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Clinical Treatment for Spine Trauma

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 22289

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Dr. Benjamin D. Elder

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Guest Editor

Department of Neurosurgery, Orthopedics and Biomedical Engineering, Mayo Clinic School of Medicine, 200 1st St. SW, Rochester, MN 55905, USA
Interests: degenerative spine pathology; complex adult spinal deformities; spinal stenosis; scoliosis/kyphosis; spine tumors; spinal cord tumors; spinal fusion; herniated discs; craniocervical junction pathology; normal pressure hydrocephalus; tissue engineering strategies for spinal fusion
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Special Issue Information

Dear Colleagues,

Traumatic spinal injuries remain increasingly common, and are managed by both orthopedic surgeons and neurosurgeons. Over the past several decades, there have been significant advances in the diagnosis and treatment of traumatic spinal injuries, with more widespread utilization of advanced imaging and optimization of advanced instrumentation techniques. Additionally, there has been extensive focus on treatment strategies for both acute and chronic traumatic spinal cord injuries, with multiple promising ongoing clinical trials.

However, multiple challenges remain in the treatment of this patient population, particularly as the elderly population continues to expand, and treating these patients introduces new challenges such as the management of patients with significant medical comorbidities and osteoporosis. It is often challenging to determine if operative or nonoperative management is better in some of these challenging situations.

Therefore, this Special Issue will provide a comprehensive focus on spinal trauma and spinal cord injury, identifying novel approaches for the treatment of these patients, outcomes and complications following both nonoperative and operative approaches, diagnostic imaging paradigms, and translational research that will provide future treatments.

Dr. Benjamin D. Elder
Guest Editor

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Keywords

Spinal trauma
Burst fracture
Fracture–dislocation
Osteoporosis
Ankylosing spondylitis
Odontoid fracture
Subaxial cervical spine trauma
Thoracolumbar fracture

Published Papers (7 papers)

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Research

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10 pages, 4890 KiB

Open AccessArticle

How Should Patients with a Thoracolumbar Injury Classification and Severity Score of 4 Be Treated?

by Nam-Hun Lee, Sung-Kyu Kim, Hyoung-Yeon Seo, Eric T. Park and Won-Young Jang

J. Clin. Med. 2021, 10(21), 4944; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10214944 - 26 Oct 2021

Cited by 3 | Viewed by 1475

Abstract

The thoracolumbar injury classification and severity score (TLICS) system help surgeons decide whether patients should undergo initial operative treatment or nonoperative treatment. However, the best treatment for patients with TLICS 4 fracture remains unknown. The aim of this study was to identify the risk factors for nonoperative treatment failure in patients with TLICS 4 fracture and establish treatment standards for TLICS 4 fractures. This study included 44 patients with TLICS 4 fracture who initially received nonoperative treatment. We divided these patients into two groups: the successful nonoperative treatment group included 18 patients, and the operative treatment group after nonoperative treatment failure included 26 patients. In multiple logistic regression analysis, spinal canal compromise (odd ratio = 1.316) and kyphotic angle (odd ratio = 1.416) were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Other factors, including age, sex, BMI, initial VAS score, and loss of vertebral body height, were not significantly associated with nonoperative treatment failure in these patients. Spinal canal compromise and kyphotic angle were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Therefore, we recommend the surgeon observe spinal canal compromise and kyphotic angle more carefully when deciding on the treatment of patients with TLICS 4 fracture. Full article

(This article belongs to the Special Issue Clinical Treatment for Spine Trauma)

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9 pages, 3688 KiB

Open AccessArticle

Analysis of Nonunion in Conservatively Managed Anterior Tear Drop Fractures of C2 Vertebra

by Sung-Kyu Kim, John M. Rhee, Eric T. Park and Hyoung-Yeon Seo

J. Clin. Med. 2021, 10(9), 2037; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10092037 - 10 May 2021

Viewed by 1921

Abstract

Many anterior C2 (2nd cervical vertebra) tear drop (TD) fractures can be successfully managed with conservative treatment. However, due to the occurrence of nonunion, large-sized or complex anterior C2 TD fractures undergo surgical treatment. To date, no surgical treatment guidelines are available about anterior C2 TD fractures. Therefore, we performed this study to investigate the factors that may affect nonunion for anterior C2 TD fractures and to suggest surgical treatment guidelines. Thirty-three patients with anterior C2 TD fractures, who underwent conservative treatment and had a minimum 1-year follow-up, were divided into union (N = 26) and nonunion (N = 7) groups. Their radiological and clinical data were analyzed retrospectively and compared between the two groups. The avulsion fracture ratio (29.5% vs. 43.3%, p < 0.05) and fracture displacement (3.6 mm vs. 5.1 mm, p < 0.05) were higher in the nonunion group compared to the union group. Incidence of associated C2 injury was higher in the nonunion group compared to the union group (15.4% vs. 57.1%, p < 0.05). Union status was negatively correlated with associated C2 injury (correlation coefficient, CC = −0.398, p < 0.05). Our results suggest that surgical treatment could be considered for anterior C2 TD fractures with an avulsion fracture ratio > 43%, fracture displacement > 5 mm, or associated C2 injury. Full article

