Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder of unknown etiology that is characterized by back pain and spinal stiffness. There may be mild pain if ankylosis has occurred. The condition is recognized radiographically by the presence of "flowing" ossification along the anterolateral margins of at least four contiguous vertebrae and the absence of changes of spondyloarthropathy or degenerative spondylosis. Even in patients who present with either lumbar or cervical complaints, radiographic findings are almost universally seen on the right side of the thoracic spine. Thus, radiographic examination of this area is critical when attempting to establish a diagnosis of DISH. The potential sequelae of hyperostosis in the cervical and lumbar spine include lumbar stenosis, dysphagia, cervical myelopathy, and dense spinal cord injury resulting from even minor trauma. There may be a delay in diagnosis of spinal fractures in a patient with DISH because the patient often has a baseline level of spinal pain and because the injury may be relatively trivial. The incidence of delayed neurologic injury due to such fractures is high as a result of unrecognized instability and subsequent deterioration. Extraspinal manifestations are also numerous and include an increased risk of heterotopic ossification after total hip arthroplasty. Prophylaxis to prevent heterotopic ossification may be indicated for these patients.     

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.     

Spinal trauma in DISH and AS: is MRI essential following the detection of vertebral fractures on CT?

BACKGROUNDBoth ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) cause a rigid spine, but through different pathophysiology. Recent data has shown that characteristic fracture patterns may also differ following trauma since the posterior osseous and soft tissue elements are often spared in DISH. CT and MRI are important in diagnosing spine injury, but given the differences between AS and DISH, the utility of obtaining both studies in all patients warrants scrutiny.PURPOSETo assess the prevalence of posterior element injury on CT and MRI in DISH and AS patients with known vertebral body injury detected on CT; to determine whether MRI demonstrates additional injuries in neurologically intact patients presumed to have isolated vertebral body injuries on CT.STUDY DESIGNMulticenter, retrospective, case-control study.PATIENT SAMPLEDISH and AS patients presenting after spine trauma between 2007 and 2017.OUTCOME MEASURESReview of CT and MRI findings at the time of presentation.METHODSOne hundred sixty DISH and 85 AS patients presenting after spine trauma were identified from 2 affiliated academic hospitals serving as level 1 trauma and tertiary referral centers. A diagnosis of DISH or AS was verified by a board-certified emergency radiologist with 3 years of experience. Age, gender, mechanism of injury, fracture type, spine CT and MRI imaging findings, surgical intervention, and neurologic deficit were recorded. The CT and MRI studies were reviewed by the same radiologist for fracture location and type using the AO spine classification. No funding source or conflict of interest was present.RESULTSMedian age was 72 and 79 years old for the AS and DISH groups, respectively. Both were predominantly male (81%) and most presented after a low energy mechanism of injury (74% and 73%). Type C AO spine injuries were seen in 52% of AS patients but only 4% of DISH patients. In patients with known vertebral body injury on CT, additional injury to the posterior elements on CT or MRI in DISH patients was 51% versus 92% in AS patients. However, in patients with an isolated vertebral body fracture on CT and no neurological deficit, MRI identified posterior element injury in only 4/22 (18%) DISH patients compared to 5 of 7 (71%) AS patients. None of the MRI findings in the DISH patients were considered clinically important while all 5 AS patients eventually underwent operative treatment despite having no neurological deficit. Epidural hematoma on MRI was seen in 43% of AS patients as opposed to 5% of DISH patients.CONCLUSIONBased on our small sample size, CT alone may be adequate in DISH patients with isolated vertebral body fractures and no neurologic deficit, but an additional MRI should be considered in the presence of an unclear neurological exam or deficit. MRI should be strongly considered for any AS patient regardless of neurologic status.     

Verletzungen der Halswirbelsäule bei der diffusen idiopathischen skelettalen Hyperostose

The incidence of diffuse idiopathic sceletal hyperostosis (DISH) is described in men more than 50 years old up to 25% and in women up to 15%. Even little trauma in patients with DISH often leads to injuries of the spine, especially the cervical spine. In many cases MRI is necessary to find the injury in this anatomically modified spine. It is often difficult to detect the injury by plane radiographs or even CT. Based on two cases of cervical spine fractures in patients with DISH we will describe the difficulties and specialities in the diagnostics and surgical treatment of injuries of the cervical spine in patients with DISH. In the one case we stabilized a patient with an odontoid fracture type Andersson II, the other case was a traumatic spondylolisthesis C4/C5. Both cases were treated operatively, the odontoid fracture was stabilized by a single screw, the spodylolisthesis by a ventral plate. If there are modifications in the spinal anatomy by degenerative diseases like DISH or spondylitis ankylosans, it is important to perform an intense search for injuries of the spine. In many cases MRI is indicated to detect the injury because plane radiographs and CT are not sensitive enough. For the planning of the operation it is important to meet concerns to the thick anterior longitudinal ligament and to use screws, that are long enough because the use of standard instruments is often not successful.     

