Management of C0 Sacral Fractures Based on the AO Spine Sacral Injury Classification: A Narrative Review.

The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type fractures representing less severe injuries and C-type fractures representing the most severe fracture types. C0 fractures represent moderately severe injuries and have historically been referred to as nondisplaced "U-type" fractures. Injury management of these fractures can be controversial. Therefore, the purpose of this narrative review is to first discuss the Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification System and describe the different fracture types and classification modifiers, with particular emphasis on C0 fracture types. The narrative review will then focus on the epidemiology and etiology of C0 fractures with subsequent discussion focused on the clinical presentation for patients with these injuries. Next, we will describe the imaging findings associated with these injuries and discuss the injury management of these injuries with particular emphasis on operative management. Finally, we will outline the outcomes and complications that can be expected during the treatment of these injuries.

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.

Two-year prevalence of spinal gunshot injuries in Mexico: A single center experience.

OBJECTIVE: The purpose of this study is to report epidemiological and clinical data of the patients that were admitted with spinal gunshot injuries. METHODS: This was retrospective study and observational study. Patients who had a spinal injury secondary to a gunshot wound that was admitted to our hospital (level III trauma center) from July 2018 through July 2020 were included in the study. Demographic and clinical data including age, gender, civil status, occupation, level of injury (cervical, thoracic, or lumbar), degree of neurological impairment at admission, associated injuries, treatment established, length of hospital stay, and mortality rate were recorded. RESULTS: A total of 55 patients were included in the study, of which 50 patients (90.9%) were men and five female patients (9.09%). The average age was 30.2 years. Three patients died during hospitalization representing a mortality rate of 5.45%. CONCLUSIONS: Spinal gunshot injuries are associated with significant sequelae, requiring long and costly treatments. This study obtained one of the highest incidences of gunshot injuries to the spine reported in the literature.

OBJETIVO: El propósito de este estudio es reportar datos epidemiológicos y clínicos de los pacientes que ingresaron con heridas por arma de fuego en columna. MÉTODOS: Estudio retrospectivo y observacional. Se incluyeron pacientes que presentaban una lesión medular a secundaria a una herida por arma de fuego que ingresaron en nuestro hospital (centro de trauma de nivel III) desde julio de 2018 hasta julio de 2020. Se registraron datos demográficos y clínicos que incluían edad, sexo, estado civil, ocupación, grado de lesión (cervical, torácica o lumbar), grado de deterioro neurológico al ingreso, lesiones asociadas, tratamiento establecido, duración de la estancia hospitalaria y tasa de mortalidad. RESULTADOS: Se incluyeron en el estudio un total de 55 pacientes, de los cuales 50 pacientes (90,9%) eran hombres y 5 mujeres (9,09%). La edad media fue de 30,2 años. Tres pacientes fallecieron durante la hospitalización lo que representa una tasa de mortalidad del 5,45%. CONCLUSIONES: Las lesiones por arma de fuego en la columna están asociadas con secuelas importantes, que requieren tratamientos largos y costosos. Este estudio obtuvo una de las incidencias más altas de heridas por arma de fuego en la columna vertebral reportadas en la literatura.

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.

Colgajo muscular de esternocleidomastoídeo para el manejo de perforación esofágica tardía: reporte de dos casos / Muscle flap of sternocleidomastoid for the management of late esophageal perforation: report of two cases

Resumen Introducción: La perforación esofágica es una complicación poco frecuente en la cirugía de columna cervical por vía anterior, sin embargo, puede tener graves consecuencias cuando hay demoras en diagnóstico y tratamiento. Casos Clínicos: Presentamos dos casos clínicos de pacientes con perforación esofágica secundaria a cirugía de columna cervical por vía anterior. Se usaron para su reparación colgajo muscular de esternocleidomastoideo (ECM). Conclusión: La perforación esofágica secundaria a cirugía de columna cervical es poco frecuente, variable desde el punto de vista clínico, el TC y estudio radiológico contrastado son fundamentales en el diagnóstico de esta patología. El colgajo muscular ECM en estos casos es una herramienta fiable y extremadamente útil debido a sus características anatómicas, fácil disección quirúrgica y baja morbilidad asociada.

