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1.
Proc Natl Acad Sci U S A ; 117(41): 25212-25218, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-32999065

RESUMO

The regrowth of severed axons is fundamental to reestablish motor control after spinal-cord injury (SCI). Ongoing efforts to promote axonal regeneration after SCI have involved multiple strategies that have been only partially successful. Our study introduces an artificial carbon-nanotube based scaffold that, once implanted in SCI rats, improves motor function recovery. Confocal microscopy analysis plus fiber tracking by magnetic resonance imaging and neurotracer labeling of long-distance corticospinal axons suggest that recovery might be partly attributable to successful crossing of the lesion site by regenerating fibers. Since manipulating SCI microenvironment properties, such as mechanical and electrical ones, may promote biological responses, we propose this artificial scaffold as a prototype to exploit the physics governing spinal regenerative plasticity.


Assuntos
Materiais Biomiméticos , Traumatismos da Coluna Vertebral/terapia , Tecidos Suporte , Animais , Feminino , Microscopia Eletrônica de Varredura , Nanotecnologia , Ratos , Ratos Wistar , Traumatismos da Coluna Vertebral/diagnóstico por imagem
2.
Chin J Traumatol ; 23(4): 196-201, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32674856

RESUMO

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência , Humanos , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente , Pneumonia Viral/prevenção & controle , Transporte de Pacientes
3.
Clin J Sport Med ; 30(4): 296-304, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639439

RESUMO

INTRODUCTION: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.


Assuntos
Traumatismos em Atletas/terapia , Serviços Médicos de Emergência/métodos , Traumatismos da Coluna Vertebral/terapia , Traumatismos em Atletas/prevenção & controle , Técnica Delfos , Remoção de Dispositivo , Serviços Médicos de Emergência/normas , Socorristas/educação , Dispositivos de Proteção da Cabeça , Humanos , Equipamentos de Proteção , Restrição Física , Traumatismos da Coluna Vertebral/prevenção & controle , Transporte de Pacientes , Estados Unidos
4.
J Athl Train ; 55(6): 563-572, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32579668

RESUMO

INTRODUCTION: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.


Assuntos
Traumatismos em Atletas/terapia , Serviços Médicos de Emergência , Futebol Americano/lesões , Lesões do Pescoço/terapia , Traumatismos da Coluna Vertebral/terapia , Medicina Esportiva , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Humanos , Medicina Esportiva/métodos , Medicina Esportiva/normas , Estados Unidos
5.
J Athl Train ; 55(6): 545-562, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32579669

RESUMO

Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.


Assuntos
Traumatismos em Atletas , Serviços Médicos de Emergência , Primeiros Socorros , Futebol Americano/lesões , Traumatismos da Coluna Vertebral , Transporte de Pacientes , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/terapia , Benchmarking , Vértebras Cervicais/lesões , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Primeiros Socorros/métodos , Primeiros Socorros/normas , Georgia , Humanos , Equipamento de Proteção Individual , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/organização & administração , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/terapia , Medicina Esportiva/normas , Transporte de Pacientes/métodos , Transporte de Pacientes/normas , Estados Unidos
6.
Bull Hosp Jt Dis (2013) ; 78(1): 42-45, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32144962

RESUMO

War has historically been a major catalyst for advancement in military medical care and medicine in general. In our current conflicts, advances in battlefield medicine, evacuation techniques, and personal protective equipment have improved survival rates among members of the armed services. With increased survival, there has been increased prevalence of serious but nonfatal injuries, particularly from blunt and penetrating trauma. Blast injuries are the major cause of trauma and have both blunt and penetrating components. With respect to the spine, blasts have led to open, contaminated wounds that are complex and difficult to treat. Additionally, blasts have led to an increased incidence of lower lumbar burst fractures and lumbosacral dissociation. As these and other injuries are being seen more commonly during war, we must ensure that our military medical system is adapting to ensure we are taking care of our military personnel at the highest level.


