Establishment of a regional multicenter traumatic spine fracture/dislocation registry

Objective：Trauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care expenditures.Although spine-related injuries constitute a small proportion of trauma cases,they need special consideration due to poor functional outcomes and substantial burden.Despite relatively extensive previous studies on traumatic spinal injuries,there is still obscurity in some aspects of the issue.The purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation registry.Methods：This is a prospective case series study,including all patients with acute traumatic spine lesions admitted to a regional multicenter since 2014.Data is extracted based upon a form developed by Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences,Tehran,Iran.Novel electronic data entry software is initiated and data will be entered to the software.Information remains confidential and security considerations will be taken based on standards of data entry systems.Results：The results of this study will include age and gender distribution of the patients,causes of injury,location of pain and neurological deficit,the American Spinal Injury Association score and Frankel grade on admission,at discharge,after 6 and 12 months and at the latest annual follow-up,radiologic findings,details of operative procedures and methods of external fixation.Conclusion：This study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment methods.It can lead to a considerable improvement in patient care and will have a great national and transnational impact.     

Biographical sketch: Nosrat Ollah Ameli, MB, ChB (Hons), ChM (Birm), FICS, FRCS (Eng)

Abstract Nosrat Ollah Ameli (1913-2010) was one of the pioneers in Iranian neurosurgery. After training in England in the 1950s, Ameli returned to his country to found the Darioush Kabir Hospital, where he started the first neurosurgical ward in collaboration with Prof. E. Samiy. Here he applied his genius and innovation to develop unique approaches to the management of challenging neurosurgical techniques, in the context of limited resource available at that time. He started the training of neurosurgeons in Iran. He was internationally recognised being elected as a vice president of the World Federation of Neurosurgical Societies (WFNS). His efforts extended beyond neurosurgery to many other fields. He published extensively in international peer reviewed medical journals around the world and contributed to the foundation of Acta Medica Iranica journal, the first scientific medical journal in English published by Tehran University of Medical Sciences. His efforts to improve medical education in Iran continued even through his years of retirement. This article recounts Nosrat Ollah Ameli's many contributions to Iran's medical education as well as his achievements as a neurosurgeon.     

Early versus late surgical decompression for traumatic thoracic/thoracolumbar (T1-L1) spinal cord injured patients: Primary results of a randomized controlled trial at one year follow-up

Objective:

To assess the efficacy of surgical decompression <24 (early) versus 24-72 hours (late) in thoracic/thoracolumbar traumatic spinal cord injury (TSCI).

Methods:

A randomized controlled trial (RCT) of 35 T1-L1 TSCI patients including early (n=16) and late (n=19) surgical decompression was conducted in the neurosurgery department of Shahid Rajaee Hospital from September 2010. Pre- and postoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor/sensory scores, length of hospitalization, complications, postoperative vertebral height restoration/rebuilding and angle reduction, and 12-month loss of height restoration/rebuilding and angle reduction were evaluated.

Results:

Sixteen patients (46%) had complete TSCI. No AIS change was seen in 17 (52%) patients. Complete TSCI patients had no motor improvement. The AIS change in this group was solely due to increased sensory scores. For incomplete TSCI, the mean motor score improved from 77 (±22) to 92 (±12) in early, and from 68 (±22) to 82 (±16) in late surgery. One deep vein thrombosis was observed in each group. There were 2 wound infections, one CSF leak, one case of meningitis, and one decubitus ulcer in the late surgery group. Six screw revisions were required.

Conclusion:

Our primary results show overall AIS and motor score improvement in both groups. Motor improvement was only observed in incomplete TSCI. Two-grade improvements in AIS were seen in 3 early, and one late surgery patient.In traumatic spinal cord injury (TSCI), surgical decompression has been implemented to improve neurological outcomes.1 Clinical benefits of early versus late surgery remain controversial due to lack of well-designed well-executed prospective, randomized controlled trials (RCTs). In this context, the role and timing of spinal decompression after acute TSCI remains one of the most controversial topics pertaining to spinal surgery. Regarding level of TSCI, most studies have been on the cervical area. Moreover, there have been few prospective cohorts systematically examining surgical patients undergoing decompression earlier than 24 hours in cervical spinal cord injury.1,2 The only RCT in this regard compared a <72 hours versus >5 day surgical treatment protocol.3 We conducted an RCT evaluating the efficacy of surgical intervention in thoracic/thoracolumbar (T1-L1) TSCI. In this primary report, we evaluated the relative effectiveness of early (<24 hours) versus late (24-72 hours) decompressive surgery in 35 selected T1-L1 TSCI patients. In the current prospective RCT, a 24 hour cutoff was adopted to define early versus late decompressive surgery based on the best available evidence in this regard.4 Clinical changes in motor and sensory examinations and radiographic outcomes of vertebral height and angle restoration were evaluated. We also assessed the impact of surgical timing on in-hospital postoperative complication rates and mortality.     

