Study of the severity of musculoskeletal injuries and triage during the 2005 Pakistan earthquake

Purpose

On 8 October 2005 a massive earthquake hit the northern mountainous areas of Pakistan and Kashmir causing 73,338 deaths and leaving over 125,000 severely injured. In a region which was less prepared for such an enormous disaster, mobilising rescue, relief and rehabilitation posed great challenges. The first author (SMA) established two level 1 orthopaedic trauma and rehabilitation units in each of two severely hit major cities through private philanthropy. According to the severity of injuries, the patients were triaged and treated. The aim of this study is to improve the future strategies in similar scenarios.

Methods

This is a retrospective review of medical records of patients suffering from musculoskeletal injuries in the aftermath of the 2005 earthquake who were managed in these centres in the order of triage priority. The patients were received, categorised, worked up and provided definitive surgical procedures. All patients were provided assistance for the fitting of a prosthesis and rehabilitation.

Results

Of 128,304 (total of injured patients), 19,700 were managed in two centres established by SMA during the first months after the earthquake. Of these, 112 patients underwent amputations of upper and lower limbs.

Conclusions

In a massive calamity over a wide geographical area away from big university hospitals, such as the 2005 Pakistan earthquake, the level 1 operating theatre facilities must be established within the area to meet the immediate needs of the patients nearest to their homes and families, and run forever so that patients can have excellent follow-up and can use the same facilities regularly. In the aftermath of this earthquake the need to practise triage in the first 72 hours was thoroughly realised and effectively practised in our centres     

Penetrating peripheral vascular injury management in a Sri Lankan military hospital

Purpose

Vascular injuries in austere military conflict settings are a challenging problem. The goal of the current study was to analyze the unique features associated with the management and early outcome of penetrating vascular injuries resulting from the conflict in Sri Lanka.

Methods

All adults with extremity vascular injuries admitted to the Military Base Hospital Anuradhapura in an eight-month period were prospectively recorded in a data sheet and retrospectively analyzed. Mechanism, location, method of repair, and outcomes were analyzed.

Result

Out of a total of 5,821 combat-related casualties, there were 128 victims with vascular injuries (2.2 %). The overall limb salvage rate was 83 % with an all-cause mortality of 3.1 %. Combined arterial and venous injuries were most common (44 %), predominantly in the popliteal zone. Among the arterial injuries, 70 % were repaired with a vein interposition graft and 7 % were primarily repaired. The majority of the venous injuries (54 %) were ligated. Twenty early major complications were recorded. A temporary intraluminal shunting technique was applied in the 14 most severely injured patients. This patient population was followed up for an average of 35 days institutionally before they were referred to rehabilitation (60 %) or transferred to other institutions (26 %).

Conclusions

Vascular reconstruction using vein, combined with a wound management strategy and early fasciotomy, resulted in a high limb salvage rate and remarkably low infection, delayed amputation, and mortality rates. Management of combat vascular injuries based on clinical guidance is feasible and leads to good outcome in a minimally equipped setting during local military conflicts. Surgeons in military hospitals should be trained in vascular injury repair to save the lives and functional limbs of patients.     

Epidemiology and management of trauma patients in a Greek multispecialty hospital in the absence of a dedicated trauma center

Purpose

In the absence of dedicated trauma centers, surgical emergency departments in hospitals assigned as trauma centers accept a huge load of trauma patients. In this audit, we aim to document and assess the epidemiologic data of trauma patients and their injuries in order to give a picture of the impact of trauma in the workload of a surgical department in the Greek healthcare system.

Methods

During a period of 2 years, we managed 6,041 trauma patients in the accident and emergency (A&E) department based on the Advanced Trauma Life Support (ATLS) protocols. We retrospectively reviewed the emergency department registry and the admissions.

Results

47.56 % of the patients seen in the A&E department were trauma patients. The mean age of the trauma patients was 44.52 years (range 15–106 years). The majority were men (60.4 %). The leading cause of trauma was motor and vehicle accidents, followed by slip and fall accidents, physical assault, fall from height, and vehicle pedestrian accidents. The majority of the patients were discharged from the hospital. Only 29 (4.6 %) out of 624 patients who were admitted to the general surgery department underwent an operation, while the rest were admitted for observation. On the other hand, patients were admitted to other departments only when surgical treatment was necessary.

