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2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
Am Surg ; 85(5): 549-555, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31126370

RESUMO

Survivors of near-hangings suffer anoxic brain injuries, but it remains uncertain whether the incidence of associated injuries warrants extensive workup or trauma activation. An 11-year retrospective review was conducted on adult patients with a hanging mechanism who underwent trauma workup and management. The majority of patients (n = 98) were white (88.8%) males (75.5%) with an average age of 30 ± 12.3 years. Two-hundred fifty-four CT and magnetic resonance scans were performed and eight injuries were uncovered: three thyroid cartilage/hyoid fractures; three vertebral injuries; and two cervical vascular injuries. Anoxic brain injury was diagnosed clinically in 35 patients (35.7%) and was present in all 19 patients (19.4%) who died. Only one patient had intra-abdominal injury requiring surgical intervention. Injuries were more likely in patients with abnormal Glasgow Coma Scale (GCS) versus normal GCS (55% vs 10.5%, respectively). Patients who present after near-hanging have a low incidence of associated injuries. Workup can be restricted to patients with abnormal GCS scores and for specific signs and symptoms or high-risk energy mechanisms. The trauma team can be activated for signs of trauma.


Assuntos
Lesões Encefálicas/epidemiologia , Vértebras Cervicais/lesões , Hipóxia Encefálica/epidemiologia , Lesões do Pescoço/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Tentativa de Suicídio , Adolescente , Adulto , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Feminino , Humanos , Hipóxia Encefálica/diagnóstico , Hipóxia Encefálica/terapia , Masculino , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/terapia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia , Adulto Jovem
9.
Mil Med Res ; 6(1): 6, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786926

RESUMO

The battlefield treatments of spinal and spinal cord injury vary from civilian settings. However, there is no unified battlefield treatment guidelines for spine trauma in PLA. An expert consensus is reached, based on spine trauma epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since the specialized treatment for spine trauma are no significant difference between civilian settings and modern war, the first aid, emergency treatment and early treatment of spine trauma are introduced separately in three levels in this consensus. In Level I facilities, the fast and accurate evaluation of spine trauma followed by fixation and stabilization are recommended during the first-aid stage. Re-evaluation, further treatment for possible hemorrhagic shock, dyspnea and infection are recommended at Level II facilities. At Level III facilities, it is recommended to strengthen the intensive care and the prevention of urinary system and lung infection for the wounded with severe spinal injury, however, spinal surgery is not recommended in a battlefield hospital. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.


Assuntos
Traumatismos da Coluna Vertebral/terapia , Guerra , China , Consenso , Tratamento de Emergência/métodos , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Humanos , Saúde do Trabalhador/normas , Traumatismos da Coluna Vertebral/etiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
11.
Acta Neurochir Suppl ; 125: 303-307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610337

RESUMO

This paper is Part II of a two-part report. In Part I of the report, injuries of the occipital bone, atlanto-occipital dissociation and the atlanto-occipital joint space were discussed. This part of the report discusses atlantoaxial dislocation and fractures of the atlas and axis.


Assuntos
Articulação Atlantoaxial/lesões , Vértebra Cervical Áxis/lesões , Atlas Cervical/lesões , Luxações Articulares/terapia , Fraturas da Coluna Vertebral/terapia , Humanos , Traumatismos da Coluna Vertebral/terapia
12.
J Bone Joint Surg Am ; 101(1): e1, 2019 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-30601421
13.
Intensive Crit Care Nurs ; 51: 57-63, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30509691

