Traumatic vs non-traumatic spinal cord injury: A comparison of primary rehabilitation outcomes and complications during hospitalization

Objective: To compare outcome for patients with traumatic (TSCI) and non-traumatic spinal cord injuries (NTSCI) after primary rehabilitation regarding neurological improvement measured by the American Spinal Injury Association Impairment Scale (AIS), length of stay and complications.

Design: Retrospective comparative cohort study on patients with TSCI and NTSCI, hospitalized during a ten-year period at Haukeland University Hospital, Norway. Impairment, length of stay and complications during first in-patient rehabilitation period were analyzed. Uni- and multivariate analysis was performed.

Setting: Spinal Cord Rehabilitation Unit, Haukeland University Hospital, Norway

Participants: A total of 174 persons with a spinal cord injury (SCI) were included; 102 with TSCI and 72 with NTSCI.

Outcome measures: Neurological improvement measured by AIS from admission to discharge, number of weeks in the hospital, frequency and significance of complications were compared.

Results: Improvement in AIS after primary rehabilitation did not differ between TSCI and NTSCI. Length of stay was in average 3.4 weeks longer for TSCI. Urinary tract infections and pressure ulcers significantly influenced length of stay in both groups. Urinary tract infections were more frequent in TSCI (67%) vs NTSCI (42%). Pressure ulcers were more frequent among NTSCI (24%) vs TSCI (14%). Pneumonia and neuropathic pain did not depend on etiology and did not influence length of stay.

Conclusions: Patients with SCI have a rehabilitation potential regardless of etiology. Complications are frequent in both groups and often prolong hospitalization. Complication patterns differ in the two groups, and specific prevention and optimal treatment will shorten and optimize the length of primary rehabilitation.     

Epidemiological features of traumatic spinal cord injury in Chongqing,China

Objective: To describe the epidemiological characteristics and trends of traumatic spinal cord injury in Chongqing, China.

Study design: Hospital-based retrospective research.

Setting: Xinqiao Hospital, Chongqing.

Methods: We reviewed medical records of 554 patients with traumatic spinal cord injury (TSCI) admitted to Xinqiao Hospital from 2009 to 2013. Variables included gender, age, marital status, etiology, occupation, time of injury, level of injury, and severity of injury, the length of hospital stay, and treatment.

Results: The mean age of patients with TSCI was 45.6 ± 13.8 years, and the male/female ratio was 4.33:1. 94.2% (522 patients) of all patients with TSCI were married. Falls, comprising low falls and high falls (10.8% and 50.9%, respectively), were the leading reason for a hospital visit. And the second reason was MVCs (21.8%). The most common injury site was the cervical spinal cord, accounting for nearly more than 54%. The length of hospital stay ranged between 1 and 219 days (mean: 28.3 days). The proportions of complete tetraplegia, incomplete tetraplegia, complete paraplegia and incomplete paraplegia were 17.1%, 37.8%, 22.2%, and 22.9%, respectively.

Conclusion: The result revealed that the proportion of males was higher, as well as falls and MVCs were the first two main reasons, with older mean age of patients with TSCI than other countries. The occupations with highest risk for TSCI were peasants and laborers. All of these results prompted that preventive methods should be based on the characteristics of different type of patients with TSCI.     

Physiotherapy Secretion Removal Techniques in People With Spinal Cord Injury: A Systematic Review

Abstract

Objective: To address whether secretion removal techniques increase airway clearance in people with chronic spinal cord injury (SCI).

Data Sources and Study Selection: MEDLINE/PubMed, CINAHL, EMBASE, and PsyclNFO were searched from inception to May 2009 for population keywords (spinal cord injury, paraplegia, tetraplegia, quadriplegia) paired with secretion removal-related interventions and outcomes. Inclusion criteria for articles were a research study, irrespective of design, that examined secretion removal in people with chronic SCI published in English.

Review Methods: Two reviewers determined whether articles met the inclusion criteria, abstracted information, and performed a quality assessment using PEDro or Downs and Black criteria. Studies were then given a level of evidence based on a modified Sackett scale.

