Many people admitted to hospital with a provisional diagnosis of nonserious back pain are subsequently found to have serious pathology as the underlying cause

To determine the proportion of patients admitted to the hospital for back pain who have nonserious back pain, serious spinal, or serious other pathology as their final diagnosis. The proportion of nonserious back pain admissions will be used to plan for future ‘virtual hospital’ admissions. Electronic medical record data between January 2016 and September 2020 from three emergency departments (ED) in Sydney, Australia were used to identify inpatient admissions. SNOMED-CT-AU diagnostic codes were used to select ED patients aged 18 and older with an admitting diagnosis related to nonserious back pain. The inpatient discharge diagnosis was determined from the primary ICD-10-AM codes by two independent clinician-researchers. Inpatient admissions were then analysed by sociodemographic and hospital admission variables. A total of 38.1% of patients admitted with a provisional diagnosis of nonserious back pain were subsequently diagnosed with a specific pathology likely unsuitable for virtual care; 14.2% with a serious spinal pathology (e.g., fracture and infection) and 23.9% a serious pathology beyond the lumbar spine (e.g., pathological fracture and neoplasm). A total of 57% of admissions were identified as nonserious back pain, likely suitable for virtual care. A challenge for implementing virtual care in this setting is screening for patients with serious pathology. Protocols need to be developed to reduce the risk of patients being admitted to virtual hospitals with serious pathology as the cause of their back pain. Key Points• Among admitted patients provisionally diagnosed in ED with non-serious back pain, 38.1% were found to have ‘serious spinal pathologies’ or ‘serious pathologies beyond the lumbar spine’ at discharge.• Spinal fractures were the most common serious spinal pathology, accounting for 9% of all provisional ‘non-serious back pain’ admissions from ED.• 57% of back pain admissions were confirmed to be non-serious back pain and may be suitable to virtual hospital care; the challenge is discriminating these patients from those with serious pathology.

Severe Thoracic Vertebral Spine Injury as a Complication of Component of Cardiopulmonary Resuscitation

Chest compression has been a component of cardiopulmonary resuscitation (CPR) since 1960. Performance of high-quality CPR is critical for survival; however, chest compressions are traumatic and may result in injuries such as rib and sternal fractures. Spinal fractures have rarely been reported. We present a case of a 69-year-old male who suffered a cardiac arrest at home. He underwent 16 minutes of CPR with manual chest compressions, and no electrical shock and medications with return of spontaneous circulation (ROSC). Computed tomography scan showed unstable fracture of T9-T10. The patient was transferred to our Level I trauma center for continued post-arrest management and neurosurgical evaluation. An MRI confirmed the unstable spinal fracture which would have required surgical stabilization. The patient remained comatose, thus he was transitioned to comfort measures and expired. Spinal injuries following CPR are rare but should be considered in the post-arrest management stage. Computed tomography scan is the ideal screening modality.

Spinal Fractures in Ankylosing Spondylitis: Patterns, Management, and Complications in the United States – Analysis of Latest Nationwide Inpatient Sample Data

Objective: Ankylosing spondylitis (AS) is a rheumatic inflammatory disease marked by chronic inflammation of the axial skeleton. This condition, particularly when severe, can lead to increased risk of vertebral fractures attributed to decreased ability of the stiffened spinal column to sustain normal loads. However, little focus has been placed on understanding the locations of spinal fractures and associated complications and assessing the correlation between these. In this review, we aim to summarize the complications and treatment patterns in the United States in AS patients with spinal fractures, using the latest Nationwide Inpatient Sample (NIS) database (2016–2018).Methods: We analyzed the NIS data of years 2016–2018 to compare the fracture patterns and complications.Results: A total of 5,385 patients were included. The mean age was 71.63 years (standard deviation [SD], 13.21), with male predominance (83.8%). The most common population is Whites (77.4%), followed by Hispanics (7.9%). The most common fracture level was thoracic level (58.3%), followed by cervical level (38%). Multiple fracture levels were found in 13.3% of the patients. Spinal cord injury (SCI) was associated with 15.8% of the patients. The cervical level had a higher proportion of SCI (26.5%), followed by thoracic level (9.2%). The mean Elixhauser comorbidity score was 4.82 (SD, 2.17). A total of 2,365 patients (43.9%) underwent surgical treatment for the fractures. The overall complication rate was 40.8%. Respiratory complications, including pneumonia and respiratory insufficiency, were the predominant complications in the overall cohort. Based on the regression analysis, there was no significant difference (p = 0.45) in the complication rates based on the levels. The presence of SCI increased the odds of having a complication by 2.164 times (95% confidence interval, 1.722–2.72; p ≤ 0.001), and an increase in Elixhauser comorbidity score predicted the complication and in-hospital mortality rate (p ≤ 0.001).Conclusion: In conclusion, AS patients with spinal fractures have higher postoperative complications than the general population. The most common fracture location was thoracic in our study, although it differs with few studies, with SCI occurring in 1/6th of the patients.

