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Thoracolumbar Trauma

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421. Chance Fracture (Follow-up)

and associated abdominal trauma. J Trauma . 1990 Apr. 30 (4):436-44. . Triantafyllou SJ, Gertzbein SD. Flexion distraction injuries of the thoracolumbar spine: a review. Orthopedics . 1992 Mar. 15 (3):357-64. . Tyroch AH, McGuire EL, McLean SF, Kozar RA, Gates KA, Kaups KL, et al. The association between Chance fractures and intra-abdominal injuries revisited: a multicenter review. Am Surg . 2005 May. 71 (5):434-8. . Mulpuri K, Reilly CW, Perdios A, Tredwell SJ, Blair GK. The spectrum of abdominal injuries (...) . 2010 Oct. 23 (7):e1-8. . Parizel PM, van der Zijden T, Gaudino S, Spaepen M, Voormolen MH, Venstermans C, et al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J . 2010 Mar. 19 Suppl 1:S8-17. . Bernstein MP, Mirvis SE, Shanmuganathan K. Chance-type fractures of the thoracolumbar spine: imaging analysis in 53 patients. AJR Am J Roentgenol . 2006 Oct. 187 (4):859-68. . Groves CJ, Cassar-Pullicino VN, Tins BJ, Tyrrell PN, McCall IW. Chance-type flexion-distraction injuries

2014 eMedicine Surgery

422. Ankylosing Spondylitis (Follow-up)

Royen BJ, De Gast A. Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis . 1999 Jul. 58(7):399-406. . . Shih LY, Chen TH, Lo WH, Yang DJ. Total hip arthroplasty in patients with ankylosing spondylitis: longterm followup. J Rheumatol . 1995 Sep. 22(9):1704-9. . Cawley MI, Chalmers TM, Ball J. Destructive lesions of vertebral bodies in ankylosing spondylitis. Ann Rheum Dis . 1971 Sep. 30(5):539 (...) of spondylarthropathies]. Rev Rhum Mal Osteoartic . 1990 Feb. 57(2):85-9. . Rasker JJ, Prevo RL, Lanting PJ. Spondylodiscitis in ankylosing spondylitis, inflammation or trauma? A description of six cases. Scand J Rheumatol . 1996. 25(1):52-7. . Dihlmann W, Delling G. Discovertebral destructive lesions (so called Andersson lesions) associated with ankylosing spondylitis. Skel Radiol . 1978. 3:10-6. Agarwal AK, Reidbord HE, Kraus DR, Eisenbeis CH Jr. Variable histopathology of discovertebral lesion (spondylodiscitis

2014 eMedicine Surgery

423. Vertebral Fracture (Diagnosis)

the use of screws to achieve stability and promote fusion Posterior rods - Effective in stabilizing multiple fractures or unstable fractures Z-plate anterior thoracolumbar plating system - Has been used for the treatment of burst fractures Cage See for more detail. Next: Background Vertebral fractures of the thoracic and lumbar spine are usually associated with major trauma and can cause spinal cord damage that results in neural deficits. Each vertebral region has unique anatomical and functional (...) . [ ] Given the shortage of neurosurgeons at many trauma centers in the United States, Baldwin et al designed a treatment protocol that used radiologic criteria to screen for potentially stable fractures and to guide treatment without spinal consultation. Using both prospective and retrospective evaluation, the study determined that use of a treatment protocol for stable thoracolumbar fractures appeared safe and could help conserve resources. Surgery for patients with complete neurologic deficit

2014 eMedicine Surgery

424. Tumors of the Conus and Cauda Equina (Diagnosis)

with the following: Pain radiating to the lower extremity Motor weakness in a specific distribution Sensory loss or paresthesia in a specific dermatomal pattern Diminished reflexes Spinal stenosis can be the result of a congenitally shallow canal, with the following: Arthropathy of the facet Hypertrophied ligamentum flavum A bulging annulus or herniated disc With neurogenic claudication (compared with vascular claudication), the pain is dermatomal and worsens with ambulation. In the setting of major trauma (...) , fractures are likely nonpathologic. The bony fragments can compress the neural elements. Vascular Epidural spinal hematoma may be posttraumatic; in anticoagulated patients, minor trauma presumably may be the cause. Alternatively, it may result from a dural vascular malformation. may cause a hemorrhage that affects the conus medullaris but is less likely to affect individual roots. Infarction may result from disruption of the radicular vessels as a result of atherosclerotic disease of the aorta

