The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

Objective To investigate the dynamic variation of D-dimer and to evaluate the efficacy and accuracy of D-dimer level in patients with thoracolumbar fractures caused by high-energy injuries. Methods A total of 121 patients with thoracolumbar fractures caused by high-energy injuries were retrospectively identified and included in this study. There were 83 males and 38 females, with an average age of 48.6 ± 11.2 years. All patients were treated with either screw fixation surgery or decompression fixation surgery. The D-dimer levels were measured 1 day before surgery and on the first, third, and fifth days after surgery. The dynamic variation of D-dimer and the effects of risk factors on D-dimer levels were analysed. A receiver operating characteristic (ROC) curve analysis was performed and the appropriate D-dimer cut-off level was determined for deep vein thrombosis (DVT) screening. Results Due to a trough on the third day, D-dimer levels grew in an unsustainable manner following surgery (P < 0.001). Patients with the operation time >120 min (P = 0.009) and those with an American Spinal Injury Association (ASIA) score A-C (P < 0.001) had higher D-dimer levels. The area under the curve of D-dimer was the greatest on the third day. Applying stratified cut-off values did not change the sensitivity, specificity and negative predictive value in the group with an operation time >120 min, and ASIA score A-C group. Conclusions D-dimer levels elevated with fluctuation in patients with thoracolumbar fractures caused by high-energy injuries after surgery. Both operation time and ASIA score had an impact on D-dimer levels. Regarding DVT diagnoses, the diagnostic value of D-dimer was highest on the third day postoperatively, and stratified cut-off values by these two factors did not show better diagnostic efficacy compared with a collective one.

Causes, Patterns, and Outcomes of Nontraumatic Spinal Cord Injury

Introduction: Nontraumatic spinal cord injury (NTSCI), refers to damage to the spinal cord resulting from a cause other than trauma. It is a condition with immense functional implications for individuals involved. The incidence of NTSCI is difficult to estimate due to its heterogeneous cluster of a wide spectrum etiologies with varying pathophysiology. The most described NTSCI causes are degenerative diseases and spinal stenosis, tumors, and inflammatory conditions. In order to avoid delay in diagnosis and time-critical treatment, knowledge of each is important. We aim to fill the gap of knowledge by assessing the causes, patterns, and outcomes of NTSCI. Methodology: This retrospective cohort study included all patients who had an NTSCI between 2016 and 2020. In addition, patients aged >18 years and treated surgically were included. Demographic and clinical data were collected. Pre- and postoperative American Spinal Injury Association (ASIA) impairment scales and last follow-up outcomes were assessed. Result: A total of 124 patients were included. The mean age of our population was 62.8 years with an average BMI of 31; 8% of them were smokers. Upon admission, back pain (45%), numbness (43%), and inability to walk (18%) were the highest recorded clinical presentations. Spinal stenosis (45%) followed by degenerative cervical myelopathy (27%) were the most observed pathologies. Lumbar injuries accounted for 45% whereas cervical injuries accounted for 41% and thoracic injuries for 14%. The average length of stay period was 23.2 days, with 48% of patients transferred to inpatient rehabilitation, and the mean follow-up duration was 15 months. Conclusion: In summary, after assessing the causes, patterns, and outcomes of NTSCI, our study showed that comorbidities were observed in 85% of patients. Spinal stenosis and degenerative cervical myelopathy were the most common etiologies. Patients who presented with urinary incontinence and/or bowel incontinence upon admission had a significantly worse ASIA score at last follow-up. Degenerative pathologies recorded a worse ASIA score, and thoracic injuries recorded the worst ASIA score improvement compared to cervical and lumbar injuries. In total, 57% of the patients showed full recovery at the last follow-up.

P.225 Factors Contributing to Prolonged Length of Stay in Adults Undergoing Spine Surgery: Results from a Quaternary Spinal Care Center

Background: Prolonged length of stay (LOS) is associated with increased resource utilization and worse outcomes. The goal of this study is identifying patient, surgical and systemic factors associated with prolonged LOS overall and per diagnostic category for adults admitted to a quaternary spinal care center. Methods: We performed a retrospective analysis on 13,493 admissions from 2006 to 2019. Factors analyzed included patient age, sex, emergency vs elective admission, diagnostic category (degenerative, deformity, oncology, trauma), presence of neurological deficits in trauma patients, ASIA score, operative management and duration, blood loss, and adverse events (AEs). Univariate and multivariate analyses determined factors associated with prolonged LOS. Results: Overall mean LOS (±SD) was 15.80 (±34.03) days. Through multivariate analyses, predictors of prolonged LOS were advanced age (p<0.001), emergency admission (p<0.001), advanced ASIA score (p<0.001), operative management (p=0.043), and presence of AEs (p<0.001), including SSI (p=0.001), other infections (systemic and UTI) (p<0.001), delirium (p=0.006), and pneumonia (p<0.001). The effects of age, emergency admission, and AEs on LOS differed by diagnostic category. Conclusions: Understanding patient and disease factors that affect LOS provides opportunities for QI intervention and allows for an informed preoperative discussion with patients. Future interventions can be targeted to maximize patient outcomes, optimize care quality, and decrease costs.

