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Thoracolumbar Trauma

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461. Sympathetic Nervous System

Sympathetic Nervous System Sympathetic Nervous System 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 Sympathetic Nervous System (...) with mediated by ) Shunts blood flow to critical organs Cardiac muscle and skeletal muscle vasodilation (beta-2 receptor) Skin and gastrointestinal striction (alpha-1 receptor) IV. Anatomy Thoracolumbar division of the Signals originate in the spinal cord intermediolateral column (T1 to L2) Transmit to target organs via paravertebral or prevertebral ganglia V. Pathophysiology See VI. References Goldberg (2014) Clinical , Medmaster, p. 54-60 Netter (1997) Atlas Human Anatomy, ICON Learning, p. 152-4 Images

2015 FP Notebook

462. Dose response and structural injury in the disability of spinal injury. Full Text available with Trip Pro

pain are deficient.To establish whether there exists a causal relationship between structural injury, low back pain and spinal disability.Retrospective analysis of prospectively gathered validated spinal outcome measures [Oswestry disability index (ODI), low back outcome score (LBO), modified somatic perception (MSP), modified Zung depression index (MZD)] between patients with healed high energy thoracolumbar spinal fractures and patients with self-perceived work-related low back pain. Causality (...) versus 24.3 (P < 0.05), MSP 4.3 versus 9.3 (P < 0.05) and MZD 20.2 versus 34.8 (P < 0.05) in groups 1 and 2, respectively.Despite high-energy trauma and significant structural damage to the spine, patients with the high energy injuries had better spinal outcome scores in all measures. There is no 'dose-response' relationship between structural injury, low back pain and spinal disability. This is the reverse of what would be anticipated if structural injury was the cause of disability in workplace

2012 European Spine Journal

463. Laceration of Abdominal Aorta by a Fragment of Fractured L2 Vertebral Body Following a Low-Energy Injury: A Case Report and Review of Literature. (Abstract)

by a displaced vertebral body fracture.The literature on aortic wall injuries after vertebral fractures is reviewed. So far, only the injuries of the thoracic aorta were extensively described. Injuries of the abdominal aorta are much less frequent and usually associated with high-energy trauma. However, coexisting disorders, predisposing the patient to thoracolumbar vertebral body fractures (e.g., osteoporosis, chronic alcoholism) and aortic wall injuries (atherosclerosis) make aforementioned complication

2012 Spine

464. Comparison between continuous and discontinuous multiple vertebral compression fractures. Full Text available with Trip Pro

absorptiometry, was 0.70 and 0.58 g/cm(3) for the continuous and discontinuous MVFs, respectively, demonstrating a significant difference. Of 34 patients with discontinuous MVFs, 32 (94%) exhibited vertebral fractures in the thoracolumbar junction. In subjects with continuous MVFs, the MVFs of 19 (44%) subjects were caused by high-energy trauma, whereas mild trauma and unknown cause were identified in 14 (41%) and 13 (38%) subjects with discontinuous MVFs, respectively.Discontinuous MVFs generally caused (...) by mild outer force, and often occurred at the thoracolumbar junction. Continuous MVFs, frequently, were caused by high-energy trauma.

2012 European Spine Journal

465. Management of Acute Neurotrauma in Rural and Remote Locations (3rd ed.)

from severe head and spinal injury is often determined by the adequacy of initial care from the scene of injury through to definitive care. Since the first edition most rural practitioners have undertaken Early Management of Severe Trauma (EMST) training. This and the rural surgeons training scheme of the Royal Australasian College of Surgeons have given rural surgeons the skills to manage acute neurotrauma. These guidelines are compatible with the EMST approach and terminology. Many larger rural (...) hospitals have access to CT scanning and teleradiology which are of great assistance in sharing the responsibility of neurotrauma management with the central neurosurgical services. All rural hospitals have access to retrieval services. The guidelines are to be seen as part of a trauma management system beginning at the accident site and continuing through to definitive care at a regional or state trauma centre. EDITORIAL COMMITTEE The Neurosurgical Society of Australasia gratefully acknowledges

2009 Publication 80

466. Research Reporting Standards for Percutaneous Vertebral Augmentation

. Balloon kyphop- lasty: one-year outcomes in vertebral body height restoration, chronic pain, andactivitylevels.JNeurosurg2003;98: 36–42. 40. Rhyne AI, Banit D, Laxer E, Odum S, Nussman D. Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma 2004; 18:294–299. 41. Hulme PA, Krebs J, Ferguson SJ, et al. Vertebroplasty and kyphoplasty: a sys- tematic review of 69 clinical studies. Spine 2006; 17:1983–2001. 42. Phillips FM, Todd Wetzel F, Lieberman I,Campbell (...) S, Kao Y, Yen C, Tu Y, Chen L. Clinicalevaluationofvertebroplasty for multiple-level osteoporotic spinal compressionfractureintheelderly.Arch Orthop Trauma Surg 2008; 128:97–101. 35. Hodler J, Peck D, Gilula LA. Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology 2003; 227:662–668. 36. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of pain- ful osteoporotic compression fractures