2014 eMedicine Surgery

425. Thoracic Spine Fractures and Dislocations (Follow-up)

of an active infection. Guidelines on management of thoracolumbar burst fractures are available from the Congress of Neurological Surgeons, [ ] and guidelines on management of spinal cord injury (SCI) are available from AOSpine [ , , , , , ] (see ). Timing of surgical treatment The literature regarding the timing of surgical intervention for thoracic and lumbar fractures with an acute spinal cord injury (SCI) is scarce. However, several studies have looked at the timing of surgery in cervical spine trauma (...) in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) . 1983 Nov-Dec. 8 (8):817-31. . Browner BD, Jupiter JB, Krettek C. Thoracolumbar Fractures. Skeletal Trauma: Basic Science, Management, and Reconstruction . 5th ed. Philadelphia, PA: Elsevier; 2014 Dec 09. 803-812, 911-979. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med . 2011 Nov. 34 (6

2014 eMedicine Surgery

426. Tumors of the Conus and Cauda Equina (Follow-up)

with the following: Pain radiating to the lower extremity Motor weakness in a specific distribution Sensory loss or paresthesia in a specific dermatomal pattern Diminished reflexes Spinal stenosis can be the result of a congenitally shallow canal, with the following: Arthropathy of the facet Hypertrophied ligamentum flavum A bulging annulus or herniated disc With neurogenic claudication (compared with vascular claudication), the pain is dermatomal and worsens with ambulation. In the setting of major trauma (...) , fractures are likely nonpathologic. The bony fragments can compress the neural elements. Vascular Epidural spinal hematoma may be posttraumatic; in anticoagulated patients, minor trauma presumably may be the cause. Alternatively, it may result from a dural vascular malformation. may cause a hemorrhage that affects the conus medullaris but is less likely to affect individual roots. Infarction may result from disruption of the radicular vessels as a result of atherosclerotic disease of the aorta

2014 eMedicine Surgery

427. Vertebral Fracture (Follow-up)

for screening and management of stable fractures. J Trauma . 2010 Dec. 69(6):1491-5; discussion 1495-6. . Guarnieri G, Izzo R, Muto M. The role of emergency radiology in spinal trauma. Br J Radiol . 2015 Nov 27. 20150833. . Inaba K, Nosanov L, Menaker J, Bosarge P, Williams L, Turay D, et al. Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: An American Association for the Surgery of Trauma Multi-Institutional Trials Group Study. J Trauma Acute Care (...) . Operative treatment of progressive deformity in spinal tuberculosis. Int Orthop . 2001. 25(5):322-5. . Dimar JR, Fisher C, Vaccaro AR, et al. Predictors of complications after spinal stabilization of thoracolumbar spine injuries. J Trauma . 2010 Dec. 69(6):1497-500. . Anderson DK, Hall ED, Braughler JM, et al. Effect of delayed administration of U74006F (tirilazad mesylate) on recovery of locomotor function after experimental spinal cord injury. J Neurotrauma . 1991 Fall. 8(3):187-92. . Baron BJ, Scalea

2014 eMedicine Surgery

428. Neurofibromatosis (Follow-up)

divided into cervical, thoracic, lumbosacral, and spinal canal pathologies. Cervical spine changes and associated complications Features of the cervical spine in patients with NF1 have not received enough attention in the literature. Cervical abnormalities occur much more frequently when a scoliosis or kyphoscoliosis is present in the thoracolumbar region, in which case the examiner's attention is focused on the more obvious deformity. The manifestations of NF1 can be observed as dystrophic changes (...) Y, Ni J, Gu S, Zhu X. Successful use of posterior instrumented spinal fusion alone for scoliosis in 19 patients with neurofibromatosis type-1 followed up for at least 25 months. Arch Orthop Trauma Surg . 2009 Jul. 129 (7):915-21. . Helenius IJ, Sponseller PD, Mackenzie W, Odent T, Dormans JP, Asghar J, et al. Outcomes of Spinal Fusion for Cervical Kyphosis in Children with Neurofibromatosis. J Bone Joint Surg Am . 2016 Nov 2. 98 (21):e95. . Lin T, Shao W, Zhang K, Gao R, Zhou X. Comparison