Introduction: Esophageal perforation is a rare complication in cervical spine surgery by anterior way, however it can have serious consequences when there are delays in diagnosis and treatment. Cases Report: We present two clinical cases of patients with esophageal perforation secondary to cervical spine surgery by anterior way. Sternocleido-mastoid muscle flaps were used for repair. Conclusion: Esophageal perforation secondary to cervical spine surgery is rare, clinically variable, CT and radiologic study are fundamental in the diagnosis of this pathology. The Sternocleidomastoid muscle flap in these cases is a reliable and extremely useful tool due to its anatomical characteristics, easy surgical dissection and low associated morbidity.

Back Pain in Children and Adolescents.

Back pain has long been considered an uncommon complaint in the pediatric population. When present, teaching had been that pediatric back pain almost always has a diagnosable cause, many of which are progressive and potentially debilitating. Recent evidence has suggested that pediatric back pain is not only more common than once thought but also, within certain populations, benign and idiopathic. This, in turn, places an increasing amount of pressure on pediatricians to accurately assess and manage their patients presenting with complaints of back pain. The aim of this article is to serve as a review of the current literature on pediatric back pain. The article reviews the epidemiology, basic anatomy, and important elements of a history and examination, which should be considered when a child presents complaining of back pain. Last, a common differential diagnosis with evaluation and management is also given to help guide pediatricians through their medical decision making.

Does a Vertebra Fracture Cause a Tumor? A Dorsolumbar Paraspinal Desmoid Tumor: Case Report

Extraabdominal desmoid tumors are uncommon soft-tissue tumors. The etiology of the tumor is still unclear. Injury is one of the etiological factors of soft-tissue tumors. A 41-year-old female patient who had a traumatic vertebral body fracture on the thoracic spine was treated conservatively. Two and a half years later, she presented a painful, palpable swelling on the thoracolumbar region. In the present report, was discuss the patient, who underwent a surgery to remove the desmoid tumor (aggressive fibromatosis), within the context of the current literature. The literature on desmoid tumor caused by a trauma is rare. This is the first case that demonstrates an extraabdominal desmoid tumor following a spinal fracture. The swelling on the region of the trauma must be examined carefully and desmoid tumor must be kept in mind as a possible diagnosis.

Impact of Cervical Collars on Intracranial Pressure Values in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies.

BACKGROUND: Spinal cord injury (SCI) is present in around 2-4% of trauma victims. More than half of this injuries are located at the cervical region. Twenty percent of victims with cervical spinal trauma and 5% of patients with severe traumatic brain injury (TBI) will have an SCI. Cervical immobilization with rigid or semirigid collars is routinely used as prophylactic or definitive treatment intervention in general trauma care. An important adverse effect of cervical collars application is the increase in intracranial pressure (ICP) values. This systematic review and meta-analysis aim to estimate the overall magnitude of ICP changes after cervical collar application. METHODS: Major electronic databases (Ovid/Medline, Embase and Cochrane Library) were systematically searched for prospective studies that assessed ICP changes after cervical collar applications. Study level characteristics and ICP values before, during and after cervical collar application, were extracted. The meta-analysis was performed using random-effects model. RESULTS: Five studies comprising 86 patients were included in the systematic review and the quantitative synthesis. The overall increase in ICP after collar application was statistically significant (weighted mean difference [WMD] = 4.43; 95%CI 1.70, 7.17; P < 0.01), meaning an overall ICP increase of approximately 4.4 mmHg. The decrease in ICP values after collar removal reached statistical significance (WMD = - 2.99; 95%CI - 5.45, - 0.52; P = 0.02), meaning an overall ICP decrease of approximately 3 mmHg after collar removal. ICP values before and after cervical collar application were not statistically significant (WMD = 0.49; 95%CI - 1.61, 2.59; P = 0.65), meaning no ICP change. CONCLUSIONS: Heterogeneous studies of application of cervical collars as a partial motion restriction strategy after injuries have demonstrated increases in ICP in TBI patients. Increases in ICP can induce complications in TBI patients. Appropriate selection criteria for cervical motion restriction in TBI patients need to be considered.

