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Thoracolumbar Trauma

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441. Cauda Equina Syndrome (Overview)

, including disc herniation, intradural disc rupture, spinal stenosis secondary to other spinal conditions, traumatic injury, primary tumors such as ependymomas and schwannomas, metastatic tumors, infectious conditions, arteriovenous malformation or hemorrhage, and iatrogenic injury. [ , ] The most common causes of cauda equina and conus medullaris syndromes are the following: Lumbar stenosis (multilevel) Spinal trauma including fractures [ ] Herniated nucleus pulposus (cause of 2-6% of cases of cauda (...) of 66 consecutive cases of patients admitted to a neurosurgical unit with suspected cauda equina syndrome found that almost half had no evidence of structural pathology on MRI. [ ] These researchers suggested that the symptoms have a functional origin in such cases. Trauma Traumatic events leading to fracture or subluxation can lead to compression of the cauda equina. [ , , , , ] Penetrating trauma can cause damage or compression of the cauda equina. Spinal manipulation resulting in subluxation has

2014 eMedicine Emergency Medicine

442. Fracture, Cervical Spine (Follow-up)

, 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

443. Stem Cell Therapy in Spinal Cord Injury

table for investigator information Principal Investigator: Alok K Sharma, MS,MCh Neurogen Brain and Spine Institute More Information Go to Publications: Sharma A, Gokulchandran N, Sane H, Badhe P, Kulkarni P, Lohia M, Nagrajan A, Thomas N. Detailed analysis of the clinical effects of cell therapy for thoracolumbar spinal cord injury: an original study. Journal of Neurorestoratology. 2013;1:13-22 Sharma A, Sane H, Gokulchandran N, Kulkarni P, Thomas N, et al. (2013) Role of Autologous Bone Marrow (...) relevant MeSH terms: Layout table for MeSH terms Wounds and Injuries Spinal Cord Injuries Spinal Cord Diseases Central Nervous System Diseases Nervous System Diseases Trauma, Nervous System

2013 Clinical Trials

444. Health-related quality-of-life outcomes after thoracic (T1-T10) fractures. (Abstract)

Health-related quality-of-life outcomes after thoracic (T1-T10) fractures. The thoracic spine exhibits a unique response to trauma as the result of recognized anatomical and biomechanical differences. Despite this response, clinical studies often group thoracic fractures (T1-T10) with more caudal thoracolumbar injuries. Subsequently, there is a paucity of literature on the functional outcomes of this distinct group of injuries.To describe and identify predictors of health-related quality

2013 The Spine Journal

445. Effects of acceleration level on lumbar spine injuries in military populations. (Abstract)

Effects of acceleration level on lumbar spine injuries in military populations. Clinical studies have indicated that thoracolumbar trauma occurs in the civilian population at its junction. In contrast, injury patterns in military populations indicate a shift to the inferior vertebral levels of the lumbar spine. Controlled studies offering an explanation for such migrations and the associated clinical biomechanics are sparse in literature.The goals of this study were to investigate the potential (...) spinal level.These findings suggest that the severity of spinal injuries increase with increasing acceleration levels and, more importantly, injuries shift inferiorly from the thoracolumbar junction to lower lumbar levels. Acknowledging that the geometry and load carrying capacity of vertebral bodies increase in the lower lumbar spine, involvement of inferior levels in trauma sparing the superior segments at greater acceleration inputs agree with military literature of caudal shift in injured levels

2013 The Spine Journal

446. Identification of Decision Criteria for Revision Surgery among Patients with Proximal Junctional Failure following Surgical Treatment for Spinal Deformity. Full Text available with Trip Pro

significantly more likely to undergo revision (P = 0.001) as were patients with more extreme proximal junctional kyphosis angulation (P = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision (P = 0.019). Variables approaching but not reaching significance as predictors of revision included female sex (P = 0.066) and higher sagittal vertical axis (SVA) (P = 0.090).The decision to perform revision surgery is complicated and varies by surgeon. Factors that seem (...) to influence this decision include traumatic etiology of PJF, severity of proximal junctional kyphosis angulation, higher SVA, and female sex. Factors that were expected to influence revision but had no statistical effect included soft tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.

2013 Spine

447. High hip fracture risk in men with severe aortic calcification - MrOS study. Full Text available with Trip Pro

High hip fracture risk in men with severe aortic calcification - MrOS study. A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥ 65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative (...) -1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95% CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95% CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar

2013 Journal of Bone and Mineral Research

448. Experience With 161 Cases of Anterior Exposure of the Thoracic and Lumbar Spine in an Acute Care Surgery Model: Impact of Exposure Level and Underlying Pathology on Morbidity. (Abstract)

service gained 3141 physician work relative value units (RVU) by performing those operations.Anterior exposure of the thoracic and lumbar spine both for trauma and nontrauma related indications can be performed with acceptable morbidity and mortality by a dedicated acute care surgery service. Morbidity and mortality were higher in trauma patients and in those who underwent thoracolumbar procedures. Patients who had midline exposure of L4 to S1 for degenerative disc disease had the lowest morbidity.4. (...) perform those operations with acceptable morbidity and mortality.A retrospective review of 161 trauma and nontrauma patients was performed. All cases were performed at a level I trauma center with a dedicated acute care surgery service. In-hospital morbidity and mortality were evaluated. A brief description of the operative techniques used by our group is also provided.Of the 161 patients, 59 (37%) were trauma patients. Ninety-three patients (58%) had anterolateral retroperitoneal exposure