Conclusions

In the absence of level one trauma centers, in multispecialty urban hospitals, the coordination of trauma burdens the general surgery team. This has financial and administrative implications. The collection of important epidemiologic data from these hospitals is mandatory in order to develop national prevention measures against injuries.     

Rehabilitation der erektilen Funktion nach nervenschonender radikaler Prostatektomie

Objective

Despite objective published data regarding rehabilitation of erectile function (EF) after nerve-sparing radical prostatectomy (nsRP) the gold-standard treatment is still under debate. The aim of this study was to evaluate the distribution of the different treatment options in Germany.

Patients and methods

Between October 2010 and May 2012 a questionnaire was sent to urologists in outpatient, general and university hospitals and rehabilitation hospitals in Germany. The survey consisted of various questions concerning, e.g. if and what kind of therapy urologists choose to support rehabilitation of EF after nsRP. Further questions dealt with the frequency, duration and optimal start of the chosen therapy.

Results

Currently 188 urologists have completed and returned the questionnaire. The distribution was urologists in hospitals n=79 and outpatient/ambulatory n=106, with 24 % performing surgical treatment and urologists in rehabilitation hospitals n=3. The question about the rehabilitation concept showed 39 different forms of treatment within this group. To increase EF after nsRP PDE5 inhibitors were mostly administered (88 %) with 45 % on request compared to 55 %on a daily or regular basis ≥ 3 times/week. The use of penile injection therapy, medicated urethral system for erection (MUSE) and vacuum constriction devices (VCD) was prescribed by 32 %, 6 % and 30 % of urologists, respectively. Only 14 % of the urologists did not choose any active kind of rehabilitation treatment for EF recovery after nsRP.

Conclusion

Many different therapeutic concepts are currently performed in Germany to increase EF recovery after nsRP. The use of PDE5 inhibitors is the most commonly chosen treatment option. Despite published data regarding effectiveness, the optimal treatment seems to be still unknown.     

Results of fusion and instrumentation of thoracic and lumbar vertebral fractures in children: a prospective ten-year study

Background

Researches on the results of surgical treatment of thoracolumbar spine fractures are infrequent. The aim of this study was to determine midterm outcomes of surgical treatment of these fractures in a prospective survey.

Methods

A case series study on pediatric patients with the diagnosis of thoracic and/or lumbar vertebral fractures was conducted over a ten-year period. Surgically treated patients were evaluated in the follow-up period, based on back pain, independent function, neurological status, and radiographic indices.

Results

There were 102 pediatric individuals, 61 boys and 41 girls, aged 3–17 years (mean 12 years of age) with thoracic and/or lumbar spinal fractures. Motor vehicle accident was the most common mechanism of injury (45.0 %). L1 was the most frequent level of fractured vertebra (24.4 %), and pelvic fracture was the most common associated orthopedic injury (21.5 %). Totally, 20 patients underwent surgery, but only fifteen (14 boys and one girl) participated in follow-up (mean 49 months; range 12–81 months). Posterior spinal fusion and instrumentation was accomplished in 12 cases. Three patients were operated by anterior approach and fusion followed by posterior fusion and instrumentation because of delay in diagnosis. There were no major perioperative complications. Two cauda equina syndromes and two incomplete spinal cord injuries improved back to normal. Five cases (33.3 %) reported occasional back pain, and all patients were functionally independent. Radiographic indices improved significantly.

Conclusions

Spinal fusion and instrumentation in pediatric patients with unstable thoracolumbar vertebral fractures with or without spinal cord injuries have favorable radiographic and functional outcomes.     

Management of facial and periocular dog bites: a review of 104 cases

Background

Dog bites are a frequent cause of facial and periocular injuries in both children and adults. This aim of this study is to review current practice in the management of facial and periorbital dog bite injuries and to examine the current evidence-base for such treatment strategies.

Methods

Five hundred eighty-seven patients with dog bite injuries requiring surgical intervention were identified from operating theatre records in one tertiary centre over a 9-year period. A retrospective case note review of 104 patients with facial and periorbital dog bite injuries was performed. Data on patient demographics, type of injury, treatment, and outcome was collected and analysed.

Results

The majority of patients were children, with a mean age of 11 years (range 1–91 years). Injuries involved the cheek in 57 cases (55 %), eyelids in 17 cases (16 %), lips in 24 cases (23 %) and nose in 8 cases (8 %). No facial fractures, canalicular, or globe injuries were recorded. All patients underwent irrigation, debridement, and primary wound closure. Surgical repair occurred within 24 h in 19 cases (18.2 %), within 48 h in 71 cases (68.3 %) and within 5 days in 14 cases (13.4 %). Three patients (2.9 %) developed a wound infection. Two patients (1.9 %) required scar revision surgery.

