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Thoracolumbar Trauma

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501. High rates of neurological improvement following severe traumatic pediatric spinal cord injury. (Abstract)

High rates of neurological improvement following severe traumatic pediatric spinal cord injury. Retrospective single-center studyTo determine the long-term outcome of pediatric spinal cord injuriesSpinal cord injuries are uncommon events in the pediatric population. In the few large series reported in the literature, recovery of neurologic function was demonstrated after mild injuries but was rare after severe injuries.A total of 4,876 cases of pediatric trauma treated at the Children's (...) Hospital of Los Angeles over a 9-year period (1993-2001) were reviewed. During the study period, 91 cases of spinal cord or spinal column injury were identified, and 30 cases involving a spinal cord injury were identified. Cauda equina injuries were excluded. Seven craniocervical, 12 cervical, 5 thoracic, and 6 thoracolumbar cases were identified. There were 6 cases of spinal cord injury without radiographic abnormality. Eight of the 30 patients received methylprednisolone at the time of admission

2004 Spine

502. Transpedicle body augmenter: a further step in treating burst fractures. (Abstract)

Transpedicle body augmenter: a further step in treating burst fractures. The efficiency of short-segment fixation with a transpedicle body augmenter for treatment of thoracolumbar burst fractures was retrospectively evaluated. Patients included in the study had limited neurologic function, a single-level burst fracture involving T11-L2, and no distraction or rotation trauma. Patients in the control group (n = 45) were treated with short-segment posterior instrumentation alone, whereas patients

2005 Clinical Orthopaedics and Related Research

503. Distracting injuries in patients with vertebral injuries. (Abstract)

Distracting injuries in patients with vertebral injuries. To describe the prevalence and types of distracting injuries associated with vertebral injuries at all levels of the spine in blunt trauma patients. A prospective cohort study was conducted at an urban Level I trauma center. All patients undergoing radiographic evaluation of the cervical, thoracic, or lumbar vertebrae after blunt trauma were enrolled. Patients had a data collection form completed by the treating physician before (...) documented indication for obtaining radiographic studies of the vertebrae. Eight (2.4%, 95% CI 1.0-4.6%) of the 336 patients had 14 acute vertebral injuries including compression fractures (5), transverse process fractures (7), spinous process fracture (1), and cervical spine rotatory subluxation (1). There were 13 thoracolumbar injuries and one cervical spine injury. Distracting injuries in the eight patients with acute vertebral injuries included 13 bony fractures. Distracting injuries in those

2005 Journal of Emergency Medicine

504. Speed bump-induced spinal column injury. (Abstract)

Speed bump-induced spinal column injury. Compression fracture of the vertebral body is common, especially in older adults. Injuries to the spinal column are one of the most frequent injuries by accidents and falls from heights. Vertebral fracture associated with minor trauma, however, is a rare occasion.Five cases were injured in the inner city buses after passing onto speed bumps are presented. On presentation, four patients complained of severe pain in the thoracolumbar region, while (...) in the other patient, physical examination revealed pain and tenderness on the neck. No neurologic deficit was noted except for one patient with tenderness on thoracic spines. Examination of the thoracolumbar X-ray and computed tomography displayed compression fractures in four patients. Other laboratory data obtained on admission were within normal limits. Posterior instrumentation was applied to three patients. All patients recovered well except for the one with cervical fracture.Drivers should

2005 American Journal of Emergency Medicine

505. Scheuermann's Disease

. [ , ] It is confusing that Scheuermann also described changes that can occur in the lumbar disc spaces - now called juvenile disc disorder. This is a quite separate condition. There is a separate article giving an overview of . Pathophysiology Osteochondroses all involve a defect in ossification. In Scheuermann's disease there is a defect in the secondary ossification centres of the vertebral bodies. A few vertebral bodies may be involved or the whole thoracolumbar spine. The cause is unknown but hereditary factors (...) . [ ] Mechanical factors and trauma have also been cited as possible causes; the aetiology is probably multi-factorial. [ ] Epidemiology Usually presents in children aged 13-16 years. The incidence is variously reported between 0.4% and 8% and some studies suggest it is more common in males, although other studies contradict this. [ ] Presentation [ ] History Poor posture with increased kyphosis (usually noticed by parents). Dull, non-radiating pain around the apex of the kyphosis Neurological symptoms