Spine Fractures in Children and Adolescents—Frequency, Causes, Diagnostics, Therapy and Outcome—A STROBE-Compliant Retrospective Study at a Level 1 Trauma Centre in Central Europe

The aim of this study was to present the frequencies and characteristics of paediatric spine fractures, focusing on injury mechanisms, diagnostics, management, and outcomes. This retrospective, epidemiological study evaluated all patients aged 0 to 18 years with spine fractures that were treated at a level 1 trauma centre between January 2002 and December 2019. The study population included 144 patients (mean age 14.5 ± 3.7 years; 40.3% female and 59.7% male), with a total of 269 fractures. Common injury mechanisms included fall from height injuries (45.8%), with an increasing prevalence of sport incidents (29.9%) and a decreasing prevalence of road incidents (20.8%). The most common localisation was the thoracic spine (43.1%), followed by the lumbar spine (38.2%), and the cervical spine (11.8%). Initially, 5.6% of patients had neurological deficits, which remained postoperatively in 4.2% of patients. Most (75.0%) of the patients were treated conservatively, although 25.0% were treated surgically. A small proportion, 3.5%, of patients presented postoperative complications. The present study emphasises the rarity of spinal fractures in children and adolescents and shows that cervical spine fractures are more frequent in older children, occurring with a higher rate in sport incidents. Over the last few years, a decrease in road incidents and an increase in sport incidents in paediatric spine fractures has been observed.

Acute L1 chalkstick fracture post fall in a patient with known ankylosing spondylitis and previous instrumentation and fusion of T8-L1

Background: Patients with ankylosing spondylitis (AS) are especially prone to sustaining spinal fractures. A 72-year-old male with AS had a previous T10/11 chalkstick fracture requiring a T8-L1 fusion 1 year ago. He subsequently presented with a newly diagnosed acute chalkstick fracture of L1 which was treated without surgery. Case Description: A 72-year-old male with AS and a T10/11 chalkstick fracture had undergone a T8-L1 thoracolumbar fusion 1 year ago. He newly presented after a fall from his bed with a new acute L1 chalkstick fracture that was successfully managed nonsurgically. Conclusion: Patients with AS are at high risk for spinal fractures. Here, elderly male, following an original T10/11 chalkstick fracture and a T8-L1 fusion 1 year ago, presented with a new acute L1 chalkstick fracture managed without surgery.

Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

Aortic impingement associated with traumatic thoracic spinal fractures is a rare and potentially lethal complication that creates management challenges in an already complex clinical problem. Traumatic aortic injury is one of the leading causes of death in blunt trauma. Magerl divided thoracic and lumbar fractures into 3 categories; the primary focus of this report, type C fractures, describes rotational injury and is one of the less common types, especially associated with aortic impingement as such. In this case, a young man was admitted following a near-fatal fall resulting in blunt force trauma to the midthoracic region. Emergency CT revealed a type C complete transection at the level of T11 and a grade I aortic injury. Definitive fixation of the spinal injury was delayed in favor of preventing further vascular injury by prioritizing the securing of hemodynamic stability. In traumatic thoracolumbar injuries, blunt traumatic aortic injury is often managed conservatively. However, blunt thoracic aortic injury is one of the leading causes of death from trauma, and each case requires its own case-by-case multidisciplinary management. In this occasion, management of the vascular insult was paramount to ensuring patient survival and favorable outcome.

Efficiency of a Novel Vertebral Body Augmentation System (Tektona™) in Non-osteoporotic Spinal Fractures

BackgroundThe restauration of the local kyphosis is crucial for spinal fractures outcomes. Recently, the Tektona™, (Spine Art) system, constituted by a flexible lamella for reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures. MethodsA retrospective longitudinal study on prospectively collected data was conducted on 53 patients. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, early post-operative and at follow-up. ResultsFractures were mainly located at the upper lumbar spine and were Magerl A3.1 type for 51%. The mean RTA was 12° in pre-operative, 4° in post-operative (p=2e-9), and 8° at the last follow-up (p=0,01). The mean correction of RTA for the fixation group was -10±6° versus -7±4° for the vertebroplasty alone group (p=0,006). The mean correction for fractures located at T10-T12 was -9±3°, -9±5° for L1, -8±3° for L2 and -5±3° for L3-L5 (p=0,045). ConclusionsThe Tektona® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.

Minimal Invasive Fluoroscopic Percutaneous Lateral Stabilization of Thoracolumbar Spinal Fractures and Luxations Using Unilateral Uniplanar External Skeletal Fixators in Dogs and Cats

Objective The aim of this study was to describe minimally invasive spinal stabilization using a unilateral uniplanar external skeletal fixator (ESF, type 1a) with polymethylmethacrylate, and to review short- and long-term outcomes and complications in a clinical case series. Materials and Methods Medical records from animals affected by spinal fracture luxation were reviewed. The data included breed, age, gender, body weight, aetiology, preoperative and postoperative neurological state, radiographic findings, surgical treatment, pin size, number of pins and stabilized vertebrae, intra- and postoperative complications and neurological state at re-examinations. Results Thirty-two animals were identified; three were treated conservatively, 19 surgically and 10 were euthanatized. In eight dogs and six cats, the injured spinal column was treated with a laterally applied percutaneous type 1a ESF under fluoroscopic guidance. Positive profile end-threaded pins inserted were from 1.6/1.9 to 3.5/4.3 mm in dogs and 1.6/1.9 to 2/2.3 mm in cats and were placed into two to five vertebral bodies. At the re-examinations, the neurological status had improved in 12 animals, deteriorated in one, and was unchanged in another one. In eight cases, no complications were detected. The most common complications included erythema, exudation and pin loosening. Conclusion The present work shows that type 1a ESF can be successfully and minimally invasively applied to fractures and luxations of the spine in dogs and cats with minimal major complications.