Long-term clinical complications associated with the use of polymethyl methacrylate in spinal stabilization of dogs and cats: case series / Complicações clínicas de longo prazo relacionadas ao uso de pino ou parafuso/polimetilmetacrilato na estabilização espinhal de cães e gatos: série de casos

Vertebral and spinal cord trauma are common conditions in small animal practice and often result in vertebral fractures/luxation (VFL) with concomitant spinal cord laceration, concussion, compression, or ischemia. These lesions have several clinical presentations that may vary from moderate to severe pain and partial to total loss of motor, sensory, and visceral functions, which may result in death or euthanasia. Our purpose is to describe five cases (four dogs and one cat) of complications secondary to the use of bone cement for vertebral stabilization. The patients, between five months and four years of age and weighing between 1.4 and 12.2 kg, were referred to the Small Animal Orthopedics and Traumatology Service of the Veterinary Hospital of the College of Veterinary Medicine and Animal Science of the University of São Paulo. They had a history of post-operatory polymethyl methacrylate (PMMA) reactions (such as drainage or cement exposure due to infection or implant failure) in periods from 9 to 18 months after undergoing spinal osteosynthesis. Surgical implant removal occurred in 80% of the patients (4/5). Complete remission was not observed in the patient with residual implants. The association of pins/screws and PMMA is a versatile osteosynthesis technique and is applicable in all spinal regions. However, delayed complications can occur, which could require additional surgical procedures. Despite the small number of cases included in this study, one can infer that complications related to the use of bone cement in spinal surgery can occur in the long term and should be highlighted during the implant choosing process for vertebral osteosynthesis in small animals.(AU)

O trauma vertebromedular é uma afecção comum na rotina clínica de pequenos animais e resulta, muitas vezes, em fraturas e luxações vertebrais (FLV) associadas à laceração, concussão, compressão ou isquemia da medula espinhal. Essas lesões apresentam sinais clínicos que variam de dor moderada a grave, acompanhada por perda parcial ou total das funções motoras, sensoriais e viscerais, podendo resultar no óbito ou na indicação de eutanásia. O objetivo deste trabalho é descrever cinco casos de complicações inerentes o uso de cimento ósseo para estabilização vertebral em quatro cães e um gato. Os pacientes possuíam idades variando entre cinco meses a quatro anos, peso entre 1,4 e 12,2kg e foram atendidos no Serviço de Ortopedia e Traumatologia do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, com histórico de reações cutâneas ao polimetilmetacrilato (PMMA), como tratos drenantes ou exposição do cimento decorrente de infecção ou soltura precoce do implante, em períodos que variaram de nove à 18 meses após serem submetidos a osteossíntese da coluna vertebral. Foi realizada a remoção cirúrgica desses implantes em quatro pacientes e mantida a estabilização prévia em um caso. Houve resolução total do quadro de infecção nos pacientes em que se removeu o PMMA associada ao tratamento clínico, e remissão parcial no paciente em que o implante não pode ser removido. A utilização do cimento ósseo associado a parafusos ou pinos é uma técnica versátil e aplicável em todas as regiões da coluna vertebral, no entanto complicações tardias são possíveis, sendo necessário muitas vezes procedimentos cirúrgicos adicionais para a resolução do problema. Apesar da pequena quantidade de casos relatados, foi possível observar que complicações relacionadas ao uso do cimento ósseo na coluna vertebral podem ocorrer no médio ao longo prazo [...].(AU)

Long-term clinical complications associated with the use of polymethyl methacrylate in spinal stabilization of dogs and cats: case series / Complicações clínicas de longo prazo relacionadas ao uso de pino ou parafuso/polimetilmetacrilato na estabilização espinhal de cães e gatos: série de casos