2014 eMedicine Surgery

429. Lumbar Spine Fractures and Dislocations (Follow-up)

Sports Med . 2008 Jan. 42(1):55-8. . Sieradzki JP, Sarwark JF. Thoracolumbar fracture-dislocation in child abuse: case report, closed reduction technique and review of the literature. Pediatr Neurosurg . 2008. 44 (3):253-7. . Schoenfeld AJ, Newcomb RL, Pallis MP, Cleveland AW 3rd, Serrano JA, Bader JO, et al. Characterization of spinal injuries sustained by American service members killed in Iraq and Afghanistan: a study of 2,089 instances of spine trauma. J Trauma Acute Care Surg . 2013 Apr. 74(4 (...) ):1112-8. . Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology . 2000 Jun. 215(3):831-4. . Hsieh CT, Chen GJ, Wu CC, Su YH. Complete fracture-dislocation of the thoracolumbar spine without paraplegia. Am J Emerg Med . 2008 Jun. 26(5):633.e5-7. . Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J . 2014 Jan. 14 (1):145-64. . Levi AD

2014 eMedicine Surgery

430. Lower Cervical Spine Fractures and Dislocations (Follow-up)

deterioration in the face of persistent compression from bone or disk fragments Although malalignment can be managed initially with cervical tong traction, definitive surgical stabilization, with or without decompression, generally is required. Anterior-column trauma may result from axial loading injuries in combination with flexion, extension, or rotational moments. Typically, the burst fracture or teardrop variant occurs with translation of bony fragments into the spinal canal. [ , , ] Direct trauma (...) herniation is identified before reduction, it can be removed anteriorly, and reduction then can be performed safely. This has been described in both unilateral and bilateral facet dislocations. Guidelines on treatment of subaxial cervical spine injuries are available from the American Association of Neurological Surgeons (AANS; see ). [ ] Next: Medical Therapy Medical management involves treating the multiple traumas and, more specifically, treating concomitant neurologic injury. The use of steroids

2014 eMedicine Surgery

431. Kyphosis (Follow-up)

. Pseudarthrosis can occur, especially with long fusions, inadequate support of the anterior column, and fusions at the thoracolumbar junction. [ ] Other risk factors in long fusions to treat scoliosis include age greater than 55 years, [ ] thoracolumbar kyphosis greater than 20°, and fusion of more than 12 levels. [ ] Implant failure can lead to loss of correction, especially at the proximal portion of the instrumentation. Patients with osteoporosis are at somewhat increased risk of implant failure or even (...) angle in the measurement of vertebral, local and segmental kyphosis of traumatic lumbar spine fractures in the lateral X-ray. Arch Orthop Trauma Surg . 2010 Dec. 130 (12):1533-8. . Perriman DM, Scarvell JM, Hughes AR, Ashman B, Lueck CJ, Smith PN. Validation of the flexible electrogoniometer for measuring thoracic kyphosis. Spine (Phila Pa 1976) . 2010 Jun 15. 35 (14):E633-40. . Bautmans I, Van Arken J, Van Mackelenberg M, Mets T. Rehabilitation using manual mobilization for thoracic kyphosis

2014 eMedicine Surgery

432. Idiopathic Scoliosis (Follow-up)

adolescent idiopathic scoliosis. This system, first published in 2001, includes the following three components [ ] : Curve type (1, 2, 3, 4, 5, or 6) Lumbar spine modifier (A, B, or C) Sagittal thoracic modifier (–, N, or +) On coronal and sagittal radiographs, the six types specified by Lenke et al have specific characteristics that distinguish structural and nonstructural curves in the proximal thoracic (PT), main thoracic (MT), thoracolumbar (TL), and lumbar (L) regions. [ ] Regional curves (...) of the thoracic curve is possible. When this is not the case, extensive fusion (at times down to the fourth lumbar segment) may become necessary. The Scoliosis Research Society has a reasonably specific definition of thoracolumbar scoliosis: a curve whose apex lies at the body of T-12 or L-1 or at the T12-L1 interspace. These curves are most commonly left-sided curves, and they present one of the most common scenarios in which anterior spinal fusion and instrumentation is utilized. Anterior approaches