RESUMO

BACKGROUND: A missed cervical spinal injury could have devastating consequences. Patients with a suspected cervical spinal injury are kept in rigid collars for cervical immobilisation. Prolonged collar use has important clinical implications. A well-defined guideline related to the removal of cervical collars from adult obtunded blunt trauma patients has not been developed. AIM: We sought to determine if Magnetic Resonance Imaging offered a definitive benefit over Computer Tomography with respect to patient management. METHOD: We searched Ovid Online, EBSCO, NICE Evidence Journals, Medline, PubMED, BNI, CINAHL and Google Scholar as well as the grey literature. Data extraction and synthesis were performed on studies that compared the radiologic findings and clinical outcomes of Computer Tomography scan and Magnetic Resonance Imaging in this patient group. RESULTS: There is evidence that supports the safe discontinuation of cervical collar use after a negative multidetector Computer Tomography scan result alone. Magnetic Resonance Imaging may detect a significant number of ligamentous injuries, but such injuries are rarely of clinical significance because they rarely alter clinical management. Its use should be limited to specific circumstances. CONCLUSION: It is important for institutions to re-examine the latest evidence regarding cervical spinal clearance in order to update their guidelines.


Assuntos
Imobilização/normas , Traumatismos da Coluna Vertebral/terapia , Ferimentos não Penetrantes/complicações , Adulto , Medula Cervical/lesões , Feminino , Humanos , Imobilização/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Traumatismos da Coluna Vertebral/prevenção & controle , Tomografia Computadorizada por Raios X/métodos , Ferimentos não Penetrantes/terapia
14.
Neurocrit Care ; 30(2): 253-260, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29589329

RESUMO

Neurocritical care is usually practiced in the comfort of an intensive care unit within a tertiary care medical center. Physicians deployed to the frontline with the US military or allied military are required to use their critical care skills and their neurocritical skills in austere environments with limited resources. Due to these factors, tactical critical care and tactical neurocritical care differ significantly from traditional critical care. Operational constraints, the tactical environment, and resource availability dictate that tactical neurocritical care be practiced within a well-defined, mission-constrained framework. Although limited interventions can be performed in austere conditions, they can significantly impact patient outcome. This review focuses on the US Army approach to the patient requiring tactical neurocritical care specifically point of injury care and care during transportation to a higher level of care.


Assuntos
Lesões Encefálicas/terapia , Cuidados Críticos/métodos , Medicina de Emergência/métodos , Medicina Militar/métodos , Militares , Traumatismos da Coluna Vertebral/terapia , Transporte de Pacientes/métodos , Cuidados Críticos/normas , Medicina de Emergência/normas , Humanos , Medicina Militar/normas , Transporte de Pacientes/normas
15.
World Neurosurg ; 122: e1359-e1364, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30448573

RESUMO

BACKGROUND: Subaxial cervical spine injuries may be treated with either nonoperative stabilization or surgical fixation. The subaxial injury classification (SLIC) provides 1 method for suggesting the degree of necessity for surgery. In the current study, we examined if the SLIC score, or other preoperative metrics, can predict failure of nonoperative management. METHODS: We performed a retrospective chart review to identify patients who presented with acute, nonpenetrating, subaxial cervical spine injury within our health system between 2007 and 2016. Patient demographics, medical comorbidities, injuries, and treatments were collected. Logistic regression analysis was used to determine potential predictors of failure of nonoperative management. RESULTS: During the study period, 40 patients met the inclusion criteria. A small subset of patients failed nonoperative management (n = 5, 12.5%). The mean SLIC score was 3.9 ± 1.9; however, 14 (35%) patients had scores >4. Neither total SLIC score (P = 0.68) nor SLIC subscores (morphology [P = 0.96], discoligamentous complex [P = 0.83], neurologic status [P = 0.60]) predicted failure of nonoperative treatment. Time to evaluation/treatment did predict failure of nonoperative management. Evaluation within 8 hours of injury was a negative predictor of failure (odds ratio = 0.03, P = 0.001) and evaluation 24 hours or more after injury was a positive predictor of failure (odds ratio = 66.00, P < 0.001). We created a modified SLIC score on the basis of these findings, which significantly predicted failure of nonoperative management (P = 0.044). CONCLUSIONS: Management of subaxial spine injuries is complex. In our cohort, SLIC scoring did not adequately predict odds of failure of nonoperative management. Time to evaluation, however, did. We created a modified SLIC score that significantly predicted failure of nonoperative management.


