Journal of spinal disorders
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Historically, early management of the blunt trauma victim with hemodynamic instability and cervical spinal cord injury has been hampered by the physician's inability to perform an accurate physical examination. Invasive and time-consuming diagnostic tests are often run to check for the presence of occult intra-abdominal injuries. For this reason, we decided to study these patients by reviewing a clinical registry to assess the frequency of intra-abdominal injuries in cases of cervical spinal cord trauma. ⋯ In fact, data from the Maryland Institute for Emergency Medical Services Systems revealed that blunt trauma victims with cervical cord injury rarely (2.6%) sustained intra-abdominal wounds. Further analysis of this population revealed that specific mechanisms of trauma and the presence of hemodynamic instability and other major injuries were factors strongly associated with occult intra-abdominal injury. In light of these findings, we have outlined a protocol for management of these patients that is geared toward more rapid stabilization of the injured spinal column.
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Twenty-five consecutive patients with unstable thoracolumbar and lumbar burst fractures were surgically treated with the AO Fixateur Interne (Synthes USA, 1690 Russell Rd., Paoli, PA). Indications for surgery included a progressive neurologic deficit, spinal canal compromise greater than 50%, vertebral body collapse greater than 50%, or sagittal angulation greater than 20 degrees. Twenty males and five females ranging in age from 16 to 60 years (average 31) were treated surgically and prospectively followed. ⋯ Both patients with complete spinal cord injuries remained unchanged neurologically postoperatively; no patients deteriorated neurologically after surgery. The average preoperative sagittal kyphosis at the fracture site was +16 degrees (range +10 degrees to +31 degrees); the immediate postoperative sagittal angular correction averaged -4 degrees (lordosis) and ranged from +12 degrees (kyphosis) to -26 degrees (lordosis). At last follow-up, the sagittal angular correction remained unchanged in three patients and decreased in 21 patients to an average of +5 degrees (range +37 degrees to -14 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
The thermoplastic Minerva body jacket: a clinical comparison with other cervical spine splinting techniques.
A retrospective analysis of the efficacy of a variety of external stabilization techniques used in 155 cases of unstable cervical spine injuries is presented. The movement at each intervertebral level was evaluated during thermoplastic Minerva body jacket stabilization in 18 additional patients. Many currently available approaches to external stabilization of the cervical spine were, thus, assessed. ⋯ Lesser injuries may be treated with a variety of available orthoses. The thermoplastic Minerva body jacket offers a superior limitation of intervertebral movement compared with other commonly used braces, including the halo jacket, for most cervical spine injuries. The technique of application of the thermoplastic Minerva body jacket is reviewed.
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Impressive clinical reports have come from several major spinal research centers regarding the results of using the AO spinal internal fixator, a recently released pedicle screw rod system. A retrospective review of the first 2 years of clinical results from a diverse group of orthopedic surgeons using this device at a Canadian University center may provide some insight into potential clinical outcomes in general use. These results contrast with the outcome data provided to date, which have been presented by expert academic spinal surgeons. The results suggest that there may be room for considering limited release of this device, perhaps with the requirement for special certification in its application.
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We carried out experiments on whole cadaveric lumbar spines in order to determine the role that each of the capsulo-ligamentous structures play in axial rotation in the neutral position and in the flexed position. Eight specimens were first tested intact, then after division of all the apophyseal joint capsules between L1 and the sacrum. Another five specimens were also first tested intact, then after division of the supra- and interspinous ligaments and yellow ligament, and finally after cutting the posterior longitudinal ligament and posterior annulus at each level as well. ⋯ The apophyseal joint capsules limit rotation both in neutral and flexed positions. In flexion, the amplitude of rotation in the lumbar spine is reduced. Of the capsulo-ligamentous structures, it is the posterior annulus and the posterior longitudinal ligament that seem to play the more important role in limiting axial rotation while the spine is flexed.