Post-traumatic cervical spine epidural hematoma: Incidence and risk factors.

BACKGROUND: The incidence and risk factors for post-traumatic cervical epidural hematoma are not well described in the current literature. Our aim was to determine the incidence and associated risk factors for post-traumatic cervical spine epidural hematoma (SEH). METHODS: We performed a retrospective review of our institution's prospectively collected data submitted to the state trauma registry, using ICD-9 codes, for all patients activated as a trauma with cervical spine injuries, between the years 2010 and 2014. Patients with MRI available were classified based on the presence of cervical epidural hematoma (CEH) or no hematoma (NEH). For our second analysis, we classified patients with cord compression associated with an epidural hematoma (CC) and no cord compression (NCC). Potential risk factors evaluated included: INR, PTT, albumin and platelets levels, radiographic findings of Ankylosing Spondylitis (AS), and ISS. No conflicts of interest exist and/or funding was used for this study. RESULTS: 497 out of 1810 trauma activations met our inclusion criteria. 46 patients (2.5%) were found to have a post-traumatic cervical SEH (CEH). Of the CEH cohort, 76% were male, with 72% Caucasian, and a mean age of 55 years. 27 patients (5.4%) were found to have cervical cord compression at the level of the SEH. Of the CC arm, 78% were male, with 67% Caucasian, and a mean age of 56 years. A higher ISS and an elevated INR were found to be associated with epidural hematoma causing cord compression. CONCLUSIONS: An incidence of 2.5% is reported for post-traumatic cervical spine epidural hematoma. Of these, 59% had associated spinal cord compression. Patients with a higher ISS and elevated INR levels are at a higher risk for developing this potentially devastating.

Clinical and demographic characteristics of online community members--does it represent reality?

BACKGROUND: The decision to undergo surgery for scoliosis is shared between the physician, patient, and family. In an effort to obtain objective data regarding scoliosis surgery, patients often use the Internet, which includes sharing experiences in online communities. To this end, physicians have limited knowledge about disease-specific online communities. PURPOSE: To analyze the clinical and demographic characteristics of patients who use disease-specific online communities. STUDY DESIGN: A retrospective clinical study. PATIENT SAMPLE: One hundred ninety-five patients with scoliosis who are also members of a popular scoliosis-specific online community. MAIN OUTCOME MEASURES: Five domains of the Scoliosis Research Society-22 (SRS-22) quality-of-life questionnaire: function, pain, mental health, self-image, and satisfaction. METHODS: An online questionnaire was submitted by members of a scoliosis-specific online community. One hundred ninety-five patients with scoliosis fulfilled the inclusion criteria, which represented 54% of all active members who have logged into this community during the time of data collection. A descriptive analysis was performed for demographic and clinical characteristics. RESULTS: Analysis revealed a bimodal age distribution. Most online members were female (74%) and underwent surgical treatment (78%). Of all surgical patients, 52% had surgery between the age of 10 and 18 years. The average time since surgery (follow-up) was 10 years and 9 months. A revision rate of 17% was calculated, which increased with longer follow-up. Five of nine surgical subgroups significantly outperformed nonsurgical patients in regards of SRS-22 total scores. CONCLUSION: This study supports that members from an online scoliosis community may be the representative sample of the general scoliosis patient population. The information obtained may be useful for physicians to understand patient concerns and mitigate treatment expectations when counseling patients.

The prevalence of transitional vertebrae in the lumbar spine.

BACKGROUND CONTEXT: Lumbosacral transitional vertebrae (LSTVs) are a congenital vertebral anomaly of the L5-S1 junction in the spine. This alteration may contribute to incorrect identification of a vertebral segment, leading to wrong-level spine surgery and poor correlation with clinical symptoms. Although several studies describe the occurrence of this anomaly in back pain populations, investigation of the prevalence in the American general population is lacking. PURPOSE: To establish the prevalence rates for LSTVs in the general population. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: Consecutive kidney-urinary bladder (KUB) radiographs of subjects from the past 2 years (2008-2009). OUTCOME MEASURES: Clinical demographics, number of lumbar vertebrae, L5-S1 transverse process (TP) height, and rib length. METHODS: Consecutive adult KUB studies of adult subjects were queried with clear visibility of the last rib's vertebral body articulation, all lumbar TPs, and complete sacral wings. Exclusion criteria consisted of any radiologic evidence of previous lumbosacral surgery that would obstruct our measurements. A total of 1,100 abdominal films were reviewed, and 211 were identified as being adequate for the measurement of the desired parameters. RESULTS: Two hundred eleven subjects were identified as eligible for the study, and 75 (35.6%) were classified as positive for a transitional lumbosacral vertebra. The most common anatomical variant was the Castellvi Type IA (14.7%). The average age at the time of the KUB study was 59.8 years (18-95 years). One hundred ninety-seven subjects (93.4%) presented five lumbar (nonribbed) vertebrae, and only 14 (6.6%) had six lumbar vertebrae. CONCLUSIONS: The significance of lumbosacral transitional level changes to the establishment of pain, degenerative changes, stenosis, and disc disease have been well documented in symptomatic patients. Although LSTV's role in low back pain remains controversial, our study has shown that, when the same criteria are used for classification, prevalence among the general population and symptomatic patients may be similar.

Validity of Cobb angle measurements using digitally photographed radiographs.

BACKGROUND CONTEXT: Advances in technology are influencing the way that medical information is archived and shared. Considering that an estimated two-thirds of the world has little or no orthopedic care, high demand exists for adequate consultation regarding diagnostic images in orthopedic specialties. PURPOSE: To validate the use of photographed scoliosis films for the accurate interpretation of Cobb angles. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: Thirty scoliosis radiographs. OUTCOME MEASURE: Cobb angle. METHODS: Thirty scoliosis radiographs were photographed using a digital camera from a straight and a 45° angle position. Cobb angles were then measured on the digital images using standard measurement software. Comparison was made between two types of curves: convex and concave, relative to the left side (side for the angled position). RESULTS: There was excellent reproducibility between the measurements of the conventional radiographs and the photographs taken from a straight on position, p value of .97 for convex curves and p value of .98 for concave curves. Photographs taken from a 45° angle significantly increased the magnitude of the curve convex to the angle (p=.001). CONCLUSION: Sharing photographs of scoliosis radiographs can be done with reliability if the image is taken directly in front of the viewbox rather than at an oblique angle; pictures taken at oblique angles are prone to misinterpretation of curve magnitude.