Complications of fractures of the cervical spine in ankylosing spondylitis

Five patients with ankylosing spondylitis who suffered severe neurologic complications after fracture of the cervical spine are presented. All developed delayed neurologic complications, ranging from 2 to 35 days after the initial injury (mean, 15.8 days). The diagnosis was delayed in four, and in three this delay contributed to morbidity. All fractures occurred in the lower cervical spine (C5 to C7). In three patients, the fracture was the result of minor trauma. A high index of suspicion, an appreciation of the extreme instability of these fractures, and prompt rigid immobilization with a halo vest or case in the alignment of preexisting kyphosis are all important factors in preventing neurologic complications.     

Concomitant fractures of the acetabulum and spine: a retrospective review of over 300 patients

BACKGROUND: The incidence and spectrum of concomitant acetabulum and spine trauma has not been clearly defined. METHODS: We retrospectively reviewed 307 acetabulum fracture patients over 5 years, and evaluated this cohort for concomitant spine injuries. Patient and injury demographics, spine and neurologic injury and delay in diagnosis were examined. RESULTS: Complete data were available for 275 (90%) of the cohort, and 55 spine injuries (54 fractures and 1 traumatic disc herniation) were identified in 34 patients. Thus, the incidence of concomitant acetabulum and spine fractures was approximately 13% (34 of 275). Four percent of the patients sustained significant thoracolumbar fractures (burst, flexion-distraction, or dislocation). An average 8.6-day delay in diagnosis occurred in three spine fracture patients. One suffered progressive neurologic injury. CONCLUSIONS: It is essential that the traumatologists have a high index of suspicion for spine injury, particularly thoracolumbar injury in patients who sustain fractures of the acetabulum. We recommend early thoracolumbar computed tomography imaging in patients with fractures of the acetabulum if plain radiographs are not possible or inadequate.     

Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey

BackgroundDiffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH.MethodsPatients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years).ResultsThe major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically.ConclusionsMinor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.     

Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients

Background contextThe clinical outcome of patients with ankylosing spinal disorders (ASDs) sustaining a spinal fracture has been described to be worse compared with the general trauma population.PurposeTo investigate clinical outcome (neurologic deficits, complications, and mortality) after spinal injury in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) compared with control patients.Study designRetrospective cohort study.Patient sampleAll patients older than 50 years and admitted with a traumatic spinal fracture to the Emergency Department of the University Medical Center Utrecht, the Netherlands, a regional level-1 trauma center and tertiary referral spine center.Outcome measuresData on comorbidity (Charlson comorbidity score), mechanism of trauma, fracture characteristics, neurologic deficit, complications, and in-hospital mortality were collected from medical records.MethodsWith logistic regression analysis, the association between the presence of an ASD and mortality was investigated in relation to other known risk factors for mortality.ResultsA total of 165 patients met the inclusion criteria; 14 patients were diagnosed with AS (8.5%), 40 patients had DISH (24.2%), and 111 patients were control patients (67.3%). Ankylosing spinal disorder patients were approximately five years older than control patients and predominantly of male gender. The Charlson comorbidity score did not significantly differ among the groups, but Type 2 diabetes mellitus and obesity were more prevalent among DISH patients. In many AS and DISH cases, fractures resulted from low-energy trauma and showed a hyperextension configuration. Patients with AS and DISH were frequently admitted with a neurologic deficit (57.1% and 30.0%, respectively) compared with controls (12.6%; p=.002), which did not improve in the majority of cases. In AS and DISH patients, complication and mortality rates were significantly higher than in controls. Logistic regression analysis showed the parameters age and presence of DISH to be independently, statistically significantly related to mortality.ConclusionsMany patients with AS and DISH showed unstable (hyperextension) fracture configurations and neurologic deficits. Complication and mortality rates were higher in patients with ASD compared with control patients. Increasing age and presence of DISH are predictors of mortality after a spinal fracture.     

Delayed diagnosis of cervical spine injuries.

