Neurotrauma means head or spine injury caused by an external force. Neurotraumatology care requires coordinated teamwork on the part of specialists, including psychological care as part of the multidisciplinary treatment team. Psychological interventions in the field of neurotraumatology aim to address the psychological consequences and challenges associated with head or spine injury. These interventions play a vital role in crisis intervention, promoting recovery, enhancing quality of life, and supporting individuals and their families in coping with the psychological impact of neurotrauma. Serious physical injuries always cause severe psychological consequences, both in short and long term. A critical accident is a sudden, unexpected, often directly life-threatening event that exceeds the individual\'s ability to respond and can create a potential crisis response, including suicidal risk, as well as the development of psychological disorders, in most cases acute stress disorder, adjustment disorder and post-traumatic stress disorder. Psychological interventions in neurotraumatology are often provided by a multidisciplinary team that may include psychologists, psychiatrists, social workers, and other healthcare professionals. These interventions are tailored to the unique needs and circumstances of each individual, with the goal of reducing psychological symptomps, promoting psychological well-being, adjustment, and overall recovery following neurotrauma. It is essential that not only patients who have experienced severe physical trauma, but also their family members have access to expert psychological support. This study summarizes psychological interventions during the treatment of neurotaruma patients at the intensive care unit.

Around a third of all cervical spine injuries occur in the upper cervical spine in the area between the occiput and the second cervical vertebra. The latter being the most common location of the injury with around 70%. But also atlas fractures, occipital condyle fractures, traumatic spondylolisthesis of C2, atypical fractures in the corpus area as well as atlantooccipital and atlantoaxial ligamentous lesions should be mentioned in connection with injuries in this area. In many cases, conservative therapy regimen is possible. In unstable or displaced injuries, however, surgical intervention is required, with various surgical procedures being used. The frequency, diagnostics, classification, and standard therapy of the individual entities are presented in detail in this continuing medical education article.

If severe cervical spinal cord injury or severe cervical vertebral fracture, subluxation or luxation is confirmed, 20-40% of the cases have vertebral artery dissection or occlusion. These can be asymptomatic, but can cause additional neurological damage in addition to cervical myelon and cervical nerve root symptoms. Vertebral artery dissection can be caused by direct injuries, stab wounds or gunshot wounds. Indirect vertebral artery dissection can occur at the same time as subluxation, luxation, or complex fractures of the cervical vertebra. CTA is the examination procedure of choice. In many cases, digital subtaction angiography examination and, if necessary, neurointerventional treatment must precede open neurosurgery. In our report, in the first patient, complete luxation of the C.VI vertebra caused unilateral vertebral artery 2-segment dissection-occlusion, while in our second patient, a stab injury caused direct vertebral artery compression and dissection. The occlusion of the vertebral artery did not cause neurological symptoms in any of the cases. In both of our cases, parent vessel occlusion was performed at the level of the vertebral artery injury before the neurosurgical operation.

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Ha súlyos nyaki gerincvelő-sérülést vagy súlyos nyaki csigolyatörést, subluxatiót vagy luxatiót igazolunk, akkor 20–40%-ban arteria vertebralis dissectio vagy okklúzió áll fenn. Ez lehet tünetmentes, de okozhat a nyaki myelon- és nyaki ideggyöktünetek mellett további neurológiai károsodásokat is. Az arteria vertebralis dissectio kialakulhat direkt sérülés által, szúrásos vagy lőtt sérülések esetén. Indirekt arteria vertebralis dissectio jöhet létre nyaki csigolya-subluxatióval, luxatióval vagy komplex csigolyatöréssel egy időben. CT-angiográfia az elsőként választandó vizsgálóeljárás. Számos esetben digitális szubsztrakciós angiográfia vizsgálatnak, illetve szükség esetén neurointervenciós beavatkozásnak kell megelőznie a nyílt idegsebészeti műtétet. Közleményünkben első betegünknél a C.VI. csigolya teljes luxálódása okozta az egyoldali arteria vertebralis kétszegmensnyi dissectiós elzáródását, míg második betegünknél szúrásos sérülés okozott direkt arteria vertebralis kompressziót és dissectiót. Az arteria vertebralis elzáródása egyik esetben sem okozott neurológiai tüneteket. Mindkét esetünkben az arteria vertebralis sérülésének magasságában szülőérelzárást végeztünk az idegsebészeti műtét előtt.