2009 Society of Interventional Radiology

467. Antithrombotic Therapies in Spine Surgery

symptomatic DVT and/or PE (including fatal PE) following elective spinal surgery? (THERAPEUTIC QUESTION) Article (Alpha by Author) Level (I-V) Type of evidence Description of study Conclusion Explanation of failure to meet guideline inclusion criteria (when applicable) Dearborn JT, Hu SS, Tribus CB, Bradford DS. Thromboembolic complications after major thoracolumbar spine surgery. Spine. Jul 15 1999;24(14):1471 -1476. Level II Type of evidence: prognostic ~~~~~~~ Level IV Type of evidence therapeutic (...) Prospective Retrospective -- (check one) Study design (select one): comparative Stated objective of study: To determine the incidence of symptomatic and asymptomatic venous thromboembolism by PE or DVT after thoracolumbar fusion surgery. Type(s) of prophylaxis: Mechanical: stockings or pneumatic compression stockings. Critique of Methodology/ Justification for Downgrading (Check all that apply): Nonconsecutive patients Nonrandomized Nonmasked reviewers Nonmasked patients No validated outcome measures used

2009 North American Spine Society

468. Overview of Female Sexual Function and Dysfunction

decreases, but genital congestion in response to sexual stimuli (eg, erotic videos) may not. Orgasm Peak excitement occurs; it is accompanied by contractions of pelvic muscles every 0.8 sec and is followed by slow release of genital congestion. Thoracolumbar sympathetic outflow tracts appear to be involved, but orgasm is possible even after complete spinal cord transection (when a vibrator is used to stimulate the cervix). Prolactin, ADH, and oxytocin are released at orgasm and may contribute (...) in dyspareunia During partial or full entry, deep thrusting, penile movement, or the man’s ejaculation; immediately after penetration; or during urination after vaginal penetration Self-image Self-confidence; feelings about desirability, body, genitals, or sexual competence Developmental history Relationship with caregivers and siblings, traumas, loss of a loved one, abuse (emotional, physical, or sexual), consequences of expressing emotions as a child, cultural or religious restrictions Past sexual

2013 Merck Manual (19th Edition)

469. Vertebral Compression Fractures

Nerve Block SOCIAL MEDIA Add to Any Platform Loading , MD, University of San Francisco - Fresno Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Most vertebral compression fractures are a consequence of osteoporosis, are asymptomatic or minimally symptomatic, and occur with no or minimal trauma. Vertebral compression fractures due to are common in the thoracic spine (usually below T6) and lumbar spine, particularly near the T12-L1 junction (...) . There may be no preceding trauma or only minimal trauma (eg, a minor fall, sudden bending, lifting, coughing). Patients who have had an osteoporotic vertebral fracture are at higher risk of other vertebral and nonvertebral fractures. Occasionally, compression or other vertebral fractures result from significant force (eg, a motor vehicle crash, a fall from a height, a gunshot wound). In such cases, a is often also present, and the spine may be fractured in > 1 place. If the cause was a fall or jump from

2013 Merck Manual (19th Edition)

470. Proximal Junctional Kyphosis Following Long Instrumented Spinal Fusion: The Effect of Implant Selection

structural rigidity at the top of the construct, there is a need to investigate it. In the proposed study, the investigators will compare the rate of proximal junctional kyphosis in patients treated with a stainless steel rod (REVERE Stabilization System) versus those treated with TRANSITION Stabilization System. Patient outcome measures (Scoliosis Research Society (SRS-22), SF12 and ODI) and radiographic measurements (including lumbar lordosis (L1-S1), adjacent segment kyphosis, thoracolumbar kyphosis (...) by radiographic measurements during follow up visits [ Time Frame: 2 years ] Radiographs will be taken to measure lumbar lordosis, adjacent segment kyphosis, thoracolumbar kyphosis, sagittal balance, Sacral slope and pelvic incidence. Secondary Outcome Measures : Patient outcome measures [ Time Frame: 2 years ] Forms to be completed at follow up visits will include VAS, SRS 22, SF12, ODI, Patient Satisfaction, Work Status Assessment and Odom's criteria. Eligibility Criteria Go to Information from the National

2011 Clinical Trials

471. The effect of vehicle protection on spine injuries in military conflict. Full Text available with Trip Pro

servicemembers who were injured during combat.Extracted medical records of servicemembers identified in the Joint Theater Trauma Registry from October 2001 to December 2009. Methods of movement were defined as mounted or dismounted. Two time periods were compared. Cohorts were created for 2×2 analysis based on method of movement and the time period in which the injury occurred. Time period 1 and 2 were separated by April 1, 2007, which correlates with the initial fielding of the modern class of uparmored (...) ). The incidence of fractures in the dismounted cohort (D1+D2) was significantly higher than in the mounted cohort (M1+M2) in both time periods (D1 vs. M1, 13.75 vs. 3.95/10,000 warrior-years [p<.001] and D2 vs. M2, 11.15 vs. 4.89/10,000 warrior-years [p<.0001]). In both the mounted and dismounted groups, the thoracolumbar (TL) junction was the most common site of injury (36.1%). Fractures to the TL junction (T10-L3) increased significantly from Time Period 1 to 2 (34% vs. 40% of all fractures, respectively, p

2011 The Spine Journal

472. Clinical Examination Is Highly Sensitive for Detecting Clinically Significant Spinal Injuries After Gunshot Wounds. (Abstract)

Clinical Examination Is Highly Sensitive for Detecting Clinically Significant Spinal Injuries After Gunshot Wounds. The optimal method for spinal evaluation after penetrating trauma is currently unknown. The goal of this study was to determine the sensitivity and specificity of a standardized clinical examination for the detection of spinal injuries after penetrating trauma.After Institutional Review Board approval, all evaluable penetrating trauma patients aged 15 years or more admitted (...) -positive and 3 with a false-negative clinical examination. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 89.6%, 46.2% and 95.2%, respectively. For clinically significant injuries requiring surgical intervention, cervical or thoracolumbar spine orthosis, or cord transections, however, the sensitivity of clinical examination was 100.0%, specificity 87.5%, positive predictive value 30.8%, and negative predictive value 87.5%.Clinically

2011 Journal of Trauma

473. Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation. Full Text available with Trip Pro

Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation. This study reviews the presentation, etiology, imaging characteristics and reasons for missed diagnosis of Andersson lesion (AL) and analyzes the surgical results of short segment fixation in the thoracolumbar region. This is a retrospective single center study. Fourteen patients (15 lesions) who were operated for AL were analyzed. The study was designed (...) in two parts. The first part consisted of analysis of clinical and radiological features (MRI and radiographs) to highlight, whether definitive characteristics exist. The second part consisted of analysis of outcome of short segment fixation as measured by VAS, Frankel score, AsQoL index, and union, with assessment of complications. The follow-up was 42.33 ± 19.29 months (13 males and 1 female) with a mean age of 61.13 ± 19.74 years. There was predisposing trauma in five patients. There was a delay

2011 European Spine Journal

474. Scoliosis

. Resulting from other conditions [ ] Secondary scoliosis due to and conditions can lead to a loss of muscular support for the spinal column so that the spinal column is pulled in abnormal directions. Some conditions which may cause secondary scoliosis include , spinal , , , spinal cord trauma, and . Scoliosis often presents itself, or worsens, during an adolescent's growth spurt and is more often diagnosed in females than males. Scoliosis associated with known syndromes is often subclassified (...) than that of the general population. Generally, the prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are larger curves carry a higher risk of progression than smaller curves, and thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, people not having yet reached skeletal maturity have a higher likelihood of progression (i.e., if the person has not yet completed the adolescent

2012 Wikipedia

475. Develop and Validate Ultrasonic Device for Osteoporotic Fracture Risk Assessment

of thoracolumbar spine or distal forearm due to minimal or moderate trauma based on review on their inpatient and outpatient medical records will be enrolled. Without osteoporotic fracture Approximately 100 control women will have no history of a prior spine, hip, or wrist fracture. Outcome Measures Go to Primary Outcome Measures : Determine whether BUSS testing is equivalent or superior to DXA for fracture risk assessment in postmenopausal women. [ Time Frame: 1 year ] Biospecimen Retention: Samples Without

