Risk Factors for Cervical Spine Injury in an Obtunded Blunt Trauma Patient

Background: In Thailand, many hospitals cannot send every obtunded blunt trauma patient for cervical spine CT scan because of the socioeconomic status. Knowing about the risk factors for cervical spine injury in an obtunded blunt trauma patient would help the clinician monitor for cervical spine injury. Objective: To identify the risk factors of cervical spine injury in an obtunded blunt trauma patient. Materials and Methods: The present study evaluated 400 obtunded blunt trauma patients with a GCS of less than 15, in the trauma center of Srinagarind Hospital between January 2015 and December 2019. The patients were chosen from the patient’s registry for the present retrospective cross-sectional study. A univariate analysis was fulfilled with potential risk factors such as age, gender, mechanism of injury, GCS, associated injury, and intracranial lesion. Then, multivariate analysis was used to identify the risk factors of cervical spine injury in obtunded blunt trauma patients. Results: Four hundred patients were included in the present study. Eighty-eight (22%, 95% CI 18.04 to 26.38) had a cervical spine injury. The mean age was 40.04 years, 73% were males with a male to female ratio of 2.7 to 1. For the mechanisms of injury, 66% of injuries resulted from motorcycle accidents, 15% from car accidents, and 14% from falls. From univariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (OR 1.93, 95% CI 1.05 to 3.54). Thoracic spine fracture had significant higher odds of cervical spine injury than other associate injuries (OR 6.2, 95% CI 1.45 to 26.5). From multivariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (aOR 1.99, 95% CI 1.07 to 3.68). Thoracic spine fracture had a significantly higher odds of cervical spine injury than the other associated injuries (aOR 6.4, 95% CI 1.48 to 27.63). In patients age older than 60 years, 42% of cervical spine injuries occurred from fall. Conclusion: From the present study, age older than 60 years and thoracic spine fracture are the significant risk factors of cervical spine injury in obtunded blunt trauma patients. Keywords: Cervical spine injury; Risk factors; Obtunded blunt trauma patient

Thoracic spine fracture associated with an extradural lipoma: Case report and systematic review of the literature

Isolated extradural lipoma (IEL), not associated to spinal dysraphisms, is a rare condition. Frequently IEL was confused with much more frequent diffuse lipomatosis. The lesion can be completely asymptomatic and occasionally diagnosed with magnetic resonance (MR) imaging. This paper describes a case of a patient with an axial compression fracture of the thoracic spine associated with an extradural lipoma. We also performed a systematic review of the pertinent literature in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.

A case of dual three-column thoracic spinal fractures following traumatic injury

Background: Thoracic spine fracture-dislocations due to motor vehicle accidents (MVAs) rarely involve double- level, noncontiguous lesions. Case Description: A 19-year-old male following an MVA was paraplegic; he exhibited full motor/sensory loss below the T4 level (i.e., ASIA scale Grade A). The chest X-ray, magnetic resonance, and computed tomography studies confirmed T3–T5 and T11–12 fractures, warranting T3–L3 thoracolumbar decompression and fusion. Despite surgical intervention, the patient’s neurological status remained unchanged. Conclusion: This case illustrates the rare presentation of noncontiguous, posttraumatic thoracic spinal lesions requiring simultaneous decompression/fixation.

UPPER THORACIC SPINE FRACTURE ASSOCIATED WITH FRACTURE OF THE STERNUM

ABSTRACT Objectives: The objectives of this presentation are to analyze the kinematics that causes this association, describe the impact of the injury, and evaluate the treatment performed Methods: Three cases are analyzed by quantifying the displacement and angulation of the sternum, the characteristics of the spinal injury and deformity, treatment, and complications Results: The mechanism that causes the injury is flexion-distraction, the component of the vertebral body presented is type A, and the most affected region was T5. Two patients had neurological picture E. Sternum injury was caused by direct trauma Conclusion: The association of these was observed in patients who have suffered from high-energy trauma in a car accident. There was no relationship between the angulation of the sternum and its displacement to the degree of kyphosis and displacement of the thoracic spine. It is important to carry out good radiographic studies that include the sternum when there is suspicion of this relationship.