Conclusions

Periorbital and facial dog bite injuries may result in considerable morbidity. However, the majority of injuries are superficial and canalicular injury and bony injury is uncommon. Early wound irrigation, debridement and primary closure results in a good cosmetic outcome with a low risk of infection.

Level of Evidence:

Level IV, risk/prognostic study.     

Increasing incidence of injuries and fatalities inflicted by wild animals in Kashmir

Objective

To clarify the causes of the increased incidence of injuries inflicted by wild animals in Kashmir, and to suggest preventive measures.

Methods

A retrospective study reviewed records of these injuries. Data were collected from the hospital in Srinagar and from the Wildlife Protection Department of Kashmir.

Results

A total of 203 attacks (26 deaths and 177 near-fatal injuries) were recorded from January 2005 to October 2007, involving 145 (71.5%) male and 58 (28.5%) female victims. The attacking animal was a black bear in 104 (51.2%), a leopard in 18 (8.8%), a wolf in 7 (3.4%) and unidentified in 74 (36.4%) cases; 130 (64%) of these attacks occurred in southern Kashmir.

Conclusion

The steady increase in human population in areas close to jungle results in deforestation and destruction of wildlife habitat. The reduction in monkeys and deer (the staple food of leopards) causes these dangerous predators to search for food in the areas occupied by humans, who may then be attacked. Treatment of these cases requires a multidisciplinary approach, including an orthopaedic surgeon, plastic surgeon, microbiologist and psychiatrist, to achieve best cosmetic and functional results.     

Surgical Conditions Account for the Majority of Admissions to Three Primary Referral Hospitals in Rural Mozambique

Background

The World Health Organization has identified the primary referral hospital as its priority site for improving surgical care in low- and middle-income countries. Little is known about the relative burden surgical patients place on health care facilities at this level. This research estimates the fraction of admissions due to surgical conditions at three hospitals in rural Mozambique.

Methods

Prospective data were collected on all inpatients at three primary referral hospitals in Mozambique during a 12-day period. We compared the number of surgical patients and their length of stay (LOS) to the patients admitted to the medicine, pediatric, and maternity wards. These findings were validated using retrospective data collected from one hospital from January to May 2012.

Results

Patients with surgical conditions (i.e., patients admitted to the surgical or maternity ward) accounted for 57.5 % of admissions and 48.0 % of patient-days. The majority of patients were admitted to the maternity ward (32.3 %). The other admissions were evenly distributed to the pediatric (22.5 %), medical (20.0 %), and surgical (25.2 %) wards. Compared to patients from the three other wards, surgical patients had longer average LOS (8.7 vs. 1.9–7.7 days) and a higher number of total patient-days (891 vs. 252–703 days). The most prevalent procedures were cesarean section (33.3 %) and laceration repair/wound care (11.8 %).

Conclusions

Surgical conditions are the most common reason for admissions at three primary referral hospitals in rural Mozambique. These data suggest that surgical care is a major component of health care delivered at primary referral hospitals in Mozambique and likely other sub-Saharan African countries.     

Skeletal injuries sustained during the Haiti earthquake of 2010: a radiographic analysis of the casualties admitted to the Israel Defense Forces field hospital

Purpose

To report the distribution and types of skeletal injuries demonstrated on the images taken at the field hospital following the Haiti 2010 earthquake.

Methods

Following the January 12, 2010, earthquake, the State of Israel dispatched a field hospital to Haiti, managing 1,111 patients from January 17, 2010, to January 26, 2010. Four hundred and seven patients (37 %) had 684 radiographic images, most of them (87 %) due to presumed skeletal injuries.

Results

There were 224 limb fractures (excluding the hands and feet), with 77 % of them in the lower limbs (30 % femur, 17 % tibial shaft, 16 % ankle). Out of 37 axial skeleton fractures, 30 involved the pelvis (21 anterior posterior, three vertical shear, three lateral compression, three combined). Nine traumatic dislocations (five hips, three shoulders, one knee) were reduced. After reviewing all the digital radiographs, on a PACS-compatible radiography screen, few false diagnoses (2 %) were encountered, with none of them affecting the management of these injuries.