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Lumbar spine injuries resulting from heavy or repetitive lifting remain a prevalent concern in workplaces. Back-support devices have been developed to mitigate these injuries by aiding workers during lifting tasks. However, existing devices often fall short in providing multidimensional force assistance for asymmetric lifting, an essential feature for practical workplace use. In addition, validation of device safety across the entire human spine has been lacking. This paper introduces the Bilateral Back Extensor Exosuit (BBEX), a robotic back-support device designed to address both functionality and safety concerns. The design of the BBEX draws inspiration from the anatomical characteristics of the human spine and back extensor muscles. Using a multi-degree-of-freedom architecture and serially connected linear actuators, the device\'s components are strategically arranged to closely mimic the biomechanics of the human spine and back extensor muscles. To establish the efficacy and safety of the BBEX, a series of experiments with human participants was conducted. Eleven healthy male participants engaged in symmetric and asymmetric lifting tasks while wearing the BBEX. The results confirm the ability of the BBEX to provide effective multidimensional force assistance. Moreover, comprehensive safety validation was achieved through analyses of muscle fatigue in the upper and the lower erector spinae muscles, as well as mechanical loading on spinal joints during both lifting scenarios. By seamlessly integrating functionality inspired by human biomechanics with a focus on safety, this study offers a promising solution to address the persistent challenge of preventing lumbar spine injuries in demanding work environments.

BACKGROUND: Computed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED.
METHODS: We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into \"c-spine injured\" and \"c-spine uninjured\". Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers.
RESULTS: We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients\' stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7-90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients.
CONCLUSIONS: Our study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis.

BACKGROUND: Traumatic spinal injury (TSI) is a disease of significant global health burden, particularly in low and middle-income countries where road traffic-related trauma is increasing. This study compared the demographics, injury patterns, and outcomes of TSI caused by road traffic accidents (RTAs) to non-traffic related TSI.
METHODS: A retrospective analysis was conducted using a neurotrauma registry from the Muhimbili Orthopaedic Institute (MOI) in Tanzania, a national referral center for spinal injuries. Patient sociodemographic characteristics, injury level, and severity were compared across mechanisms of injury. Neurological improvement, neurological deterioration, and mortality were compared between those sustaining TSI through an RTA versus non-RTA, using univariable and multivariable analyses.
RESULTS: A total of 626 patients were included, of which 302 (48%) were RTA-related. The median age was 34 years, and 532 (85%) were male. RTAs had a lower male preponderance compared to non-RTA causes (238/302, 79% vs. 294/324, 91%, p<0.001) and a higher proportion of cervical injuries (144/302, 48% vs. 122/324, 38%, p<0.001). No significant differences between RTA and non-RTA mechanisms were found in injury severity, time to admission, length of hospital stay, surgical intervention, neurological outcomes, or in-hospital mortality. Improved neurological outcomes were associated with incomplete injuries (AIS B-D), while higher mortality rates were linked to cervical injuries and complete (AIS A) injuries.
CONCLUSIONS: Our study in urban Tanzania finds no significant differences in outcomes between spinal injuries from road traffic accidents (RTAs) and non-RTA causes, suggesting the need for equitable resource allocation in spine trauma programs. Highlighting the critical link between cervical injuries and increased mortality, our findings call for targeted interventions across all causes of traumatic spinal injuries (TSI). We advocate for a comprehensive trauma care system that merges efficient pre-hospital care, specialized treatment, and prevention measures, aiming to enhance outcomes and ensure equity in trauma care in low- and middle-income countries.

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BACKGROUND: Anterior Cervical Discectomy and Fusion (ACDF) and Anterior Cervical Corpectomy and Fusion (ACCF) are both common surgical procedures in the management of pathologies of the subaxial cervical spine. While recent reviews have demonstrated ACCF to provide better decompression results compared to ACDF, the procedure has been associated with increased surgical risks. Nonetheless, the use of ACCF in a traumatic context has been poorly described. The aim of this study was to assess the safety of ACCF as compared to the more commonly performed ACDF.
METHODS: All patients undergoing ACCF or ACDF for subaxial cervical spine injuries spanning over 2 disc-spaces and 3 vertebral-levels, between 2006 and 2018, at the study center, were eligible for inclusion. Patients were matched based on age and preoperative ASIA score.
RESULTS: After matching, 60 patients were included in the matched analysis, where 30 underwent ACDF and ACCF, respectively. Vertebral body injury was significantly more common in the ACCF group (p = 0.002), while traumatic disc rupture was more frequent in the ACDF group (p = 0.032). There were no statistically significant differences in the rates of surgical complications, including implant failure, wound infection, dysphagia, CSF leakage between the groups (p ≥ 0.05). The rates of revision surgeries (p > 0.999), mortality (p = 0.222), and long-term ASIA scores (p = 0.081) were also similar.
CONCLUSIONS: Results of both unmatched and matched analyses indicate that ACCF has comparable outcomes and no additional risks compared to ACDF. It is thus a safe approach and should be considered for patients with extensive anterior column injury.

» Pediatric thoracolumbar trauma, though rare, is an important cause of morbidity and mortality and necessitates early, accurate diagnosis and management.» Obtaining a detailed history and physical examination in the pediatric population can be difficult. Therefore, the threshold for advanced imaging, such as magnetic resonance imaging, is low and should be performed in patients with head injuries, altered mental status, inability to cooperate with examination, and fractures involving more than 1 column of the spine.» The classification of pediatric thoracolumbar trauma is based primarily on adult studies and there is little high-level evidence examining validity and accuracy in pediatric populations.» Injury pattern and neurologic status of the patient are the most important factors when determining whether to proceed with operative management.