Results: Of 2,416 abstracts and titles retrieved, 24 met the inclusion criteria. Subjects were young (mean, 31 years) and 84% were male. Most evidence was level 4 or 5 and only 2 studies were randomized controlled trials. Three reports described outcomes for secretion removal techniques in addition to cough, whereas most articles examined the immediate effects of various components of cough. Studies examining insufflation combined with manual assisted cough provided the most consistent, high-level evidence. Compelling recent evidence supports the use of respiratory muscle training or electrical stimulation of the expiratory muscles to facilitate airway clearance in people with SCI.

Conclusion: Evidence supporting the use of secretion removal techniques in SCI, while positive, is limited and mostly of low level. Treatments that increase respiratory muscle force show promise as effective airway clearance techniques.     

Mortality and causes of death after traumatic spinal cord injury in Estonia

Abstract

Study design

Retrospective population-based study with mortality follow-up.

Objective

To study mortality, causes and risk factors for death in Estonian patients with traumatic spinal cord injury (TSCI).

Setting

All Estonian hospitals.

Methods

Medical records of patients with TSCI from all regional, central, general, and rehabilitation hospitals in Estonia from 1997 to 2007, were retrospectively reviewed. Mortality status was ascertained as of 31 December 2011. Causes of death were collected from the Estonian Causes of Death Registry. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. A Cox proportional hazards modeling was used to identify the risk indicators for death.

Results

During the observation period (1997–2011) 162 patients of 595 died. Nearly half of the patients (n = 76) died during the first year after TSCI. The main causes of death were external causes (30%), cardiovascular disease (29%). and suicide (8%). The overall SMR was 2.81 (95% confidence interval 2.40–3.28) and SMR was higher for women than for men (3.80 vs. 2.70). Cause-specific SMRs were markedly elevated for sepsis and suicide. Mortality was significantly affected by the age at the time of injury, neurological level, and extent of the injury as well as the year of TSCI and complications.

Conclusion

Life expectancy is significantly decreased in patients with TSCI in Estonia compared with the general population. Deaths during the first year after the injury have an important impact on statistics. Treatment of cardiovascular diseases, infections, and prevention of suicide are useful for reducing mortality in patients with TSCI.     

Epidemiology of traumatic spinal cord injury in Asia: a systematic review

Study design

A systematic review.

Background

The number of traumatic spinal cord injury (TSCI) reports grows annually, especially in China and Korea. The epidemiological characteristics of TSCI in Asia differ from those in other countries. Thus, we compiled epidemiological factors from Asia to compare with those from other countries.

Method

We searched articles published in any language between January 1980 to December 2011 using the terms “spinal cord injury”, “traumatic spinal cord injury”, “epidemiology”, and “Asia”. The articles were reviewed for information regarding TSCI incidence, total cases, case criteria, case source, causes of injury, male/female ratio, mean age, prospective or retrospective, neurological level of injury, extent of injury, and America Spinal Injury Association Impairment Scale (AIS)/grade.

Results

Epidemiological data were extracted from 39 reports in the published literature that met the inclusion criteria. Only two studies reported prevalence rates. Incidence rates ranged from 12.06 to 61.6 per million. The average age ranged from 26.8 to 56.6 years old. Men were at higher risk than women. Motor vehicle collisions (MVCs) and falls were the main causes of TSCI. However, several countries reported war wounds as the major cause. The neurological level and extent of injury were mixed, and most patients were categorized as AIS/Frankel grade A.

Conclusion

TSCI is an important public health problem and a major cause of paralysis. We must understand the epidemiology to implement appropriate preventative measures. Asian epidemiology is different from that in other regions, so intervention measures must be established according to population-specific characteristics.     

What to call spinal cord damage not due to trauma? Implications for literature searching

Abstract

Objectives

To illustrate the importance of multiple search terms and databases when searching publications on spinal cord damage not due to trauma. To develop comprehensive search filter for this subject, compare the results for 2000–2009 with the Medical Subject Headings (MeSH) and Emtree term ‘spinal cord diseases’ and determine changes in the number of articles over this period.

