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1.
Unfallchirurg ; 123(2): 143-154, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32016493

RESUMO

Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.


Assuntos
Cifose , Fusão Vertebral , Traumatismos da Coluna Vertebral , Tratamento Conservador , Humanos , Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares , Osteotomia , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas , Resultado do Tratamento
2.
World Neurosurg ; 133: e76-e83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521757

RESUMO

OBJECTIVE: Spine fractures, including associated spinal cord injury, account for 3%-6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. METHODS: Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011-2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. RESULTS: A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P = 0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P = 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P = 0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. CONCLUSIONS: Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer.


Assuntos
Transferência de Pacientes , Traumatismos da Coluna Vertebral/reabilitação , Atividades Cotidianas , Adulto , Idoso , Continuidade da Assistência ao Paciente , Feminino , Hospitais Comunitários , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/cirurgia , Centros de Atenção Terciária , Centros de Traumatologia , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
4.
Ideggyogy Sz ; 72(7-8): 227-235, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31517454

RESUMO

Background and purpose: 3D technologies (3D virtual and physical model, 3D printing, computer aided engineering, finite element analysis based simulations) play an important role in personalized spine surgery. Objective - In collaboration with AOSpine a global, online survey-based study was performed in order to determine the acceptance rate and the factors which stand against the wider spread of 3D technologies. Methods: A survey containing 21 questions was developed and divided into five pages, every page corresponding to one chapter. Our analysis is based on the responses of 282 spine surgeons from 57 countries. To interpret our results in a global context, we used the Human Development Index of the respondent's countries in comparisons. Results: Significant difference between the AOSpine regions (p ≤ 0.05) was found, with the highest acceptance in Asia-Pacific region. There was no significant difference in acceptance score according to the field of spine surgery, or the surgical experience in years (p=0.77, and p=0.19). In the case of public practice, we found significantly higher acceptance compared to private and mixed (public and private) surgical practice (p ≤ 0.05). The acceptance of the technology varied based on the respondent's resident country's Human Development Index and was significantly different between "Medium" vs "Very high" (p = 0.0005) and "High" vs "Very high" (p=0.019) category. Significant positive correlation was found between the acceptance score and the HDI score (Spearman test, ρ = 0.37, p = 0.007). The main limitation factor was identified as the lack of information. Conclusion: There is high interest among spine surgeons towards the incorporation of 3D technologies into the clinical practice. Education, the healthcare system, and the economic environment plays a major role in acceptance. Our results provide the basis of a strategy to promote the application of 3D technologies.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Impressão Tridimensional , Coluna Vertebral/cirurgia , Cirurgiões/psicologia , Humanos , Prática Profissional/estatística & dados numéricos , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Inquéritos e Questionários
5.
A A Pract ; 13(8): 322-324, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31449075

RESUMO

We present a case of bilateral visual loss in a patient who underwent spine surgery after sustaining a fall and trauma to her face and cervical spine. Visual loss in the right eye, not recognized until after surgery, was a result of blunt injury to the eye. Visual loss in the left eye was caused by posterior ischemic optic neuropathy, an unfortunate complication of surgery in the prone position.


Assuntos
Vértebras Cervicais/cirurgia , Complicações Pós-Operatórias , Traumatismos da Coluna Vertebral/cirurgia , Transtornos da Visão/etiologia , Acidentes por Quedas , Idoso , Vértebras Cervicais/lesões , Traumatismos Faciais/etiologia , Feminino , Humanos , Coluna Vertebral/cirurgia
6.
Chirurg ; 90(10): 782-790, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31463657

RESUMO

Studies have shown that the numbers of injuries of the cervical spine increase in elderly patients. An early clinical examination and adequate diagnostics are necessary to initiate the appropriate treatment. A computed tomography (CT) scan is recommended to exclude injuries of the cervical spine. Dynamic fluoroscopy and magnetic resonance imaging (MRI) can additionally be helpful to detect instabilities. The treatment of the injury depends on the extent of the fracture and includes conservative treatment options with soft or rigid ortheses for cervical spine immobilization, retention with a halo fixator or open/closed reduction and fixation. In the selection of treatment it should be taken into consideration that the use of rigid immobilization or a halo fixator is associated with a significant reduction of the quality of life. In the region of the upper cervical spine only unstable fractures of the atlas and of the axis should be operatively treated. In the region of the subaxial cervical spine fractures are prone to be unstable due to the lack of flexibility of the cervical spine in elderly patients. Therefore, fractures of types B and C according to AO Spine, for which operative treatment is recommended, are regularely seen. In addition, a pre-existing stenosis of the spinal cord may lead to neurological symptoms which negatively influence the clinical outcome.