Spinal cord injuries from road traffic crashes in southeastern Iran

Objective ： To analyze the data of patients with spinal cord injury （SCI） induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning. Methods ： In this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated. Results： Among 64 patients with SCI, 38 patients （59.4 %, 36 males and 2 females, aged 27.42 years ± 9.44 years on average） were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases （68.4%） and 12 cases （31.6%）, respectively. And 31patients （81. 6%） had complete SCI. Conus medularis （T12-L2 ） was the most affected level. Conclusions： Results are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.     

National Spinal Cord Injury Registry of Iran (NSCIR-IR) e a critical appraisal of itsstrengths and weaknesses

The National Spinal Cord Injury Registry of Iran (NSCIR-IR) is a not-for-profit, hospital-based, and pro spective observational registry that appraises the quality of care, long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran. Benchmarking validity in every registry includes rigorous attention to data quality. Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid. We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and rec ommendations for efficient and rational governance of patient registries. In summary, the steering committee, funded and maintained by the Ministry of Health and Medical Education of Iran, the inter national collaborations, continued staff training, suitable data quality, and the ethical approval are considered to be the strengths of the registry, while limited human and financial resources, poor interoperability with other health systems, and time-consuming processes are among its main weaknesses.     

Spontaneous brain rupture: a complication of untreated hydrocephalus

A case of infantile hydrocephalus with secondary spontaneous brain rupture is reported. As far as the authors' knowledge, this is the first case of spontaneous brain and ventricular rupture secondary to high-pressure hydrocephalus. It is a case of infantile hydrocephalus occurring due to the expansility of an infantile skull, which is normally not seen these days, and is a fatal sequela of untreated hydrocephalus. This rare complication occurs with the rupture of thinnest part of the ependymal layer of the ventricle, cerebral tissue, meningeal membranes, bone and scalp.     

Efficacy of surgical decompression in the setting of complete thoracic spinal cord injury

BACKGROUND/OBJECTIVE: An assessment of neurological improvement after surgical intervention in the setting of traumatic thoracic spinal cord injury (SCI). METHODS: A retrospective evaluation of a nonconsecutive cohort of patients with a thoracic SCI from T2 to T11. The analysis included a total of 12 eligible patients. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. Data included patient age, level of injury, neurologic examination according to the Frankel grading system, the performance of surgery, and the mechanism of the time-related SCI decompression. RESULTS: All patients had a complete thoracic SCI. The median interval from injury to surgery was 11 days (range, 1-36 days). Decompression, bone fusion, and instrumentation were the most common surgical procedures performed. The median length of follow-up was 18 months after surgery (range, 9-132 months). Motor functional improvement was seen in 1 patient (Frankel A to C). CONCLUSION: Surgical decompression and fusion imparts no apparent benefit in terms of neurologic improvement (spinal cord) in the setting of a complete traumatic thoracic SCI. To better define the role of surgical decompression and stabilization in the setting of a complete SCI, randomized, controlled, prospective studies are necessary.     

Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran

Background  

In Iran, there are an estimated 200,000 injecting drug users (IDUs). Injecting drug use is a relatively new phenomenon for this country, where opium smoking was the predominant form of drug use for hundreds of years. As in many countries experiencing a rise in injecting drug use, HIV/AIDS in Iran is associated with the injection of drugs, accounting for transmission of more than two-thirds of HIV infections. This study aimed to: describe the range of characteristics of IDUs in Tehran, Iran's capital city; 2) examine the injecting-related HIV risk behaviors of IDUs, and 3) suggest necessary interventions to prevent HIV transmission among IDUs and their families and sex partners.     

Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran

Purpose: To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center. Methods: Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences. Results: Among the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%). Conclusion: Motorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.