Introduction: The poor correlation between neurological injury and degree of retropulsion in thoracolumbar burst fractures has been identified, but not adequately explained. We have examined the possibility that variation in the termination of the conus medullaris may offer protection from neurological injury in a proportion of these fractures. Methods: A retrospective study was made of 39 patients presenting with single level thoracolumbar burst fractures between June 1998 and April 2001. Admission MRI was performed on all patients. Age, sex, ISS, neurological status, mode of treatment and any neurological recovery were recorded. From the MRI scans the levels of the conus and the fracture were noted. Transverse Spine Area(TSA) was measured at the cranial, caudal and injured levels. A predicted TSA and % TSA for the injury level was calculated from the mean of the two other levels. Analysis was of severity of neurological injury in relation to canal compromise and involvement of the conus. Results: 26 male and 13 female patients of mean age 35.9 (SD 17) years and mean ASIA motor score 90.4 (SD 23) were studied. Neither sex nor age distribution differed between 18 neurologically injured and 21 intact patients. Mean ISS was 20.2 in the neurologically injured and 10.5 in the intact (p=0.0005). Mean TSA of the canal was 218mm2 in the intact and 150mm2 in the injured groups (p=0.006) and mean %TSA was 70 and 49 respectively (p=0.007). The conus lay between T12 and L2 in all. When the conus lay cranial to the fracture (n=13), 38% were neurologically intact. When the conus lay at the level of the fracture (n=26), 62% were intact (NS). Neurological deficit did not occur in the absence of neurological compression on MRI. Conclusions:
To present the results of multi-modal IOM in 298 patients who underwent spinal deformity correction. We reviewed the notes, surgical and IOM charts of all patients who underwent spinal surgery with the use of cortical and cervical SSEPs, as well as upper/lower limb transcranial electrical MEPs under the senior author. We recorded IOM events which we categorised as true, transient true and false (+) or (−). We correlated the IOM events with surgical or anaesthetic incidents.Aim:
Method:
Objective.
The August 2015 Trauma Roundup. 360 . looks at: Thromboprophylaxis not required in lower limb fractures; Subclinical thyroid dysfunction and fracture risk: moving the boundaries in fracture; Posterior wall fractures refined;
To analyse and compare long-term functional outcome of combined spino-pelvic injuries to an isolated pelvis and spinal fractures, the outcome of matched 30 patients with combined pelvic and spinal fractures was compared with 32 patients with isolated pelvic fractures and 30 patients with isolated spinal fractures. Functional outcome was measured using the self-report questionnaire EuroQol EQ-5D, a generic outcome tool. The functional outcome was compared with the average UK population scores. The mean age, median ISS and demographic profile were similar in all 3 groups.
Introduction: Sports injuries to the cervical spine account for about one in ten of all cervical spine injuries. They occur at all levels of participation. Fortunately, the number of patients suffering spinal cord injury is relatively small.
Introduction and Aims: Knee dislocation is an uncommon but serious injury. This study assessed the initial mechanism of injury, pattern of ligament injury, osteochondral and peri-articular soft-tissue trauma, and associated neurovascular injuries in the multi-ligament knee injury. Outcomes following operative and non-operative management were reviewed. Method: Retrospective review of patients with multi-ligament knee injuries was performed. Inclusion criteria were either a confirmed knee dislocation, or complete rupture of two or more ligaments requiring reconstruction. Systematic review of hospital records and imaging was performed for all patients, and clinical assessment, including validated outcome scores, were performed in the majority of patients. All reconstructive surgery was performed by the two senior authors. Results: Forty-five patients with 47 knee injuries were identified over a 13-year period (1990–2003). The most common mechanisms of injury were motorcycle and motor vehicle accidents. Other mechanisms included pedestrians hit by cars, sporting injuries and falls. Approximately half had a documented knee dislocation, while the remainder were located at the time of presentation. Vascular injury occurred in around 25% of patients, all having positive clinical findings. Routine angiography was not performed in the absence of positive clinical findings.