Post-Traumatic Vertebral Injuries
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Published:
Apr 24, 2023
Keywords:
Spine, trauma, fracture, kinematics, vertebral fracture, spinal injury
Main Article Content
Abstract
Introduction: Spinal injuries are common among young adult men. Recognizing kinematics can help reduce the number of late diagnoses, especially if there are consciousness disorders. Vertebral fractures can be single or multiple, and they are often associated with extravertebral injuries.
Objectives: To examine the distribution of the lesion based on the mechanism of production, to characterize the neurological condition, to evaluate the lesion pattern and its relationship with extravertebral lesions, and to analyze the treatment.
Materials and Methods: This was a multicenter, prospective study of patients admitted with post-traumavertebral injuries between July 1, 2018 and June 30, 2020. Age, gender, kinematics, neurological condition, affected sector, pattern of injury, and associated extravertebral injuries were all examined.
Results: There were 281 patients (60% men) evaluated, with 400 vertebral and 118 extravertebral lesions. The causes were as follows: polytrauma in 62 cases, falls from great heights in 147 patients, and traffic accidents in 98. ASIA E was the most frequently observed neurological picture (8 cases), which was not determined at admission. The T2-L5 sector was the most affected, mostly by compression injuries. Head and chest trauma were the most common extravertebral injuries; there was one case of SCIWORA and one early death.
Conclusions: The most commonly affected spinal sectors were thoracolumbar, thoracic, and lumbar; the injuries are typically caused by falls from great heights and, in general, are isolated, with no neurological injuries. The treatment is determined by the stability and neurological condition.
Objectives: To examine the distribution of the lesion based on the mechanism of production, to characterize the neurological condition, to evaluate the lesion pattern and its relationship with extravertebral lesions, and to analyze the treatment.
Materials and Methods: This was a multicenter, prospective study of patients admitted with post-traumavertebral injuries between July 1, 2018 and June 30, 2020. Age, gender, kinematics, neurological condition, affected sector, pattern of injury, and associated extravertebral injuries were all examined.
Results: There were 281 patients (60% men) evaluated, with 400 vertebral and 118 extravertebral lesions. The causes were as follows: polytrauma in 62 cases, falls from great heights in 147 patients, and traffic accidents in 98. ASIA E was the most frequently observed neurological picture (8 cases), which was not determined at admission. The T2-L5 sector was the most affected, mostly by compression injuries. Head and chest trauma were the most common extravertebral injuries; there was one case of SCIWORA and one early death.
Conclusions: The most commonly affected spinal sectors were thoracolumbar, thoracic, and lumbar; the injuries are typically caused by falls from great heights and, in general, are isolated, with no neurological injuries. The treatment is determined by the stability and neurological condition.
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How to Cite
Bazán, P. L., Cortes Luengo, C., Borri, Álvaro E., Medina, M., Ciccioli, N. M., Poza Roman, D. D., Patalano, L., Beltrán Moreno, P., Casco, E. A., Marin, E., Godoy Adaro, A. O., Gutierrez, E. E., Avero Gonzalez, R. A., Acevedo Yoga, J. D., Soria Adaro, J. C., Terraza, S., & Belloni Barreto, A. (2023). Post-Traumatic Vertebral Injuries. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(2), 138-147. https://doi.org/10.15417/issn.1852-7434.2023.88.2.1510
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Clinical Research
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https://doi.org/10.1097/TA.0000000000003071
20. Bazan PL, Bravo M, Gutierrez E, Terraza S, Cortes C, Borri Á, et al. Fracturas de la columna vertebral en pacientes con espondilitis anquilosante. Rev Asoc Argent Ortop Traumatol 2021;86(1):58-63. https://doi.org/10.15417/issn.1852-7434.2021.86.1.1094
21. Bazán PL, Ciccioli NM, Borri AE, Medina M. Fractura de columna torácica alta asociada a fractura de esternón.
Coluna/Columna 2017;16(1):60-3. https://doi.org/10.1590/S1808-18512017160115184
22. Bazán PL, Betemps A, Ciccioli N, Borri A, Medina M. Combination of upper thoracic fracture and sternum fracture. Global Spine J 2015;5(1_suppl):s-0035-1554442-s-0035-1554442. https://doi.org/10.1055/s-0035-1554442
23. Boden BP, Jarvis CG. Spinal injuries in sport. Neurol Clin 2008;26(1):63-78. https://doi.org/10.1016/j.ncl.2007.12.005
24. Bazán PL, Marin E, Betemps A, Borri ÁE, Romano Yalour N, Ciccioli NM, et al. Lesiones toracolumbares en la
práctica de acrobacia en tela. Reporte de casos. Rev Asoc Argent Ortop Traumatol 2020;85(2):119-24.