Reconstructing Nanohydroxyapatite Prosthesis Based on CT-Scanning Data and Its Application in Spinal Injury

This study investigated the nanohydroxyapatite (nHA) prosthesis application effect based on CT-scanning data in spinal injury. This study chose 26 spinal injury patients treated in our hospital from September 2017 to September 2018, who were randomly divided into two groups. nHA prosthesis based on CT-scanning data was implanted in the nHA group, whereas titanium mesh was implanted in the titanium mesh group. Consequently, osteoblasts were cultured to test the biological activity of nHA and titanium alloy. In cell tests, we found osteoblasts could better adhere to nHA, and proliferation and activity were higher when planted on nHA material. After surgical treatment, all patients’ spinal symptoms (VAS score, JOA score, and Cobb angle) had improved and did not cause obvious inflammatory foreign body reactions. During a two-year follow-up, the fusion time and support settlement in the nHA group was lower, and the vertebral fusion rate and ASIA score were higher than those in the titanium mesh group. Thus, CT-scanning data could further improve the vertebral fusion rate in the nHA group. Consequentially, nHA prosthesis based on CT-scanning data is a better choice for spinal injury therapy.

Risk Factors, Assessments, and Treatment of Intra- and Postoperative New Neurologic Deficits in Complex Spine Disorders

Background: New Neurologic Deficits (NND) is one of the most threatening complications of spinal surgery, and its incidence in complex spine disorders ranges from 0.99% to 3.54%, which is higher than that in noncomplex spine disorders. To date, the early management of NNDs in complex spine disorders remains poorly researched.Methods. A retrospective review was performed for patients with complex spine disorders who experienced NNDs from 2010 to 2020. The pre- and postoperative neurologic condition was assessed using the American Spinal Injury Association (ASIA) scale. Patient age, sex, diagnosis, lesion level, operating time, blood loss, intraoperative neurophysiologic monitoring (IONM) test results, wake-up test results, lowest mean arterial pressure (MAP) at surgery, NND types, possible etiology of NNDs, treatment, and total recovery time were reviewed retrospectively.Results: Five patients with complex spine disorders who experienced NNDs were included (4 males and 1 female; average age of 23±17 years) in the present study. The primary diseases varied from congenital scoliosis to Langerhans histiocytosis. The mean operation time was 488±264 min with a mean blood loss of 1920±1413 mL, and the mean lowest MAP at surgery was 66.2±7.6 mmHg. Regarding the type of NND, 4 cases had spinal cord injuries, and 1 case had nerve root injury. The possible etiologies of NNDs in the patients were as follows: spinal cord overtraction and spinal cord ischemia in 2 cases; spinal cord compression and spinal cord ischemia in 2 cases; and spinal cord ischemia 1 case. Two patients underwent revision surgery, and 1 patient underwent prolonged surgery. The average hospital stay was 37±11 days. The preoperative ASIA score was 4.4±0.8, while the postoperative ASIA score was 0.8±0.7. All patients achieved full recovery at a mean follow-up period of 6.8±4.5 months.Conclusion: Surgeries for complex spine disorders carry significant risks that can lead to intraoperative or postoperative NNDs. NNDs can occur secondary to spinal cord overtraction (overcorrection of deformity), spinal cord compression (due to implants, bone tissue, soft tissue, or hematoma), and spinal cord ischemia (owing to anemia, low MAP, vascular embolism, or intramedullary vascular malformation). Patients with risk factors should be closely observed during and after the operation. Once NNDs are confirmed, emergency examination should be performed to rule out spinal cord overtraction and spinal cord compression. If a mechanical obstruction is found, emergency revision surgery is recommended. If no mass lesion is identified, conservative treatment should be utilized for the principle of maintaining arterial pressure, nutriating nerves, dilating blood vessels, and eliminating edema.