Over a 32-month period, the cases of all patients with multiple injuries on whom cervical spine roentgenograms (CSRs) were obtained during blunt trauma evaluation in a trauma center were reviewed to determine the incidence, outcome, and clinical consequence of delayed diagnosis of cervical spine injuries. A total of 1,331 patients had CSRs following blunt injury. Sixty-one (4.6%) of the patients had documented cervical fractures or dislocations. The patients were seriously injured (mean Trauma Score, 12; mean Glasgow Coma Scale score, 11; and mean Injury Severity Score, 30.3). Eleven of the patients died in the trauma room; 9 with fatal atlantoaxial dislocation. Of the 50 survivors (81.9%), neurologic deficits were present in 15 (30%), and 8 of those had complete spinal cord injuries. The diagnosis of the cervical spine injury was made during the initial evaluation in 56 of the 61 patients (91.8%). Five patients had delayed recognition of their cervical spine injury (2-21 days). The reason for the delay was incomplete CSRs in all patients, despite multiple views (up to 13). The missed injuries occurred in patients in whom complete visualization of the spine was most difficult (i.e., severe degenerative arthritis of the cervical spine in two patients; previous cervical fractures in one patient; instability during resuscitation in one patient). Radiologic misinterpretation occurred in one patient. The diagnosis of cervical spine injury was pursued because of persistent neck pain in two patients, and the development of subtle neurologic findings in three. The neurologic deficits in the three patients resolved.(ABSTRACT TRUNCATED AT 250 WORDS)     

胸腰椎过伸骨折合并弥漫性特发性骨肥厚症的临床研究

目的分析合并弥漫性特发性骨肥厚症(DISH)胸腰椎过伸骨折的损伤机制、损伤特点,以指导治疗方案的选择。方法回顾性分析自2007-01—2015-12诊治的95例合并DISH胸腰椎过伸骨折,根据X线片、CT及MRI评估脊柱损伤类型:前柱经椎间盘损伤44例(46.3%),经骨损伤41例(43.2%),混合型损伤10例(10.5%)。所有患者均行脊柱后路切开复位椎弓根钉内固定手术治疗。结果术后3例出现切口愈合不良,给予换药、抗生素治疗后痊愈。术后X线片显示8枚椎弓根钉位置不佳。在治疗期间,4例出现贫血,5例出现全身炎症性反应综合征(SIRS),4例抗甲氧西林金黄色葡萄球菌感染(MRSA),5例肺或肾脏衰竭,2例肺部感染,1例泌尿系感染,1例出现褥疮。4例在创伤后3个月内死亡,死亡患者年龄75~88(81.7±4.1)岁。结论随着高龄人口及脊柱代谢疾病的增多,DISH患者中出现的胸腰椎过伸损伤也会随之增加。临床骨科医师要充分认识合并DISH胸腰椎过伸骨折的特点,以便制定较为合理的治疗方案。     

多节段非相邻型脊柱骨折的诊治

目的 探讨多节段非相邻型脊柱骨折(multiple-level noncontiguous spinal fractures，MNSF)的致伤机制、临床特点及治疗方法。方法 回顾性分析2000年1月～2003年12月23例MNSF患者的临床资料。男15例，女8例。年龄13～75岁。原发损伤T11～L2 13例，T1～T10 7例，C2～C6 3例。原发损伤合并神经症状14例，继发损伤合并神经症状3例。神经损伤按Frankel分级：A级7例，B级1例，C级3例，D级6例，E级6例。16例行手术治疗，7例行非手术治疗。结果 1例术后4d死亡，2例失访，20例获随访3个月～4年，平均11．5个月。无神经症状加重、切口感染、内固定失败及植骨不融合发生。术前有神经症状的17例中，12例Frankel分级改善1～3级，其中6例D级、2例C级和1例B级恢复至E级，1例C级恢复至D级，2例A级恢复至B级；余5例均为Frankel A级患者，其中4例无变化，1例术后死亡。结论 MNSF致伤机制复杂，易漏诊，应仔细全面检查脊柱损伤患者，必要时摄脊柱全长X线片。根据骨折稳定性、脊髓神经损伤情况采取相应的治疗方法。     

强直性脊柱炎脊柱骨折的治疗

目的 了解强且性脊柱炎(AS)脊柱骨折治疗的特点及注意事项。方法对19例AS脊柱骨折病例进行回顾性分析硬随访,19例中颈椎骨折11例,9例发生在C5-7间;胸腰椎骨折8例,7例为应力骨折,均发生存T10-L2间。二柱骨折16例。9例并发脊髓损伤,其中8例为颈椎骨折。所有19例患者均接受了手术治疗。颈椎骨折或脱位采用了4种手术方式,其中9例做了前路间盘切除或椎体次全切除、椎间值骨加钢板内固定术。胸腰椎骨折也做了4种术式,其中5例的术式为后路长节段固定加前、后联合融合,结果术岳18例患者获得了平均46．4个月的随访。并发脊髓损伤的9例患者,术后8例的神经功能有恢复。18例患者的骨折部位均已骨性愈合一术中并发脊髓损伤2例,因脑血管意外死亡1例,并发肺炎2例。结论 AS脊柱骨折好发于下颈椎及胸腰段,大多为三柱骨折,颈椎骨折并发脊髓损伤的发生率较高。胸腰椎多为应力骨折一手术治疗可使大多数患者的骨折愈合良好,神经功能有不同程度的恢复。对颈椎骨折患者,可采用前路椎体问植骨、钢板内固定的术式;而对于胸腰椎骨折,主张后路长节段固定,前、后联合植骨融合,术中及术后均可能出现并发症,应注意预防或避免。     