Assuntos
Vértebras Cervicais , Qualidade de Vida , Fraturas da Coluna Vertebral , Traumatismos da Coluna Vertebral/cirurgia , Idoso , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Fraturas da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
World Neurosurg ; 130: 339-340, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31330331

RESUMO

Catastrophic subaxial vertical cervical distraction injury is rare. In this report, we present a 49-year-old male whose dreadlocks were caught in a drill press. His head was spun around, resulting in a degloving and distraction injury. He was unresponsive with a Glasgow Coma Scale score of 3T. He coded multiple times and underwent cardiopulmonary resuscitation. Computed tomography of the cervical spine showed a 4.8-cm vertical distraction of the spine at the C5-6 level and subglottic tracheal separation. Computed tomography of the head showed diffuse cerebral edema. Despite aggressive resuscitation, he did not survive this catastrophic injury. This is the first report of such subaxial vertical cervical distraction injury from the United States.


Assuntos
Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Tomografia Computadorizada por Raios X/métodos
8.
Orthopedics ; 42(4): e370-e375, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31323109

RESUMO

Cervical spine injuries in elite athletes can have detrimental consequences, which makes return to play for professional athletes after cervical spine injury controversial. Although most athletes can return to sport under some circumstances, such as single-level anterior cervical diskectomy and fusion for cervical disk herniation, return to play after cervical disk arthroplasty and multilevel fusion for cervical disk herniation remains controversial. Allowing athletes to return to play after a finding of cervical stenosis and in the incidence of pseudarthrosis remains unclear. This review provides a systematic framework to guide return-to-play decision-making in common cervical conditions in elite athletes. [Orthopedics. 2019; 42(4):e370-e375.].


Assuntos
Atletas , Traumatismos em Atletas/cirurgia , Vértebras Cervicais/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Recuperação de Função Fisiológica/fisiologia , Volta ao Esporte , Traumatismos da Coluna Vertebral/cirurgia , Discotomia , Humanos , Fusão Vertebral
9.
J Clin Neurosci ; 67: 239-243, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31213379

RESUMO

Non-missile penetrating spinal injury (NMPSI) is a rare form of traumatic spinal injury. Cases with neurological deficit on presentation are treated surgically. In the extremely rare circumstance of NMPSI presenting with no neurological deficit the management is contentious. We report a case of a 43-year-old male presenting with a penetrating stab injury through the thoracolumbar spinal canal. On presentation he had no neurological deficits and subsequently the knife was removed in theatre without deep surgical exploration. In this report we review the literature of non-missile penetrating spinal injuries as well as their management and conclude that exploratory surgery for NMPSI without neurological deficit may not be necessary as previously thought.


Assuntos
Traumatismos da Coluna Vertebral/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Adulto , Humanos , Masculino , Traumatismos da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/terapia , Ferimentos Perfurantes/patologia , Ferimentos Perfurantes/cirurgia , Ferimentos Perfurantes/terapia
10.
Eur J Orthop Surg Traumatol ; 29(7): 1395-1397, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31154508

RESUMO

The AOSpine group has launched a new subaxial cervical spine injury system (AOSCIS) based on morphology. The objective of this study was to use the AOSCIS and compare it to the widely used Allen classification (AC) based on mechanics for subaxial cervical spine injury. Twenty-two consecutive patients with subaxial cervical spine injury who received posterior cervical fixation in our hospital were included in this study. Medical records were evaluated retrospectively. The evaluated factors were as follows: preoperative ASIA impaired scale (AIS), AOSCIS, AC, and diffuse idiopathic skeletal hyperostosis (DISH). There was AIS A in nine patients, AIS C in four patients, AIS D in four patients, and AIS E in five patients. Two patients with AOSCIS B2 were classified as AC DF1. Two AOSCIS F3 patients were classified as AC CE1. Eighteen AOSCIS C patients were classified into multiple categories: five as AC DF2, three as DF3, one as CF4, one as CF5, four as DE2, three as CE3 + DE1, and one as CE3 + VC2. All of the AOSCIS A0 (F) or B patients were classified as AC stage 1, and all of the AOSCIS C patients were classified as AC stage 2 and higher (P < 0.05). All of six patients with DISH were classified as AOSCIS C and CE3, DE2, or DF3. AOSCIS and AC are correlated. Conducting an evaluation using both systems helps us to better comprehend subaxial cervical spine injuries.


