UNASSIGNED: Pediatric cervical spine injuries (CSIs) from blunt trauma carry a high risk of neurological damage. Accurate diagnosis is vital for preventing harm and aiding recovery, yet the diagnostic accuracy of clinical decision rules (CDRs) remains unclear.
UNASSIGNED: To assess the effectiveness of triage tools for detecting CSI in pediatric trauma patients.
UNASSIGNED: A summary of the Cochrane Review by Tavender et al. (2024), with comments from a rehabilitation perspective.
UNASSIGNED: Five studies with 21,379 participants assessed seven CDRs. Direct comparisons showed high sensitivity but low specificity across different CDRs. Indirect comparison studies also demonstrated varying sensitivities and specificities.
UNASSIGNED: Insufficient evidence exists to determine the best tools for deciding if imaging is necessary for diagnosing potential CSI in children. Better quality studies are needed to assess the accuracy of CDRs for cervical spine clearance in this population.

OBJECTIVE: Minimally invasive spinal trauma surgery includes percutaneous pedicle screw fixation and miniature open anterolateral retractor-based approaches, which can improve surgical outcomes by reducing blood loss, operative time, and postoperative pain. Therefore, this study aimed to evaluate the effect of minimally invasive surgery on pain scores, functional recovery, and postoperative complications in patients with spinal trauma.
METHODS: This retrospective study included 100 spinal trauma patients treated in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine between May 2019 and May 2022. Patients who underwent traditional open surgery were included in the traditional group, and those who received percutaneous pedicle screw internal fixation combined with posterior minimally invasive small incision decompression were included in the research group, each comprising 50 patients. The effectiveness of these two surgical approaches was determined by assessing their outcome measures, including surgery-related indices, postoperative pain, spinal morphology, functional recovery, and postoperative complications.
RESULTS: Minimally invasive surgery was associated with significantly shorter surgical wounds, length of hospital stay, operative time, and postoperative time-lapse before off-bed activity, and less intraoperative hemorrhage volume and postoperative drainage volume compared to open surgery (p < 0.001). Compared to open surgery, patients with minimally invasive surgery showed significantly lower visual analogue scale (VAS) scores at 3 days, 3 months, and 6 months after surgery and lower Oswestry dysfunction index (ODI) at 7 days and 3 months after surgery (p < 0.05). Furthermore, the difference in the spine morphology between the two arms did not achieve statistical significance (p > 0.05). Additionally, minimally invasive surgery resulted in a significantly lower incidence of postoperative complications than open surgery (p < 0.05).
CONCLUSIONS: Minimally invasive surgery causes less surgical damage for patients with spinal trauma, improves surgery-related indexes, alleviates postoperative pain, and provides better morphological and functional recovery of the spine.

BACKGROUND: Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed.
METHODS: An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75-85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2.
RESULTS: Twenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90-95%). The integral flowchart received strong consensus (93%).
CONCLUSIONS: This study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.

Morphology of injuries following gunshot wounds requires specific treatment approaches. Currently, there are no similar classifications for assessing fracture stability with subsequent tactical recommendations. Taking into account diagnostic limitations (contraindications for MRI due to implantable metal fragments, limitations of functional radiography of the spine in seriously injured patients), we make decisions considering CT data. In this study, we will determine severity of vertebral damage and effect of these damages on mechanical stability of spinal motion segments. In the future, CT-based assessment of inter-expert agreement will be performed. Finally, we will propose the scoring system for classification of spinal gunshot wounds.
OBJECTIVE: To present a research protocol for development of new scoring system for unstable spinal gunshot wounds based on inter-expert agreement assessment.
METHODS: To create a new tactical classification, we will distinguish and analyze clinical and CT data of patients with thoracolumbar spinal gunshot wounds. The Delphi method will be used to collaborate between several surgeons. A three-stage study will result a questionnaire (for 30 clinical cases). We will develop tactical scoring system and analyze statistical data (kappa).
CONCLUSIONS: Various classifications have been developed for closed spinal injuries. These systems describe the nature of injury and allow one to develop tactical decisions for further actions. Another mechanism of injuries following gunshot wounds does not allow the classification of closed injuries to be adequately applied in some cases. Indeed, spinal structures follow either direct passage of a wounding projectile through the spine or transferring the energy of this projectile in contrast to classical compression, distraction and rotational-translation mechanisms typical for closed trauma.
Морфология повреждений при огнестрельных ранениях требует специфических подходов к тактике лечения данной группы пациентов. В настоящее время отсутствуют подобные классификации для оценки стабильности перелома с последующими тактическими рекомендациями. Учитывая диагностические ограничения (противопоказания к магнитно-резонансной томографии из-за наличия металлических осколков в теле, ограничение применения функциональной рентгенографии позвоночника у тяжелораненых), все решения принимаются на основе анализа компьютерной томограммы. В исследовании планируется определить тяжесть повреждений анатомических структур позвонков, влияние этих повреждений на механическую стабильность позвоночно-двигательного сегмента. В дальнейшем на основе анализа данных компьютерной томограммы будет проанализирован уровень согласия хирургов-экспертов и предложена балльная оценка стабильности по новой классификации огнестрельных ранений позвоночника.
UNASSIGNED: Представить протокол исследования по разработке новой тактической классификации, позволяющей произвести балльную оценку стабильности повреждения в позвоночно-двигательном сегменте при огнестрельных ранениях на базе оценки уровня согласия в группе хирургов-экспертов.
UNASSIGNED: Для создания новой тактической классификации планируется выделить и проанализировать результаты клинических данных и компьютерно-томографические исследования пациентов с огнестрельным ранением грудопоясничного отдела позвоночника, соответствующих критериям включения. Для совместной работы нескольких хирургов будет применен метод Delphi. В результате трехэтапного исследования будет составлен опросник (для 30 клинических случаев), разработана балльная тактико-хирургическая классификация и проведен статистический анализ полученных данных (kappa).
UNASSIGNED: Для закрытых повреждений позвоночника разработаны классификации, которые описывают характер травмы и позволяют выработать тактические решения для дальнейших действий. Иной механизм повреждения при огнестрельных ранениях в ряде случаев не позволяет адекватно применить классификации закрытых повреждений, так как переломы структур позвоночника возникают в результате или прямого прохождения через них ранящего снаряда, или путем передачи энергии от снаряда, а не в результате классических компрессионных, дистракционных и ротационно-трансляционных механизмов при закрытой травме.