Assuntos
Vértebra Cervical Áxis/lesões , Ferimentos não Penetrantes/terapia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Traumatismos da Coluna Vertebral/classificação , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/terapia , Falha de Tratamento , Ferimentos não Penetrantes/etiologia
16.
Ann Vasc Surg ; 56: 24-28, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30500652

RESUMO

BACKGROUND: The aim of this study is to describe the timing of venous thromboembolism (VTE) diagnosis in patients with cerebral or spinal trauma and stroke and describe the relationships between VTE prophylaxis and timing of VTE diagnosis at a community hospital. METHODS: Retrospective cohort observational study over a span of 10 years from 2006 to 2016 was conducted. RESULTS: Lower extremity ultrasound surveillance identified 138 patients who developed VTE during their hospital stay (mean age 62 years, 61.6% males). Mechanical prophylaxis was used in 79.7% and pharmacologic prophylaxis in 78.3% of patients. The average time of admission to administration of mechanical prophylaxis was 1.92 and 7.7 days for pharmacologic prophylaxis. In patients who received pharmacologic prophylaxis within 2 days, 51.5% of all VTE events occurred during the first week, 73.5% by the second week, and 91.2% by the third week of the hospital stay. In patients who started pharmacologic prophylaxis after 2 days in the hospital, 85% of all VTE events occurred within the first week and 90% within 10 days of the hospital stay (P < 0.001). The timing of initiation of mechanical prophylaxis did not influence the timing of VTE events. CONCLUSIONS: In immobilized patients with stroke, traumatic brain injury, or spinal cord injury, VTE screening should be performed at different schedules based on the timing of initiation of pharmacologic prophylaxis. In patients who did not start prophylaxis during the first 2 days of admission to the hospital, the majority of the VTE events occurred during the first 10 days.


Assuntos
Repouso em Cama/efeitos adversos , Lesões Encefálicas/terapia , Admissão do Paciente , Traumatismos da Coluna Vertebral/terapia , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologia , Adulto Jovem
17.
Neurosurgery ; 84(1): E43-E45, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30202931

RESUMO

QUESTION: Does the active maintenance of arterial blood pressure after injury affect clinical outcomes in patients with thoracic and lumbar fractures? RECOMMENDATIONS: There is insufficient evidence to recommend for or against the use of active maintenance of arterial blood pressure after thoracolumbar spinal cord injury. Grade of Recommendation: Grade Insufficient However, in light of published data from pooled (cervical and thoracolumbar) spinal cord injury patient populations, clinicians may choose to maintain mean arterial blood pressures >85 mm Hg in an attempt to improve neurological outcomes. Consensus Statement by the Workgroup The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_6.


Assuntos
Hemodinâmica , Vértebras Lombares/lesões , Neurocirurgia/normas , Traumatismos da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/fisiopatologia
18.
Neurosurgery ; 84(1): E50-E52, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30203034

RESUMO

QUESTION 1: Does the surgical treatment of burst fractures of the thoracic and lumbar spine improve clinical outcomes compared to nonoperative treatment? RECOMMENDATION 1: There is conflicting evidence to recommend for or against the use of surgical intervention to improve clinical outcomes in patients with thoracolumbar burst fracture who are neurologically intact. Therefore, it is recommended that the discretion of the treating provider be used to determine if the presenting thoracic or lumbar burst fracture in the neurologically intact patient warrants surgical intervention. Strength of Recommendation: Grade Insufficient. QUESTION 2: Does the surgical treatment of nonburst fractures of the thoracic and lumbar spine improve clinical outcomes compared to nonoperative treatment? RECOMMENDATION 2: There is insufficient evidence to recommend for or against the use of surgical intervention for nonburst thoracic or lumbar fractures. It is recommended that the decision to pursue surgery for such fractures be at the discretion of the treating physician. Strength of Recommendation: Grade Insufficient The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_1.


