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Spinal Trauma: Management and Treatment Strategies

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (10 January 2024) | Viewed by 10767

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Special Issue Editors

Dr. Aria Nouri

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Guest Editor

Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
Interests: degenerative cervical myelopathy (DCM); magnetic resonance imaging (MRI); cervical canal stenosis; subacute combined degeneration of the spinal cord (SACD); anemia and DCM; cervical spine surgery; surgical decision-making; surgical outcome prediction; ossification of the posterior longitudinal ligament (OPLL); cervical spondylolithesis; spinal cord injury
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Prof. Dr. Enrico Tessitore

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Guest Editor

Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
Interests: degenerative cervical myelopathy; the aging spine
Special Issues, Collections and Topics in MDPI journals

Dr. Dennis E. Dominguez

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Guest Editor

Division of Orthopedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
Interests: deformity and spine trauma; gait lab analysis; musculoskeletal pain; chiropractic

Special Issue Information

Dear Colleagues,

Spinal trauma is a common clinical problem that can result from both high-velocity injuries, such as motor vehicle accidents, and low-velocity injuries, such as minor falls. The management of fractures due to these traumas varies based on the severity of injury to the spine, the presence or absence of instability, the likelihood of healing without surgical intervention, pain, and importantly, the presence of neurological deficits, amongst other components. Great variability exists with regard to how these fractures are treated, and clear guidelines with regard to the optimal treatment strategies are lacking. This is partially due to the lack of literature on the subject to help direct clinical management. Consequently, this Special Issue aims to provide a collection of research in an effort to help advance the management of spinal trauma and discuss surgical treatment strategies for all types of spinal injuries arising from trauma.

Dr. Aria Nouri
Prof. Dr. Enrico Tessitore
Dr. Dennis E. Dominguez
Guest Editors

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Keywords

spine
spinal cord injury
cervical trauma
thoracic trauma
thoracolumbar trauma
lumbar trauma sacral trauma
osteoporotic fractures
surgery
imaging
conservative management
spinopelvic dislocation
polytrauma

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Published Papers (5 papers)

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Research

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20 pages, 5358 KiB

Open AccessFeature PaperArticle

MRI Spinal Cord Reconstruction Provides Insights into Mapping and Migration Following Percutaneous Epidural Stimulation Implantation in Spinal Cord Injury

by Siddharth Venigalla, Muhammad Uzair Rehman, Jakob N. Deitrich, Robert Trainer and Ashraf S. Gorgey

J. Clin. Med. 2024, 13(22), 6826; https://doi.org/10.3390/jcm13226826 - 13 Nov 2024

Viewed by 448

Abstract

Background: Spinal cord epidural stimulation (SCES) has the potential to restore motor functions following spinal cord injury (SCI). Spinal cord mapping is a cornerstone step towards successfully configuring SCES to improve motor function, aiming to restore standing and stepping abilities in individuals with SCI. While some centers have advocated for the use of intraoperative mapping to anatomically target the spinal cord locomotor centers, this is a resource-intensive endeavor and may not be a feasible approach in all centers. Methods: Two participants underwent percutaneous SCES implantation as part of a clinical trial. Each participant underwent a temporary (1-week, two-lead) trial followed by a permanent, two-lead implantation. SCES configurations were matched between temporary and permanent mappings, and motor evoked potential in response to 2 Hz, for a duration of 250–1000 µs and with an amplitude of 1–14 mA, was measured using electromyography. T2 axial MRI images captured prior to implantation were used to retrospectively reconstruct the lumbosacral segments of the spinal cord. The effects of lead migration on mapping were further determined in one of the participants. Results: In both participants, there were recognized discrepancies in the recruitment curves of the motor evoked potentials across different muscle groups between temporary and permanent SCES mappings. These may be explained by retrospective MRI reconstruction of the spinal cord, which indicated that the percutaneous leads did not specifically target the entire L1-S2 segments in both participants. Minor lead migration appeared to have a minimal impact on spinal cord mapping outcomes in one of the participants but did dampen the motor activity of the hip and knee muscle groups. Conclusions: Temporary mapping coupled with MRI reconstruction has the potential to be considered as guidance for permanent implantation considering target activation of the spinal cord locomotor centers. Since lead migration may alter the synergistic coordination between different muscle groups and since lead migration of 1–2 contacts is expected and planned for in clinical practice, it can be better guided with proper spinal cord mapping and a diligent SCES lead trial beforehand. Full article