Vertebral and spinal cord trauma are common conditions in small animal practice and often result in vertebral fractures/luxation (VFL) with concomitant spinal cord laceration, concussion, compression, or ischemia. These lesions have several clinical presentations that may vary from moderate to severe pain and partial to total loss of motor, sensory, and visceral functions, which may result in death or euthanasia. Our purpose is to describe five cases (four dogs and one cat) of complications secondary to the use of bone cement for vertebral stabilization. The patients, between five months and four years of age and weighing between 1.4 and 12.2 kg, were referred to the Small Animal Orthopedics and Traumatology Service of the Veterinary Hospital of the College of Veterinary Medicine and Animal Science of the University of São Paulo. They had a history of post-operatory polymethyl methacrylate (PMMA) reactions (such as drainage or cement exposure due to infection or implant failure) in periods from 9 to 18 months after undergoing spinal osteosynthesis. Surgical implant removal occurred in 80% of the patients (4/5). Complete remission was not observed in the patient with residual implants. The association of pins/screws and PMMA is a versatile osteosynthesis technique and is applicable in all spinal regions. However, delayed complications can occur, which could require additional surgical procedures. Despite the small number of cases included in this study, one can infer that complications related to the use of bone cement in spinal surgery can occur in the long term and should be highlighted during the implant choosing process for vertebral osteosynthesis in small animals.

O trauma vertebromedular é uma afecção comum na rotina clínica de pequenos animais e resulta, muitas vezes, em fraturas e luxações vertebrais (FLV) associadas à laceração, concussão, compressão ou isquemia da medula espinhal. Essas lesões apresentam sinais clínicos que variam de dor moderada a grave, acompanhada por perda parcial ou total das funções motoras, sensoriais e viscerais, podendo resultar no óbito ou na indicação de eutanásia. O objetivo deste trabalho é descrever cinco casos de complicações inerentes o uso de cimento ósseo para estabilização vertebral em quatro cães e um gato. Os pacientes possuíam idades variando entre cinco meses a quatro anos, peso entre 1,4 e 12,2kg e foram atendidos no Serviço de Ortopedia e Traumatologia do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, com histórico de reações cutâneas ao polimetilmetacrilato (PMMA), como tratos drenantes ou exposição do cimento decorrente de infecção ou soltura precoce do implante, em períodos que variaram de nove à 18 meses após serem submetidos a osteossíntese da coluna vertebral. Foi realizada a remoção cirúrgica desses implantes em quatro pacientes e mantida a estabilização prévia em um caso. Houve resolução total do quadro de infecção nos pacientes em que se removeu o PMMA associada ao tratamento clínico, e remissão parcial no paciente em que o implante não pode ser removido. A utilização do cimento ósseo associado a parafusos ou pinos é uma técnica versátil e aplicável em todas as regiões da coluna vertebral, no entanto complicações tardias são possíveis, sendo necessário muitas vezes procedimentos cirúrgicos adicionais para a resolução do problema. Apesar da pequena quantidade de casos relatados, foi possível observar que complicações relacionadas ao uso do cimento ósseo na coluna vertebral podem ocorrer no médio ao longo prazo [...].

Vertebroplastia percutánea guiada por tomografía para el manejo del dolor en pacientes con fractura del cuerpo vertebral / CT-guided Vertebroplasty for Painful Vertebral Fractures

Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada. Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga. Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0a7dondeel 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes. Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.

Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography. Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS). Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space. Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.

Classificação AO e conceito de Dennis na indicação cirúrgica dos traumatismos raquidianos e raquimedulares. Todas as situações são contempladas? / Spinal trauma and spinal cord injury: The AO classification. The Denis concept. The surgical indication. Are all situations addressed?

Os autores discutem a aplicação da classificação AO e do conceito de Denis na qualificação dos traumatismos raquimedular e raquidiano, com ênfase nas indicações de cirurgia da coluna vertebral, expondo um quadro prático para tomada de decisão, que engloba todas as situações. Citam que embora tais classificações, as mais usadas na atualidade, sejam úteis para alicerçar o raciocínio clínico e cirúrgico dos casos de traumatismo raquimedular (TRM) e traumatismo raquidiano (TR), independente da forma de classificação empregada, ou mesmo que surjam outras classificações para os mesmos propósitos, duas questões serão sempre as mais importantes a serem respondidas pelos médicos assistentes na tomada de decisão: Há déficit neurológico? Há instabilidade da coluna vertebral?

The authors discuss the application of the AO classification and the concept of Denis, in qualifying of spinal cord injury, with emphasis on indications of spine surgery, exposing a practical framework for decision making, which includes all situations. Although these ratings, the most used are useful to support the clinical reasoning and surgical cases, two questions must always be answered by attending physicians for making decisions: Is there neurological deficit? Is there instability of the spine?