2014 eMedicine Surgery

433. Decompression Sickness (Follow-up)

== processing > Decompression Sickness Treatment & Management Updated: Mar 05, 2019 Author: Stephen A Pulley, DO, MS, FACOEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Decompression Sickness Treatment Prehospital Care Extricate the patient from the water. Immobilize if trauma is suspected. Generally, in-water recompression (IWR) is not believed to be a safe option. Problems with air supply, hypothermia, potential oxygen toxicity with seizure, dehydration (...) the patient into the Trendelenburg position. Placing the patient in a head-down posture used to be a standard treatment of diving injuries to prevent cerebral gas embolization. Avoid this practice. [ ] The process actually increases intracranial pressure and exacerbates injury to the blood-brain barrier. [ ] It also wastes time and complicates movement of the patient. Perform intubation and aggressive resuscitation including advanced cardiac and trauma life support. Be alert for the potential of tension

2014 eMedicine Emergency Medicine

434. Cauda Equina Syndrome (Follow-up)

decompression is necessary to minimize the chances of permanent neurologic injury. Next: Emergency Department Care No proven medical treatment exists, and therapy generally is directed at the underlying cause of cauda equina syndrome. For penetrating trauma, steroids have not shown significant benefit. Surgery is controversial. The timing of decompression is controversial, with immediate, early, and late surgical decompression showing varying results. [ , , ] For mechanical compression of the cauda due (...) principles. Neurosurg Focus . 2004 Jun 15. 16(6):e4. . Fisher RG. Sacral fracture with compression of cauda equina: surgical treatment. J Trauma . 1988 Dec. 28(12):1678-80. . Schizas C, Ballesteros C, Roy P. Cauda equina compression after trauma: an unusual presentation of spinal epidural lipoma. Spine (Phila Pa 1976) . 2003 Apr 15. 28(8):E148-51. . Thongtrangan I, Le H, Park J, Kim DH. Cauda equina syndrome in patients with low lumbar fractures. Neurosurg Focus . 2004 Jun 15. 16(6):e6. . Haldeman S

2014 eMedicine Emergency Medicine

435. Spinal Cord Injuries (Diagnosis)

: Destruction from direct trauma Compression by bone fragments, hematoma, or disk material Ischemia from damage or impingement on the spinal arteries Edema could ensue subsequent to any of these types of damage. Neurogenic shock Neurogenic shock refers to the hemodynamic triad of hypotension, bradycardia, and peripheral vasodilation resulting from severe autonomic dysfunction and the interruption of sympathetic nervous system control in acute spinal cord injury. Hypothermia is also characteristic (...) is the most common cause in some US urban settings. Among patients who had suffered an assault, spinal cord injury from a penetrating injury tended to be worse than that from a blunt injury [ ] ; (4) and sports (8.0%), in which diving is the most common cause). [ ] Spinal cord injury (SCI) due to trauma has major functional, medical, and financial effects on the injured person, as well as an important effect on the individual's psychosocial well-being. [ , , ] Other causes of spinal cord injury include

2014 eMedicine Emergency Medicine

436. Spinal Cord Injuries (Follow-up)

, or general ward. The most common levels of injury on admission are C4, C5 (the most common), and C6, whereas the level for paraplegia is the thoracolumbar junction (T12). The most common type of injury on admission is American Spinal Injury Association (ASIA) level A (see Neurologic level and extent of injury under Clinical). Transfer Depending on local policy, patients with acute spinal cord injury are best treated at a regional spinal cord injury center. Therefore, once stabilized, early referral (...) have multiple associated injuries, consultation with a general surgeon or a trauma specialist as well as other specialists may also be required. Next: Prehospital Management Most prehospital care providers recognize the need to stabilize and immobilize the spine on the basis of mechanism of injury, pain in the vertebral column, or neurologic symptoms. Patients are usually transported to the emergency department (ED) with a cervical hard collar on a hard backboard. Commercial devices are available

