Traumatic spine injuries in children. Experience on 434 cases and therapeutic perspectives

Abstract Traumatic spine injuries in pediatric patients have a low incidence, mainly due to a more flexible spine and is a specific matter in comparison to spinal injury in adults. Pediatric spine fractures constitute 1 to 3% of all pediatric fractures. Between 20 % and 60% of the fractures occur in the lumbar and thoracic spine. These spine injury appeared most frequently in sport events, followed by traffic events and accidental falling. The vast majority of the children with spinal trauma had grade D and E lesions on Frankel scale and had a good recovery in 1 to 3 months after the event. Prognosis and outcome is better in children with spine trauma, reducing toward adolescence and in young adults and the death rate was extremely low compared to the adult population

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Neck Injury

Pediatrics in Review ◽

10.1542/pir.16.1.28 ◽

1995 ◽

Vol 16 (1) ◽

pp. 28-28

Author(s):

Jeffrey R. Avner

Keyword(s):

At Risk ◽

Cervical Spine ◽

Cervical Spine Injury ◽

Pediatric Patients ◽

Neck Injury ◽

Spine Injury ◽

Clinical Markers ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Spine Radiographs

Although rare in pediatrics, cervical spine injuries still are associated with serious morbidity, disability, and mortality. Many of these injuries are exacerbated by inadequate neck immobilization or improper manipulation. Thus, the physician should be aware of which children are at risk for cervical spine injury and how to assess these patients properly. To find clinical markers that identify children who actually have cervical spine injuries, Rachesky et al reviewed 2133 cervical spine radiographs obtained in pediatric patients during a 7-year period. Of these children, 25 (1.2%) had abnormalities confirmed on radiographs. The incidence of injury increased with age; only four of the children who had cervical spine injuries were less than 8 years old.

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A study on functional outcome following surgical fixation for lower spine injuries

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212773 ◽

2021 ◽

Author(s):

M. Sivakumar ◽

M. Ganesh Kumar

Keyword(s):

Cervical Spine ◽

Functional Outcome ◽

Tamil Nadu ◽

Spinal Injury ◽

Spine Injury ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Disc Bulge ◽

Surgical Fixation

Background: Cervical spine injuries are one of the common causes of serious morbidity mortality following trauma. 6% of trauma patients have spine injuries of which >50% is contributed by a cervical spine injury. The aim of the study was to determine the functional outcome following surgical fixation for sub-axial cervical spine.Methods: this prospective study involving 17 patients who were all admitted with sub-axial cervical spine injuries and amenable to intervention in our department of orthopedics and traumatology, government Theni medical college, Tamil Nadu, India in the year 2019-2020. Duration of 6 months from December 2019 to may 2020.Results: Most of the injuries presented within 24 hours of injury. Most of the patients presented with an incomplete neurological deficit. C5-C6 subluxation with disc bulge was the most common spinal injury. 5 patients were operated on more than 2 levels. The rest of the patients were operated on at 2 levels.Conclusions: We consider that the anterior decompression and fusion with a locking compression plate is a viable procedure in sub-axial cervical spine injuries.

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SPINE TRAUMA

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.03.376 ◽

2018 ◽

Vol 25 (03) ◽

pp. 371-375

Author(s):

Muhammad Sajid Mehmood ◽

Muhammad Asad Javed ◽

Muhammad Zafar Elahi ◽

Sana Sehrish ◽

Sultan Shah

Keyword(s):