BACKGROUND: Subaxial cervical spine injuries (SCSI) can lead to disastrous consequences such as quadriplegia, with/without respiratory paralysis (RP) and hemodynamic instability (HDI). Till date, there is no literature available for reporting outcomes of SCSI patients specifically pertaining to those presenting with RP/HDI and ours is the first study to document the same.
METHODS: Retrospective 6-year study from a tertiary trauma centre database including patients >/= 18 years of operated SCSI. Only patients with ASIA A grade with admission RP/HDI and unstable injuries (fractures, subluxations) were included. Patients with ASIA grade B and above, patients with non-osseous injuries (such as disc herniation, central cord syndrome etc.) were excluded.
RESULTS: 24 cases were analysed. C5 and C6 levels were the commonest. Vertebral listhesis/subluxation was the predominant radiological finding. The mean age was 47.4 years (22-79 years) and all, except one were males. Fall from height and road traffic accident (RTA) were the most common mechanisms of injury. The most common surgery was anterior discectomy and fusion followed by corpectomy. The overall mortality rate was 22/24 (92)%. Cord edema and hemorrhage had significant association with survival. None of the grade A survivors with HDI/RP showed improvement. The mean FU duration was 18.5 months (range, 16.5-20.5 months).
CONCLUSIONS: Subaxial ASIA A cervical spine injuries with pre-operative RP/HDI is an indicator for non-improvement. This is the first study documenting outcome in such patients. The mortality rate in these patients is very high and is an extremely poor prognostic factor for recovery. Hence, surgery in such patients need to be decided judiciously, especially in developing countries that has a significant financial impact on the family members.

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.

BACKGROUND: A difficult airway is anticipated with cervical spine injuries (CSIs) as immobilization techniques such as manual in-line stabilization (MILS) are used, which distort the oro-pharyngeal-laryngeal axis. Video laryngoscopes (VLs) make difficult airway management easy, as they do not require axis alignment. The present study aimed to compare the total time taken by Macintosh laryngoscope (ML), conventional blade, and D-blade ™ of C-MAC ® VL in simulated CSI scenarios using MILS.
METHODS: Ninety patients were randomly allocated into three groups: Group M (ML), Group C (conventional blade of C-MAC ® ), and Group D (D-blade ™ of C-MAC ® ) with MILS applied before intubation. Primary outcome was the total time taken for successful intubation, while secondary outcomes were to assess Cormack-Lehane (CL) grade, number of attempts, hemodynamic response, and associated complications.
RESULTS: Total time for intubation in Group C was 23.40 ± 7.06 sec compared to 35.27 ± 6.53 and 47.27 ± 2.53 sec in groups D and M, respectively ( P < 0.001). CL-grade I was observed in 15/30 (50%) in Group M, 25/30 (83.3%) in Group C, and 29/30 (96.7%) in Group D. Group M reported 7/30 (23.3%) failed intubations, while none were observed in other groups. Hemodynamic parameters were significantly higher at 3 and 5 min in Group M. Postoperative sore throat was recorded in 12/30 (40%) in Group M compared to 3/30 (10%) in groups C and D each ( P value 0.037).
CONCLUSIONS: C-MAC ® VL requires less time for intubation, provides better glottic view, and has higher success, with better attenuation of hemodynamic response and fewer complications compared to ML.

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.