Missile injuries of spine and spinal cord in civilian Kashmir – Analysis and outcome evaluated by new Modified SKIMS-Functional Scales

Bhat, Abdul Rashid; Wani, Mohammed Afzal; Kirmani, Altaf Rehman; Alam, Shafiq; Raina, Tariq; Arif, Sajad; Ramzan, Altaf; Lahawal, Masood A.

doi:10.1016/j.ijnt.2012.11.012

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…The dorso-lumbar junction (D12-L1) and lumbar 2 nd and 3 rd bodies were approached through Modified posterolateral Extra-pleural Retro-peritoneal approach. (17) In our study we found that the initial neurological deficit was the most important factor for the outcome of these patients, patients with incomplete injury at admission had good recovery and patients with complete injury at admission had poor outcome.…”

Section: Original Articlementioning

confidence: 50%

Profile of Spinal Trauma in Kashmir

Habib¹,

Ahanger²,

Reshi³

et al. 2015

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Spinal cord injury is a devastating condition that affects all regions of the world. A high incidence of spinal cord injury in younger populations has resulted in enormous financial and physical costs for individual and the society. AIMS: The aim of this study was to know the epidemiological and clinico-radiological features of spinal trauma, analyse the diagnostic tools and to reveal the outcome of spinal trauma. METHODS: This was a retroprospective hospital based study. All patients of spinal trauma admitted in the department of Neurosurgery SKIMS, Srinagar from September 2003 to October 2013 were taken up for the study. RESULTS: A total of 667 cases of spinal trauma were reported from September 2003 to October 2013. 526 were males and 141 were females. The most prevalent age group was 21-40 years (49.93%). Most common mode of injury was fall from height (66.41%), followed by Road traffic accidents (28.63%). 38.08% had cervical, 31.64% had dorsal and 30.28% had lumbar spine injury. Trauma was most common in the month of August and was mainly due to fall from height. 69.61% patients were managed surgically and 30.58% conservatively. 41.22% patients showed improvement in neurological grade, 20.68% made complete recovery, 26.53% showed no neurological improvement. CONCLUSION: Spinal trauma occurs most commonly in young productive age group. Fall from height is the most common cause of injury. CT and MRI are complementary to each other in diagnosis. Initial neurological grade is most important prognostic factor.

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Section: Original Articlementioning

confidence: 50%

Profile of Spinal Trauma in Kashmir

Habib¹,

Ahanger²,

Reshi³

et al. 2015

jebmh

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“…18 The present study reveals that all types of approaches and procedures were used in 79.01% (527/667) patients to decompress spinal cord and roots, while simultaneously to construct and stabilize the spinal column. 19 Silberstein and Rabinovich reported a mortality of 16.8% and most of the patients who died (84.8%) had injuries to the cervical spinal cord at the level of C4 and above. 20 The present walnut-spine study showed that ASIA neurologic grade of A and B on admission in more than 94% cervical injuries and in more than 86% of dorsal spinal injuries caused by walnut-tree falls had worst outcome in terms of severe disabilities and deaths.…”

Section: Discussionmentioning

confidence: 99%

“Walnut-Spine” — Nonpenetrating Spinal Trauma: An Orchard Hazard in Kashmir

Bhat

Kirmani

Wani

2016

IJNT

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Aims?Among the causes of nonpenetrating spinal cord injuries in this snow bound valley, the fall of young and occupationally productive population from walnut trees, has emerged as a new orchard hazard, locally called walnut-spine, which restricts the social and economic development and at the same time increases the social burden of disabilities. We ought to analyze the causes, number, sex, and outcome of nonpenetrating spinal injuries for the epidemiologic purposes, and to project and prevent the occupational hazard such as walnut-spine. Methods?The study is based on the retrospective work and data from January 2003 to December 2012 in the Department of Neurosurgery. All the patients with nonpenetrating spinal trauma from C2 to L5 vertebral body level were included in the study. The patients with C1 injury and penetrating causes of spinal injuries such as missiles, knives, nails, iron rods, etc. were excluded from the study. The statistical law of variance was used wherever applicable. Results?While analyzing 667 cases of nonpenetrating spinal trauma, it was revealed that the males (526/667?=?78.86%) outnumbered the females (141?=?21.14%) by a ratio of 526 (3.7): 141 (1.0). The most prevalent age group was 21?40 years (403/667?=?60.41%). The most common mode of injury was fall from a walnut tree, called walnut-spine locally, which led to more than half (337/667?=?50.52%) of the total nonpenetrating-type of spinal injuries. The other causes were fall from building heights (222/667?=?33.28%) such as rooftops, windows, walls, etc. and road-traffic accidents (16.19%?=?108/667). The most injured segment of the spine was dorsal spine (282/667?=?42.27%) and cervical spine (35.68%?=?238/667). The walnut-tree falls alone have emerged as the cause of most of the cervical, dorsal, and lumbar spinal injuries. About 21.28% (142/667) patients had associated head, thoracic, abdominal, and other skeletal injuries. The outcome of walnut-spine was worst in terms of neurodeficits, disability, and mortality. Conclusion?A high incidence of walnut-spines ? an occupational orchard hazard ? among nonpenetrating spinal injuries in younger population has resulted in enormous financial and physical costs for an individual and the society.

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Surgical management of penetrating spinal cord injury primarily due to shrapnel and its effect on neurological outcome: a literature review and meta-analysis

Lawless

Lytle

McGlynn

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEThis study was performed to determine whether decompression of penetrating spinal cord injury (SCI) due to explosive shrapnel leads to greater neurological recovery than conservative management.METHODSIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search using PubMed/MEDLINE, Web of Science, Google Scholar, and the Defense Technical Information Center public site was conducted on May 2, 2016. Studies that described penetrating SCI with shrapnel as an etiology, included surgical and/or conservative management, and demonstrated admission and follow-up neurological status were eligible for inclusion in this study. Odds ratios were calculated for the overall effect of surgical treatment on neurological recovery. Funnel plots were used to evaluate publication bias.RESULTSFive case series (Level IV evidence) met the study criteria, and 2 of them had estimable odds ratios for use in the Forest plot analysis. Among the patients from all 5 studies, 65% were injured by shrapnel, 25% by high-velocity bullet, 8% by low-velocity bullet, and 2% by an unknown cause. A total of 288 patients were included in the overall odds ratio calculations. Patients were stratified by complete and incomplete SCI. The meta-analysis showed no significant difference in outcomes between surgical and conservative management in the complete SCI cohort or the incomplete SCI cohort. Overall rates of improvement for complete SCI were 25% with surgery and 27% with conservative treatment (OR 1.07, 95% CI 0.44–2.61, p = 0.88); for incomplete SCI, 70% with surgery and 81% with conservative treatment (OR 1.67, 95% CI 0.68–4.05, p = 0.26).CONCLUSIONSThis study demonstrates no clear benefit to surgical decompression of penetrating SCI due predominantly to shrapnel. There is a considerable need for nonrandomized prospective cohort studies examining decompression and stabilization surgery for secondary and tertiary blast injuries.

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Missile injuries of spine and spinal cord in civilian Kashmir – Analysis and outcome evaluated by new Modified SKIMS-Functional Scales

Cited by 3 publications

References 31 publications

Profile of Spinal Trauma in Kashmir

Profile of Spinal Trauma in Kashmir

“Walnut-Spine” — Nonpenetrating Spinal Trauma: An Orchard Hazard in Kashmir

Surgical management of penetrating spinal cord injury primarily due to shrapnel and its effect on neurological outcome: a literature review and meta-analysis

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