Lumbar Spine ◽

Traffic Accidents ◽

Road Traffic ◽

Spinal Injury ◽

Tertiary Care ◽

Neurological Status ◽

Spine Injury ◽

Care Hospital ◽

Spine Trauma ◽

Cross Sectional

Objectives: To determine the etiology and level of spine trauma in patientspresenting in tertiary care hospital of Pakistan. Study Design: Descriptive, cross-sectional study.Setting: This study was conducted at the Department of Neurosurgery, Pakistan Institute ofMedical Sciences (PIMS), Islamabad, from September 20th, 2014 to March 20th, 2015. Subjects:The patients in the study were of both genders, between 15 to 80 years of age (N=315, meanage 38.17 years, SD 17.31). Materials and Methods: All 315patientsbetween 15 to 80 yearsof age with spine trauma presenting to the Neurosurgery department of PIMS, Islamabadconsented to participate in the study. All these patients had underwent thorough history andphysical examination after stabilization and initial emergency management. X-ray spine wascarefully reviewed and patient details, bio-data, etiology of trauma, spinal injury type, level,neurological status and diagnosis were recorded. Results: The most frequently affected agegroup presenting with spine trauma were young and between 15 to 30 years of age (17.1%).The most frequent etiologies seen for spine injury were falls; 158 (50.2%) followed by RTA’s;129 (41%). The most common level of spine trauma presentation was at the lumbar spine;142 (45.1%) followed by thoracic spine fractures; 80 (25.4%). Conclusion: Lumbar spine andyounger male people are more prone to spinal injuries in Pakistan. The most frequent reasonfor the trauma was due to falls followed by road traffic accidents.

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Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150022 ◽

2015 ◽

Vol 73 (5) ◽

pp. 445-450 ◽

Cited By ~ 2

Author(s):

Halisson Y. F. da Cruz ◽

Andrei F. Joaquim ◽

Helder Tedeschi ◽

Alpesh A. Patel

Keyword(s):

Cervical Spine ◽

Spine Injury ◽

Spine Trauma ◽

Severe Injuries ◽

Cervical Spine Injuries ◽

Results Of Treatment ◽

Subaxial Cervical Spine ◽

Number Of Patients ◽

Spine Injuries ◽

Injury Classification

The SLICS (Sub-axial Cervical Spine Injury Classification System) was proposed to help in the decision-making of sub-axial cervical spine trauma (SCST), even though the literature assessing its safety and efficacy is scarce. Method We compared a cohort series of patients surgically treated based on surgeon’s preference with patients treated based on the SLICS. Results From 2009-10, 12 patients were included. The SLICS score ranged from 2 to 9 points (mean of 5.5). Two patients had the SLICS < 4 points. From 2011-13, 28 patients were included. The SLICS score ranged from 4 to 9 points (mean of 6). There was no neurological deterioration in any group. Conclusion After using the SLICS there was a decrease in the number of patients with less severe injuries that were treated surgically. This suggests that the SLICS can be helpful in differentiating mild from severe injuries, potentially improving the results of treatment.

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The Relevance of the Occult Cervical Spine Controversy and Mechanism of Injury to Prehospital Protocols: A Review of the Issues and Literature

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00043004 ◽

1996 ◽

Vol 11 (3) ◽

pp. 228-233 ◽

Cited By ~ 11

Author(s):

Alexander M. Butman ◽

Daniel T. Schelble ◽

Richard W. Vomacka

Keyword(s):

Spinal Cord ◽

Clinical Signs ◽

Signs And Symptoms ◽

Neurological Deficits ◽

Spine Injury ◽

Mechanism Of Injury ◽

Spine Trauma ◽

Spinal Cord Damage ◽

Spinal Immobilization ◽

Spine Injuries

Prehospital guidelines that define the clinical indications for spine trauma also serve as the criteria for selective spinal immobilization in the field. Therefore, these criteria are important for avoiding further spinal cord damage. Because some spine injuries may occur without neurological deficits or other clinical signs, the recommended field guidelines extend beyond the signs and symptoms and include mechanisms of injury or other injuries commonly associated with a high risk of spine injury.

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Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

CJEM ◽

10.2310/8000.2013.130978 ◽

2014 ◽

Vol 16 (02) ◽

pp. 131-135 ◽

Cited By ~ 3

Author(s):

Hendrik P. Van Zyl ◽

James Bilbey ◽

Alan Vukusic ◽

Todd Ring ◽

Jennifer Oakes ◽

...

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Clinical Skills ◽

Ct Scans ◽

Spine Injury ◽

Emergency Physicians ◽

Cervical Spine Injuries ◽

Spine Ct ◽

Spine Injuries ◽

Rule Out

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

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The Glasgow Outcome Scale-Extended Pediatric Scores of Intracranial Bleeding Patients with Acquired Prothrombin Complex Deficiency Post Craniotomy and Duraplasty

Pediatric Neurosurgery ◽

10.1159/000511020 ◽

2020 ◽

Vol 55 (5) ◽

pp. 254-258

Author(s):

Robert Sinurat

Keyword(s):

