Pub Date : 2024-08-28DOI: 10.1016/j.mporth.2024.07.005
Himanshu Shekhar, Andreas K. Demetriades
In comparison to upper cervical and thoraco-lumbar regions, injury to the lower cervical spine (subaxial, C3–C7) is more likely to be associated with spinal cord injury. This makes this a region of special interest in the context of trauma. A sound understanding of the different injury patterns, morphology, mechanisms, neurological deficit and patient-specific factors is essential in individualizing management strategies. In this article we review the anatomy, clinical patterns of injury, and the options in their clinical management.
{"title":"Trauma to the lower cervical spine (sub-axial or C3–C7) in adults","authors":"Himanshu Shekhar, Andreas K. Demetriades","doi":"10.1016/j.mporth.2024.07.005","DOIUrl":"10.1016/j.mporth.2024.07.005","url":null,"abstract":"<div><div>In comparison to upper cervical and thoraco-lumbar regions, injury to the lower cervical spine (subaxial, C3–C7) is more likely to be associated with spinal cord injury. This makes this a region of special interest in the context of trauma. A sound understanding of the different injury patterns, morphology, mechanisms, neurological deficit and patient-specific factors is essential in individualizing management strategies. In this article we review the anatomy, clinical patterns of injury, and the options in their clinical management.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 289-295"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.mporth.2024.07.003
Gabriel Metcalf-Cuenca, Sadaquate Khan
Cauda equina syndrome is a rare presentation of lumbar spine disease that can result in significant lower limb neurological deficits and permanent bladder, bowel and sexual dysfunction. Delays in diagnosis and treatment can result in irreversible worsening of the condition. Therefore, this is a major cause of litigation against spinal surgeons in the NHS. Urgent MRI scanning is the diagnostic gold-standard and should be available at all hours in all hospitals where patients with potential cauda equina syndrome present. Imaging should be performed within 4 hours of requesting and if the scan is positive for cauda equina compression then treatment should be undertaken as a matter of urgency. Surgery to decompress the cauda equina can prevent further deterioration in symptoms but compared to elective lumbar surgery carries a much higher rate of complications owing to the nature of the disease. Despite rapid treatment, patients can suffer from significant long-term sequelae and require prolonged periods of rehabilitation.
{"title":"Cauda equina syndrome","authors":"Gabriel Metcalf-Cuenca, Sadaquate Khan","doi":"10.1016/j.mporth.2024.07.003","DOIUrl":"10.1016/j.mporth.2024.07.003","url":null,"abstract":"<div><div>Cauda equina syndrome is a rare presentation of lumbar spine disease that can result in significant lower limb neurological deficits and permanent bladder, bowel and sexual dysfunction. Delays in diagnosis and treatment can result in irreversible worsening of the condition. Therefore, this is a major cause of litigation against spinal surgeons in the NHS. Urgent MRI scanning is the diagnostic gold-standard and should be available at all hours in all hospitals where patients with potential cauda equina syndrome present. Imaging should be performed within 4 hours of requesting and if the scan is positive for cauda equina compression then treatment should be undertaken as a matter of urgency. Surgery to decompress the cauda equina can prevent further deterioration in symptoms but compared to elective lumbar surgery carries a much higher rate of complications owing to the nature of the disease. Despite rapid treatment, patients can suffer from significant long-term sequelae and require prolonged periods of rehabilitation.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 273-278"},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.mporth.2024.07.006
George Mataliotakis, Saeed Mohammad, Athanasios I Tsirikos
Fractures of the thoracic and thoracolumbar spine are common both in low- and high-energy injuries. Most of the fractures can be treated conservatively; however surgical intervention may be required in unstable injuries and those with spinal cord involvement. This article describes the biomechanics of the thoracic and thoracolumbar regions of the spine, explains the classification of the fracture and injury patterns and provides guidance on the decision-making for surgical management. Special considerations with regards to the approaches and length of fixation in each fracture pattern are mentioned. Categories such as fractures on the background of osteoporosis or ankylosing spondylitis are also covered.
{"title":"Injuries of the thoracic spine and the thoracolumbar junction","authors":"George Mataliotakis, Saeed Mohammad, Athanasios I Tsirikos","doi":"10.1016/j.mporth.2024.07.006","DOIUrl":"10.1016/j.mporth.2024.07.006","url":null,"abstract":"<div><div>Fractures of the thoracic and thoracolumbar spine are common both in low- and high-energy injuries. Most of the fractures can be treated conservatively; however surgical intervention may be required in unstable injuries and those with spinal cord involvement. This article describes the biomechanics of the thoracic and thoracolumbar regions of the spine, explains the classification of the fracture and injury patterns and provides guidance on the decision-making for surgical management. Special considerations with regards to the approaches and length of fixation in each fracture pattern are mentioned. Categories such as fractures on the background of osteoporosis or ankylosing spondylitis are also covered.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 296-303"},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.mporth.2024.07.008
M.Zaki B. Choudhury, Athanasios I. Tsirikos
Spinal fractures without significant trauma are commonly observed in daily practice. There are various descriptive terms, such as pathological fracture, vertebral compression fracture (VCF) and insufficiency fracture. Fundamentally speaking the problem arises from the inability of the bone, due to various causes to support physiological load. It is important to be able to rapidly identify the underlying causes of fractures and thus appropriately treat them. We provide an overview of the two key categories to differentiate between and a scheme to determine likely causes. Background biomechanical principles are discussed and treatment pathways reviewed.
{"title":"Spinal fractures associated with metabolic and metastatic conditions: principles of diagnosis and management","authors":"M.Zaki B. Choudhury, Athanasios I. Tsirikos","doi":"10.1016/j.mporth.2024.07.008","DOIUrl":"10.1016/j.mporth.2024.07.008","url":null,"abstract":"<div><div>Spinal fractures without significant trauma are commonly observed in daily practice. There are various descriptive terms, such as pathological fracture, vertebral compression fracture (VCF) and insufficiency fracture. Fundamentally speaking the problem arises from the inability of the bone, due to various causes to support physiological load. It is important to be able to rapidly identify the underlying causes of fractures and thus appropriately treat them. We provide an overview of the two key categories to differentiate between and a scheme to determine likely causes. Background biomechanical principles are discussed and treatment pathways reviewed.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 311-319"},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.mporth.2024.07.009
Maryem-Fama Ismael Aguirre, Athanasios I Tsirikos
Spinal trauma in children and adolescents, including spinal cord injury, fractures and dislocations, is relatively uncommon, but represents the highest risk of morbidity and mortality of all paediatric injuries. Motor vehicle accidents, falls from heights and sport accidents resulting in blunt trauma are the most frequent mechanisms of injury. The average age of presentation is approximately 12 years old. Injury following spinal trauma differs according to age-specific biomechanical characteristics of the developing spine. The most common site of injury in younger children is the cervical spine, whereas injury to the thoracolumbar spine is more common in adolescents. Differential diagnosis following trauma should include physiological particularities of the developing spine. Search for concomitant lesions is mandatory as patients frequently present with more than one vertebral fracture. Injury in this population can significantly affect the developing spine leading to neurological trauma and progressive deformity.
{"title":"Spinal trauma in children and adolescents: mechanisms of injury, anatomical characteristics and principles of treatment","authors":"Maryem-Fama Ismael Aguirre, Athanasios I Tsirikos","doi":"10.1016/j.mporth.2024.07.009","DOIUrl":"10.1016/j.mporth.2024.07.009","url":null,"abstract":"<div><div>Spinal trauma in children and adolescents, including spinal cord injury, fractures and dislocations, is relatively uncommon, but represents the highest risk of morbidity and mortality of all paediatric injuries. Motor vehicle accidents, falls from heights and sport accidents resulting in blunt trauma are the most frequent mechanisms of injury. The average age of presentation is approximately 12 years old. Injury following spinal trauma differs according to age-specific biomechanical characteristics of the developing spine. The most common site of injury in younger children is the cervical spine, whereas injury to the thoracolumbar spine is more common in adolescents. Differential diagnosis following trauma should include physiological particularities of the developing spine. Search for concomitant lesions is mandatory as patients frequently present with more than one vertebral fracture. Injury in this population can significantly affect the developing spine leading to neurological trauma and progressive deformity.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 320-324"},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1016/j.mporth.2024.07.007
Michael J Price, Paul Lambton Rodham, Athanasios I Tsirikos, Tristan E McMillan
Spinopelvic dissociation describes the traumatic separation of the axial and appendicular skeleton, commonly involving bilateral vertical sacral fractures which may be linked by a transverse fracture line. This injury may occur in patients with osteoporosis, in which there may be relative stability with minimal displacement; or result from high-energy trauma with extensive associated injuries and an increased risk of complications. Operative intervention forms the mainstay of treatment for high-energy injuries, although the heterogenous nature and relative rarity of this phenomenon renders a comprehensive treatment strategy difficult to define.
{"title":"Spinopelvic dissociation: aetiology, presentation and principles of treatment","authors":"Michael J Price, Paul Lambton Rodham, Athanasios I Tsirikos, Tristan E McMillan","doi":"10.1016/j.mporth.2024.07.007","DOIUrl":"10.1016/j.mporth.2024.07.007","url":null,"abstract":"<div><div>Spinopelvic dissociation describes the traumatic separation of the axial and appendicular skeleton, commonly involving bilateral vertical sacral fractures which may be linked by a transverse fracture line. This injury may occur in patients with osteoporosis, in which there may be relative stability with minimal displacement; or result from high-energy trauma with extensive associated injuries and an increased risk of complications. Operative intervention forms the mainstay of treatment for high-energy injuries, although the heterogenous nature and relative rarity of this phenomenon renders a comprehensive treatment strategy difficult to define.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 304-310"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1016/j.mporth.2024.07.004
Himanshu Shekhar, Andreas K Demetriades
The upper cervical spine is responsible for a significant portion of the flexion, extension and rotation movements of the whole cervical spine. It is a complex region with anatomical and biomechanical relationships between the occipital condyles, atlas, axis and their joints. These make this a region of special interest in the context of trauma. In this article we review the anatomy of the cranio-vertebral junction, the clinical patterns of injury, and the options in their clinical management.
{"title":"Trauma of the upper cervical spine and cranio-vertebral junction in adults","authors":"Himanshu Shekhar, Andreas K Demetriades","doi":"10.1016/j.mporth.2024.07.004","DOIUrl":"10.1016/j.mporth.2024.07.004","url":null,"abstract":"<div><div>The upper cervical spine is responsible for a significant portion of the flexion, extension and rotation movements of the whole cervical spine. It is a complex region with anatomical and biomechanical relationships between the occipital condyles, atlas, axis and their joints. These make this a region of special interest in the context of trauma. In this article we review the anatomy of the cranio-vertebral junction, the clinical patterns of injury, and the options in their clinical management.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 279-288"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1016/j.mporth.2024.07.010
Louise Robiati, Edward Spurrier, Athanasios I. Tsirikos
Trauma-related spinal injuries have been reported as far back as Egyptian times when their severity was recognized but treatment limited and outcomes poor. Advances in the knowledge and management of these injuries have arisen due to increased periods of conflict in the 20th and 21st centuries. With terrorist activity increasing globally, clinicians working in the civilian environment are increasingly being called upon to manage severe, high-energy injuries of the sort usually seen in conflict. This review considers the differences in the mechanism, pattern, and management of spinal trauma in a military combat setting to allow translation to a civilian setting.
{"title":"Spinal trauma related to military combat: characteristics, mechanisms of injury and principles of management","authors":"Louise Robiati, Edward Spurrier, Athanasios I. Tsirikos","doi":"10.1016/j.mporth.2024.07.010","DOIUrl":"10.1016/j.mporth.2024.07.010","url":null,"abstract":"<div><div>Trauma-related spinal injuries have been reported as far back as Egyptian times when their severity was recognized but treatment limited and outcomes poor. Advances in the knowledge and management of these injuries have arisen due to increased periods of conflict in the 20th and 21st centuries. With terrorist activity increasing globally, clinicians working in the civilian environment are increasingly being called upon to manage severe, high-energy injuries of the sort usually seen in conflict. This review considers the differences in the mechanism, pattern, and management of spinal trauma in a military combat setting to allow translation to a civilian setting.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 325-330"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1016/j.mporth.2024.07.002
Simon B Roberts, Athanasios I Tsirikos
Spinal cord injury (SCI) is a catastrophic neurological condition resulting in increased physical dependency, medical comorbidity, psychological distress and economic burden. New SCI affects 250,000–500,000 individuals globally each year. The pathophysiological mechanisms following SCI are incompletely understood, and the management of patients following SCI is challenging. Understanding the evolution of pathophysiological changes following SCI is fundamental to delivering and developing appropriate management strategies. Timely interventions following acute SCI can prevent secondary neurological deterioration and improve potential for neurological recovery. A bespoke, multidisciplinary and holistic approach to the management and rehabilitation of SCI patients can optimize physical and mental wellbeing and maximize patient's neurological recovery and functional capabilities. Current therapeutic options following SCI are limited and do not overcome the debilitating effects of SCI. Current knowledge of the pathophysiological mechanism following SCI, management strategies and novel therapies for adult and paediatric SCI patients are reviewed.
{"title":"Spinal cord injury: pathophysiology and principles of management","authors":"Simon B Roberts, Athanasios I Tsirikos","doi":"10.1016/j.mporth.2024.07.002","DOIUrl":"10.1016/j.mporth.2024.07.002","url":null,"abstract":"<div><div>Spinal cord injury (SCI) is a catastrophic neurological condition resulting in increased physical dependency, medical comorbidity, psychological distress and economic burden. New SCI affects 250,000–500,000 individuals globally each year. The pathophysiological mechanisms following SCI are incompletely understood, and the management of patients following SCI is challenging. Understanding the evolution of pathophysiological changes following SCI is fundamental to delivering and developing appropriate management strategies. Timely interventions following acute SCI can prevent secondary neurological deterioration and improve potential for neurological recovery. A bespoke, multidisciplinary and holistic approach to the management and rehabilitation of SCI patients can optimize physical and mental wellbeing and maximize patient's neurological recovery and functional capabilities. Current therapeutic options following SCI are limited and do not overcome the debilitating effects of SCI. Current knowledge of the pathophysiological mechanism following SCI, management strategies and novel therapies for adult and paediatric SCI patients are reviewed.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 264-272"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1016/j.mporth.2024.07.001
Simon B Roberts, Athanasios I Tsirikos
Biomechanics is the application of principles of engineering and computers to biological problems. Clinical biomechanics of the spine is the understanding of normal and pathological functions of the human vertebral column in response to mechanical insult, which may include traumatic, degenerative, pathological, or slowly applied loads to the spine. Spinal biomechanics involves the regional features of the vertebrae, intervertebral discs, ligaments, facet joints and muscles. The role of these structures individually and in concert in relation to spinal injuries is discussed. Regional spinal biomechanics, maintenance of spinal stability and assessment of spinal instability following injury are described. Finally, the biomechanical principles, individual structural components, mechanisms of injury and principles specific to the adult and paediatric spine are reviewed.
{"title":"Biomechanics of the spine and the implications for spinal injuries","authors":"Simon B Roberts, Athanasios I Tsirikos","doi":"10.1016/j.mporth.2024.07.001","DOIUrl":"10.1016/j.mporth.2024.07.001","url":null,"abstract":"<div><div>Biomechanics is the application of principles of engineering and computers to biological problems. Clinical biomechanics of the spine is the understanding of normal and pathological functions of the human vertebral column in response to mechanical insult, which may include traumatic, degenerative, pathological, or slowly applied loads to the spine. Spinal biomechanics involves the regional features of the vertebrae, intervertebral discs, ligaments, facet joints and muscles. The role of these structures individually and in concert in relation to spinal injuries is discussed. Regional spinal biomechanics, maintenance of spinal stability and assessment of spinal instability following injury are described. Finally, the biomechanical principles, individual structural components, mechanisms of injury and principles specific to the adult and paediatric spine are reviewed.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"38 5","pages":"Pages 258-263"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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