(This article belongs to the Special Issue Spinal Trauma: Management and Treatment Strategies)

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13 pages, 1668 KiB

Open AccessArticle

Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment

by Philipp Raisch, Jan Pflästerer, Michael Kreinest, Sven Y. Vetter, Paul A. Grützner and Matthias K. Jung

J. Clin. Med. 2024, 13(3), 700; https://doi.org/10.3390/jcm13030700 - 25 Jan 2024

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Abstract

Introduction: This study analyzed the incidence of secondary dislocations (sDLs) after surgical stabilization of AO Spine type B and C injuries of the subaxial cervical spine (sCS). Materials and Methods: Patients treated for injuries of the sCS from 2010 to 2020 were retrospectively analyzed for the incidence of sDL within 60 days after first surgery. A univariate analysis of variables potentially influencing the risk of sDL was performed. Patients with solitary anterior stabilization underwent subgroup analysis. The treatment of sDLs was described. Results: A total of 275 patients were included. sDLs occurred in 4.0% of patients (n = 11) in the total sample, most frequently after solitary anterior stabilization with 8.0% (n = 10, p = 0.010). Only one sDL occurred after combined stabilization and no sDLs after posterior stabilization. In the total sample and the anterior subgroup, variables significantly associated with sDL were older age (p = 0.001) and concomitant unstable facet joint injury (p = 0.020). No neurological deterioration occurred due to sDL and most patients were treated with added posterior stabilization. sDL is frequent after solitary anterior stabilization and rare after posterior or combined stabilization. Discussion: Patients of higher age and with unstable facet joint injuries should be followed up diligently to detect sDLs in time. Neurological deterioration does not regularly occur due to sDL, and most patients can be treated with added posterior stabilization. Full article

(This article belongs to the Special Issue Spinal Trauma: Management and Treatment Strategies)

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10 pages, 2160 KiB

Open AccessArticle

Spinal Fractures during Touristic Motorboat Sea Cruises: An Underestimated and Avoidable Phenomenon

by Adrien Thomas May, Nicolas Bailly, Aurore Sellier, Valentin Avinens, Maxime Huneidi, Mikael Meyer, Lucas Troude, Pierre-Hugues Roche, Henry Dufour, Arnaud Dagain, Pierre-Jean Arnoux, Kaissar Farah and Stéphane Fuentes

J. Clin. Med. 2023, 12(4), 1426; https://doi.org/10.3390/jcm12041426 - 10 Feb 2023

Cited by 1 | Viewed by 1454

Abstract

Purpose: Each summer, many vacationers enjoy the Mediterranean Sea shores. Among the recreational nautical activities, motorboat cruise is a popular choice that leads to a significant number of thoracolumbar spine fractures at our clinic. This phenomenon seems to be underreported, and its injury mechanism remains unclear. Here, we aim to describe the fracture pattern and propose a possible mechanism of injury. Methods: We retrospectively reviewed the clinical, radiological, and contextual parameters of all motorboat-related spinal fracture cases during a 14-year period (2006–2020) in three French neurosurgical level I centers bordering the Mediterranean Sea. Fractures were classified according to the AOSpine thoracolumbar classification system. Results: A total of 79 patients presented 90 fractures altogether. Women presented more commonly than men (61/18). Most of the lesions occurred at the thoracolumbar transition region between T10 and L2 (88.9% of the levels fractured). Compression A type fractures were seen in all cases (100%). Only one case of posterior spinal element injury was observed. The occurrence of neurological deficit was rare (7.6%). The most commonly encountered context was a patient sitting at the boat’s bow, without anticipating the trauma, when the ship’s bow suddenly elevated while crossing another wave, resulting in a “deck-slap” mechanism hitting and propelling the patient in the air. Conclusions: Thoracolumbar compression fractures are a frequent finding in nautical tourism. Passengers seated at the boat’s bow are the typical victims. Some specific biomechanical patterns are involved with the boat’s deck suddenly elevating across the waves. More data with biomechanical studies are necessary to understand the phenomenon. Prevention and safety recommendations should be given before motorboat use to fight against these avoidable fractures. Full article