Principais complicações do Traumatismo Raquimedularnos pacientes internados na unidade de neurocirurgiado Hospital de Base do Distrito Federal / Major complications Spinal Trauma in patients in neurosurgery unit BaseHospital Distrito Federal

Introdução: O trauma raquimedular é uma agressão à medula espinhalque pode ocasionar danos neurológicos, tais como alterações da funçãomotora, sensitiva e autônoma. Acidentes automobilísticos, queda de altura,acidente por mergulho em água rasa e ferimentos por arma de fogo têmsido as principais causas de traumatismo raquimedular.Objetivos: Levantar as principais complicações do traumatismo raquimedularnos pacientes internados na unidade de neurocirurgia do Hospitalde Base do Distrito Federal no ano de 2012.Metodologia: Trata-se de um estudo quantitativo, retrospectivo, descritivo,com corte transversal, realizado por meio de pesquisa de dados secundários.O estudo foi realizado com dados obtidos no banco de dadosdo prontuário eletrônico (TRACK CARE) do Hospital de Base do DistritoFederal.Resultado e discussão: A avaliação dos 36 prontuários eletrônicos de vítimasde traumatismo raquimedular permitiu verificar as complicações demaior incidência, sendo a bexiga neurogênica (intrínseca da patologia) e aúlcera por pressão (decorrente da internação) as mais prevalentes. Mais dametade dos pacientes apresentaram complicações durante a hospitalização,com destaque para a bexiga neurogênica, sendo que as lesões completasforam as que tiveram maior incidência de complicações relacionadasao traumatismo raquimedular.

Introduction: The spinal cord injury is an insult to the spinal cord whichcan cause neurological damage, such as changes in motor function, sensoryand autonomous. Automobile accidents, falls, accidents per dive inshallow water and injury by firearms have been the main causes of SpinalCord Trauma.Objectives: Raise the main complications of spinal cord injury in patientsadmitted to the neurosurgery unit of the Base Hospital District Federal in2012.Methodology: This is a quantitative, retrospective, descriptive, cross-sectionalstudy using secondary data research. The study was conducted withdata from the database of electronic medical records (TRACK CARE) ofthe Hospital de Base do Distrito Federal.Results and discussion: In the evaluation of the electronic medical recordsof 36 victims of spinal cord injury has shown complications, whichthe highest incidence of them was neurogenic bladder (intrinsic of the patology)and pressure ulcers (arising from hospitalization). Over half of thepatients had complications during hospitalization, especially the neurogenicbladder, more prevalent in complete lesions, which had the higherincidence of complications related to spinal cord injury.

Lumbar pseudomeningocele following blunt trauma without spinal fractures / Pseudomeningocele lombar após trauma fechado sem fraturas vertebrais

The lumbar pseudomeningocele (PSM) is an uncommon condition, mainly, after a lumbar blunt trauma. The authors present a rare case of PSM following a lumbar blunt trauma which did not show any abnormalities in the magnetic resonance imaging (MRI) of the lumbar region. Firstly, the patient underwent to conservative treatment that fail and then it was performed a surgical approach of the lumbar area, however, the lumbar fluid collection appeared again and a lumboperitoneal shunt (LPS) was then performed with complete successful. One year and half afterwards the LPS the patient continues asymptomatic. The standard treatment of this condition remains uncertain, but the conservative treatment followed by LPS is a good option and can be done in several cases.

A pseudomeningocele lombar é uma condição incomum, principalmente após trauma lombar fechado. Os autores apresentam um caso raro de pseudomeningocele lombar após trauma lombar fechado que não apresentou alterações na ressonância magnética da região lombar. Primeiramente, o paciente foi submetido ao tratamento conservador que falhou, sendo submetido, em seguida, à abordagem cirúrgica da região lombar, entretanto, a coleção lombar fluida apareceu novamente, sendo, então, realizada uma derivação lomboperitoneal com remissão completa da coleção. Um ano e meio após a derivação lomboperitoneal, o paciente permanece assintomático. O tratamento padrão dessa patologia ainda permanece incerto, mas o tratamento conservador seguido de derivação lomboperitoneal é uma boa opção e pode ser feito em certos casos.