Prothrombin Time ◽

Vitamin K ◽

Glasgow Outcome Scale ◽

Pediatric Patients ◽

Vegetative State ◽

Fresh Frozen Plasma ◽

Intracranial Bleeding ◽

Good Recovery ◽

Blood Tests ◽

Complex Deficiency

Introduction: Surgical evacuation of intracranial bleeding in pediatric patients due to acquired prothrombin complex deficiency (APCD) is a life-saving surgery when conservative treatment insufficient and impending brain herniation. This study aimed to evaluate the Glasgow outcome scale-extended pediatric (GOS-ePed) score of the pediatric intracranial bleeding patients with APCD after craniotomy and duraplasty. Method: This was a retrospective study in the last 5 years of our experience. All of the pediatric patients with intracranial bleeding due to APCD who needed surgery were investigated. The data were collected from medical records after their parents have given their written informed concern and approved by the Ethics Review Committee, Faculty of Medicine, Universitas Kristen Indonesia. The inclusion criteria were patients who operated on by craniotomy and duraplasty. The patient with a second disease was excluded. Blood tests include hemoglobin, prothrombin time, activated prothrombin time, and platelets were investigated before and after intravenous vitamin K injection, transfusion packed red cells (PRCs), and fresh frozen plasma (FFP) administration. The Glasgow coma scale (GCS) pre- and postoperatively was evaluated using a modified GCS for infants and children. The outcome was evaluated by the GOS-ePed score. All data were analyzed with the normality test and paired t test. Results: There were 5 patients age between 37 and 60 days, and all patients did not get vitamin K prophylaxis after birth. The blood tests of all patients revealed anemia, prothrombin, and activated prothrombin time increased, but platelets were normal. All these values returned to normal after vitamin K injection, transfusion of PRCs, and FFP. The paired t tests were p < 0.05. The GCS of all patients before surgery was 8 or below. After surgery, the GCS of 4 patients was increased become 12 and 15. One patient did not change significantly. The GOS-ePed score showed 4 patients (80%) had upper or lower good recovery, and 1 patient (20%) was in a vegetative state. Conclusions: The GOS-ePed score of the pediatric intracranial bleeding with APCD after craniotomy and duraplasty was mostly in upper or lower good recovery.

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MR-Proadrenomedullin as biomarker of renal damage in urinary tract infection in children

BMC Pediatrics ◽

10.1186/s12887-021-02765-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rafael Peñalver Penedo ◽

Marta Rupérez Lucas ◽

Luis Antonio Álvarez-Sala Walther ◽

Alicia Torregrosa Benavent ◽

María Luisa Casas Losada ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Pediatric Patients ◽

Pediatric Population ◽

Adult Population ◽

Roc Curves ◽

Renal Scintigraphy ◽

Reactive Protein ◽

Sensitivity Specificity

Abstract Background Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. Methods A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. Results 62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66–1.59), while in patients without RS were 0.48 nmol/L (0.43–0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77–0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. Conclusion MR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction.

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Paramedic Documentation of Indicators for Cervical Spine Injury

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00040826 ◽

1994 ◽

Vol 9 (1) ◽

pp. 40-43 ◽

Cited By ~ 10

Author(s):

Andre M. Pennardt ◽

Wm. John Zehner

Keyword(s):

Emergency Department ◽

Cervical Spine ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Spinal Injury ◽

Medical Center ◽

Prehospital Care ◽

Retrospective Chart Review ◽

Spine Injury ◽

Status Assessment

AbstractIntroduction:Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should “wear that collar and be strapped to that board.” Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport.Hypothesis:Algorithms exist for physicians to “clear” the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations.Methods:A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted.Results:All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR).Conclusion:Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.

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An unusual presentation and resolution of syringomyelia after cervical spine injury

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.6.0482 ◽

2005 ◽

Vol 3 (6) ◽

pp. 482-484 ◽

Cited By ~ 1

Author(s):

Joseph Cusick ◽

Zvi Lidar

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spine Injury ◽

Type I ◽

Cervical Spine Trauma ◽

Spine Trauma ◽

Resonance Imaging ◽

Chiari Malformation Type I ◽

Content Type ◽

Sequence Of Events

✓ The authors describe a case of noncommunicating syringomyelia associated with Chiari malformation Type I in a patient in whom acute symptomatic exacerbation occurred following cervical spine trauma. Surgical stabilization and realignment of the spine resulted in marked resolution of the neurological abnormalities, and subsequent magnetic resonance imaging demonstrated persistent collapse of the syrinx. The authors review the various factors in the pathogenesis of this unusual sequence of events.

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