Management of non-contiguous vertebral fractures

Non-contiguous vertebral fractures are not common. In 78 consecutive patients with acute thoracolumbar fractures, we found that 13 patients (16.7%) had non-contiguous spinal injuries. Five patients had a combination of cervical and thoracolumbar injuries and eight had a combination of thoracic and lumbar injuries. Four of the eight patients in the thoracic and lumbar group had posterior surgical stabilisation procedures. Two patients had instrumentation of all injured, non-contiguous vertebrae and healing occurred uneventfully, and two patients had instrumentation of only the major fracture and a progressive deformity occurred at the site of the minor fracture. We concluded that: patients with a spinal fracture should have radiographic evaluation of their entire spine to rule out non-contiguous fractures; if non-contiguous fractures are evident on standard radiographs, all levels of injury should be evaluated with computerised tomography; and all unstable or potentially unstable injuries should be reduced, stabilised, and fused.     

The relevance of problems and models to treatment outcome: a comparative study of two agencies.

The aim of this study was to compare the progress of clients attending two substance misuse treatment agencies. A wide range of problems were recorded at 1, 3-6, and 12 month intervals; these included measures of substance misuse and dependence together with social problems and physical and mental health problems. Differences in outcome between the two agencies were entirely attributable to the number and severity of a range of problems rather than simply to severity of dependence or differences between the agencies themselves. This raised questions of how treatment outcomes are understood and explained, and the usefulness of therapeutic models per se.     

Back injuries in college athletes

Frequency and types of back injuries sustained by intercollegiate athletes were determined by examining medical records of 4,790 athletes that competed in 17 varsity sports over a 10-year period. These athletes sustained 333 back injuries, an injury rate of 7 per 100 participants. Injury rates were significantly higher in football and gymnastics, and 80% of the injuries occurred in practice, 6% in competition, and 14% during preseason conditioning. Muscle strains occurred with much greater frequency than other types of injuries, and acute back injuries were much more prevalent (59%) than overuse injuries (12%) or injuries associated with pre-existing conditions (29%).     

Improved postoperative course after spinous process segmental instrumentation of thoracolumbar fractures

This article compares the postoperative course of 40 patients who had Harrington instrumentation with 40 patients who had Harrington instrumentation and interspinous process segmental instrumentation of unstable thoracolumbar fractures and reviews the findings. The two groups of patients were otherwise homogeneous, and average operative time, total blood loss, and days to oral intake were similar for both groups of patients. On average, however, patients undergoing interspinous process segmental instrumentation were out of bed sooner (4.5 versus 7.7 days, P less than 0.0001), discharged sooner (32 versus 38 days, P less than 0.079), and brace-free earlier (2.1 versus 5.9 months, P less than 0.001) and had fewer fixation-related complications than did patients undergoing Harrington instrumentation alone. Comparison of average hospital costs documented a savings of $5,160 for the typical patient undergoing interspinous process segmental instrumentation.     

Unusual causes of back pain in athletes.

Typical causes of back pain in the athlete include muscle strain, intervertebral disc injury, interspinous bursitis, and spondylolysis. If initial evaluation does not indicate that any of these potential conditions is the cause, the physician or trainer should consider less common conditions. In this report, we discuss the identification and management of five unusual causes of back pain in the high school and college athlete: (a) disc space collapse after herniated disc excision, (b) sacralization of L5, (c) facet fracture of L5, (d) fracture of the lumbar vertebral apophysis, and (e) interosseous herniation of the lumbar disc.