Traumatic L5-S1 spondylolisthesis in a 15-year-old: a case report.

Traumatic spondylolisthesis is a rare injury resulting from complex trauma and high-energy mechanisms. We present a case report of traumatic spondylolisthesis at the L5-S1 disc space of a patient who was buried after a wall fell on his back. In the physical examination, bilaterally decreased muscle strength was observed. Examination images indicated a 90% slip at L5-S1. Surgical treatment was provided with a posterior and anterior approach using pedicle fixation and an anterior cage. After 4 months, there was significant recovery of muscle strength in the lower limbs.

Whole-body computerized tomography and concomitant spine and head injuries: a study of 355 cases.

The authors present a prospective study on the coexistence of spinal injury (SI) and severe traumatic brain injury (TBI) in patients who were involved in traffic accidents and arrived at the Emergency Department of Hospital das Clinicas of the University of Sao Paulo between September 1, 2003 and December 31, 2009. A whole-body computed tomography was the diagnostic method employed in all cases. Both lesions were observed simultaneously in 69 cases (19.4%), predominantly in males (57 individuals, 82.6%). Cranial injuries included epidural hematoma, acute subdural hematoma, brain contusion, ventricular hemorrhage and traumatic subarachnoid hemorrhage. The transverse processes were the most fragile portion of the vertebrae and were more susceptible to fractures. The seventh cervical vertebra was the most commonly affected segment, with 24 cases (34.78%). The distribution of fractures was similar among the other cervical vertebrae, the first four thoracic vertebrae and the lumbar spine. Neurological deficit secondary to SI was detected in eight individuals (11.59%) and two individuals (2.89%) died. Traumatic subarachnoid hemorrhage was the most common intracranial finding (82.6%). Spinal surgery was necessary in 24 patients (34.78%) and brain surgery in 18 (26%). Four patients (5.79%) underwent cranial and spinal surgeries. The authors conclude that it is necessary a judicious assessment of the entire spine of individuals who presented in coma after suffering a brain injury associated to multisystemic trauma and whole-body CT scan may play a major role in this scenario.

Clinical patterns of spontaneous recovery of paralyzed triceps brachii associated with C5 to C7 injuries of the brachial plexus.

Some patients who sustain C5 to C7 nerve root injuries may demonstrate a natural recovery of elbow extension via the lower trunk; however the surgical effect of the reinnervation of the triceps brachii in such cases is still unknown. This study aims to determine the incidence of spontaneous recovery of the tricipital function and to identify the clinical and/or radiological predictors of poor spontaneous functional rehabilitation of elbow extension resulting from injuries of the upper roots of the brachial plexus. We conducted a review of the charts of 24 subjects sustaining an upper trunk syndrome with complete elbow extension palsy and who did not undergone any intervention for reinnervation of the triceps brachii in the primary brachial plexus surgery. Two years posttrauma, the muscle was scored as M0 in 12 patients (50%), M1 in 3 (12.5%), M2 in 1 (4.1%), M3 in 4 (16.6%), and M4 in 4 subjects (16.6%). The number of avulsed roots and the preoperative power of the latissimus dorsi did not demonstrate any significance in predicting the outcome of spontaneous elbow extension recovery; whereas the preoperative paralysis of the muscles for wrist extension was determined to be reliable predictive parameter for poor natural recovery of tricipital function.

Work-related traumatic spinal cord lesions in Chile, a 20-year epidemiological analysis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To describe the characteristics of patients with work-related traumatic spinal cord injuries (TSCI) in Chile. SETTING: Hospital del Trabajador in Santiago, Santiago, Chile. METHODS: Patients suffering from TSCI incurred at the workplace from 1986 to 2005 were identified through records of the Asociación Chilena de Seguridad (ACHS, Chilean Safety Association). RESULTS: The medical records of 173 patients, 172 men and 1 woman, were analyzed. The yearly average incidence was 7.8 per million workers. Age at TSCI onset was 38.2 ± 12.1 years. The principal external causes for TSCI incurred at the workplace were falls from a height in 86 cases (49.7%) and trauma blows to the vertebral spine in 61 cases (35.3 %). More falls occurred in the field construction, and other traumas occurred as a result of traumatic blows caused by tree trunks and stones in forestry and mining sectors. Mortality in this series was 8.7%, and the worst prognosis was for older patients with complete tetraplegia. The paraplegia:tetraplegia ratio was 3.2:1. CONCLUSIONS: The characteristics of workplace TSCI are specific to this population. It is important therefore to develop prevention programs for specific work-related TSCI.