Design

Literature searches and search filter development.

Setting

Australia.

Interventions

Titles and abstracts searched in MEDLINE and EMBASE (2000–2009) for articles involving humans using search terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ (concise search). Develop comprehensive search filter for ‘spinal cord damage not due to trauma’ and compare the results with the MeSH term ‘spinal cord diseases.’

Outcome measures

Annual publications (2000–2009) identified in MEDLINE and EMBASE literature searches.

Results

Concise search identified 35 articles published during 2000–2009. More publications were identified using the term ‘nontraumatic spinal cord injury’ (n = 20) than ‘non-traumatic spinal cord injury’ (n = 16). Publications increased for both terms ‘spinal cord diseases’ (2000 = 279; 2009 = 415) and ‘spinal cord damage not due to trauma’ identified by the comprehensive search filter (2000 = 1251; 2009 = 1921).

Conclusions

Concise searches using terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ fail to identify relevant articles unless combinations of terms and databases are used. These are inadequate search terms for a comprehensive search. Further research is needed to validate our comprehensive search filter. An international consensus process is required to establish an agreed term for ‘spinal cord damage not due to trauma.’     

Statewide Investigation of Medically Attended Adverse Health Conditions of Persons With Spinal Cord Injury

Abstract

Background/Objective: To report over a 10-year period the statewide prevalence and incidence of medically attended adverse health conditions in people with new traumatic spinal cord injury (TSCI).

Design: Retrospective cohort study.

Methods: (a) Identified all new TSCI cases discharged alive from statewide acute care hospitals, 1996 to 2000, using ICD-9-CM methodology, (b) Followed cases from 1996 to 2005 to quantify medically attended health conditions documented during emergency department visits, acute care hospitalizations, and outpatient hospital visits, (c) Used the life table method to calculate the prevalence and incidence of health conditions, (d) Examined Cox proportional hazard ratio of mortality by gender controlling for age and TSCI severity.

Results: Nine hundred eighty-eight residents (257 women, 731 men) with TSCI were alive 90 days after discharge from acute care hospitalization from 1996 to 2000. Nine hundred twenty-three (251 female, 672 male) (93.4%) residents had an observed medically attended adverse health condition in the 10-year follow-up period. The most prevalent classes of diseases and disorders were (a) muscle and connective tissue, (b) renal and urinary, (c) digestive, (d) circulatory, (e) respiratory, (f) endocrine/nutritional/metabolic, and (g) infectious. Incidence of new injury was 29.0% for males and 26.9% for females. During the follow-up period, 49 women (19%) and 104 men (14%) died.

Conclusions: People with TSCI experience diverse adverse health conditions in the 10 years after initial injury. An interdisciplinary health care provider team approach to allocating resources and implementing countermeasures to prevent or limit occurrence of these conditions is vital to these patients’ continuum of care.

J Spinal Cord Med. June 2010; 33(3): 221–231     

Epidemiology of traumatic spinal cord injury in Tianjin,China: An 18-year retrospective study of 735 cases

Study Design: Hospital-based retrospective study

Objectives: To evaluate the pathogenetic features of traumatic spinal cord injury (TSCI) during 1999–2016 according to changed injury etiology with time, explore different characteristics of patients suffered a TSCI during 1999–2007 and 2008–2016 in Tianjin, China.

Setting: Tianjin Medical University General Hospital

Methods: In this study, the medical records of TSCI patients were obtained from Tianjin Medical University General Hospital (TMUGH) from 1st January 1999 to 31th December 2016. Variables were recorded, including age, gender occupation, etiology, the level of injury, America Spinal Injury Association (ASIA) impairment scale, the severity, concomitant injuries, death and its cause. To explore the differences in characteristics by etiology and by two periods, related statistical methods were used to calculate the correlation of some variables. Differences in etiology of TSCI during 1999–2016 were evaluated and differences in epidemiological characteristics were separately compared and analyzed between the 1999–2007 period and the 2008–2016 period.