Assuntos
Traumatismos da Coluna Vertebral/classificação , Vértebras Cervicais , Feminino , Humanos , Hiperostose Esquelética Difusa Idiopática/etiologia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/cirurgia
11.
World Neurosurg ; 128: e796-e805, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31078803

RESUMO

PURPOSE: The aim of this study was to compare the feasibility, safety, and fusion results of posterior transarticular stand-alone screw (SAS) instrumentation of C1-C2 with a minimally invasive technique to those of a posterior midline exposure. METHODS: Between 2008 and 2016, 164 patients underwent surgical treatment for traumatic injuries to the upper cervical vertebrae at our institution. We included 38 patients (27 men and 11 women; age range, 17-81 years) in the study. The posterior midline approach (PMA) group (23 patients) included patients who underwent surgery by means of a conventional midline incision after percutaneous screw insertion. The transmuscular approach (TMA) group (15 patients) included patients who underwent SAS fixation by use of a minimally invasive technique. The mean follow-up period was 58 months (range, 12-118 months). RESULTS: Statistical analysis revealed that the operative time, blood loss volume, and severity of postoperative pain were lower in the TMA group. No significant excess of radiation exposure to the surgical team and the patients occurred in TMA group compared with the PMA group. C1-C2 fusion was observed in 37 patients. Stable fibrous fusion between the C1 and C2 vertebrae was found in 1 patient. CONCLUSIONS: A minimally invasive technique by use of a paravertebral transmuscular approach provides an alternative to routine posterior transarticular SAS fixation of C1 and C2 through a posterior midline approach. The minimally invasive technique reduces the duration of surgery and the volume of blood loss, decreases the severity of postoperative pain, and does not increase the amount of radiation exposure for the surgical team and the patient.


Assuntos
Parafusos Ósseos , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/métodos , Traumatismos da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação Atlantoaxial/cirurgia , Perda Sanguínea Cirúrgica , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Estudos Retrospectivos , Fusão Vertebral/métodos , Adulto Jovem
12.
World Neurosurg ; 129: e97-e103, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31100527

RESUMO

OBJECTIVE: To review the surgical outcomes of the octogenarian population at a single institution after spinal traumatic injury. METHODS: Patients with both radiographic and clinical evidence of acute traumatic spine injury were reviewed using an institutional trauma survey to determine patient demographics and outcome data in a population of patients aged 80 years and older. RESULTS: Thirty-nine patients aged 80 years and older underwent surgical intervention for acute spinal trauma. There were 25 cases of cervical spine and 14 cases of thoracolumbar spine surgical intervention. Falls were the number one cause of acute spinal injury (31/39, 71%). Major respiratory disorders were the most common postoperative adverse event (12/39, 31%). Five patients experienced superficial wound dehiscence, fascial dehiscence, superficial infection, or delayed wound erosion. Patients were either discharged to home (10.5%), inpatient rehabilitation, (38.5%), skilled nursing facilities (17.9%), or long-term care facilities (17.9%). The postoperative mortality was 10.3%. CONCLUSIONS: Although the octogenarian population has increased risk for postoperative events after acute spinal injuries, surgical intervention may be worthwhile in the elderly population. Although direct surgical complication rates are not higher, medical risks are significantly higher after surgery.


Assuntos
Procedimentos Ortopédicos , Complicações Pós-Operatórias/epidemiologia , Traumatismos da Coluna Vertebral/cirurgia , Resultado do Tratamento , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
13.
World Neurosurg ; 128: e552-e555, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051302

RESUMO

BACKGROUND: Antibiotics after spine instrumentation are often extended while the surgical drain is in place, particularly for traumatic injuries. We sought to study if continuing antibiotics past 24 hours affected outcomes. METHODS: We performed a retrospective observational study of all patients who underwent spine fixation with hardware and surgical drains for trauma at our institution. We compared the effect of perioperative (≤24 hours of antibiotics) versus prolonged (>24 hours) antibiotics on surgical outcomes. Bivariate and multivariable logistic and linear regression statistics were performed. RESULTS: Three hundred and forty-six patients were included in the analysis. On multivariate analysis, antibiotic duration >24 hours did not predict surgical site infection (odds ratio, 2.68; 95% confidence interval, 0.88-8.10, P = 0.08) or mortality (odds ratio, 0.59; 95% confidence interval, 0.10-3.44; P = 0.56). CONCLUSIONS: Continuing antibiotics past 24 hours after traumatic spine instrumentation was not associated with improved outcomes. A prospective study to verify these findings may be warranted.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Cuidados Pós-Operatórios/métodos , Traumatismos da Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Drenagem , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Tempo
14.
Acta Orthop Belg ; 85(1): 40-46, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31023198