Tuberculosis atípica de la columna / Atypical tuberculosis of the spine

La forma de presentación de la tuberculosis espinal atípica, se divide en dos grandes grupos: prestación clínica y radiográfica. Dentro de la presentación clínica se describe el prolapso discal, el absceso tuberculoso sin lesión ósea y los granulomas tuberculosos. Por otra parte, en la presentación radiográfica atípica se encuentra la afección vertebral única, con todas sus variantes y la afección vertebral múltiple en continuidad o en saltos. El objetivo de este artículo de revisión es describir las diferentes formas atípicas de presentación, por lo difícil que se hace su diagnóstico y la escasa bibliografía que aborda este tema.

The form of presentation of atypical spinal tuberculosis is divided into two big groups: clinical and radiographic presentations. The clinical presentation describes disc prolapse, tuberculous abscess without osseous lesion and tuberculous granuloma. On the other hand, the atypical radiographic presentation includes single vertebral disease with all its variants, and continuos or leaped multiple vertebral disease. The objective of this review article was to describe the different atypical forms of presentation because of the difficulties in diagnosis and the scanty literature dealing with this topic.

La présentation de la tuberculose spinale atypique est divisée en deux types: clinique et radiographique. Dans la présentation clinique, on peut trouver le prolapsus discal, l'abcès tuberculeux sans lésion osseuse et les granulomes tuberculeux, tandis que dans la présentation radiographique atypique on peut voir l'affection vertébrale unique, avec toutes ses variations, et l'affection vertébrale multiple à continuité ou en sauts. L'objectif de cet article de revue est de décrire les différentes formes atypiques de présentation, étant donné la difficulté de leur diagnostic et la manque de bibliographie abordant ce sujet.

Una hipótesis para las algias de columna: las lesiones incompletas de los ligamentos producen una disfunción del control muscular / A hypothesis for the spine algias: incomplete injuries of ligaments produce a dysfunction of the muscular control

Muchos informes clínicos y estudios de investigación han descrito el comportamiento de los pacientes con dolor lumbar crónico y dolor cervical crónico. Sólo algunas hipótesis han intentado explicar los múltiples hallazgos de estas investigaciones. Acá se presenta una nueva hipótesis, basada en el concepto de que las lesiones incompletas de los ligamentos (ligamentos espinales, anillo discal y cápsulas facetarias) pueden provocar dolor lumbar producto de una disfunción en el control muscular. La hipótesis tiene la siguiente secuencia de pasos. Se produce un trauma único o microtraumas acumulativos que provocan lesiones incompletas en los ligamentos y en los mecanorreceptores inmersos en ellos. Estos mecanorreceptores lesionados generan señales de transducción alteradas, que producen un patrón alterado de respuesta muscular generado por la unidad de control neuromuscular. La coordinación muscular y las características de la fuerza muscular individual, es decir, la activación, magnitud y desactivación, están alteradas. Esto produce niveles anormales de estrés y tensión sobre los ligamentos, mecanorreceptores y músculos, además de una carga excesiva en las articulaciones facetarias. Debido a la reparación deficiente que presentan en forma inherente los ligamentos espinales, puede ocurrir una degeneración acelerada de los discos y de las articulaciones facetarias. Estas condiciones anormales pueden persistir y, con el tiempo, pueden conducir a un dolor lumbar crónico debido a la inflamación de los tejidos neurales. La hipótesis explica muchas de las observaciones clínicas y los hallazgos en relación a los pacientes con dolor lumbar. Además, puede ayudar a entender de mejor manera a los pacientes con dolor lumbar y cervical crónico, y mejorar el manejo clínico.