Results: From 1999–2016, 831 TSCI cases were identified and 96 cases were excluded from analyses. The male-to-female ratio was 2.9:1 and the mean age was 49.7±15.2 years, which changed significantly between 1999–2007 (45.1±14.2) and 2008–2016 (51.6±15.2). Traffic accidents (45.8%) were the leading cause of TSCI during the 1999–2007 period, followed by low falls (30.7%). However, the opposite result was observed during the 2008–2016 period. Significant difference was observed compared with thoracic, lumbar and sacral levels, cervical level was the most commonly affected levels and the percentage decreased to a certain degree between 1999–2007 and 2008–2016 (from 84.4% to 68.9%). The proportions of ASIA grades A, B, C, and D were 20.5%, 10.3%, 23.3%, and 45.9%, respectively. The percentage of complete tetraplegia decreased from 22.9% in 1999–2007 to 13.2% in 2008–2016, and the percentage of incomplete paraplegia increased from 9.7% to 27.9%.

Conclusion: According to the changes in the epidemiological characteristics of TSCI, relevant health service, laws and regulations, preventative strategies should be readjusted to follow up the changing situation and epidemiological characteristics of TSCI.     

Determining priorities in functional rehabilitation related to quality of life one-year following a traumatic spinal cord injury

Context/Objective: To determine the relationship between the different functional aspects (as determined by the Spinal Cord Independence Measure) and quality of life (QOL) following a traumatic spinal cord injury (TSCI), considering clinical confounding factors.

Design: Retrospective review of a prospective cohort

Setting: A single Level-1 trauma center specialized in SCI care

Participants: One hundred and forty-two individuals sustaining an acute traumatic SCI

Interventions: Not applicable

Outcome measures: The four QOL domains as assessed by the WHOQoL-bref questionnaire 6–12 months following a TSCI.

Results: Mobility subscore was the only functional aspect significantly associated with all QOL domains (physical, psychological, social and environmental). Females present better chronic social and environmental QOL when compared to males. The level of injury may also influence environmental QOL.

Conclusion: Mobility training (mobility in bed, mobility with or without technical aids, transfers and stair management) should be an important part of the rehabilitation process in order to optimize chronic QOL following a TSCI.     

Spinal tumours: recommendations of the Polish Society of Spine Surgery,the Polish Society of Oncology,the Polish Society of Neurosurgeons,the Polish Society of Oncologic Surgery,the Polish Society of Oncologic Radiotherapy,and the Polish Society of Orthopaedics and Traumatology

Purpose

The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities.

Methods

The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society’s grades of recommendation for summaries or reviews of studies.

Results

The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies.

Conclusion

The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

     

The impact of early spasticity on the intensive functional rehabilitation phase and community reintegration following traumatic spinal cord injury

Context/Objectives: To determine the impact of spasticity presenting during the acute care hospitalization on the rehabilitation outcomes following a traumatic spinal cord injury (TSCI).

Design: Retrospective cohort study.

Setting: A single Level 1 trauma center specialized in SCI care.

Participants: 150 individuals sustaining an acute TSCI.

Interventions: Not applicable.

Outcome Measures: The total inpatient functional rehabilitation length of stay. The occurrence of medical complications and the discharge destination from the inpatient functional rehabilitation facility were also considered.

Results: 63.3% of the cohort presented signs and/or symptoms of spasticity during acute care. Individuals with early spasticity developed medical complications during acute care and during intensive functional rehabilitation in a higher proportion. They were also hospitalized significantly longer and were less likely to return home after rehabilitation than individuals without early spasticity. Early spasticity was an independent factor associated with increased total inpatient rehabilitation length of stay.

Conclusion: The development of signs and symptoms of spasticity during acute care following a TSCI may impede functional rehabilitation outcomes. In view of its association with the occurrence of early spasticity, higher vigilance towards the prevention of medical complications is recommended. Early assessment of spasticity during acute care is recommended following TSCI.     