RESUMO

Lack of consensus in spinal trauma management and differences in the practical organization between trauma regions can have significant consequences on the fate of patients with spine trauma. For this reason a national survey was conducted among the 11 trauma regions in the Netherlands. Representative surgeons were sent a survery on seven areas of spinal trauma management: treatment protocol, (2) referral, (3) advisory committee, (4) classification used, (5) responsible medical specialist, (6) timing of surgical intervention, and (7) the current view on spinal trauma care. All 11 centers completed the survey yielding a response rate of 100%. The results of this study shows that in a relative small country, all seven areas in the management of spine trauma differs substantially and can be of use to show the possible areas of discrepancies between trauma centers in comparable European countries.


Assuntos
Procedimentos Ortopédicos/métodos , Traumatismos da Coluna Vertebral/cirurgia , Pesquisas sobre Serviços de Saúde , Humanos , Países Baixos , Fraturas da Coluna Vertebral/cirurgia
15.
In Vivo ; 33(3): 827-832, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31028204

RESUMO

BACKGROUND/AIM: Reconstruction of spinal soft tissue defects is challenging, especially when neural structures or prosthetic material are exposed. They should be covered with well-vascularized tissue such as paraspinal perforator flaps. MATERIALS AND METHODS: This is a retrospective study of soft tissue reconstructions with paraspinal perforator flaps from 2011 to 2018. The technique is described and risk factors for poor wound healing were assessed. Postoperative complications are reported. RESULTS: Twenty patients with a mean age of 63.65 years were included. Defects had an average size of 47 cm2 and were mainly located in the lumbosacral region (9 patients). Twelve patients suffered from infection following spinal stabilization, seven of whom were diagnosed with osteomyelitis, two patients presented with pressure sore and one patient experienced wound dehiscence. One partial flap necrosis with a lumbar defect occurred, which required revision surgery. No total flap loss occurred. Stable, closed wounds were achieved at their final follow-up. CONCLUSION: Perforator paraspinal flaps are suitable for immediate reconstruction of spinal defects.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Traumatismos da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fatores de Risco , Traumatismos da Coluna Vertebral/etiologia , Resultado do Tratamento
16.
Ulus Travma Acil Cerrahi Derg ; 25(2): 167-171, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30892669

RESUMO

BACKGROUND: Injuries caused by motorcycle accidents have been reported in several studies with an examination from a general trauma point of view. However, to our knowledge, there is no detailed study specific to central nervous system injuries. This research was focused on central nervous system injuries associated with motorcycle accidents. METHODS: The medical records of 540 patients who were admitted to the emergency department between 2008 and 2016 as the result of a motorcycle accident were retrospectively evaluated. Data were collected from electronic medical records, follow-up forms, and radiological images. Information on patient age, gender, type and site of injury, helmet use, alcohol level, Glasgow Coma Scale score on admission, length of stay in the intensive care unit and hospital, neurological status on discharge, and follow-up was collected and analyzed. RESULTS: A total of 486 of 540 patients (90%) were male, 54 (10%) were female, and the mean age was 31+-18 years (range: 2-85 years, median: 25 years). Cranial injuries were detected in 320 cases (59%). The distribution of cranial injuries was: epidural hemorrhage (12.6%), subdural hemorrhage (15.2%), depressed fracture (10.4%), linear fracture (23%), skull base fracture (5.5%), diffuse axonal injury (9.3%), subarachnoid hemorrhage (25.2%), intracerebral hemorrhage (13.5%), and contusion (26.3%). Spinal fractures were detected in 52 cases (9.6%). Twenty-two (4.07%) of the spinal fractures were observed in the cervical region, 10 (1.85%) in the thoracic region, and 20 (3.7%) in the lumbar region. The mean length of stay in the hospital was 8.2+-4 days and 7 days in the intensive care unit. Sixty-eight patients (12.6%) died. Traumatic cranial entities other than linear fracture were associated with an elevated level of mortality. A Glasgow Coma Scale score of 6 or less was associated with significant mortality (68%). CONCLUSION: A detailed report of motorcycle accident-associated central nervous system injuries is provided. The use of protective equipment, such as helmets, significantly reduced the rate of cerebral injury and death.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais , Motocicletas , Traumatismos da Coluna Vertebral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/cirurgia , Adulto Jovem
17.
World Neurosurg ; 126: e1494-e1502, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30910750

