A high risk group for thoracolumbar fractures

Stanislas, M.J.C.; Latham, Jeremy M.; Porter, KM; Alpar, E. K.; Stirling, Allan

doi:10.1016/s0020-1383(97)00109-5

Cited by 51 publications

(27 citation statements)

References 13 publications

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“…No cervical spine injuries were missed following 158 entire CT scans in combination with plain films [147]. Entire CT may represent a minimum standard once an injury is detected because 10-31% of cervical fractures have associated non-contiguous fractures [148,149]. Nunez et al [128,129] reviewed 88 patients with fractures previously diagnosed on plain films or directed CT.…”

Section: Computerised Tomographymentioning

confidence: 99%

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Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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Section: Computerised Tomographymentioning

confidence: 99%

“…An unstable thoracolumbar spine injury is almost always associated with a fracture, and therefore should be apparent on plain films [11,62,148,163]. However, there is a recognised minority of isolated cervical spine ligamentous injuries that have no associated fracture and may not appear on plain films or CT.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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“…It is urgently indicated in the event of decompression of the spinal column with reposition and stabilisation of the fracture. Typically, the stabilisation is initially performed from the posterior approach (Stanislas et al 1998). However, the structure responsible for spinal stability is the anterior spinal column, and this is where the attention of spine surgery is currently focused (Rosenthal 2000).…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of the MACSTL Internal Fixator for Thoracic Spinal Stabilisation

Veselý

Florian²,

Wendsche

et al. 2008

Acta Vet. Brno

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Unstable fractures of the thoracic spine in humans represent a serious social and economic issue. They may lead to persistent consequences and chronic disease. The anatomical and biomechanical characteristics of the thoracic spine are different from all the other spinal parts due to its higher mobility. The vertebrae of the chest area are less mobile, conferring a higher degree of rigidity to the spine. To destabilize this relatively rigid system, a considerable force is necessary.The treatment of unstable spinal fractures is solely surgical. The decompression of the spinal canal with reposition and stabilisation of the fracture is indicated urgently. This intervention is performed mostly from the posterior approach in the first phase. However, the anterior spinal column is the structure responsible for the stability of the spine. Therefore, the recent advances in spine surgery focus on this area of expertise. For this reason, we carried out a bio-mechanical study aimed at assessing the effectiveness of two surgical tactics used. The study consisted of comparative experiments performed by computer-aided device on segments of pig cadavers (n = 5). The experiment involved a comparison of segments of the thoracic spine under the following conditions: an anatomically intact segment, a spine segment with an artificially created anterior instability, and a segment with an applied internal fixator. The experiment compared the mechanical characteristics of these segments.The experiment has demonstrated that after application of the internal fixator used for stabilisation of the injured anterior spinal column at defined pre-loading of 200 N, the stability of damaged spinal segment in torsion increased twofold. It was also verified that sufficient stability can be ensured using the Modular Anterior Construct System (MACS TL ) implant for ventral stabilisation of thoracic spine unstable injuries. Endoscopic application of this implant represents an additional advantage of this surgical procedure. Thoracic spine, unstable fractures, anterior approach, biomechanical study, swine, model Unstable fractures of the thoracic spine represent a serious social and economic issue in human medicine. On one hand, these injuries involving damage to the spinal cord can result in irreversible persistent consequences; on the other hand, such traumas with minimal force without radiographic signs develop into a chronic condition that can result in permanent disability.The thoracic spine is the longest section of the spine with a prevalence of trauma exposure, especially in its lower area. Anatomical and biomechanical characteristics of the thoracic spine differ from other, more flexible, sections of the spine. The chest limits motion and contributes greatly to spinal rigidity. This is obvious especially in extension movements. Flexion and lateral rotation in the thoracic area are, however, limited in comparison to other parts of the spine. Apart from the skeleton, the ligament apparatus is also important for spinal stability. In bio-mecha...

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“…Доказано, что 50 % застарелых посттравматических деформаций является следствием своевременно не выяв-ленных переломов позвоночника, причина тому -тяжесть состояния пациентов с сочетанной травмой, когда диаг-ностические манипуляции затруднены [14,60,129,139]. В таких случаях необходимо при наличии симптоматики, указывающей на повреждение позвоночника, проводить соответствующее лечение с обязательным дообследовани-ем пациента после выхода его из тяжелого состояния.…”

Section: таблицаunclassified

Injuries of the Thoracic and Lumbar Spine

Ramikh¹,

Tsivyan²

2008

Hir. pozvonoč.

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A high risk group for thoracolumbar fractures

Cited by 51 publications

References 13 publications

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Biomechanical Evaluation of the MACSTL Internal Fixator for Thoracic Spinal Stabilisation

Injuries of the Thoracic and Lumbar Spine

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