(This article belongs to the Special Issue Spinal Trauma: Management and Treatment Strategies)

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Review

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16 pages, 2878 KiB

Open AccessReview

Multidisciplinary and Coordinated Management of Osteoporotic Vertebral Compression Fractures: Current State of the Art

by Khalid Al Taha, Nicolas Lauper, David E. Bauer, Andreas Tsoupras, Enrico Tessitore, Emmanuel Biver and Dennis E. Dominguez

J. Clin. Med. 2024, 13(4), 930; https://doi.org/10.3390/jcm13040930 - 6 Feb 2024

Cited by 3 | Viewed by 4082

Abstract

Osteoporotic vertebral compression fractures (OVCFs) present a significant health concern, affecting a substantial portion of the older adult population worldwide. This narrative review explores the prevalence, diagnostic challenges and management strategies for OVCFs. Despite the increasing incidence and impact on morbidity and mortality, existing clinical guidelines lack consistency and clear diagnostic and therapeutic recommendations. The review addresses key questions faced by physicians dealing with older adult patients experiencing acute back pain, offering insights into triage, radiological assessments and classification systems. We propose a comprehensive algorithm for clearing OVCF, considering clinical presentation, radiological findings and morphological aspects. Emphasis is placed on the importance of medically treating osteoporosis alongside OVCF management. The review encompasses relevant literature from 1993 to 2023, provides a detailed discussion on triage issues and incorporates a clinically oriented classification system developed by the German Society for Orthopaedics and Trauma. The Material and Methods section outlines the extensive literature search carried out in PUBMED, encompassing clinical and experimental studies, systematic reviews and meta-analyses. The articles retained focused mainly on answering critical questions regarding radiological assessments, imaging modalities and the presence of a specific classification system for OVCFs. The review emphasises that the evaluation and management of OVCFs necessitates a multidisciplinary approach involving spine specialists and bone disease experts. It also addresses the role of conservative versus surgical treatments, with a focus on percutaneous vertebral augmentation. The conclusion summarises the algorithm derived for use in emergency departments and general practice, aiming to streamline OVCF management, reduce unnecessary examinations and ensure optimal patient care. The algorithm recommends primary diagnosis using computed tomography, with magnetic resonance imaging reserved for specific cases. The review advocates a holistic approach, integrating medical and surgical interventions to address the complex challenges posed by OVCFs in ageing populations. Full article

(This article belongs to the Special Issue Spinal Trauma: Management and Treatment Strategies)

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13 pages, 281 KiB

Open AccessFeature PaperReview

Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults

by Hideaki Nakajima, Kazuya Honjoh, Shuji Watanabe, Ai Takahashi, Arisa Kubota and Akihiko Matsumine

J. Clin. Med. 2023, 12(21), 6795; https://doi.org/10.3390/jcm12216795 - 27 Oct 2023

Cited by 2 | Viewed by 3034

Abstract

The incidence of cervical spinal cord injury (CSCI) without major bone injury is increasing, possibly because older people typically have pre-existing cervical spinal canal stenosis. The demographics, neurological injury, treatment, and prognosis of this type of CSCI differ from those of CSCI with bone or central cord injury. Spine surgeons worldwide are debating on the optimal management of CSCI without major bone injury. Therefore, this narrative review aimed to address unresolved clinical questions related to CSCI without major bone injury and discuss treatment strategies based on current findings. The greatest divide among spine surgeons worldwide hinges on whether surgery is necessary for patients with CSCI without major bone injury. Certain studies have recommended early surgery within 24 h after injury; however, evidence regarding its superiority over conservative treatment remains limited. Delayed MRI may be beneficial; nevertheless, reliable factors and imaging findings that predict functional prognosis during the acute phase and ascertain the necessity of surgery should be identified to determine whether surgery/early surgery is better than conservative therapy/delayed surgery. Quality-of-life assessments, including neuropathic pain, spasticity, manual dexterity, and motor function, should be performed to examine the superiority of surgery/early surgery to conservative therapy/delayed surgery. Full article

(This article belongs to the Special Issue Spinal Trauma: Management and Treatment Strategies)

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