Conclusions

To the best of our knowledge, this is the first report of the radiological results emerging from a field hospital following a mass casualty event. Laptop personal computer-based workstations provide an adequate solution for radiographic image viewing in a field hospital setting. Recognition of the prevalence and distribution of skeletal injuries can improve the preparedness of such delegations before departure in the future.     

The Extent of Soft Tissue and Musculoskeletal Injuries after Earthquakes; Describing a Role for Reconstructive Surgeons in an Emergency Response

Background

Earthquakes are the leading cause of natural disaster-related mortality and morbidity. Soft tissue and musculoskeletal injuries are the predominant type of injury seen after these events and a major reason for admission to hospital. Open fractures are relatively common; however, they are resource-intense to manage. Appropriate management is important in minimising amputation rates and preserving function. This review describes the pattern of musculoskeletal and soft-tissue injuries seen after earthquakes and explores the manpower and resource implications involved in their management.

Methods

A Medline search was performed, including terms “injury pattern” and “earthquake,” “epidemiology injuries” and “earthquakes,” “plastic surgery,” “reconstructive surgery,” “limb salvage” and “earthquake.” Papers published between December 1992 and December 2012 were included, with no initial language restriction.

Results

Limb injuries are the commonest injuries seen accounting for 60 % of all injuries, with fractures in more than 50 % of those admitted to hospital, with between 8 and 13 % of these fractures open. After the first few days and once the immediate lifesaving phase is over, the management of these musculoskeletal and soft-tissue injuries are the commonest procedures required.

Conclusions

Due to the predominance of soft-tissue and musculoskeletal injuries, plastic surgeons as specialists in soft-tissue reconstruction should be mobilised in the early stages of a disaster response as part of a multidisciplinary team with a focus on limb salvage.     

Outcome of preemptive penile rehabilitation before bilateral cavernosal nerve injury in rats

Purpose

In this study, prophylactic penile rehabilitation (PR) with sildenafil before and after a cavernosal nerve (CN) injury was analyzed in an animal model.

Materials and methods

Thirty-six animals were divided into six groups as follows: (1) those with no CN injury (i.e., sham), (2) those with a bilateral CN injury (i.e., control), (3, 4) those with a bilateral CN injury treated with 10–20 mg/kg of sildenafil subcutaneously (SC) on a daily basis commencing 1 month prior to and after nerve injuries, respectively, (5, 6) those with a bilateral CN injury treated daily with 10–20 mg/kg of sildenafil SC after the nerve injuries, respectively. Mean arterial pressure (MAP) and intracavernosal pressure (ICP) were measured in response to CN stimulation to assess erectile function (EF). Neuronal nitric oxide synthase (nNOS) immunohistochemical analysis and real-time polymerase chain reaction (RT-PCR) were performed.

Results

The maximal ICP/MAP ratio was 60 ± 18% in the sham, 22 ± 5% in the control, 28 ± 9% in Group III, 45 ± 16% in Group IV, 45 ± 17% in Group V, and 49 ± 21% in Group VI. Although EF was improved with sildenafil treatment in a dose-dependent fashion, no statistically significant difference was observed between the preemptive and standard rehabilitation groups. Again, nNOS immunoreactivity and RT-PCR results showed the beneficial effect of sildenafil, but the study did not support the efficacy of preemptive rehabilitation when compared to the standard rehabilitation group.

Conclusions

Although, a dose–response relationship was observed for PR treatment with sildenafil; i.e., outcomes improved at higher doses of sildenafil for PR, preemptive PR should not be pursued as an alternative rehabilitation modality.     

Age and traumatic chest injury: a 3-year observational study

Background

A quarter of trauma-related deaths are attributable to traumatic chest injury (TCI).

Objective

To outline the pattern and outcome of TCI in a rapidly developing country among different age groups.

Methods

We conducted a retrospective observational study for patients who sustained TCI and admitted between January 2008 and December 2010 to the Level I trauma center at Hamad General Hospital in Qatar. Patients were classified and analyzed in four age groups (group 1 ≤18, group 2 between 19–44, group 3 45–59, and group 4 >60 years). Multivariate regression analysis was performed for predictors of mortality.