RESUMO

OBJECTIVE: Spine trauma management in children varies from one team to another, and to date, no clear consensus has been reached. The goal of this study was to describe the epidemiology of spine trauma in children and evaluate the timing and techniques of surgery when it was required. METHODS: A retrospective review of all patients admitted to our pediatric trauma center for spine traumas that required surgical management, between 2005 and 2016, was performed. All patients were followed with clinical and radiologic examination to evaluate the quality of fusion and realignment. RESULTS: Seventy-three children, with a mean age of 14.1 years, were admitted. Spinal injuries were more common in the teenage group (14-18 years). The predominant etiology of spine injuries was motor vehicle collision (36%). The spinal level of injury varied according to the age group: young children presented more cervical traumas (P < 0.01), while teenagers presented more lumbar traumas. There were more fractures alone in the teenage group (P < 0.005), while there were more luxations alone in the school-age group (P < 0.05). Median timing for surgical intervention in patients with neurologic deficits was 1 day. Patients with posterior wall recession >5 mm underwent surgical management quicker than patients with no posterior wall recession (P < 0.03). At follow-up, out of the 37 patients with initial neurologic deficits, 14 had improved (38%). CONCLUSIONS: Diskoligament maturation is an essential concept in spine traumas in children, as well as in surgical management. Surgical procedures should be carried out as soon as possible when patients present with neurologic deficits. At the thoracolumbar junction, a 2-level up-and-down fixation is recommended.


Assuntos
Traumatismos da Coluna Vertebral/cirurgia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Fixação Intramedular de Fraturas , Humanos , Lactente , Vértebras Lombares/lesões , Masculino , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/epidemiologia , Tempo para o Tratamento , Tomografia Computadorizada por Raios X
19.
Asian Cardiovasc Thorac Ann ; 27(4): 302-303, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30808190

RESUMO

A 68-year-old man presented with back pain after falling from a ladder and was found to have anterolisthesis of thoracic vertebrae T11-12 with secondary focal aortic injury and disruption of the aortic wall. This was successfully repaired using thoracic endovascular aortic repair (TEVAR) followed by spinal fusion with excellent result.


Assuntos
Acidentes por Quedas , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Idoso , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Fusão Vertebral , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
20.
Mymensingh Med J ; 28(1): 182-192, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30755568

RESUMO

Spine injuries, a common component in Polytrauma are usually affects the young people and is a major cause of morbidity and poses a significant health care expenditure and considerable threats to survival and quality of life. We retrospectively assess the demographics, incidence, mode of trauma, associated spine injuries, complications, neurological improvement and mortality. Records of total 1695 admitted patients, spinal injuries were 262 patients. Among them 30(11.45%) patients were associated with Polytrauma victims. Eleven patients (36.67%) were admitted through Ortho emergency dept, 14(46.67%) patients through Intensive care unit (ICU), 5(16.66%) patients through other department (CVS, Urology). Most (56%) of the patients were young in the age range of 16 to 40 years. Cervical spines were most commonly (44%) affected followed by lumbar (31%), thoracic (13%), thoraco-lumbar (9%) and Cervico-thoracic (3%) spines. Road traffic accident was the common cause (80%). Twelve patients (40%) had problems at various steps of management and maximum problems occur in step III. Nineteen patients (63.33%) management needs co-ordination between various specialties. Significant number of patients (76.67%) required operative treatment (p<0.05) and 13.33% were managed conservatively. Mortality rate (10%) was insignificant (p>0.05%). Of these patients, 73.33% had shown neurological improvement of at least one ASIA grade. The treatment of spinal injury in polytrauma patient should follow the principle of Advanced Trauma Life Support (ATLS). Once life and limb-threatening injuries have been identified and addressed, suspected spinal cord injury patients should be immobilized as early as possible to reduced the secondary injury, improve motor and sensory function as well as reduced the extend of permanent paralysis.


Assuntos
Traumatismo Múltiplo/cirurgia , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Traumatismo Múltiplo/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
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