2013 Spine

449. Survival of diced and block cartilage grafts in combination with injectable calcium hydroxylapatite. Full Text available with Trip Pro

Survival of diced and block cartilage grafts in combination with injectable calcium hydroxylapatite. Dorsal nasal irregularities after trauma, and various procedures such as excessive nasal hump resection, are major problems for patients who have undergone rhinoplasty. Many grafts have been described for the correction of dorsal nasal irregularities. In this study, we used an injectable implant, in combination with diced or block cartilage grafts, to test the efficacy of injectable calcium (...) hydroxylapatite on the survival of diced or block cartilage grafts.Prospective, controlled, parallel group animal study.Fourteen New Zealand white rabbits were used. Block cartilage and diced cartilage grafts, alone and in combination with injectable calcium hydroxylapatite, were placed subcutaneously in the rabbits' dorsal thoracolumbar region. On the 90th day following surgery, the graft areas were extracted immediately after the rabbits were sacrificed. Pathological examination was conducted on all

2013 Laryngoscope

450. Neurosurgical injuries resulting from the 2011 tornados in Alabama: the experience at the University of Alabama at Birmingham Medical Center. Full Text available with Trip Pro

Neurosurgical injuries resulting from the 2011 tornados in Alabama: the experience at the University of Alabama at Birmingham Medical Center. The April 27, 2011, tornados that affected the southeastern US resulted in 248 deaths in the state of Alabama. The University of Alabama at Birmingham (UAB) Medical Center, the largest Level I trauma center in the state, triaged and treated a large number of individuals who suffered traumatic injuries during these events, including those requiring (...) produced significant neurosurgical injuries that primarily involved the spine. There were a disproportionate number of patients with thoracolumbar fractures, a finding possibly due to the county medical examiner's postmortem findings that demonstrated a high prevalence of fatal cervical spine and traumatic brain injuries. The UAB experience can be used to aid other institutions in preparing for the appropriate allotment of resources in the event of a similar natural disaster.

2013 Journal of Neurosurgery

451. Paravertebral compartment syndrome after training causing severe back pain in an amateur rugby player: report of a rare case and review of the literature. Full Text available with Trip Pro

Paravertebral compartment syndrome after training causing severe back pain in an amateur rugby player: report of a rare case and review of the literature. Acute compartment syndrome (CS) of the paravertebral muscles without external trauma is rarely reported in literature. Not all of clinical symptoms for CS are applicable to the paravertebral region.A 30-year-old amateur rugby player was suffering from increasing back pain following exertional training specially targeting back muscles. He (...) presented with hardly treatable pain of the lumbar spine, dysaesthesia of the left paravertebral lumbar region as well as elevated muscle enzymes. Magnetic resonance imaging (MRI) showed an edema of the paravertebral muscles. Compartment pressure measurement revealed increased values of 47 mmHg on the left side. Seventy-two hours after onset of back pain a fasciotomy of the superficial thoracolumbar fascia was performed. Immediately postoperatively the clinical condition improved and enzyme levels

2013 BMC Musculoskeletal Disorders

452. The Unusual Chance Fracture: Case Report & Literature Review Full Text available with Trip Pro

The Unusual Chance Fracture: Case Report & Literature Review The Chance fracture represents a spinal lesion caused by a flexion-distraction injury pattern. We describe a rare case of a male driver admitted at the Emergencies of our Institution, level A Trauma center. The was involved in an automobile accident without wearing a seatbelt. Radiological findings of plain radiography and computed tomography (CT) demonstrated a horizontal fracture extending across the vertebral body to the posterior (...) elements with loss of vertebral height at the anterior aspect of T12. Based on these findings, the diagnosis of a T12 Chance fracture was established. The patient was treated conservatively with a thoracolumbar orthosis, without any subsequent disabilities. Although Chance fractures are rare lesions, they should always be considered in spinal injuries, even in cases of motor-vehicle accidents where no seatbelt is used.