Bone and joint tuberculosis

Introduction

Bone and joint tuberculosis has increased in the past two decades in relation with AIDS epidemics.

Material and methods

A literature review of bone and joint tuberculosis, focusing on Pott’s disease.

Results

Bone and joint TB comprises a group of serious infectious diseases whose incidence has increased in the past two decades, especially in underdeveloped countries, in part due to the AIDS epidemic. Tuberculous spinal infections should be suspected in patients with an insidious, progressive history of back pain and in individuals from an endemic area, especially when the thoracic vertebrae are affected and a pattern of bone destruction with relative disc preservation and paravertebral and epidural soft tissue masses are observed. Atypical tuberculous osteoarticular manifestations involving the extraspinal skeleton, a prosthetic joint, or the trochanteric area, and nontuberculous mycobacterial infections should be considered in favorable epidemiological contexts. Surgery combined with prolonged specific antituberculous chemotherapy is mainly indicated in patients with neurological manifestations or deformities, and provides satisfactory results in most cases.

Conclusions

Spinal tuberculosis is still a relative common extra spinal manifestation of spinal tuberculosis that requires a high degree of suspicion in order to avoid neurological complications and need of surgery.

     

The Effects Of Sildenafil On The Cardiovascular Response In Men With Spinal Cord Injury At Or Above The Sixth Thoracic Level

Abstract

Background: Sildenafil is efficacious for erectile dysfunction in men with spinal cord injury (SCI), but can induce hypotension in neurologically intact people. Those with SCI at or above the sixth thoracic level (T6) often have pre-existing hypotension, yet the cardiovascular response to sildenafil has not been studied in this group.

Objective: To evaluate the effect of sildenafil on the cardiovascular response in men with complete SCI at or above T6.

Methods: This was a randomized, double-blind, placebo-controlled, cross-over study. Twenty-three SCI participants were each randomly given placebo; sildenafil, 50 mg; and sildenafil, 1 00 mg; separated by at least 1 week. The following were measured before administration, and hourly for 4 hours afterward: (a) blood pressure (BP) and heart rate (HR) , both supine and sitting; and (b) perceived dizziness on a visual analog scale upon sitting.

Results: Analysis was done using a 4-way repeated-measures analysis of variance. No significant changes occurred with placebo. Sildenafil caused the following changes. Systolic BP changed little in thoracic spinal cord-injured (TSCI) participants, but decreased significantly (P < 0.005) in cervical spinal cord-injured (CSCI) participants. Diastolic BP decreased in all participants (P < 0.005). HR increased in the TSCI participants for 1 hour (P < 0.05), but was not altered in the CSCI participants. Dizziness increased in the TSCI participants after administration of 100 mg (P < 0.05) and in the CSCI participants after administration of 50 mg (P < 0.05). There were no adverse events or outcomes.

Conclusion: Sildenafil induces significant hypotension in people with cervical-level injuries-more so than in thoracic-level injuries-and can cause dizziness in both populations. It should be prescribed with caution and informed consent from the patient.     

Tridimensional trunk surface acquisition for brace manufacturing in idiopathic scoliosis

Introduction

Brace manufacturing for idiopathic scoliosis requires trunk surface acquisition. Two methods are currently available to design the trunk shape: craft made technique based on a plaster mold and computer-aided design with 3-D reconstruction of the trunk by optical scanning. The objective of the present review was to compare these two methods.

Methodology

We describe the different steps to design and manufacture braces used for spinal deformities.

Results

Our prospective evaluation showed good results in terms of the correction achieved and regarding patients’ in-brace comfort.

Discussion

Optical scanning for computer-aided design and manufacturing (CAD-CAM) of trunk orthoses have proven their effectiveness. These technologies may help in monitoring conservative treatment and may enhance the brace interaction with the spinal deformity when orthopedic treatment is indicated.