Assuntos
Conflitos Armados/história , Traumatismos por Explosões/história , Traumatismos por Explosões/terapia , Medicina Militar/história , Traumatismos da Coluna Vertebral/história , Traumatismos da Coluna Vertebral/terapia , História do Século XX , História do Século XXI , Humanos
8.
World Neurosurg ; 137: e493-e498, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058120

RESUMO

OBJECTIVE: To determine whether Thoracolumbar Injury Classification and Severity Score (TLICS) and the Thoracolumbar AOSpine Injury Score (TL AOSIS) have any superiority to each other in terms of the reliability of their recommendations for guiding the treatment strategy of thoracolumbar spine injuries. METHODS: A total of 110 consecutive patients with thoracolumbar injuries hospitalized from January to September 2019 were analyzed retrospectively. The TLICS and the TL AOSIS systems were compared based on patients' therapeutic decisions suggested by each system. RESULTS: A total of 110 patients were studied. The TL AOSIS matched treatment decision-making in 108 patients (98.18%), and the TLICS matched 96 patients (87.27%). Of the patients without neurologic deficit, according to TL AOSIS system, 12 of 62 received >5 points, 12 received 4 or 5 points, and 38 received <4 points. According to TLICS system, 12 of 62 received ≥5 points, 50 received ≤3 points, and none received 4 points. The TL AOSIS matched 60 patients (96.77%), and the TLICS matched 48 patients (77.42%). Of the patients with neurologic deficits, according to TL AOSIS system, 36 of 48 received >5 points, and 12 received 4 or 5 points. According to TLICS system, 22 received >4 points, and 26 received 4 points, and the systems achieved agreement. CONCLUSIONS: Recommendations of TL AOSIS might be more reliable than those of TLICS particularly for guiding the surgical management of complete burst fractures.


Assuntos
Vértebras Lombares/lesões , Traumatismos da Coluna Vertebral/diagnóstico , Vértebras Torácicas/lesões , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/terapia , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
9.
Prim Care ; 47(1): 165-176, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32014132

RESUMO

Neck injuries are relatively uncommon but have the potential to cause serious and permanent disability. In athletes, injuries are most common in contact sports, and occur with direct axial loading with a forward-flexed neck. Soft tissue and peripheral nerve injuries are typically minor and self-limiting, with excellent recovery potential and return to activities based on symptoms. Concern for devastating spinal cord injuries has led to routine immobilization using spine boards and hard cervical collars. This approach may provide more harm than benefit when applied universally, and a more commonsense protocol can be used to better address potential neck injuries.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Vértebras Cervicais/lesões , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/terapia , Humanos , Pescoço/diagnóstico por imagem , Aparelhos Ortopédicos , Volta ao Esporte , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/terapia , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia
10.
BMC Musculoskelet Disord ; 21(1): 4, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900159

RESUMO

BACKGROUND: The present study is to highlight the challenges in managing cervical spine injuries in toddlers (less than 4 years of age) without neurological deficit. Cases of unilateral cervical C4-C5 facet dislocation in toddlers are very rare. CASE PRESENTATION: A 3-year-old girl suffered cervical spine injury after a motor vehicle collision with unilateral C4-C5 facet dislocation without neurological deficit. Magnetic resonance imaging (MRI) showed no spinal cord injury, Frankel grade E. Initial management was cervical spine protection. Definite treatment and complication were discussed with the patient's parents before closed reduction maneuver with minerva cast was applied under sedation. The patient showed no complication after closed reduction and the cervical spine had aligned well in radiographs. The minerva cast was removed at 8 weeks, at which point neck muscle stretching rehabilitation program started. At one-year follow up, the child was asymptomatic, had full active cervical motion and good function. In radiographs, the cervical spine had normal alignment and was healed. CONCLUSIONS: Unilateral cervical facet dislocation in toddlers is very rare. Closed reduction maneuver and the minerva cast applied were optional in this case. The parents were highly satisfied with the effective treatment and outcome.