2013 The open orthopaedics journal

453. Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course. (Abstract)

), acetabulum (n = 266), proximal or diaphyseal femur (n = 569), and/or thoracolumbar spine (n = 98) fractures. Chest (n = 447), abdomen (n = 328), and head (n = 155) injuries were present.Definitive surgery was within 24 hours in 572 patients and after 24 hours in 433.Complications related to the initial trauma episode included infections, sepsis, pneumonia, deep venous thrombosis, pulmonary embolism, acute respiratory distress syndrome (ARDS), organ failure, and death.Days in intensive care unit (ICU (...) Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course. We hypothesized that early definitive management (within 24 hours of injury) of mechanically unstable fractures of the pelvis, acetabulum, femur and spine would reduce complications and shorten length of stay.Retrospective review.Level 1 trauma center.1005 skeletally mature patients with Injury Severity Score (ISS) ≥18 with pelvis (n = 259

2013 Journal of Orthopaedic Trauma

454. Spinal Infection

Spinal Infection Spinal Infection Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Spinal Infection Spinal Infection Aka: Spinal (...) IV. Pathophysiology: Sources of Spinal Infection Hematogenous spread (50%) Contiguous spread (33%) Psoas Abscess Direct introduction of infection Spinal injection Spinal surgery V. Pathophysiology: Sites of Spinal Infection Most cases involve thoracolumbar spine Anterior Epidural Abscess (20%) Associated infections Disk space infection (Discitis) Blunt and associated hematoma infection Direct extension from adjacent infection Retroperitoneal abscess Posterior Epidural Abscess (80%) Distant source

2015 FP Notebook

455. Scoliosis XRay

Scoliosis XRay Scoliosis XRay Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Scoliosis XRay Scoliosis XRay Aka: Scoliosis XRay , Cobb (...) behind Patient's right side is physician's right side Define direction of curve (left or right) Based on the direction of the convexity Left curve has its apex on the left Define curve location based on apex e level Cervical Thoracic Thoracolumbar (apex at T12 or L1) Lumbar Double Major (2 curves in different regions) V. Measurement: Cobb Angle Diagram Technique Select most tilted e above the apex Draw a line along the top of the e Extend the line into the margin of the Xray Drop a line down

2015 FP Notebook

456. Scoliosis

Scoliosis Scoliosis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Scoliosis Scoliosis Aka: Scoliosis , Idiopathic Scoliosis (...) (25 degrees or more) progress more severely Initial measurement is the most important predictor of Scoliosis requiring formal management Skeletal maturity determines Skeletal maturity (by Riser Grade or Digital skeletal age score) best predicts the likelihood of Scoliosis progression Early adolescence is associated with the greatest risk of curve change Other factors impacting Scoliosis severity and progression Female gender Higher apex l level Thoracic or thoracolumbar curve (70% progression

2015 FP Notebook

457. Cervical Spine Injury

Cervical Spine Injury Cervical Spine Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Cervical Spine Injury Cervical Spine (...) Injury Aka: Cervical Spine Injury , C-Spine Injury , Cervical Spine Trauma , C-Spine Trauma , Spinal Trauma , Spinal Injury From Related Chapters II. Epidemiology Significant spinal cord injuries per year: 11,500 Patients who die of their injuries: 6500 New quadriplegic and paraplegic patients: 500 of morbidity in United States Paralysis or paresis in United States: 265,000 (in 2010) Males account for 80% of spinal cord injuries Mechanisms of Spinal Injury in United States : 40% Violent crime: 26

2015 FP Notebook

458. Anatomy of the Penis

Anatomy of the Penis Anatomy of the Penis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Anatomy of the Penis Anatomy of the Penis (...) ) s supplied by thoracolumbar plexus V. Anatomy: Vascular Supply of the Penis Arterial inflow Supplies glans penis and shaft of penis Branches of deep internal pudendeal arteries Common penile artery Bulbar artery Dorsal artery l artery Cavernosal artery Venous drainage Superficial penile veins Superficial dorsal vein Intermediate penile veins Emissary vein Circumflex vein Deep dorsal vein Deep penile veins Hilar vein (Santorini's Plexus) Cavernosal vein VI. Physiology: Erection Step 1: Flaccid

2015 FP Notebook

459. Abdominal Muscle Wall Pain

Abdominal Muscle Wall Pain Abdominal Muscle Wall Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Abdominal Muscle Wall Pain (...) Abdominal Muscle Wall Pain Aka: Abdominal Muscle Wall Pain , Abdominal Wall Pain From Related Chapters II. Symptoms Constant pain or fluctuating pain changes and movement, lifting, bending, straining affect not related to bowel function not related to meals History of predisposing factors of Abdominal Wall Pain History of abdominal surgery, or History of Thoracolumbar back pain Discrete, small, coin size pain (can be localized with a finger) Lateral margins of rectus abdominis muscles Muscle or fascia

2015 FP Notebook

460. Scheuermann's Kyphosis

Scheuermann's Kyphosis Scheuermanns Kyphosis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Scheuermann's Kyphosis Scheuermann's (...) or segmentation failure in development) Neuromuscular kyphosis ( , , , polio) Postural kyphosis VII. Imaging Thoracolumbar Xray Lateral: Diagnosis requires 5 degrees or more of wedging in at least 3 adjacent e Also evaluate for and disc space narrowing VIII. Management Bracing indications Kyphosis 55-80 degrees before skeletal maturity Surgery indications Kyphosis >80 degrees in Kyphosis >65 degrees in thoracolumbar spine Progressive or refractory course resulting in pain, neurologic deficit or balance

2015 FP Notebook

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