The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI). Patients with tSCI requiring surgical spinal decompression presenting to 17 centres in Europe were recruited. Depending on the timing of decompression, patients were divided into early (≤ 12 hours after injury) and late (> 12 hours and < 14 days after injury) groups. The American Spinal Injury Association neurological (ASIA) examination was performed at baseline (after injury but before decompression) and at 12 months. The primary endpoint was the change in Lower Extremity Motor Score (LEMS) from baseline to 12 months.Aims
Methods
Fracture of the odontoid process (OP) in the elderly is associated with mortality rates similar to those of hip fracture. The aim of this study was to identify variables that predict mortality in patients with a fracture of the OP, and to assess whether established hip fracture scoring systems such as the Nottingham Hip Fracture Score (NHFS) or Sernbo Score might also be used as predictors of mortality in these patients. We conducted a retrospective review of patients aged 65 and over with an acute fracture of the OP from two hospitals. Data collected included demographics, medical history, residence, mobility status, admission blood tests, abbreviated mental test score, presence of other injuries, and head injury. All patients were treated in a semi-rigid cervical orthosis. Univariate and multivariate analysis were undertaken to identify predictors of mortality at 30 days and one year. A total of 82 patients were identified. There were 32 men and 50 women with a mean age of 83.7 years (67 to 100).Aims
Patients and Methods
We performed a retrospective, comparative study of elderly patients
with an increased risk from anaesthesia who had undergone either
anterior screw fixation (ASF) or halo vest immobilisation (HVI)
for a type II odontoid fracture. A total of 80 patients aged 65 years or more who had undergone
either ASF or HVI for a type II odontoid fracture between 1988 and
2013 were reviewed. There were 47 women and 33 men with a mean age
of 73 (65 to 96; standard deviation 7). All had an American Society
of Anesthesiologists score of 2 or more.Aims
Patients and Methods
Identifying cervical spine injuries in confused or comatose patients
with multiple injuries provides a diagnostic challenge. Our aim
was to investigate the protocols which are used for the clearance
of the cervical spine in these patients in English hospitals. All hospitals in England with an Emergency Department were asked
about the protocols which they use for assessing the cervical spine.
All 22 Major Trauma Centres (MTCs) and 141 of 156 non-MTCs responded
(response rate 91.5%).Aim
Patients and Methods
We assessed the frequency and causes of neurological
deterioration in 59 patients with spinal cord injury on whom reports
were prepared for clinical negligence litigation. In those who deteriorated
neurologically we assessed the causes of the change in neurology
and whether that neurological deterioration was potentially preventable.
In all 27 patients (46%) changed neurologically, 20 patients (74%
of those who deteriorated) had no primary neurological deficit.
Of those who deteriorated, 13 (48%) became Frankel A. Neurological
deterioration occurred in 23 of 38 patients (61%) with unstable
fractures and/or dislocations; all 23 patients probably deteriorated
either because of failures to immobilise the spine or because of
inappropriate removal of spinal immobilisation. Of the 27 patients who
altered neurologically, neurological deterioration was, probably,
avoidable in 25 (excess movement in 23 patients with unstable injuries,
failure to evacuate an epidural haematoma in one patient and over-distraction following
manipulation of the cervical spine in one patient). If existing
guidelines and standards for the management of actual or potential
spinal cord injury had been followed, neurological deterioration
would have been prevented in 25 of the 27 patients (93%) who experienced
a deterioration in their neurological status. Cite this article:
This study examined spinal fractures in patients
admitted to a Major
The aim of this study was first, to determine
whether CT scans undertaken to identify serious injury to the viscera were
of use in detecting clinically unrecognised fractures of the thoracolumbar
vertebrae, and second, to identify patients at risk of ‘missed injury’. We retrospectively analysed CT scans of the chest and abdomen
performed for blunt injury to the torso in 303 patients. These proved
to be positive for thoracic and intra-abdominal injuries in only
2% and 1.3% of cases, respectively. However, 51 (16.8%) showed a
fracture of the thoracolumbar vertebrae and these constituted our subset
for study. There were eight women and 43 men with mean age of 45.2
years (15 to 94). There were 29 (57%) stable and 22 (43%) unstable
fractures. Only 17 fractures (33.3%) had been anticipated after
clinical examination. Of the 22 unstable fractures, 11 (50%) were
anticipated. Thus, within the whole group of 303 patients, an unstable spinal
injury was missed in 11 patients (3.6%); no harm resulted as they
were all protected until the spine had been cleared. A subset analysis
revealed that patients with a high Injury Severity Score, a low
Glasgow Coma Scale and haemodynamic instability were most likely
to have a significant fracture in the absence of positive clinical
findings. This is the group at greatest risk. Clinical examination alone cannot detect significant fractures
of the thoracolumbar spine. It should be combined with CT imaging
to reduce the risk of missed injury.