https://doi.org/10.15417/issn.1852-7434.2020.85.2.1010
25. Blumer CE, Quine S. Prevalencia de lesión de la médula espinal: una comparación internacional.
Neuroepidemiología 1995;14:258-68. https://doi.org/10.1159/000109801
National Spinal Injuries Unit. Eur Spine J 2009;18(7):938-42. https://doi.org/10.1007/s00586-009-0923-y
2. Heidari P, Zarei MR, Rasouli MR, Vaccaro AR, Rahimi-Movaghar V. Spinal fractures resulting from traumatic
injuries. Chin J Traumatol 2010;13(1):3-9. https://doi.org/10.3760/cma.j.issn.1008-1275.2010.01.001
3. Zulkipli Z, Faudzi M, Manap A, Paiman N. Non-fatal spine injuries resulting from motorcycle crashes. IATSS
Research 2018;42(3):121-7. https://doi.org/10.1016/j.iatssr.2017.09.001
4. Yadollahi M, Paydar S, Ghaem H, Ghorbani M, Mousavi SM, AkerdiATA, et al. Epidemiology of cervical spine
fractures. Trauma Mon 2016;21(3):e33608. https://doi.org/10.5812/traumamon.33608
5. Verheyden AP, Spiegl UJ, Ekkerlein H, Gercek EG, Hauck S, Joste C, et al. Treatment of fractures of the
thoracolumbar spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018;8(2 Suppl):34S-45S. https://doi.org/10.1177/2192568218771668
6. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine
injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976)
2013;38(23):2028-37. https://doi.org/10.1097/BRS.0b013e3182a8a381
7. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, et al. AO Spine subaxial cervical spine
injury classification system. Eur Spine J 2016;25(7):2173-84. https://doi.org/10.1007/s00586-015-3831-3
8. Vaccaro AR, Schroeder GD, Divi SN, Kepler CK, Kleweno CP, Krieg JC, et al. Description and reliability of the
AOSpine Sacral Classification System. J Bone Joint Surg Am 2020;102(16):1454-63. https://doi.org/10.2106/JBJS.19.01153
9. Bazán PL, Borri AE, Pesci P, Szmidt VE. Lesiones vertebrales y medulares en pacientes con caída de altura y lesión raquimedular. Rev Asoc Platense Ortop Traumatol 2006/2009:149-54.
10. Bazán PL, Borri AE, Szmidt VE. Accidente en vía pública y lesión raquimedular. Rev Asoc Platense Ortop
Traumatol 2006/2009:139-54.
11. Borri AE, Sanchez A, Lías A, Bazán PL, Szmidt VE. Diagnóstico y tratamiento de las lesiones traumáticas de la
columna toracolumbar y lumbar. Rev Asoc Platense Ortop Traumatol 2006/2009:117-24.
12. Bazan PL. Significance of SCIWORA in adult. Coluna/Columna 2015;14(2):134-7. https://doi.org/10.1590/S1808-1851201514020R130
13. Bazán PL, Borri AE, Medina M. Predictores en el cuadro SCIWORA del adulto. Coluna/Columna 2013;12(4):326-
9. https://doi.org/10.1590/S1808-18512013000400014
14. Bazán PL, Micchia NO, Schmidt D, Areco P, Re M, Casabone A, et al. Lesión medular post-traumática. Tratamiento multidisciplinario.Rev Asoc Platense Ortop Traumatol 2002/2005:201-6.
15. Kuo SCH, Kuo PJ, Rau CS, Chen YC, Hsieh HY, Hsieh CH. The protective effect of helmet use in motorcycle
and bicycle accidents: a propensity score-matched study based on a trauma registry system. BMC Public Health
2017;17(1):639. https://doi.org/10.1186/s12889-017-4649-1
16. Zileli M, Osorio-Fonseca E, Konovalov N, Cardenas-Jalabe C, Kaprovoy S, Mlyavykh S, et al. Early management
of cervical spine trauma: WFNS Spine Committee Recommendations. Neurospine 2020;17(4):710-22. https://doi.org//10.14245/ns.2040282.141
17. Smith JA, Siegel JH, Siddiqi SQ. Spine and spinal cord injury in motor vehicle crashes: A function of change in
velocity and energy dissipation on impact with respect to the direction of crash. J Trauma 2015;59(1):117-31.
https://doi.org/10.1097/01.TA.0000171534.75347.52
18. Roche SJ, Sloane PA, Mcabe JP. Epidemiology of spine trauma in an Irish regional trauma unit: a 4-year
study. Injury 2008;39(4):436-42. https://doi.org/10.1016/j.injury.2007.12.012
19. Driessen MLS, Sturms LM, van Zwet EW, Bloemers FW, Ten Duis HJ, Edwards MJR, et al. Evaluation of the
Berlin polytrauma definition: A Dutch nationwide observational study. J Trauma 2021;90(4):694-9.
https://doi.org/10.1097/TA.0000000000003071
20. Bazan PL, Bravo M, Gutierrez E, Terraza S, Cortes C, Borri Á, et al. Fracturas de la columna vertebral en pacientes con espondilitis anquilosante. Rev Asoc Argent Ortop Traumatol 2021;86(1):58-63. https://doi.org/10.15417/issn.1852-7434.2021.86.1.1094
21. Bazán PL, Ciccioli NM, Borri AE, Medina M. Fractura de columna torácica alta asociada a fractura de esternón.
Coluna/Columna 2017;16(1):60-3. https://doi.org/10.1590/S1808-18512017160115184
22. Bazán PL, Betemps A, Ciccioli N, Borri A, Medina M. Combination of upper thoracic fracture and sternum fracture. Global Spine J 2015;5(1_suppl):s-0035-1554442-s-0035-1554442. https://doi.org/10.1055/s-0035-1554442
23. Boden BP, Jarvis CG. Spinal injuries in sport. Neurol Clin 2008;26(1):63-78. https://doi.org/10.1016/j.ncl.2007.12.005
24. Bazán PL, Marin E, Betemps A, Borri ÁE, Romano Yalour N, Ciccioli NM, et al. Lesiones toracolumbares en la
práctica de acrobacia en tela. Reporte de casos. Rev Asoc Argent Ortop Traumatol 2020;85(2):119-24.
https://doi.org/10.15417/issn.1852-7434.2020.85.2.1010
25. Blumer CE, Quine S. Prevalencia de lesión de la médula espinal: una comparación internacional.
Neuroepidemiología 1995;14:258-68. https://doi.org/10.1159/000109801