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Bone & Joint 360
Vol. 13, Issue 5 | Pages 51 - 52
1 Oct 2024
Marson BA

The Cochrane Collaboration has produced three new reviews relevant to bone and joint surgery since the publication of the last Cochrane Corner. These are relevant to a wide range of musculoskeletal specialists, and include reviews in lateral elbow pain, osteoarthritis of the big toe joint, and cervical spine injury in paediatric trauma patients


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 6 | Pages 877 - 881
1 Nov 1994
Lieberman I Webb J

We reviewed 41 patients over the age of 65 years (mean 76.5) who had suffered cervical spine injuries, 12 of them with neurological deficit. Eleven patients died during treatment, mostly from respiratory disease. Seven patients were treated by surgical stabilisation, five by halo traction, and the rest by rigid collars or halo-vests. The cervical injury was missed at the first examination in four patients. We conclude that most injuries can be treated by a rigid collar, and that the use of a halo-vest or surgical stabilisation are effective alternatives. Bed rest and traction are poorly tolerated by old people. There should be a high index of suspicion that any elderly patient who presents with a history of a fall or minor trauma may have a cervical spine injury


The Bone & Joint Journal
Vol. 98-B, Issue 6 | Pages 825 - 828
1 Jun 2016
Craxford S Bayley E Walsh M Clamp J Boszczyk BM Stokes OM

Aim. 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. Patients and Methods. 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%). Results. Written guidelines were used in 138 hospitals (85%). CT scanning was the first-line investigation in 122 (75%). A normal CT scan was sufficient to clear the cervical spine in 73 (45%). However, 40 (25%) would continue precautions until the patient regained full consciousness. MRI was performed in all confused or comatose patients with a possible cervical spinal injury in 15 (9%). There were variations in the grade and speciality of the clinician who had responsibility for deciding when to discontinue precautions. A total of 31 (19%) reported at least one missed cervical spinal injury following discontinuation of spinal precautions within the last five years. Only 93 (57%) had a formal mechanism for reviewing missed injuries. Take home message: There are significant variations in protocols and practices for the clearance of the cervical spine in multiply injured patients in acute hospitals in England. The establishment of trauma networks should be taken as an opportunity to further standardise trauma care. Cite this article: Bone Joint J 2016;98-B:825–8


The Journal of Bone & Joint Surgery British Volume
Vol. 71-B, Issue 2 | Pages 283 - 287
1 Mar 1989
Tamura T

Neck injury of the whiplash type may lead to the cranial symptoms of the Barre-Lieou syndrome. Forty patients with this syndrome and 40 without it were investigated by a variety of imaging techniques. There was a clear correlation between root sleeve defects at C3/4 shown by special oblique myelographic views and cranial symptoms. Good results were obtained by anterior cervical discectomy and fusion at C3/4 in 21 cases. It is suggested that the syndrome may result from irritation of the sympathetic nervous supply at this level.


The Bone & Joint Journal
Vol. 100-B, Issue 9 | Pages 1201 - 1207
1 Sep 2018
Kirzner N Etherington G Ton L Chan P Paul E Liew S Humadi A

Aims. The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma. Patients and Methods. A total of 155 patients (130 men, 25 women. Mean age 42.7 years; 16 to 87) who had undergone ACDF between 1 January 2001 and 1 January 2016 were included in the study. Outcome measures included the Neck Disability Index (NDI) and visual analogue scale (VAS) for pain. Lateral cervical spine radiographs taken in the immediate postoperative period were reviewed to compare the interfacet distance of the operated segment with those of the facet joints above and below. Results. There was a statistically significant relationship between greater facet distraction and increased NDI and VAS pain scores. This was further confirmed by Spearman correlation, which showed evidence of a moderate correlation between both NDI score and facet joint distraction (Spearman correlation coefficient 0.34; p < 0.001) and VAS score and facet distraction (Spearman correlation coefficient 0.52; p < 0.001). Furthermore, there was a discernible transition point between outcome scores. Significantly worse outcomes, in terms of both NDI scores (17.8 vs 8.2; p < 0.001) and VAS scores (4.5 vs 1.3; p < 0.001), were seen with facet distraction of 3 mm or more. Patients who went on to have a posterior fusion also had increased NDI and VAS scores, independent of facet distraction. Conclusion. After undergoing ACDF for the treatment of cervical spine injury, patients with facet joint distraction of 3 mm or more have worse NDI and VAS pain scores. Cite this article: Bone Joint J 2018;100-B:1201–7


Bone & Joint 360
Vol. 2, Issue 4 | Pages 19 - 21
1 Aug 2013

The August 2013 Spine Roundup. 360 . looks at: SPECT CT and facet joints; a difficult conversation: scoliosis and complications; time for a paradigm shift? complications under the microscope; minor trauma and cervical injury: a predictable phenomenon?; more costly all round: incentivising more complex operations?; minimally invasive surgery = minimal scarring; and symptomatic lumbar spine stenosis