     

Unilateral microscopic approach for lumbar spinal stenosis decompression: a scoping review

Background

Microscopic unilateral laminotomy for bilateral decompression (ULBD) is a minimally invasive technique used in the treatment of lumbar spinal stenosis and could limit spinal instability and be associated with better clinical outcomes. However, there is ongoing debate regarding its utility compared to conventional laminectomy (CL). The primary objective was to collate and describe the current evidence base for ULBD, including perioperative parameters, functional outcomes, and complications. The secondary objective was to identify operative techniques.

Methods

A scoping review was conducted between January 1990 and August 2022 according to the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Major databases were searched for full text English articles reporting on outcomes following microscopic unilateral laminotomy in patients with lumbar spinal stenosis.

Results

Seventeen articles met the inclusion criteria. Two studies were randomised controlled trials. Two studies were prospective data collection and the rest were retrospective analysis. Three studies compared ULBD with CL. ULBD preserves the osteoligamentous complex and may be associated with shorter operative time, less blood loss, and similar clinical outcomes when compared to CL.

Conclusion

This review highlights that ULBD aims to minimise disruption to the normal posterior spinal anatomy and may have acceptable clinical outcomes. It also highlights that it is difficult to draw valid conclusions given there are limited data available as most studies identified were retrospective or did not have a comparator group.

     

A Retrospective Study of Five Clinical Criteria and One Age Criterion for Selective Prehospital Spinal Immobilization

Abstract Abstract Introduction: Full spinal immobilization of blunt trauma victims is a widely accepted prehospital measure, applied in order to prevent (further) damage to the spinal cord. However, looking at the marginal evidence that exists for the effectiveness of spinal immobilization, and the growing evidence for the negative effects following immobilization, a more selective protocol might be able to reduce possible morbidity and mortality as good as the present prehospital immobilization protocol. In a retrospective study, the sensitivity of a selective prehospital immobilization protocol that adds an age criterion to five clinical spine clearance criteria is examined. Materials and Methods: Based on ICD-9 codes, all patients admitted to the trauma center diagnosed with spinal fractures with or without spinal damage were identified. The sensitivity of the combination of five clinical criteria (reduced awareness, evidence of intoxication, neurological deficit, pain of the spine on palpation, (significant) distracting injury) and an age criterion (65 years or older at time of accident) was determined. If one or more criteria were positive, standard full immobilization would be indicated. The other patients would not have been immobilized. Results: A total of 238 blunt trauma victims primarily admitted to the trauma center were included for this study. Median age of the included patients was 39 years (range 5–98), with 32.8% female. A total of 236 had at least one positive criterion (sensitivity 99.2%). The two missed patients were male, 40 and 41 years old. Radiology showed a small fissure in the arch of C2, and a transverse process fracture of L3, respectively. Both patients were discharged the next day without complications or medical interventions. Conclusion: In this retrospective study, a selective protocol based on clinical criteria instead of trauma mechanism showed 99.2% sensitivity for spinal fractures with or without spinal cord damage. Based on this study and the current controversy surrounding spinal immobilization, a prospective study should be considered to evaluate the five clinical criteria and one age criterion in the prehospital setting.     

Association between spinal immobilization and survival at discharge for on-scene blunt traumatic cardiac arrest: A nationwide retrospective cohort study

IntroductionSpinal immobilization has been indicated for all blunt trauma patients suspected of having cervical spine injury. However, for traumatic cardiac arrest (TCA) patients, rapid transportation without compromising potentially reversible causes is necessary. Our objective was to investigate the temporal trend of spinal immobilization for TCA patients and to examine the association between spinal immobilization and survival.MethodsWe conducted a retrospective cohort study using the Japan Trauma Data Bank 2004–2015 registry data. Our study population consisted of adult blunt TCA patients encountered at the scene of a trauma. The primary outcome was the survival proportion at hospital discharge, and the secondary outcome was the proportion achieving return of spontaneous circulation (ROSC). We examined the association between spinal immobilization and these outcomes using a logistic regression model based on imputed data sets with the multiple imputation method to account for missing data.ResultsAmong 4313 patients who met the inclusion criteria, 3307 (76.7%) were immobilized. The proportion of patients that underwent spinal immobilization gradually decreased from 82.7% in 2004–2006 to 74.0% in 2013–2015. 1.0% of immobilized and 0.9% of non-immobilized patients had severe cervical spine injury. Spinal immobilization was significantly associated with lower survival at discharge (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.42 to 0.98) and ROSC by admission (OR, 0.48; 95%CI, 0.27 to 0.87). There was no significant sub-group difference of the association between spinal immobilization and survival at discharge by patients with or without cervical spine injury (p for interaction 0.73).ConclusionSpinal immobilization is widely used even for blunt TCA patients, even though it is associated with a lower rate of survival at discharge and ROSC by admission. According to these results, we suggest that spinal immobilization should not be routinely recommended for all blunt TCA patients.     