Abdominal injuries associated with lumbar spine fractures in blunt trauma

BACKGROUND: Specific analysis of the relationship between abdominal injuries and lumbar spine fractures has not yet been reported. METHODS: A retrospective review of 258 blunt trauma patients with lumbar spine fractures treated between 1991 and 1996. RESULTS: 26 patients sustained concomitant lumbar spine fractures and abdominal injuries. The mechanism of injury was motor vehicle collision (73%), pedestrian-struck (11%), fall (8%) and assault (8%) resulting in ISS, RTS and mortality of 27 +/- 4, 6.5 +/- 0.4 and 8%, respectively. Forty-four lumbar spine fractures were identified (1.7/pt) in association with splenic (54%), renal (41%), hepatic (32%) and small bowel (23%) injuries and no retroperitoneal involvement. Multilevel lumbar spine fractures were associated with a higher organ injury/fracture ratio compared with single level fractures (p < 0.01) including a twofold higher incidence of solid organ (spleen, liver and kidney) injury (p < 0.01). The level and type of fracture did not affect the incidence of total and individual organ injury. Patients with abdominal injuries were more severely injured mainly due to increased incidence of associated thoracic injuries although no significant difference in mortality was observed. CONCLUSION: Abdominal injuries occurred only in the minority of blunt trauma patients with lumbar spine fractures. These injuries, which followed a similar distribution pattern as in blunt trauma in general, occurred most commonly due to motor vehicle collisions and in association with multilevel vertebral fractures. No correlation with fracture type or level was identified.     

Blunt trauma to the carotid arteries

Blunt carotid artery trauma is an uncommon but potentially dangerous clinical entity. We report eight patients from a 10-year interval who sustained blunt injuries to the carotid arteries. Six of eight patients suffered a hyperextension injury or had a cervical spine fracture or both. Arteriography revealed four arterial dissections and four thrombotic occlusions. Two asymptomatic common carotid artery occlusions and one dissection with transient ischemic attacks had successful arterial reconstructions. Five patients were treated nonoperatively: three internal carotid artery dissections with minor or no neurologic deficit; one asymptomatic thrombosis; and one internal carotid artery thrombosis with a major fixed neurologic deficit that did not improve. No patient died, and seven of eight made a complete neurologic recovery or remained asymptomatic. The diagnosis of blunt carotid artery injuries should be suspected in patients with neck hyperextension injuries or with cervical spine fractures as well as in patients with neurologic deficits not explained by intracranial trauma. Duplex scanning may be a useful noninvasive study. Surgery is indicated for selected patients with accessible lesions who have minor or no neurologic deficits. Asymptomatic patients with small intimal flaps or dissections may be successfully treated nonoperatively.     

Diffuse Idiopathic Skeletal Hyperostosis

DISH is a relatively common disorder affecting between 3% and 30% of men older than the age of 50. It produces nonmarginal osteophyte formation in the spine that often results in ankylosis. Although often asymptomatic, patients may develop stiffness and axial neck or back pain. Most significantly, DISH places patients at great risk of neurologic injury after seemingly insignificant trauma. Treating physicians must maintain a high index of suspicion when evaluating patients who have a history of DISH because even low-energy trauma may have disastrous complications in this patient population.     

Sternal fractures associated with spinal injury

Twenty-eight cases of sternal fractures and/or dislocations were reviewed for the presence of associated spinal injury. Patient records and radiographs were studied. Sixteen cases had inadequate radiographs to rule out spine fracture. Three cases had known direct injuries to the sternum. Of the remaining nine patients, eight had spine fractures. All of the spine fractures were consistent with a flexion injury mechanism. Three patients had spine fractures at the thoracic level and four at the lumbar level. One patient had lower cervical and thoracic injuries. In the patients with spine injury, the proximal manubrial fragment tended to displace posteriorly. Similarly, the manubrium would move posteriorly in manubriosternal dislocations. A case of spontaneous sternal fracture in a patient with osteoporosis and multiple thoracic compression fractures is described. One patient had open reduction of the manubriosternal joint. Three patients who were admitted for their sternal injuries had spine fractures which were not recognized during the hospitalization. There were no cases of mediastinal injury in the patients with combined sternal and spinal injuries. Flexion injury to the spine may cause buckling of the sternum. However, indirect sternal injury continues to be overlooked. Careful evaluation for spine injuries should be done on all patients with sternal fractures and vice versa.     

