analizaron 388 historias clínicas, mostrando un aumento del 15% en las cirugías de columna durante la pandemia. Hubo una diferencia significativa en la etiología de las cirugías (p=0,05), siendo más frecuente el traumatismo lumbar en los hombres y también más casos de déficit neurológico (p=0,001). También hubo una reducción en la estancia en la UTI (p=0,0001), que fue menor durante la pandemia. Conclusión: La pandemia de COVID-19 no impactó directamente en el número de cirugías realizadas en un Hospital de Referencia en Urgencias de Alta Complejidad en Goiás, pero hubo una priorización de las cirugías de emergencia. Nivel de Evidencia II; Estudio Retrospectivo.

Retrospective study on the incidence of cats and dogs' spinal injuries by computed tomographic scan. Part I: Cervical and Cervicothoracic / Estudo retrospectivo sobre incidência de injúrias em coluna vertebral de cães e gatos por meio de exame tomográfico. Parte I: Cervical e Cervicotorácica

Injuries involving the spine are frequent in dogs and knowledge of them is important to define the patient's treatment and prognosis. The objective of this retrospective study was to describe the epidemiological profile of animals and lesions in the cervical (C1-5) and cervicothoracic (C6-T2) spine diagnosed through tomographic examination. Compilation of computed tomography (CT) reports for the referred regions was carried out in a diagnostic center between 01/04/2017 and 30/04/2020, with or without contrast, from the clinical routine, in order to relate the most common lesions and their locations, as well as the species, breeds and ages most affected. A total of 1164 CT scans were performed in the period, 57.56% (n=670/1164) for the spine, with 89.7% (n=601/670) reports accessed, where both regions referred to here totaled 26.95% of the studies (n=162/601). Male mixed-breed dogs (MBD) showed the most lesions. For the cervical spine, the most identified lesion was disk extrusion and the site was C3-C4, while the mean age for lesions was 8.09±3.55 years. As for cervicothoracic, disk mineralization was more frequent and the mean age for lesions was 6.96±2.93 years. It was concluded that the spine is the main target of CT scans, that lesions related to the intervertebral disk were the main ones identified, and older MBD animals are the main ones affected.

As lesões envolvendo coluna vertebral são frequentes em animais de companhia, podendo ocorrer à nível vertebral, medula espinal, disco intervertebral, meninges ou raízes nervosas, e o conhecimento das mesmas é importante para definir o tratamento e prognóstico do animal. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral cervical (C1-5) e cervicotorácica (C6-T2) diagnosticadas por meio de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina clínica, a fim de relacionar as lesões, raças e locais mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670/1164) para a coluna, com 89,7% dos laudos acessados (n=601/670), sendo que as regiões cervical e cervicotorácica somaram 26,95% dos estudos (n=162/601). Em ambas regiões, os cães sem raça definida (SRD) machos foram os que mais demonstraram lesões. Para a coluna cervical, a lesão mais identificada foi extrusão de disco e o local mais afetado foi C3-C4, enquanto a média de idade para lesões foi 8,09±3,55 anos. Já para cervicotorácica, a mineralização de disco foi mais frequente e média de idade para ocorrência de lesões foi de 6,96±2,93 anos. Concluiu-se que a coluna vertebral foi o principal alvo de tomografias, as lesões relacionadas ao disco intervertebral foram as mais identificadas, sendo animais SRD com idade avançada os mais acometidos.

Retrospective study on the incidence of cats and dogs' spinal injuries by computed tomographic scan. Part II: Thoracolumbar and lumbosacral / Estudo retrospectivo sobre incidência de injúrias em coluna vertebral de cães e gatos por meio de exame tomográfico. Parte II: Toracolombar e Lombossacral

For vertebromedullary injuries, epidemiological knowledge is essential to guide the choice of the most effective diagnostic method. The objective of this retrospective study was to describe the epidemiological profile of animals and thoracolumbar and lumbosacral spine lesions diagnosed by computed tomography scan. A compilation of CT scan reports for the aforementioned regions performed in a comercial diagnostic center from 04/01/2017 to 04/30/2020, contrasted and non-contrasted, from routine, was performed in order to list the most common lesions and their locations, as well as the species, breeds and ages most affected. There were 1164 CT scans performed in the period evaluated, all of them in dogs, 57,56% (n=670) for the spine, with 89,7% reports accessed (n=601), where the regions mentioned here added up to 73,05% studies (n=439). In both regions, male French Bulldog dogs had the most injuries. For the thoracolumbar region, disk mineralization, followed by extrusion, were the most frequent injuries, while the site was T12-13 and the mean age 6,5±3,63 years old. In the lumbosacral, disk protrusion was most frequent, the most affected site was L7-S1 and age 6,65±3,79 years. It was concluded that the spine is the main target of CT scans, and that lesions related to the intervertebral disk were the main ones identified, with chondrodystrophic animals being more predisposed to injury.