Assuntos
Acidentes de Trânsito , Redução Fechada , Luxações Articulares/terapia , Traumatismos da Coluna Vertebral/terapia , Articulação Zigapofisária/lesões , Pré-Escolar , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Recuperação de Função Fisiológica , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/etiologia , Resultado do Tratamento , Articulação Zigapofisária/diagnóstico por imagem
11.
Unfallchirurg ; 123(4): 289-301, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-31768566

RESUMO

BACKGROUND: To protect the spine from secondary damage, spinal immobilization is a standard procedure in prehospital trauma management. Immobilization protocols aim to support emergency medicine personnel in quick decision making but predominantly focus on the adult spine; however, trauma mechanisms and injury patterns in adults differ from those in children and applying adult prehospital immobilization protocols to pediatric patients may be insufficient. Adequate protocols for children with spinal injuries are currently unavailable. OBJECTIVE: The aim of this study was (i) to develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) to perform a first analysis of the quality of results if the protocol is used by emergency personnel. MATERIAL AND METHODS: Based on a structured literature search a new immobilization protocol was developed. Analysis of the quality of results was performed by a questionnaire containing four case scenarios in order to assess correct decision making. The decision about spinal immobilization was made without and with the utilization of the protocol. RESULTS: The E.M.S. IMMO Protocol Pediatric was developed based on the literature. The analysis of the quality of results was performed involving 39 emergency medicine providers. It could be shown that if the E.M.S. IMMO Protocol Pediatric was used, the correct type of immobilization was chosen more frequently. A total of 38 out of 39 participants evaluated the protocol as helpful. CONCLUSION: The E.M.S. IMMO Protocol Pediatric provides decision-making support whether pediatric spine immobilization is indicated with respect to the cardiopulmonary status of the patient. In a first analysis, the E.M.S. IMMO Protocol Pediatric improves decision making by emergency medical care providers.


Assuntos
Serviços Médicos de Emergência , Traumatismos da Coluna Vertebral , Vértebras Cervicais , Criança , Protocolos Clínicos , Serviço Hospitalar de Emergência , Humanos , Imobilização , Traumatismos da Coluna Vertebral/terapia
13.
Pan Afr Med J ; 34: 26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762894

RESUMO

Introduction: Road traffic accidents (RTAs) are the most frequent cause of traumatic spinal injuries (TSIs), which account for up to 33.6% of all spinal fractures. The Kingdom of Saudi Arabia (KSA) is one of the countries which has high rates of SCIs and bears the economic burden of that situation. Methods: 120 patients were included in this study, using a stringent set of inclusion and exclusion criteria. The patients were followed-up from the point of triage to admission and discharge. We analysed the clinical notes of the patients to determine the severity of their traumatic spinal injuries, the neurosurgical management carried out, and other prognosticating factors such as blood transfusion and the Glasgow Coma Scale (GCS). The data collected was analysed anonymously, and the confidentiality of all participants was respected. Results: Most of the patients were young adults and adolescents under the age of 40 (n = 96). There was a male preponderance of 84.1%. With respect to spinal injury stratification, 55 patients had cervical spine fractures, 10 patients had cervical lacerations, 85 patients had thoracolumbar spinal fractures, and 10 patients had thoracolumbar spinal lacerations. 35 patients had other fractures documented. All 120 patients were followed up to assess the management of their traumatic spinal injuries. 66.6% (n= 80) of all patients were managed conservatively, whereas the remaining 33.3% (n=40) were managed surgically. Conclusion: Trauma is an important cause of spinal injuries (TSIs), and untreated TSIs may lead to poor clinical outcome, especially if the cervical region is involved.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Fraturas da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/terapia , Adulto Jovem
14.
Wilderness Environ Med ; 30(4S): S87-S99, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31780084

RESUMO

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards.


Assuntos
Padrões de Prática Médica , Traumatismos da Medula Espinal/terapia , Traumatismos da Coluna Vertebral/terapia , Medicina Selvagem/normas , Humanos , Imobilização/efeitos adversos , Imobilização/métodos , Sociedades Médicas , Traumatismos da Medula Espinal/prevenção & controle , Traumatismos da Coluna Vertebral/prevenção & controle , Medicina Selvagem/métodos
15.
Wilderness Environ Med ; 30(4): 412-416, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31706730

RESUMO

INTRODUCTION: To compare the effectiveness of a molded fleece jacket with that of a standard cervical collar at limiting movement of the cervical spine in 3 different directions. METHODS: This is a prospective study using 24 healthy volunteers to measure cervical flexion/extension, rotation, and lateral flexion with both the fleece collar and the standard cervical collar. A hand-held goniometer was used for measurements. The results were then analyzed for the 3 independent movements using a noninferiority test. RESULTS: The fleece collar was determined to be noninferior at limiting the designated motions. Comfort was greater while wearing the improvised fleece collar. CONCLUSIONS: Our small study demonstrated that mountain travelers and rescuers may be able to use an improvised fleece jacket collar in place of a standard collar if spine trauma is suspected after a backcountry accident. Further research should examine different types of improvised collars, their ability to remain in place over extended evacuations, and when to apply collars to backcountry patients.


Assuntos
Vértebras Cervicais/lesões , Desenho de Equipamento , Imobilização/instrumentação , Imobilização/métodos , Traumatismos da Coluna Vertebral/terapia , Contenções , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Estudos Prospectivos , Amplitude de Movimento Articular
16.
Clin J Sport Med ; 29(6): 482-485, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688179

RESUMO

INTRODUCTION: Exercise-related injuries (ERIs) are a common cause of nonfatal emergency department and hospital visits. CrossFit is a high-intensity workout regimen whose popularity has grown rapidly. However, ERIs due to CrossFit remained under investigated. METHODS: All patients who presented to the main hospital at a major academic center complaining of an injury sustained performing CrossFit between June 2010 and June 2016 were identified. Injuries were classified by anatomical location (eg, knee, spine). For patients with spinal injuries, data were collected including age, sex, body mass index (BMI), CrossFit experience level, symptom duration, type of symptoms, type of clinic presentation, cause of injury, objective neurological examination findings, imaging type, number of clinic visits, and treatments prescribed. RESULTS: Four hundred ninety-eight patients with 523 CrossFit-related injuries were identified. Spine injuries were the most common injuries identified, accounting for 20.9%. Among spine injuries, the most common location of injury was the lumbar spine (83.1%). Average symptom duration was 6.4 months ± 15.1, and radicular complaints were the most common symptom (53%). A total of 30 (32%) patients had positive findings on neurologic examination. Six patients (6.7%) required surgical intervention for treatment after failing an average of 9.66 months of conservative treatment. There was no difference in age, sex, BMI, or duration of symptoms of patients requiring surgery with those who did not. CONCLUSIONS: CrossFit is a popular, high-intensity style workout with the potential to injure its participants. Spine injuries were the most common type of injury observed and frequently required surgical intervention.


Assuntos
Condicionamento Físico Humano/efeitos adversos , Condicionamento Físico Humano/métodos , Traumatismos da Coluna Vertebral/epidemiologia , Adulto , Feminino , Humanos , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Fatores de Risco , Lesões do Ombro/epidemiologia , Lesões do Ombro/etiologia , Lesões do Ombro/terapia , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/terapia , Adulto Jovem
17.
Spine (Phila Pa 1976) ; 44(22): E1342-E1347, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689257

RESUMO

STUDY DESIGN: Case report. OBJECTIVE: We present a 18-year-old male patient with gunshot injury through right scapular region with the bullet ending up and causing a fracture in the odontoid process. SUMMARY OF BACKGROUND DATA: Odontoid fracture owing to gunshot wound is an extremely rare injury. METHODS: An 18-year-old male patient was brought to the emergency department with gunshot injury. x-Ray imaging showed retained bullet in the odontoid process. Computed tomography scan showed fracture of the odontoid and body of scapula consistent with the trajectory of the bullet. Owing to a normal neurological examination, conservative follow-up was decided and given a Philadelphia collar. RESULTS: At 2 years' follow-up, patient demonstrated limited axial rotation and flexion/extension. However, no pain and neurologic problem were observed. CONCLUSION: Odontoid fracture owing to gunshot wound can be treated conservatively; emergency or elective surgical intervention was not necessary. In the follow-up, patient did not demonstrate any signs of neurological impairment or infection. LEVEL OF EVIDENCE: 5.


Assuntos
Processo Odontoide , Traumatismos da Coluna Vertebral , Ferimentos por Arma de Fogo , Adolescente , Tratamento Conservador , Humanos , Masculino , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/terapia
18.
J Neurosurg Spine ; 31(4): 457-463, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31574462

RESUMO

The authors believe that the standardized and systematic study of immobilization techniques, diagnostic modalities, medical and surgical treatment strategies, and ultimately outcomes and outcome measurement after cervical spinal trauma and cervical spinal fracture injuries, if performed using well-designed medical evidence-based comparative investigations with meaningful follow-up, has both merit and the remarkable potential to identify optimal strategies for assessment, characterization, and clinical management. However, they recognize that there is inherent difficulty in attempting to apply evidence-based medicine (EBM) to identify ideal treatment strategies for individual cervical fracture injuries. First, there is almost no medical evidence reported in the literature for the management of specific isolated cervical fracture subtypes; specific treatment strategies for specific fracture injuries have not been routinely studied in a rigorous, comparative way. One of the vulnerabilities of an evidenced-based scientific review in spinal cord injury (SCI) is the lack of studies in comparative populations and scientific evidence on a given topic or fracture pattern providing level II evidence or higher. Second, many modest fracture injuries are not associated with vascular or neural injury or spinal instability. The application of the science of EBM to the care of patients with traumatic cervical spine injuries and SCIs is invaluable and necessary. The dedicated multispecialty author groups involved in the production and publication of the two iterations of evidence-based guidelines on the management of acute cervical spine and spinal cord injuries have provided strategic guidance in the care of patients with SCIs. This dedicated service to the specialty has been carried out to provide neurosurgical colleagues with a qualitative review of the evidence supporting various aspects of care of these patients. It is important to state and essential to understand that the science of EBM and its rigorous application is important to medicine and to the specialty of neurosurgery. It should be embraced and used to drive and shape investigations of the management and treatment strategies offered patients. It should not be abandoned because it is not convenient or it does not support popular practice bias or patterns. It is the authors' view that the science of EBM is essential and necessary and, furthermore, that it has great potential as clinician scientists treat and study the many variations and complexities of patients who sustain acute cervical spine fracture injuries.


Assuntos
Vértebras Cervicais/lesões , Traumatismos da Coluna Vertebral/terapia , Gerenciamento Clínico , Medicina Baseada em Evidências , Humanos
19.
Scand J Trauma Resusc Emerg Med ; 27(1): 83, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464620

RESUMO

BACKGROUND: A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. "The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury" was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. METHOD: An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. RESULTS: In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. CONCLUSION: Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline.


Assuntos
Serviços Médicos de Emergência , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Traumatismos da Coluna Vertebral/terapia , Adulto , Currículo , Educação a Distância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Inquéritos e Questionários , Adulto Jovem
20.
Vet Comp Orthop Traumatol ; 32(6): 492-498, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31242518

RESUMO

OBJECTIVE: The aim of this study was to describe the signalment, clinical presentation, diagnostic findings, medical and surgical treatment and outcome of 22 farm animals diagnosed with a vertebral fracture or luxation. STUDY DESIGN: Medical records of 22 farm animals (7 goats, 6 alpacas, 5 cattle, 3 sheep and 1 deer) were reviewed for signalment, history, presenting clinical signs and neurological examination findings, clinicopathological results, diagnostic imaging, final diagnosis, medical and surgical management, clinical progression and outcome. RESULTS: Animals' age ranged from 1 day to 15 years. Neurological examination findings included decreased motor function (20/22), recumbency (14/22), altered mentation (13/22), cranial nerve deficits (4/22) and lack of nociception (3/22). Lesions were localized to the atlanto-occipital region (2/22), C1 to C5 (7/22), C6 to T2 (4/22), T3 to L3 (3/22), and L4 to S1 (6/22). Diagnoses included vertebral fracture only (4/22), luxation only (5/22) or both vertebral fracture and luxation (13/22). In five cases, no therapy was attempted, while 12 cases were treated medically and five cases were treated surgically. Surgical interventions included manual reduction (n = 1); arthrodesis (n = 2); laminectomy (n = 1); and laminectomy with pin fixation, cerclage wire and polymethylmethacrylate bridging (n = 1). Five of the 22 cases survived to hospital discharge; two of these were treated surgically. CONCLUSION: The cervical region was most commonly affected. Prognosis for these injuries in farm animals is guarded.


Assuntos
Fraturas Ósseas/veterinária , Luxações Articulares/veterinária , Gado/lesões , Fraturas da Coluna Vertebral/veterinária , Animais , Feminino , Fraturas Ósseas/patologia , Fraturas Ósseas/terapia , Luxações Articulares/patologia , Luxações Articulares/terapia , Masculino , Estudos Retrospectivos , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/veterinária , Resultado do Tratamento
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