The spine journal : official journal of the North American Spine Society
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Traumatic spine injuries are often transferred to regional tertiary trauma centers from outside hospitals (OSHs) and subsequently discharged from the trauma center's emergency department (ED) suggesting secondary overtriage of such injuries. ⋯ This study is the first to investigate interfacility transfers with spine injuries and found high rate of secondary overtriage of neurologically intact patients with isolated spine injuries. Potential solutions include increasing spine coverage in community EDs, increasing direct communication between the OSH and the spine specialist at the tertiary center, and utilization of teleradiology.
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Review Case Reports
Sequential changes of ascending myelopathy after spinal cord injury on magnetic resonance imaging: a case report of neurologic deterioration from paraplegia to tetraplegia.
Marked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive. ⋯ Our MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.
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Randomized Controlled Trial
The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis.
Dysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF), and it is closely related to prevertebral soft-tissue swelling (PSTS). A few studies have found that local or systemic methylprednisolone is effective against laryngopharyngeal edema and airway obstruction. ⋯ The short-term use of systemic methylprednisolone after ACDF appears to be effective in relieving dysphagia and decreasing the PSTS. Furthermore, the short-term use of methylprednisolone was not associated with any adverse effects of short-term IV steroid usage, such as peptic ulcer disease or postoperative infection. The clinical use of methylprednisolone in relieving dysphagia and decreasing PSTS deserves consideration during the early postoperative period.
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Surgical adverse event (AE) monitoring is imprecise, of uncertain validity, and tends toward underreporting. Reports focus on specific procedures rather than outcomes in the context of presenting diagnosis. Specific intraoperative (intraop) or postoperative (postop) AEs that may be independently associated with degenerative spondylolisthesis (DS) have never been reported. ⋯ Risk of intraop AEs, but not postop AEs, increased with increasing age. Having multiple comorbidities does not predispose to more AEs. Infections predominate among the postop AEs. Patients at increased risk of delirium or of having an increased length of hospital stay may more easily be predicted. Studies specifically designed to prospectively assess AEs have the potential to more accurately identify postop AE rates.
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A narrow cervical spinal canal (CSC) is a well-known risk factor for cervical myelopathy (CM). However, no epidemiologic data of the CSC based on a population-based cohort are available. ⋯ This study firstly confirmed the age-related differences in CSC diameters and the significant association of the narrow CSC diameter with CM in a population-based cohort.