2008 Mentor

506. Cauda Equina Syndrome Full Text available with Trip Pro

of herniated lumbar discs. [ ] A congenitally narrow spinal canal or acquired spinal stenosis arising from a combination of degenerative changes of the disc and the segmental posterior joints may predispose to CES. [ ] Aetiology Herniation of a lumbar disc; the most common cause of CES is compression arising from large central lumbar disc herniation at the L4/L5 and L5/S1 level. [ ] Tumours: metastases, lymphomas, spinal tumours. Trauma. Infection, including epidural abscess. [ ] Congenital - eg (...) to trauma. Spinal tumour. . . Management Patients should be referred immediately for a neurosurgical consultation. Urgent surgical spinal decompression is indicated for most patients to prevent permanent neurological damage. [ ] Immobilise the spine if CES is due to trauma. Surgery is indicated to remove blood, bone fragments, tumour, herniated disc or abnormal bone growth. Lesion debulking is required for space-occupying lesions - eg, tumours, abscess. If surgery cannot be performed, radiotherapy may

2008 Mentor

507. Ankylosing Spondylitis

and less severely affected, usually as asymmetrical oligoarthritis. In children, AS tends to commence with arthritis prior to spinal disease developing. Temporomandibular joints are occasionally involved. Examination Measure chest expansion, lateral lumbar flexion and forward lumbar flexion. Schober's test - see separate article , which deals with thoracolumbar back examination. Palpate and stress the sacroiliac joints. Examine peripheral joints for synovitis or enthesitis. Always look for extra (...) , or recent infective diarrhoea or sexually transmitted disease. The differential diagnosis for AS includes: . Inflammatory conditions - eg, , , . Degenerative conditions - eg, . Infection - eg, . Neoplasms, primary or secondary. Referred pain. Congenital spinal deformity. Trauma. Investigations Blood tests No laboratory tests are specific and are often more helpful to exclude other diagnoses rather than confirming AS. Guidance suggests that only FBC and inflammatory markers should be taken prior

2008 Mentor

508. Open MR imaging in spine surgery: experimental investigations and first clinical experiences Full Text available with Trip Pro

reduction of the posterior wall of the vertebral body can be imaged immediately. The diameter of the spinal canal can be determined in any plane.The open MRI has proven useful in orthopedic and trauma surgery. The size and configuration of the artifacts caused by instruments and implants is predictable. Therefore exact positioning of the implants is achieved more easily. Dorsal instrumentation of unstable thoracolumbar fractures with a percutaneous technique has turned out safe and less traumatic under (...) Open MR imaging in spine surgery: experimental investigations and first clinical experiences The latest open MRI technology allows to perform open and closed surgical procedures under real-time imaging. Before performing spinal trauma surgery preclinical examinations had to be done to evaluate the artifacts caused by the implants.The MRT presented is a prototype developed by GE. Two vertically positioned magnetic coils are installed in an operation theater. By that means two surgeons are able

1999 European Spine Journal

509. A comparison of the chest radiograph and computerised tomography in assessing lung changes in acute spinal injuries--an assessment of their prevalence and the accuracy of the chest X-ray compared with CT in their assessment. Full Text available with Trip Pro

with patients with acute spinal injuries suggested that in paralysed patients lung changes were frequent and that in many spinal patients large pleural effusions and lung consolidation could be present without the usual associated chest radiograph changes being recognised. This study was performed to assess the prevalence of chest pathology and the sensitivity of the chest radiograph in portraying it. Sixty patients (50 males, 10 females, 31 cervical, 29 thoracic or thoracolumbar; 15 incomplete, 45 complete (...) the degree of change and in 13 the chest radiograph suggested greater pathology than was shown on computerised tomography. Thirteen of the 20 patients with cervical lesions but no chest trauma had lung changes.(ABSTRACT TRUNCATED AT 250 WORDS)

1995 Paraplegia Controlled trial quality: uncertain

510. Spinal subdural hematoma revealing hemophilia A in a child: A case report Full Text available with Trip Pro

Spinal subdural hematoma revealing hemophilia A in a child: A case report BACKGROUND: Intraspinal bleeding especially in the form of subdural hematoma is rare in hemophiliacs. In the present case, we report a neglected hemophilic A child with such a problem and discuss its management options. CASE PRESENTATION: A 9-year old hemophilic A boy presented with quadriparesis, confusion and meningismus after a fall 4 days previously. There was no sign of direct trauma to his back. His CT Scan and MRI (...) approached normal. CONCLUSION: This case calls attention to the clinical manifestation, radiological features and management options of the rarely reported intraspinal hematoma in hemophilic children. Although this case has been managed operatively for its hematoma in the thoracolumbar region, at the same time it can be considered a successful case of conservative management of intraspinal hematoma in the cervicothoracic region. Both conservative and surgical management could be an option in managing

2003 BMC blood disorders

511. The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine Full Text available with Trip Pro

The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine In 65 consecutive cases of trauma (n=55), pseudo-arthrosis (n=4) and metastasis (n=6), anterior reconstruction of the thoracic and lumbar spine was performed using a new minimal invasive but open access procedure. No operation had to be changed into an open procedure. The thoracolumbar junction was approached by a left-sided mini-thoracotomy (n=50

2001 European Spine Journal

512. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. (Abstract)

literature for conditions other than trauma and ankylosing spondylitis.Thirty-three consecutive patients with sagittal imbalance treated with lumbar pedicle subtraction osteotomy at one institution (minimum 2-year follow-up) were analyzed. Complications were also analyzed for the entire group of consecutive pedicle subtraction osteotomies done at our institution to date (n = 66).For the 33 patients with minimum 2-year follow-up, there were significant improvements in the overall Oswestry score (P 0.0001 (...) ) and pain score (P = 0.0001). Most patients reported improvement in pain and self-image and reported overall satisfaction based on ultimate SRS-24 questionnaire. There was one pseudarthrosis in the lumbar spine through an area of pedicle subtraction osteotomy (area of previous laminectomy and nonunion), and six patients had thoracic pseudarthroses (levels other than the osteotomy level) and one patient had a pseudarthrosis at L5-S1. Two patients had acute angular kyphosis at the thoracolumbar junction

2003 Spine

513. Spinal cord injuries from gunshot wounds to the spine. (Abstract)

Spinal cord injuries from gunshot wounds to the spine. Although vehicular trauma traditionally has accounted for the majority of spinal cord injuries, gunshot wounds are the second most common cause. Furthermore, the proportion of spinal cord injuries caused by gunshot wounds are increasing although the proportion of injuries caused by high-speed vehicular trauma is decreasing. Gunshot wounds to the spine commonly are thought to be stable injuries. There is, however, a potential for instability (...) if the bullet passes transversely through the spinal canal and fractures pedicles and facets. Injuries to the thoracic region of the spine are the most common, followed by the thoracolumbar area and the cervical spine. Completeness of injury is related to the anatomic region. Patients with incomplete injuries and patients with injuries in the thoracolumbar region have the greatest improvement in motor function. Approximately (1/4) of individuals are able to ambulate 1 year after injury. Surgical

2003 Clinical Orthopaedics and Related Research

514. Complications and problems related to pedicle screw fixation of the spine. (Abstract)

Complications and problems related to pedicle screw fixation of the spine. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. One hundred twelve patients were treated using the Cotrel-Dubousset pedicle screw fixation system for degenerative disease (57 patients), trauma (42 patients), infection (eight patients), and tumor (five patients) of the lumbar or thoracolumbar spine (...) was not affected significantly. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use.

2003 Clinical Orthopaedics and Related Research

515. Operative versus non-operative treatment for thoracolumbar burst fractures without neurological deficit. (Abstract)

to remove bone fragments which have intruded into the vertebral canal.To compare operative with non-operative treatment for thoracolumbar burst fractures without neurological deficit.We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (May 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (January 1966 to April 2005), EMBASE (January 1988 to April 2005), and the Chinese Biomedical Literature Database (CBM) available (...) Operative versus non-operative treatment for thoracolumbar burst fractures without neurological deficit. Spinal burst fractures result from the failure of both the anterior and the middle columns of the spine under axial compression loads. Conservative management is through bed rest, and immobilization with a brace once the acute symptoms have settled. Surgical treatment involves either anterior or posterior stabilization of the fracture with screws, often with decompression, an operation