(This article belongs to the Special Issue Clinical Treatment for Spine Trauma)

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11 pages, 2079 KiB

Open AccessArticle

Does Dynamic Anterior Plate Fixation Provide Adequate Stability for Traumatic Subaxial Cervical Spine Fractures at Mid-Term Follow-Up?

by Siegmund Lang, Carsten Neumann, Lasse Fiedler, Volker Alt, Markus Loibl and Maximilian Kerschbaum

J. Clin. Med. 2021, 10(6), 1185; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10061185 - 12 Mar 2021

Cited by 2 | Viewed by 2287

Abstract

Background: It remains questionable if the treatment of cervical fractures with dynamic plates in trauma surgery provides adequate stability for unstable fractures with disco-ligamentous injuries. The primary goal of this study was to assess the radiological and mid-term patient-reported outcome of traumatic subaxial cervical fractures treated with different plate systems. Patients and Methods: Patients, treated with anterior cervical discectomy and fusion (ACDF) between 2001 and 2015, using either a dynamic plate (DP: Mambo™, Ulrich, Germany) or a rigid locking plate (RP: CSLP™, Depuy Synthes, USA), were identified. For radiological evaluation, the sagittal alignment, the sagittal anterior translation and the bony consolidation were evaluated. After at least two years, the patient-reported outcome measures (PROM) were evaluated using the German Short-Form 36 (SF-36), Neck Disability Index (NDI) and the EuroQol in 5 Dimensions (EQ-5D) scores. Results: 33 patients met the inclusion criteria (DP: 13; RP:20). Twenty-six patients suffered from AO Type B or C fractures. Both the sagittal alignment and the sagittal translation could be sufficiently improved in both groups (p ≥ 0.05). No significant loss of reduction could be observed at the follow-up in both groups (p ≥ 0.05). Bony consolidation could be observed in 30 patients (DP: 12/13 (92%); RP: 18/20 (90%); (p ≥ 0.05)). In 20 patients, PROMs could be evaluated (follow-up: 71.2 ± 25.5 months). The whole cohort showed satisfactory PROM results (EQ-5D: 72.0 ± 4.9; SF-36 PCS: 41.9 ± 16.2, MCS: 45.4 ± 14.9; NDI: 11.0 ± 9.1). without significant differences between the DP and RP group (p ≥ 0.05) Conclusion: The dynamic plate concept provides enough stability without a difference in fusion rates in comparison to rigid locking plates in a population that mostly suffered fragile fractures. Full article

(This article belongs to the Special Issue Clinical Treatment for Spine Trauma)

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8 pages, 1038 KiB

Open AccessArticle

Adult Spinal Cord Injury without Major Bone Injury: Effects of Surgical Decompression and Predictors of Neurological Outcomes in American Spinal Injury Association Impairment Scale A, B, or C

by Bo-Ram Na and Hyoung-Yeon Seo

J. Clin. Med. 2021, 10(5), 1106; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051106 - 06 Mar 2021

Cited by 5 | Viewed by 2268

Abstract

The cervical spine can be injured even in the absence of radiographic abnormality, and the best surgical treatment for adult spinal cord injury without bone injury is debated. The aim of this study was to retrospectively investigate the effect of surgical decompression for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome. We analyzed 11 patients who underwent surgical decompression in severe adult spinal cord injury without major bone injury patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C. Neurological assessments were performed using AIS at preoperative and postoperative 1-year follow-up. Radiological evaluations were performed using cervical magnetic resonance imaging (MRI) at preoperative. Seven cases were classified as AIS grade A; two cases as AIS grade B; and two cases as AIS grade C. Five of 11 (45.5%) patients showed improved neurological grade 1-year postoperatively. Intramedullary lesion length (IMLL) (p = 0.047) and compression rate (p = 0.045) had the most powerful effect on AIS grade conversion. This study shows that the fate of the injured spinal cord is determined at the time of the injury, but adequate decompression may have limited contribution to the recovery of neurological function. Compression rate and IMLL on MRI can be used as a predictor of neurological recovery. Full article

(This article belongs to the Special Issue Clinical Treatment for Spine Trauma)

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Review

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18 pages, 1063 KiB

Open AccessReview

Hypothermia Therapy for Traumatic Spinal Cord Injury: An Updated Review

by Seth C. Ransom, Nolan J. Brown, Zachary A. Pennington, Nikita Lakomkin, Anthony L. Mikula, Mohamad Bydon and Benjamin D. Elder