Clinical efficacy and therapeutic value of delayed surgery in patients with symptomatic old thoracolumbar fractures

Background To investigate the clinical efficacy and therapeutic value of posterior decompression reduction, bone grafting fusion, and internal fixation for treatment of symptomatic old thoracolumbar fractures. Method Retrospective analysis was conducted for 14 patients (9 men, 5 women; average age 40.1 years) with old thoracolumbar fractures who underwent posterior operation. American Spinal Injury Association (ASIA) scores were used to evaluate neurologic function. Vertebral body height, Cobb angle in the sagittal plane, spinal canal volume ratio (%) and bone graft fusion were analyzed by radiography and computed tomography on different follow-up times. Results Mean follow-up was 27.1 months (23–36 months). Of three patients with ASIA grade A, 2 had improved postoperative urination and defecation, although no classification change. Preoperative ASIA score for eight patients with incomplete injury was grade B; four patients recovered to grade C at final follow-up. Preoperative ASIA score was C in three patients, increased to D in two patients and returned to normal E in one patient. Preoperative results showed average injured vertebra height loss rate decreased from 50.4 to 8.9%; average Cobb angle on the sagittal plane recovered from 39.6 to 6.9°; and the average spinal canal volume ratio recovered from 33.8 to 5.9%. Bony fusion was achieved; local lumbago and leg pain were relieved to some extent. No patients exhibited loosening of the fracture treated by internal fixation, pseudoarthrosis, or other related serious complications. Conclusion Treatment of old thoracolumbar fractures by posterior decompression reduction, bone grafting fusion, and internal fixation can relieve spinal cord compression, improve neurologic function of some patients (ASIA grades B–C), effectively relieve pain, correct deformity, restore biomechanical stability, and significantly improve quality of life.

Clinical Efficacy and Therapeutic Value of Delayed Surgery in Patients With Symptomatic Old Thoracolumbar Fractures

Background: The objective of this study was to investigate the clinical efficacy and therapeutic value of posterior decompression reduction, bone grafting fusion, and internal fixation for treatment of symptomatic old thoracolumbar fractures. Methods: Retrospective analysis was conducted for 14 patients (9 men, 5 women; average age 40.1 years) with old thoracolumbar fractures who underwent posterior operation. American Spinal Injury Association (ASIA) scores were used to evaluate neurologic recovery. Recovery of vertebral body height, Cobb angle in the sagittal plane, spinal canal volume ratio (%) and bone graft fusion were analyzed by radiography and computed tomography on different follow-up times. Results: Mean follow-up was 27.1 months (23–36 months). Of three patients with ASIA grade A, 2 had improved postoperative urination and defecation, although no classification change. Preoperative ASIA score for eight patients with incomplete injury was grade B; four patients recovered to grade C at final follow-up. Preoperative ASIA score was C in three patients, increased to D in two patients and returned to normal E in one patient. Preoperative results showed average injured vertebra height loss rate decreased from 50.4% to 8.9%; average Cobb angle on the sagittal plane recovered from 39.6° to 6.9°; and the average spinal canal volume ratio recovered from 33.8% to 5.9%. Bony fusion was achieved; local lumbago and leg pain were relieved to some extent. No patients exhibited loosening of the fracture treated by internal fixation, pseudoarthrosis, or other related serious complications.Conclusion: Treatment of old thoracolumbar fractures by posterior decompression reduction, bone grafting fusion, and internal fixation can relieve spinal cord compression, improve neurologic function of some patients (ASIA grades B–C), effectively relieve pain, correct deformity, restore biomechanical stability, and significantly improve quality of life.

Ten years of clinical observation of olfactory ensheathing cell transplantation in patients with spinal cord injury

Objective:To evaluate the long-term curative efficacy and safety of olfactory ensheathing cell (OEC) transplantation by 10 years of follow-up investigation.Methods:A follow-up observation was done on 13 patients with allograft olfactory bulb-derived OEC transplantation from September 2005 to September 2007 at the Second Affiliated Hospital of Xi’an Jiaotong University. After cell purification, amplification, and identification, a 2 × 107/mL cell suspension was prepared for transplantation. In the posterior horn of the spinal cord 0.5 cm distal and proximal to the spinal cord injury zone, 4 needle points were selected to avoid the blood vessels. The needle depth was 3 mm, and the injection volume per point was 10 μL. Postoperatively and at 1 week, 4 weeks, 12 weeks, 24 weeks, 1 year, 3 years, 5 years, and 10 years after the surgery, the patient’s American Spinal Injury Association (ASIA) score, adverse reactions, and other minor observations were assessed.Results:All the patients did not have serious complications. No gliomas or other new organisms formed during the 10-year observation period. Eight of 13 patients had improvement in sensory function, and 5 patients showed improvement in motor function. The ASIA acupuncture, light touch, and exercise scores improved significantly 1 year after the surgery, and this improvement continued until the 10-year follow-up period. Three of 13 patients had improvement in defecation and urination, and 1 patient had improved neuralgia after spinal cord injury.Conclusion:OEC transplantation is safe and effective in treating spinal cord injury. The observation period of OEC transplantation is 1 to 3 years.