2010 Clinical Trials

476. Identification of Microcirculation and Inflammation After Posterior Stabilization of the Spine

Sponsor: RWTH Aachen University Information provided by (Responsible Party): RWTH Aachen University Study Details Study Description Go to Brief Summary: In this project, with unstable vertebral fractures, the microcirculation of the skin and muscle (O2C,Laser-Doppler/White-light -Spectroscopy and contrast-enhanced sonography) will be evaluated in both conventional and in percutaneous minimally invasive technique (XIA versus Mantis) at the thoracolumbar junction. Condition or disease Intervention (...) /treatment Phase Vertebral Fracture Procedure: Mantis Procedure: XIA Not Applicable Detailed Description: In this project, with unstable vertebral fractures, the microcirculation of the skin and muscle (O2C,Laser-Doppler/Whitelight-Spectroscopy and contrast-enhanced sonography) will be evaluated in both conventional and in percutaneous minimal-invasive technique (XIA versus Mantis) at the thoracolumbar junction. And after placing a fixator, the inflammatory potency (laboratory chemicals, cytokines

2010 Clinical Trials

477. A Comparison of the Diagnostic Performances of Visceral Organ-Targeted Versus Spine-Targeted Protocols for the Evaluation of Spinal Fractures Using Sixteen-Channel Multidetector Row Computed Tomography: Is Additional Spine-Targeted Computed Tomography Nec (Abstract)

A Comparison of the Diagnostic Performances of Visceral Organ-Targeted Versus Spine-Targeted Protocols for the Evaluation of Spinal Fractures Using Sixteen-Channel Multidetector Row Computed Tomography: Is Additional Spine-Targeted Computed Tomography Nec It remains to be determined whether spine-targeted computed tomography (thoracolumbar spine computed tomography [TLS-CT]) images and visceral organ-targeted CT (abdominopelvic [AP]-CT) images are comparable for the evaluation of thoracolumbar (...) detection were 0.996 and 0.995, respectively; no significant difference was found between the two sets. Concordance rates for typing performance also showed no statistical significance between the two sets for any of the three observers.Sixteen-channel multidetector row CT images reconstructed using a soft algorithm and a wide display FOV that cover the entire abdomen using a visceral organ-targeted protocol with 1.5-mm collimation are sufficient for the evaluation of spine fractures in trauma patients

2010 Journal of Trauma

478. Long-term follow-up of the surgical management of neuropathic arthropathy of the spine. (Abstract)

the long-term outcomes of surgery for Charcot spine.Retrospective case series. Cases took place at Stanford University Medical Center and Santa Clara Valley Medical Center.All patients had either complete paraplegia or dense paraparesis with both major motor and sensory deficits. Seven patients developed Charcot spine after spinal instrumentation for trauma, one after scoliosis repair for meningomyelocele, and one after spinal instrumentation for neuromuscular scoliosis caused by birth injury resulting (...) in C6-C7 quadraplegia. Average time between initial instrumentation and development of Charcot spine was 7.6 years. Two patients underwent posterior fusion alone, six had anterior-posterior fusion, and one was managed with thoracolumbar orthosis.Average follow-up was 14.3 years. Revisions were necessary in 75% (6 of 8) of patients for complications including nonunion, new Charcot joints, recurrent hardware failure, and osteomyelitis. Achieving fusion often required multiple operations

2010 The Spine Journal

479. Computed tomographic screening for thoracic and lumbar fractures: is spine reformatting necessary? (Abstract)

of the spine. Although the patient does not incur more radiation, the charges associated with this are significant. This study compared the sensitivity of these CT modalities in detecting thoracolumbar spine fractures.A retrospective chart review identified blunt trauma victims, admitted through the emergency department, with a discharge diagnosis of thoracic or lumbar spine fracture that received (1) a chest and T-spine CT, (2) an abdominal/pelvic and lumbar spine CT, or both. Final radiologic readings (...) in sensitivity were significant (P < .001) for both comparisons.Reformatting of CCT and APCT scans gives improved sensitivity in the detection of thoracic and lumbar spine fractures in trauma patients. Future study looking at clinically significant fractures or those that change clinical management decisions may find that the reformatted images are not routinely needed as a screening tool.

2010 American Journal of Emergency Medicine

480. Unique features of pediatric spinal cord injury. (Abstract)

, and 5.4% to 34% in the thoracolumbar spine. The most frequent incident of spinal injury (50%-56%) occurs during motor vehicle accidents.A systematic review of the English language literature explored articles published between 1950 and 2009. Electronic databases (Medline and Embase) and reference lists of key articles were searched to identify unique features of pediatric SCI based on 2 questions: (1) "What is the most effective means to achieve spinal stabilization in pediatric patients with a SCI (...) ?" and (2) "What is the most effective treatment of post-traumatic spinal deformities in pediatric patients with a SCI?" Three Spinal Trauma Study Group faculty members assessed the level of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria and disagreements were resolved by a modified Delphi consensus.No Level 1 or 2 evidence articles were discovered. Question 1 was addressed by 417 abstracts; from those 15 were selected for inclusion. This literature

2010 Spine

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