2006 Cochrane

516. Neck and back trauma

):332-7. 22 Holmes JF , Panacek EA, Miller PQ, Lapidis AD, Mower WR. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. Journal of Emergency Medicine 2003;24(1):1-7. 23 Hendey GW, Wolfson AB, Mower WR, Hoffman JR, for the National Emergency X-Radiography Utilization Study Group. Spinal Cord Injury without Radiographic Abnormality: Results of the National Emergency X-Radiography Utilization Study in Blunt Cervical Trauma. Journal of Trauma-Injury Infection (...) Neck and back trauma INTRODUCTION Spinal cord injury (SCI) most commonly affects young and ?t people and will continue to affect them to a varying degree for the rest of their lives. In the extreme, SCI may prove immediately fatal where the upper cervical cord is damaged, paralysing the diaphragm and respiratory muscles. Partial cord damage, however, may solely affect individual sensory or motor nerve tracts producing varying long-term disability. It is important to note

2006 Joint Royal Colleges Ambulance Liaison Committee

517. Trauma - neck and back trauma

):332-7. 22 Holmes JF , Panacek EA, Miller PQ, Lapidis AD, Mower WR. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. Journal of Emergency Medicine 2003;24(1):1-7. 23 Hendey GW, Wolfson AB, Mower WR, Hoffman JR, for the National Emergency X-Radiography Utilization Study Group. Spinal Cord Injury without Radiographic Abnormality: Results of the National Emergency X-Radiography Utilization Study in Blunt Cervical Trauma. Journal of Trauma-Injury Infection (...) Trauma - neck and back trauma INTRODUCTION Spinal cord injury (SCI) most commonly affects young and ?t people and will continue to affect them to a varying degree for the rest of their lives. In the extreme, SCI may prove immediately fatal where the upper cervical cord is damaged, paralysing the diaphragm and respiratory muscles. Partial cord damage, however, may solely affect individual sensory or motor nerve tracts producing varying long-term disability. It is important to note

2007 Joint Royal Colleges Ambulance Liaison Committee

518. The value of indicated computed tomography scan of the chest and abdomen in addition to the conventional radiologic work-up for blunt trauma patients. Full Text available with Trip Pro

trauma patients.Clinical and radiologic data from 106 consecutive blunt trauma patients were reviewed. Diagnoses revealed by conventional work-up of the chest, abdomen, pelvis, and thoracolumbar spine were compared with that detected by CT scan of the chest and abdomen. Unexpected findings by CT scan and rejected diagnoses by CT scan were collected. Therapeutic consequences of these diagnoses were determined both theoretically and collected from the medical records.In 74% (95% confidence interval [CI (...) The value of indicated computed tomography scan of the chest and abdomen in addition to the conventional radiologic work-up for blunt trauma patients. Multidetector computed tomography (CT) is more sensitive and specific in detecting traumatic injuries than conventional radiology is. However, still little is known about the diagnostic value and the therapeutic impact of indicated thoraco-abdominal CT scan when it is performed in addition to the complete conventional radiologic work-up for blunt

2007 Journal of Trauma

519. Spiral computed tomography for the initial evaluation of spine trauma: A new standard of care? (Abstract)

for thoracolumbar imaging (13 mSv vs. 26 mSv).SCT is a more rapid and sensitive modality for evaluating the spine compared with PFR and is obtained at a similar cost. The advantages of SCT suggest that this readily available diagnostic modality may replace PFR as the standard of care for the initial evaluation of the spine in trauma patients. (...) Spiral computed tomography for the initial evaluation of spine trauma: A new standard of care? Although spiral computed tomographic scanning (SCT) is frequently used for spinal imaging in injured patients, many trauma centers continue to rely on plain film radiography (PFR). The purpose of this study was to determine the effects of a trauma center's transition from PFR to SCT for initial spine evaluation in trauma patients by comparing diagnostic sensitivity, time required for radiographic

2006 Journal of Trauma

520. Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. (Abstract)

Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. Fracture of the thoracolumbar (TL) spine is reported in 8 to 15% of victims of blunt trauma. Current screening of these patients is done with conventional radiography. This may require repeated sets of films and take hours to days. It is imperative that these patients get timely, accurate evaluation to allow for treatment (...) planning and early mobilization; alternatives to plain films would aid in this. The objective of this study is to determine whether the data obtained from admission chest/abdomen/pelvis (CAP) computed tomography (CT) scans after blunt trauma has utility in thoracolumbar spine evaluation.The records of all patients admitted to a Level I trauma center over a 2-month period who underwent CAP CT were reviewed for the presence of TL spine fracture, time to completion of plain film evaluation, and clinical

2005 Journal of Trauma

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