2014 eMedicine Emergency Medicine

437. Cauda Equina Syndrome (Treatment)

decompression is necessary to minimize the chances of permanent neurologic injury. Next: Emergency Department Care No proven medical treatment exists, and therapy generally is directed at the underlying cause of cauda equina syndrome. For penetrating trauma, steroids have not shown significant benefit. Surgery is controversial. The timing of decompression is controversial, with immediate, early, and late surgical decompression showing varying results. [ , , ] For mechanical compression of the cauda due (...) principles. Neurosurg Focus . 2004 Jun 15. 16(6):e4. . Fisher RG. Sacral fracture with compression of cauda equina: surgical treatment. J Trauma . 1988 Dec. 28(12):1678-80. . Schizas C, Ballesteros C, Roy P. Cauda equina compression after trauma: an unusual presentation of spinal epidural lipoma. Spine (Phila Pa 1976) . 2003 Apr 15. 28(8):E148-51. . Thongtrangan I, Le H, Park J, Kim DH. Cauda equina syndrome in patients with low lumbar fractures. Neurosurg Focus . 2004 Jun 15. 16(6):e6. . Haldeman S

2014 eMedicine Emergency Medicine

438. Decompression Sickness (Treatment)

== processing > Decompression Sickness Treatment & Management Updated: Mar 05, 2019 Author: Stephen A Pulley, DO, MS, FACOEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Decompression Sickness Treatment Prehospital Care Extricate the patient from the water. Immobilize if trauma is suspected. Generally, in-water recompression (IWR) is not believed to be a safe option. Problems with air supply, hypothermia, potential oxygen toxicity with seizure, dehydration (...) the patient into the Trendelenburg position. Placing the patient in a head-down posture used to be a standard treatment of diving injuries to prevent cerebral gas embolization. Avoid this practice. [ ] The process actually increases intracranial pressure and exacerbates injury to the blood-brain barrier. [ ] It also wastes time and complicates movement of the patient. Perform intubation and aggressive resuscitation including advanced cardiac and trauma life support. Be alert for the potential of tension

2014 eMedicine Emergency Medicine

439. Spinal Cord Injuries (Overview)

: Destruction from direct trauma Compression by bone fragments, hematoma, or disk material Ischemia from damage or impingement on the spinal arteries Edema could ensue subsequent to any of these types of damage. Neurogenic shock Neurogenic shock refers to the hemodynamic triad of hypotension, bradycardia, and peripheral vasodilation resulting from severe autonomic dysfunction and the interruption of sympathetic nervous system control in acute spinal cord injury. Hypothermia is also characteristic (...) is the most common cause in some US urban settings. Among patients who had suffered an assault, spinal cord injury from a penetrating injury tended to be worse than that from a blunt injury [ ] ; (4) and sports (8.0%), in which diving is the most common cause). [ ] Spinal cord injury (SCI) due to trauma has major functional, medical, and financial effects on the injured person, as well as an important effect on the individual's psychosocial well-being. [ , , ] Other causes of spinal cord injury include

2014 eMedicine Emergency Medicine

440. Fracture, Cervical Spine (Overview)

, Izzo R, Muto M. The role of emergency radiology in spinal trauma. Br J Radiol . 2016. 89 (1061):20150833. . Winslow JE 3rd, Hensberry R, Bozeman WP, Hill KD, Miller PR. Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. J Trauma . 2006 Sep. 61(3):686-7. . Duane TM, Dechert T, Wolfe LG, Aboutanos MB, Malhotra AK, Ivatury RR. Clinical examination and its reliability in identifying cervical spine fractures. J Trauma . 2007 Jun. 62(6):1405-8 (...) in odontoid fractures and atlanto-occipital dislocation. [ , , , , , , ] Radiographic evaluation is indicated in the following [ , , , , , , ] : Patients who exhibit neurologic deficits consistent with a cord lesion Patients with an altered sensorium from head injury or intoxication Patients who complain about neck pain or tenderness Patients who do not complain about neck pain or tenderness but have significant distracting injuries A standard trauma series is composed of 5 views: cross-table lateral

2014 eMedicine Emergency Medicine

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