Results

Of 5,118 cases admitted to the Section of Trauma Surgery, 1,355 (26.5 %) had TCI (12, 67, 16, and 5 % in groups 1–4, respectively), which was due to blunt trauma in 96 % of cases. The overall mean age was 33 ± 15 years and males comprised 94 % of cases. Children (≤18 years of age) had more traffic-related injury, intubation, high Injury Severity Score (ISS) (19 ± 12), and associated head and liver injuries in comparison to the other groups. The overall mortality rate was 13 % (24, 11, 12, and 16 % in groups 1–4, respectively). The death rate was higher in pedestrians, followed by motor vehicle crashes (MVCs) and fall-related injuries (24 vs. 13 vs. 7 %, respectively, p = 0.001). The highest mortality occurred within the first day (n = 115, 65 %). In comparison to old age, children were more likely to die early (on the first day) and the adult group died mostly within the first week of hospitalization. Independent predictors for mortality included associated head injury [odds ratio (OR) 2.3, 95 % confidence interval (CI) 1.48–3.62), ISS (OR 1.11, 95 % CI 1.09–1.13), and age (OR 0.37, 95 % CI 0.22–0.62).

Conclusion

TCI is an alarming problem in Qatar, with a bimodal mortality curve. The highest mortality peak occurred in children, followed by old age. However, young males are the most exposed population. Regulatory efforts and strict enforcement of traffic laws would likely reduce morbidity and mortality.     

Outcome and treatment of postoperative spine surgical site infections: predictors of treatment success and failure

Background

Surgical site infection (SSI) is an important complication after spine surgery. The management of SSI is characterized by significant variability, and there is little guidance regarding an evidence-based approach. The objective of this study was to identify risk factors associated with treatment failure of SSI after spine surgery.

Patients and methods

A total of 225 consecutive patients with SSI after spine surgery between July 2005 and July 2010 were studied retrospectively. Patients were treated with aggressive surgical debridement and prolonged antibiotic therapy. Outcome and risk factors were analyzed in 197 patients having 1 year of follow-up. Treatment success was defined as resolution within 90 days.

Results

A total of 126 (76 %) cases were treated with retention of implants. Forty-three (22 %) cases had treatment failure with five (2.5 %) cases resulting in death. Lower rates of treatment success were observed with late infection (38 %), fusion with fixation to the ilium (67 %), Propionibacterium acnes (43 %), poly microbial infection (68 %), >6 operated spinal levels (67 %), and instrumented cases (73 %). Higher rates of early resolution were observed with superficial infection (93 %), methicillin-sensitive Staphylococcus aureus (95 %), and <3 operated spinal levels (88 %). Multivariate logistic regression revealed late infection was the most significant independent risk factor associated with treatment failure. Superficial infection and methicillin-sensitive Staphylococcus aureus were predictors of early resolution.

Conclusion

Postoperative spine infections were treated with aggressive surgical debridement and antibiotic therapy. High rates of treatment failure occurred in cases with late infection, long instrumented fusions, polymicrobial infections, and Propionibacterium acnes. Removal of implants and direct or staged re-implantation may be a useful strategy in cases with high risk of treatment failure.     

Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study

Purpose

To clarify the relative frequency of various histopathological primary spinal cord tumors and their features in Japanese people and to compare this data with other reports.

Methods

Primary spinal cord tumor surgical cases from 2000 to 2009, which were registered in our affiliated hospital database were collected. We examined age at surgery, sex, anatomical location, vertebral level of the tumor, and pathological diagnosis in each case.

Results

Of the 678 patients in our study, 377 patients (55.6 %) were males and 301 patients (44.4 %) were females (male/female ratio 1.25). The mean age at surgery was 52.4 years. Of these tumors, 123 cases (18.1 %) were intramedullary, 371 cases (54.7 %) were intradural extramedullary, 28 cases (4.1 %) were epidural, and 155 cases (22.9 %) were dumbbell tumors. The pathological diagnoses included 388 schwannomas (57.2 %), 79 meningiomas (11.6 %), 54 ependymomas (8.0 %), 27 hemangiomas (4.0 %), 23 hemangioblastomas (3.4 %), 23 neurofibromas (3.4 %), and 9 astrocytomas (1.3 %). The male/female ratios for schwannomas, meningiomas, ependymomas, hemangiomas, hemangioblastomas, neurofibromas, malignant lymphomas, and lipomas are 1.4, 0.34, 1.3, 1.5, 2.3, 1.3, 2.7 and 2.3, respectively.