Para lesões vertebromedulares é indispensável o conhecimento epidemiológico para direcionar a escolha do método diagnóstico mais eficaz. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral toracolombar e lombossacral diagnosticadas através de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina, a fim de relacionar as lesões e seus locais de ocorrência, bem como a espécie, raças e idades mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670) para a coluna, com 89,7% laudos acessados (n=601), nos quais as regiões toracolombar e lombossacral somaram 73,05% dos estudos (n=439). Em ambas as regiões, os cães Bulldog Francês machos foram os que mais apresentaram lesões. Para a região toracolombar, a mineralização de disco, seguida pela extrusão, foram as lesões mais frequentes, enquanto o local foi T12-13 e a média de idade 6,5±3,63 anos. Na lombossacral, a protusão de disco foi mais frequente, o local mais afetado foi L7-S1 e idade de 6,65±3,79 anos. Concluiu-se que a coluna vertebral é o principal alvo de tomografias, e que as lesões relacionadas ao disco intervertebral foram as principais identificadas, sendo os animais condrodistróficos mais predispostos a lesões.

Fracturas vertebrales múltiples / Multiple vertebral fractures

Introducción: Las fracturas vertebrales múltiples son el resultado de traumatismos de alta energía. Se clasifican en contiguas cuando hay fractura de dos o más cuerpos vertebrales en forma adyacente y no contiguas cuando hay lesiones de varios niveles separadas por, al menos, una vértebra sin lesión. Objetivos: Evaluar la clínica y la cinemática de las fracturas vertebrales múltiples, establecer su distribución, evaluar la asociación con lesiones extravertebrales y detallar las complicaciones. Materiales y métodos: Estudio multicéntrico, prospectivo y observacional de pacientes con fracturas vertebrales múltiples. Resultados: 66 pacientes (26 mujeres y 40 hombres; promedio de edad 39 años) con 196 lesiones vertebrales, 55 no tenían déficit neurológico. Cinemática: 32 accidentes automovilísticos, 27 caídas de altura, 5 traumas directos y 2 traumas deportivos. Topografía: dos C0-C3, cuatro C3-C7, ocho C7-T1, 61 T1-T10, 91 T10-L2, 28 L2-L5 y una sacro. Combinación: 21 toracolumbar-toracolumbar y 8 torácica-torácica. Treinta y dos fracturas eran contiguas; 19, no contiguas y 15 tenían un patrón mixto. Veintiséis pacientes pre-sentaron 47 lesiones extravertebrales (20 politraumatismos), 12 traumas torácicos. Treinta y seis pacientes recibieron tratamiento conservador y 30 fueron operados. Conclusiones: La presencia de fracturas vertebrales múltiples es frecuente y son consecuencia de accidentes automovilísticos, la mayoría de los pacientes no tiene compromiso neurológico. El sector más afectado fue entre T2 y L5, la combinación más frecuente fue toracolumbar-toracolumbar, seguida de torácica-torácica. Las lesiones extravertebrales más frecuentes fueron traumatismos de cráneo y de tórax. Nivel de Evidencia: IV

Background: Multiple vertebral fractures (MVF) are the result of high-energy trauma. These can be contiguous (CMVF) when there is a fracture of two or more vertebral bodies in an adjacent way and non-contiguous (NCMVF) when there are lesions of various levels separated by at least one vertebra without injury. Objective: To evaluate clinical features and kinematics, establish distribution, evaluate association with extra-vertebral injuries, detail complications. materials and methods: A multicenter, prospective, and observational study. Patients with MVF. Results: Sixty-six patients presented 196 vertebral lesions, without neurological deficit in 55; 26 were women and 40 were men, with an average age of 39 years old. Kinematics: 32 car accidents, 27 falls from height, 5 direct traumas and 2 sports traumas. Topography: 2 C0-C3, 4 C3-C7, 8 C7TT1, 61 T1-T10, 91 T10-L2, 28 L2-L5 and 1 sacrum. Combination: 21 thoracolumbar-thoracolumbar and 8 thoracic-thoracic. There were 32 contiguous injuries, 19 non-contiguous injuries, and 15 mixed-pattern injuries. Twenty-six patients presented 47 extra-verterbral injuries (20 multiple trauma, 12 thoracic trauma). 36 patients received non-surgical treatment and 30 patients underwent surgery. Conclusion: The presence of MVF in spinal cord trauma is frequent, most do not show neurological involvement and are consequences of motor vehicle accidents. The most affected sector was between T2 to L5, the most frequent combination was thoracolumbar-thoracolumbar, followed by thoracic-thoracic; the most frequent were extra-vertebral injuries, mainly head and chest trauma. Complications: one patient had increased kyphosis; one, surgical site infection; and one patient died. Level of Evidence: IV

Protocol paper: kainic acid excitotoxicity-induced spinal cord injury paraplegia in Sprague-Dawley rats

BACKGROUND: Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method. METHODS: In this study, 0.05 mM KA was administered at dose of 10 µL/100 g body weight, at a rate of 10 µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher. RESULTS: This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment. CONCLUSIONS: Kainic acid intra-spinal injection at the concentration of 0.05 mM, and rate 10 µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.