Postoperative Spinal Wound Infections and Postprocedural Diskitis

Abstract

Background/Objective: Postprocedural infections are a significant cause of morbidity after spinal interventions.

Methods: Literature review. An extensive literature review was conducted on postprocedural spinal infections. Relevant articles were reviewed in detail and additional case images were included.

Results: Clinical findings, laboratory markers, and imaging modalities play important roles in the detection of postprocedural spinal infections. Treatment may range from biopsy and antibiotics to multiple operations with complex strategies for soft tissue management.

Conclusions: Early detection and aggressive treatment are paramount in managing postprocedural spinal infections and limiting their long-term sequelae.     

Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study

BackgroundPeople of Aboriginal (Indigenous) ancestry are more likely to experience traumatic spinal cord injury (TSCI) than other Canadians; however, outcome studies are limited. This study aims to compare Aboriginal and non-Aboriginal populations with acute TSCI with respect to preinjury baseline characteristics, injury severity, treatment, outcomes and length of stay.MethodsThis was a retrospective analysis of participants with a TSCI who were enrolled in the prospective Rick Hansen Spinal Cord Injury Registry (RHSCIR), Saskatoon site (Royal University Hospital), between Feb. 13, 2010, and Dec. 17, 2016. Demographic, injury and management data were assessed to identify any differences between the populations.ResultsOf the 159 patients admitted to Royal University Hospital with an acute TSCI during the study period, 62 provided consent and were included in the study. Of these, 21 self-identified as Aboriginal (33.9%) and 41 as non-Aboriginal (66.1%) on treatment intake forms. Compared with non-Aboriginal participants, Aboriginal participants were younger, had fewer medical comorbidities, had a similar severity of neurologic injury and had similar clinical outcomes. However, the time to discharge to the community was significantly longer for Aboriginal participants (median 104.0 v. 34.0 d, p = 0.016). Although 35% of non-Aboriginal participants were discharged home from the acute care site, no Aboriginal participants were transferred home directly.ConclusionThis study suggests a need for better allocation of resources for transition to the community for Aboriginal people with a TSCI in Saskatchewan. We plan to assess outcomes from TSCI for Aboriginal people across Canada.     

Revision surgery after PSO failure with rod breakage: a comparison of different techniques

Study design

Author experience and literature review.

Objectives

To compare different revision techniques in the treatment of implant failure after pedicle subtraction osteotomy (PSO).

Summary of background data

The complication rate of pedicle subtraction osteotomy is substantially higher than other corrective procedures available for the treatment of spinal sagittal imbalance: in particular, hardware failures and mechanical complications affect this technique and their biomechanical explanation is still purely speculative.

Methods

The author’s experience and the literature regarding the revision techniques for PSO failures are discussed.

Results

In this paper, eight consecutive revision cases due to rod breakage after PSO surgery are reported. In our experience, the main goals are to restore the spinal balance, through a posterior approach (correction and hardware revision and implementation) and to get a solid anterior fusion (both through a traditional anterior approach or minimally invasive transpsoas approach).

Conclusion

The efficacy of PSO should be balanced with the high risk of the procedure reported in the literature. Management of revision surgery after PSO may require the addition of anterior column support to maintain correction and reduce complications.