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 5 | Pages 678 - 683
1 May 2012
Matsumoto M Okada E Ichihara D Chiba K Toyama Y Fujiwara H Momoshima S Nishiwaki Y Takahata T

We conducted a prospective follow-up MRI study of originally asymptomatic healthy subjects to clarify the development of Modic changes in the cervical spine over a ten-year period and to identify related factors. Previously, 497 asymptomatic healthy volunteers with no history of cervical trauma or surgery underwent MRI. Of these, 223 underwent a second MRI at a mean follow-up of 11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100 women with a mean age at second MRI of 50.5 years (23 to 83). Modic changes were classified as not present and types 1 to 3. Changes in Modic types over time and relationships between Modic changes and progression of degeneration of the disc or clinical symptoms were evaluated. A total of 31 subjects (13.9%) showed Modic changes at follow-up: type 1 in nine, type 2 in 18, type 3 in two, and types 1 and 2 in two. Modic changes at follow-up were significantly associated with numbness or pain in the arm, but not with neck pain or shoulder stiffness. Age (≥ 40 years), gender (male), and pre-existing disc degeneration were significantly associated with newly developed Modic changes. In the cervical spine over a ten-year period, type 2 Modic changes developed most frequently. Newly developed Modic changes were significantly associated with age, gender, and pre-existing disc degeneration


The Bone & Joint Journal
Vol. 105-B, Issue 8 | Pages 920 - 927
1 Aug 2023
Stanley AL Jones TJ Dasic D Kakarla S Kolli S Shanbhag S McCarthy MJH

Aims

Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in motor impairment affecting the upper limbs more than the lower, with occasional sensory impairment and urinary retention. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study was to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age.

Methods

Patients aged ≥ 18 years with a traumatic CCS between January 2012 and December 2017 in Wales were identified. Patient demographics and data about injury, management, and outcome were collected. Statistical analysis was performed to assess mortality and between-group differences.


Bone & Joint 360
Vol. 11, Issue 4 | Pages 29 - 32
1 Aug 2022


Bone & Joint Research
Vol. 11, Issue 11 | Pages 814 - 825
14 Nov 2022
Ponkilainen V Kuitunen I Liukkonen R Vaajala M Reito A Uimonen M

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Methods

PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.


The Journal of Bone & Joint Surgery British Volume
Vol. 45-B, Issue 1 | Pages 36 - 38
1 Feb 1963
Roaf R

1. Evidence is presented that certain types of cervical spine injury are due mainly to lateral flexion forces. 2. These injuries are often complicated by a brachial plexus lesion as well as a lesion of the spinal cord. 3. It is not always easy to detect the brachial plexus injury when the patient is first seen. 4. In the cases reviewed there has been little or no recovery of cord function, and the existence of a brachial plexus injury has, of course, made rehabilitation much more difficult. 5. The practical importance of recognising the mechanism of this type of injury is that treatment which will cause further separation of the vertebrae is inadvisable



Bone & Joint 360
Vol. 10, Issue 1 | Pages 31 - 33
1 Feb 2021


The Bone & Joint Journal
Vol. 102-B, Issue 5 | Pages 627 - 631
1 May 2020
Mahon J Ahern DP Evans SR McDonnell J Butler JS

Aims

The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation.

Methods

All patients transferred to a national tertiary spinal referral centre for primary surgical fixation of unstable spinal injuries without preoperative neurological deficit between 1 July 2016 and 20 October 2017 were eligible for inclusion. Data were collected retrospectively. Patients were divided into early and late cohorts based on timing from initial trauma to first spinal operation. Early fixation was defined as within 72 hours, and late fixation beyond 72 hours.


The Bone & Joint Journal
Vol. 102-B, Issue 9 | Pages 1210 - 1218
14 Sep 2020
Zhang H Guan L Hai Y Liu Y Ding H Chen X

Aims

The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS).

Methods

We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores.


Bone & Joint 360
Vol. 7, Issue 1 | Pages 38 - 39
1 Feb 2018
Das A


Bone & Joint 360
Vol. 8, Issue 5 | Pages 30 - 32
1 Oct 2019


Bone & Joint 360
Vol. 8, Issue 2 | Pages 31 - 33
1 Apr 2019


The Bone & Joint Journal
Vol. 97-B, Issue 4 | Pages 527 - 531
1 Apr 2015
Todd NV Skinner D Wilson-MacDonald J

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: Bone Joint J 2015;97-B:527–31.


The Bone & Joint Journal
Vol. 100-B, Issue 1 | Pages 81 - 87
1 Jan 2018
Peng B Yang L Yang C Pang X Chen X Wu Y

Aims

Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness.

Patients and Methods

Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain.