The spine journal : official journal of the North American Spine Society
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Observational Study
Cervical spine clearance protocols in Level I, II, and III trauma centers in California.
Cervical spine clearance protocols were developed to standardize the clearance of the cervical spine after blunt trauma and prevent secondary neurologic injuries. The degree of incorporation of evidence-based guidelines into protocols at trauma centers in California is unknown. ⋯ Written cervical spine clearance protocols exist in 63% of California's trauma centers and only 51% of the centers have protocols that follow current evidence-based guidelines. Standardization and utilization of these protocols should be encouraged to prevent missed injuries and secondary neurologic injuries.
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The annulus-endplate anchorage system performs a critical role in the disc, creating a strong structural link between the compliant annulus and the rigid vertebrae. Endplate failure is thought to be associated with disc herniation, a recent study indicating that this failure mode occurs more frequently than annular rupture. ⋯ Annulus-endplate anchorage is more vulnerable to failure in axial tension compared with both torsion and in-plane tension and is probably due to acute fiber bending at the soft-hard interface of the tidemark. This finding is consistent with evidence showing that flexion, which induces a similar pattern of axial tension, increases the risk of herniation involving endplate failure. The study also highlights the important strengthening role of calcification at this junction and provides new evidence of a fibril-based form of structural integration across the cement line.
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Blunt cerebrovascular injuries (BCVIs) have the potential to cause brain, cerebellar, and/or spinal cord ischemia. Certain subtypes of spine fractures, such as vertebral subluxation, fractures through the foramen transversarium, and C1-C3 fractures have been linked to a higher incidence of BCVI. On the other hand, BCVI in association with craniocervical distraction injuries (CCDs) have been only anecdotally reported. ⋯ Blunt cerebrovascular injuries were seen in more than 50% of the patients screened, with major strokes occurring in 20% of the patients. We suggest screening for BCVI in all patients presenting with C0-C1 and/or C1-C2 distraction injuries.
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Insertion of intervertebral fusion devices between consecutive Smith-Peterson osteotomies (SPOs) provides an anterior fulcrum during compression, which has been documented to improve achievable Cobb angle correction. Extension of these principles to an expandable device would theoretically provide greater surgical adjustment for flatback and scoliotic cases than a static cage. ⋯ The expandable interbody did have a slight effect on lordotic correction; each additional millimeter in height expansion yielded approximately 1° in correction across the three SPO levels. Even without significant differences between the states, an expandable device may allow the surgeon more control of lordotic correction within the operating room than a static spacer alone.
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The presence or absence of marrow edema is used in the assessment of fracture acuity in magnetic resonance imaging (MRI). We have observed variability in the degree of marrow edema in acute trauma. Our aim was to characterize the utility of marrow edema in fracture detection and fracture acuity on MRI. We hypothesized that only vertebral body compression injuries reliably generate marrow edema and that distraction injuries or fractures without compression do not reliably generate marrow edema and may give a false negative MRI examination. ⋯ There is variability in the presence or degree of marrow edema on MRI evaluation after traumatic injury. Only fractures derived from vertebral body compression reliably generate marrow edema. Fractures without compression and/or fractures with distraction do not reliably generate marrow edema and can lead to a false negative MRI. An awareness of fracture types that produce more or less marrow edema can be beneficial when evaluating fractures by MRI.