Assuntos
Vértebras Lombares/lesões , Neurocirurgia/normas , Traumatismos da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/terapia
19.
Neurosurgery ; 84(1): E39-E42, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30203078

RESUMO

QUESTION 1: Does routine screening for deep venous thrombosis prevent pulmonary embolism (or venous thromboembolism (VTE)-associated morbidity and mortality) in patients with thoracic and lumbar fractures? RECOMMENDATION 1: There is insufficient evidence to recommend for or against routine screening for deep venous thrombosis in preventing pulmonary embolism (or VTE-associated morbidity and mortality) in patients with thoracic and lumbar fractures. Strength of Recommendation: Grade Insufficient. QUESTION 2: For patients with thoracic and lumbar fractures, is one regimen of VTE prophylaxis superior to others with respect to prevention of pulmonary embolism (or VTE-associated morbidity and mortality)? RECOMMENDATION 2: There is insufficient evidence to recommend a specific regimen of VTE prophylaxis to prevent pulmonary embolism (or VTE-associated morbidity and mortality) in patients with thoracic and lumbar fractures. Strength of Recommendation: Grade Insufficient. QUESTION 3: Is there a specific treatment regimen for documented VTE that provides fewer complications than other treatments in patients with thoracic and lumbar fractures? RECOMMENDATION 3: There is insufficient evidence to recommend for or against a specific treatment regimen for documented VTE that would provide fewer complications than other treatments in patients with thoracic and lumbar fractures. Strength of Recommendation: Grade Insufficient. RECOMMENDATION 4: Based on published data from pooled (cervical and thoracolumbar) spinal cord injury populations, the use of thromboprophylaxis is recommended to reduce the risk of VTE events in patients with thoracic and lumbar fractures. Consensus Statement by the Workgroup The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_7.


Assuntos
Vértebras Lombares/lesões , Neurocirurgia/normas , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Tromboembolia/etiologia , Tromboembolia/terapia , Anticoagulantes/uso terapêutico , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Traumatismos da Medula Espinal/complicações , Fraturas da Coluna Vertebral/complicações
20.
Neurosurgery ; 84(1): E46-E49, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30203096

RESUMO

BACKGROUND: Thoracic and lumbar burst fractures in neurologically intact patients are considered to be inherently stable, and responsive to nonsurgical management. There is a lack of consensus regarding the optimal conservative treatment modality. The question remains whether external bracing is necessary vs mobilization without a brace after these injuries. OBJECTIVE: To determine if the use of external bracing improves outcomes compared to no brace for neurologically intact patients with thoracic or lumbar burst fractures. METHODS: A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to thoracolumbar trauma. Clinical studies specifically comparing external bracing to no brace for neurologically intact patients with thoracic or lumbar burst fractures were selected for review. RESULTS: Three studies out of 1137 met inclusion criteria for review. One randomized controlled trial (level I) and an additional randomized controlled pilot study (level II) provided evidence that both external bracing and no brace equally improve pain and disability in neurologically intact patients with burst fractures. There was no difference in final clinical and radiographic outcomes between patients treated with an external brace vs no brace. One additional level IV retrospective study demonstrated equivalent clinical outcomes for external bracing vs no brace. CONCLUSION: This evidence-based guideline provides a grade B recommendation that management either with or without an external brace is an option given equivalent improvement in outcomes for neurologically intact patients with thoracic and lumbar burst fractures. The decision to use an external brace is at the discretion of the treating physician, as bracing is not associated with increased adverse events compared to no brace. QUESTION: Does the use of external bracing improve outcomes in the nonoperative treatment of neurologically intact patients with thoracic and lumbar burst fractures? RECOMMENDATION: The decision to use an external brace is at the discretion of the treating physician, as the nonoperative management of neurologically intact patients with thoracic and lumbar burst fractures either with or without an external brace produces equivalent improvement in outcomes. Bracing is not associated with increased adverse events compared to not bracing. Strength of Recommendation: Grade B The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_8.


Assuntos
Braquetes , Vértebras Lombares/lesões , Neurocirurgia/normas , Traumatismos da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/terapia
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