J. Clin. Med. 2022, 11(6), 1585; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061585 - 13 Mar 2022

Cited by 9 | Viewed by 2563

Abstract

Although hypothermia has shown to protect against ischemic and traumatic neuronal death, its potential role in neurologic recovery following traumatic spinal cord injury (TSCI) remains incompletely understood. Herein, we systematically review the safety and efficacy of hypothermia therapy for TSCI. The English medical literature was reviewed using PRISMA guidelines to identify preclinical and clinical studies examining the safety and efficacy of hypothermia following TSCI. Fifty-seven articles met full-text review criteria, of which twenty-eight were included. The main outcomes of interest were neurological recovery and postoperative complications. Among the 24 preclinical studies, both systemic and local hypothermia significantly improved neurologic recovery. In aggregate, the 4 clinical studies enrolled 60 patients for treatment, with 35 receiving systemic hypothermia and 25 local hypothermia. The most frequent complications were respiratory in nature. No patients suffered neurologic deterioration because of hypothermia treatment. Rates of American Spinal Injury Association (AIS) grade conversion after systemic hypothermia (35.5%) were higher when compared to multiple SCI database control studies (26.1%). However, no statistical conclusions could be drawn regarding the efficacy of hypothermia in humans. These limited clinical trials show promise and suggest therapeutic hypothermia to be safe in TSCI patients, though its effect on neurological recovery remains unclear. The preclinical literature supports the efficacy of hypothermia after TSCI. Further clinical trials are warranted to conclusively determine the effects of hypothermia on neurological recovery as well as the ideal means of administration necessary for achieving efficacy in TSCI. Full article

(This article belongs to the Special Issue Clinical Treatment for Spine Trauma)

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15 pages, 7708 KiB

Open AccessReview

Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

by Aleksander Chaibi, Knut Stavem and Michael Bjørn Russell

J. Clin. Med. 2021, 10(21), 5011; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10215011 - 28 Oct 2021

Cited by 16 | Viewed by 7187

Abstract

(1) Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); (2) Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, respectively; (3) Results: Six studies were included. The overall pooled effect size for neck pain was very large −1.37 (95% CI, −2.41, −0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((−2.8 (46%) (95% CI, −2.1, −3.4) vs. −1.7 (30%) (95% CI, −1.1, −2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported; (4) Conclusions: SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings. Full article

(This article belongs to the Special Issue Clinical Treatment for Spine Trauma)

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18 pages, 6053 KiB

Open AccessReview

Is Kummell’s Disease a Misdiagnosed and/or an Underreported Complication of Osteoporotic Vertebral Compression Fractures? A Pattern of the Condition and Available Treatment Modalities

by Olga Adamska, Krzysztof Modzelewski, Artur Stolarczyk and Jurij Kseniuk

J. Clin. Med. 2021, 10(12), 2584; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10122584 - 11 Jun 2021

Cited by 18 | Viewed by 3556

Abstract

This narrative review provides the outcomes of minimally invasive surgery (MIS) and describes the available conservative treatment options for patients with osteoporotic vertebral compression fractures (OVCFs) that have risk factors for Kummell’s disease (KD). It aims to explore the evidence, emphasize the possible therapy complications, and aims to propose the most efficient clinical strategies for maintaining a good overall condition of individuals who may suffer from neurological deficits from a late-diagnosed OVCF complication. The secondary objective is to sum up the diagnostic particularities concerning individuals prone to OVCFs and KD, as the major risk factor for developing these severe conditions remains osteoporosis. Findings of our narrative review are based on the results found in PubMed, Embase, and Google Scholar from the beginning of their inception to December 2020, described independently by two authors. All of the studies included in the review focus on reporting the following treatment methods: conservative methods, vertebroplasty, kyphoplasty, targeted percutaneous vertebroplasty, frontal and side-opening cannula vertebroplasty, SpineJack, bone-feeling mesh container treatment, and the difference in the cement viscosity used (high vs. low) and the approach used (unilateral vs. bilateral). The comparison of randomized control trials (RCTs) as well as prospective and retrospective case series showed a comparable efficacy of kyphoplasty and vertebroplasty, and described cement-augmented screw fixation and the SpineJack system as effective and safe. Although it should be noted that several studies revealed inconsistent results in regards to the efficacy of using back braces and analgesics in patients who had vertebral fractures that were overlooked or not enrolled in any active surveillance program to track the patient’s deterioration immediately. Nevertheless there are non-standardized guidelines for treating patients with OVCFs and their complications already established. Using these guidelines, a treatment plan can be planned that takes into consideration the patients’ comorbidities and susceptibilities. However, the primary approach remains the management of osteoporosis and that is why prophylaxis and prevention play a crucial role. These measures reduce the risk of disease progression. Unfortunately, in the majority of cases these measures are not taken into account and KD develops. Full article

(This article belongs to the Special Issue Clinical Treatment for Spine Trauma)

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