Conclusion

This is the first published research in English on the epidemiology of primary spinal cord tumors in Japanese people. Similar to other reports from Asian countries, our data indicates a higher male/female ratio overall for spinal cord tumors, a higher proportion of nerve sheath cell tumors, and a lower proportion of meningiomas and neuroepithelial tumors compared to reports from non-Asian countries. Data in the current study represent the characteristics of primary spinal cord tumors in Asian countries.     

Analytical study of burns in Kashmir

Kashmir Valley is part of Jammu and Kashmir State. It is surrounded on all sides by the Pirpanchal range of mountains, and as a result of this position it is cold in the valley for about three-quarters of the year. The population of the Kashmir Valley is 31 30 090 and that of the Srinagar district is 7 21 078. The people of the valley use a ‘Kangri’ which is a portable unguarded heater to keep themselves warm. Burns being common in the area it prompted the undertaking of an analytical study of 100 burn cases admitted to the Medical College Hospital, Srinagar, Kashmir. The pattern of cases referred to or admitted directly in our hospital reflect the percentage of burn injuries sustained in Kashmir Valley since it is the only provincial hospital of its kind in the Valley having facilities for the undertaking of plastic surgery.     

Therapeutischer Stellenwert der BGSW bei Verletzungen des Bewegungsapparats

Aims

Inpatient follow-up treatment approved by an employers’ liability insurance is part of the special statuary accident insurance treatment program. This inpatient procedure aims at intensive medical rehabilitation leading to occupational reintegration. In case of an obstinate condition or a complicated course, a complex inpatient rehabilitation can be carried out at an employers’ liability insurance hospital. Here we question the effects of time and the severity of the injury on the major aim of occupational rehabilitation.

Methods and materials

A prospective study was made on the course of therapy of all patients treated under the employers’ liability insurance inpatient treatment scheme in the occupational insurance hospital in Murnau in the year 2004. The diagnostic, conservative and surgical procedures which had been carried out up to the point of admission were analysed. Patients with spinal chord or craniocerebral trauma were not included in this examination due to the particular long-term problems following such injuries. The course with respect to future work and occupational reintegration was also determined at the end of the treatment program. The mean follow-up was 12 months (range 6–18 months). In addition, the duration between the healing process for each injury, the beginning of the employers’ liability insurance treatment and the reduction in work capability as a measure of the severity of the injury was evaluated. A total of 209 patients (152 males and 57 females) with an average age of 45 years (range 15–74 years) were examined.

Results

There were an average of 4.2 months between the end of the treatment process and the beginning of occupational rehabilitation at the Murnau hospital. The occupational reintegration rate was 62% at the time of the follow-up examination. The average reduction in work capability was 13.1% (0–40%). Unsatisfactory results were most common in patients with shoulder, ankle and foot injuries, while patients with vertebral injuries were more successful than average.

Discussion

Employers’ liability insurance inpatient treatment should begin early and be carried out consistently with the aim of occupational reintegration. Close cooperation with the accident insurance carrier is essential. Here, the severity of the injury is not the deciding factor for the success of the reintegration.     

Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma

Purpose

Traumatic cervical spinal cord injuries (SCIs) frequently develop dural tears and resultant cerebrospinal fluid (CSF) leaks. They are not usually identified with advanced imaging, and there are no reports on managing CSF leaks after cervical trauma. Hence, the authors evaluated the incidence of CSF leaks after cervical SCIs and described how to predict and manage CSF leaks.

Methods

An observational retrospective study was done confirming intraoperative CSF leaks among 53 patients with anterior cervical surgery after cervical spine trauma between 2004 and 2011.

Results

Seven patients (13.2 %) had dural tears and resultant CSF leaks intraoperatively (M:F ratio of 6:1; mean age, 44.7 years). An initial poor American Spinal Injury Association (ASIA) scale was significantly associated with CSF leaks (p = 0.009). From magnetic resonance imaging (MRI), disruption of the ligamentum flavum was correlated with CSF leaks (p = 0.02). Intraoperative application of fibrin glue on the operated site, postoperative management through the early removal of the wound drain within the first 24 h and early rehabilitation were performed in patients with CSF leaks without perioperative insertion of a lumbar drain. During the follow-up period, none of the patients developed CSF-leak-related complications.

Conclusion

The incidence of CSF leaks after traumatic cervical SCI is relatively higher than that of degenerative cervical spinal surgery. An initial poor neurological status and disruption of the ligamentum flavum on the MRI in patients were predictable factors of dural tears and CSF leaks.