Anterior spine stabilization and decompression for thoracolumbar injuries

In a series of patients with thoracolumbar spine injuries, anterior spinal canal decompression resulted in better neurologic recovery than did previously reported posterior instrumentation or nonoperative treatment. The technique allows stabilization over a much shorter segment of the spine than posterior instrumentation and therefore is indicated for fractures at L2 and below and in all patients with burst fractures and neurologic compromise.     

Traumatic instability in the previously fused cervical spine.

The effect of fused segments in the cervical spine has been documented to cause chronic changes in adjacent levels. This article reports an association between the presence of fused cervical segments and the predisposition to acute, traumatic instability at adjacent levels. Patients with cervical fractures were reviewed during a 12-year period. Fifteen patients were identified who sustained cervical fractures in the presence of previously fused segments. The presence of fusion was reviewed for its effect of neurologic injury, delay in diagnosis, and patterns of fractures. The diagnostic studies used to document instability were reviewed. We found that preexisting cervical fusions often result in a delay of diagnosis because of altered anatomy and atypical fracture patterns. The fractures occurred within one or two levels from the fused segment. There are different fracture patterns associated with fusions in the upper cervical spine and those fusions in the lower cervical spine. The presence of fusions significantly affected treatment choices in this group of patients.     

Cervical spine injuries in children

Review of 24 consecutive cases of cervical spine injuries in children were reviewed showed that this uncommon injury occurred at a rate of 1.2 cases per year. Associated injuries occurred in 38%, and neurologic injury occurred in 29%, including two deaths. Results showed that 43% of children with neurologic injuries recovered. Nonoperative treatment was successful in 95%; however, 14% later developed kyphotic deformities. Surgical stabilization is recommended for flexion injuries associated with late sequelae and for compression (burst) fractures associated with neurologic injuries.     

Alterations of the biomarker S-100B and NSE in patients with acute vertebral spine fractures

Background contextAlthough several publications concerning the use of the biomarkers S100B and neuron-specific enolase (NSE) in vertebral spine fractures in animal experimental studies have proven their usefulness as early indicators of injury severity, there are no clinical reports on their effectiveness as indicators in patients with spinal injuries. As these biomarkers have been examined, with promising results, in patients with traumatic brain injury, there is a potential for their implementation in patients with vertebral spine fractures.PurposeTo investigate the early serum measurement of S100B and NSE in patients with vertebral spine fractures compared with those in patients with acute fractures of the proximal femur.Study designProspective longitudinal cohort study.Patient sampleA cohort of 34 patients admitted over an 18-month period to a single medical center for suspected vertebral spine trauma. Twenty-nine patients were included in the control group.Outcome measuresS100B and NSE serum levels were assessed in different types of vertebral spine fractures.MethodsWe included patients older than 16 years with vertebral spine fractures whose injuries were sustained within 24 hours before admission to the emergency room and who had undergone a brief neurologic examination. Spinal cord injuries (SCIs) were classified as being paresthesias, incomplete paraplegias, or complete paraplegias. Blood serum was obtained from all patients within 24 hours after the time of injury. Serum levels of S100B and NSE were statistically analyzed using Wilcoxon signed-rank test.ResultsS100B serum levels were significantly higher in patients with vertebral spine fractures (p=.01). In these patients, the mean S100B serum level was 0.75 μg/L (standard deviation [SD] 1.44, 95% confidence interval [CI] 0.24, 1.25). The mean S100B serum level in control group patients was 0.14 μg/L (SD 0.11, 95% CI 0.10, 0.19). The 10 patients with neurologic deficits had significantly higher S100B serum levels compared with the patients with vertebral fractures but without neurologic deficits (p=.02). The mean S100B serum level in these patients was 1.18 μg/L (SD 1.96). In the 26 patients with vertebral spine fractures but without neurologic injury, the mean S100B serum level was 0.42 μg/L (SD 0.91, 95% CI 0.08, 0.76). The analysis revealed no significant difference in NSE levels.ConclusionsWe observed a significant correlation not only between S100B serum levels and vertebral spine fractures but also between S100B serum levels and SCIs with neurologic deficit. These results may be meaningful in clinical practice and to future studies.