Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS).

Background: The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies.

Methods: A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established.

Neurological recovery after early versus delayed surgical decompression for acute traumatic spinal cord injury.

The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI). Patients with tSCI requiring surgical spinal decompression presenting to 17 centres in Europe were recruited. Depending on the timing of decompression, patients were divided into early (≤ 12 hours after injury) and late (> 12 hours and < 14 days after injury) groups.

Management of a Lumbar Burst Fracture Occurring After a Sneeze in a Patient Affected by Systemic Mastocytosis: A Case Report.

Case: We present a 36-year-old man with L1 burst fracture after a sneeze. He was in follow-up for indolent systemic mastocytosis (ISM), and osteoporosis was treated with bisphosphonate. Owing to neurologic impairment, posterior decompressive laminectomy and thoraco-lumbar fusion with cemented screws were performed.

Use of the SpineJack direct reduction for treating type A2, A3 and A4 fractures of the thoracolumbar spine: a retrospective case series.

Background: Compression injuries of the thoracolumbar spine without neurological impairment are usually treated with minimally invasive procedures. Intravertebral expandable implants represent an alternative strategy in fractures with low fragments' displacement.

Methods: Patients with A2, A3 and A4 fractures of the T10-L2 spinal segment without neurological impairment, fracture gap >2 mm, vertebra plana, pedicle rupture, pedicle diameter <6 mm, spinal canal encroachment ≥50%, and vertebral body spread >30% were treated with the SpineJack device.

Posterior Osteotomy and Osteosynthesis for Malunited Atlas Fracture: A Surgical Technique.

Conservative treatment is commonly accepted and widely used for most atlas compression fractures. Malunion due to mismatching of the articular surfaces in C0-C1 and C1-C2 is therefore frequent even without associated instability. Such a result is considered acceptable in the elderly with low functional requests but should be avoided in young patients.

Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience.

Study Design: Retrospective multicenter.

Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH.

Pharyngo-Esophageal Perforations After Anterior Cervical Spine Surgery: Management and Outcomes.

Objective: To report about the diagnosis, surgical treatment, and postoperative management of pharyngo-esophageal perforations (PEPs) after anterior cervical spine (ACS) surgery in 17 patients.

Methods: A retrospective multicenter case series of patients surgically treated for PEP after ACS surgery was performed. Data regarding cervical spine pathology and surgery, comorbidities, diagnosis and surgical management of PEP, airway management, antibiotic therapy, postoperative course, and feeding route after repair surgery at discharge and last follow-up were collected.

Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study.

Study Design: Retrospective multicenter study.

Objective: Analysis of impact of conservative and surgical treatments on functional outcome of geriatric odontoid fractures.

Summary Of Background Data: Treatment of odontoid fractures in aged population is still debatable.

Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal?

Purpose: Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome.

Methods: A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index (CCI).

Vertebral body spread in thoracolumbar burst fractures can predict posterior construct failure.

Background Context: The load sharing classification (LSC) laid foundations for a scoring system able to indicate which thoracolumbar fractures, after short-segment posterior-only fixations, would need longer instrumentations or additional anterior supports.

Purpose: We analyzed surgically treated thoracolumbar fractures, quantifying the vertebral body's fragment displacement with the aim of identifying a new parameter that could predict the posterior-only construct failure.

Study Design: This is a retrospective cohort study from a single institution.

Lumboiliac fixation in lumbosacral dislocation and associated injuries of the pelvis and lumbosacral junction: a long-term radiological and clinical follow-up.

Introduction: The goal of the study was to evaluate both clinical and radiological outcome of a consecutive series of 11 patients submitted to lumboiliac fixation after lumbopelvic disjunction or associated injuries of the pelvis and lumbosacral tract in mid- and long-term follow-up.

Material And Methods: The following were evaluated from clinical charts: damage control preoperative procedures, surgery, and pre-, intra- and post-operative complications; imaging was also evaluated from the preoperative assessment to the final follow-up (4 to 13.2 years; average 7.

Aggressive hemangioma of the spine in a pregnant female: a case report and literature review.

Type and timing of treatment for symptomatic hemangiomas in pregnant females are challenging due to fetus survival and conflicts in neurological recovery. In this article, we report a 40-year-old female patient at pregnancy week 23 with a complicated hemangioma at T1 level. Physical examination revealed an incomplete spastic paraplegia.

Costotransverse screw fixation in a severe cervicothoracic deformity because of a type 1 neurofibromatosis: case report.

Background Context: Spinal implant placement may be challenging in cases of severe cervicothoracic spinal deformities and anatomical anomalies as in Type 1 neurofibromatosis. Intralaminar screwing of the thoracic spine has been described in few cases in which pedicles were hypoplasic. The costovertebral joints have never been used before as an anchorage point for screws.

Sitting imbalance cause and consequence of post-traumatic Charcot spine in paraplegic patients.

Purpose: To analyze the role of spine alignment in post-traumatic paraplegic patient as a potential cause of late Charcot spine disease (CSD).

Method: A retrospective review of three cases in which the disease appeared more than 15 years after a spinal cord injury treated by posterior fusion. A review of the literature concerning spine balance in sitting position, especially referred to paraplegic patients, is done to validate this hypothesis.

Traumatic expulsion of T4 vertebral body into the spinal canal treated by vertebrectomy and spine shortening.

Study Design: A case report.

Objective: To describe an exceptional case of traumatic 2-level adjacent disk disruption with expulsion of the vertebral body into the spinal canal treated by vertebrectomy and spine shortening.

Summary Of Background Data: Traumatic spondyloptosis is a very rare injury caused by high-energy trauma.

En bloc resections for primary spinal tumors in 20 years of experience: effectiveness and safety.

Background Context: Many studies have demonstrated that en bloc surgical resection of primary spinal tumors with adequate margins results in improved local disease control and survival compared with intralesional excision. Nevertheless, the use of this procedure is under debate because most of the current evidence is provided by small and heterogeneous series of cases.

Purpose: To validate the application of en bloc resection for the treatment of aggressive benign and primary malignant spinal tumors.

Occipito-cervical fusion in post-traumatic instability of the upper cervical spine and cranio-cervical junction.

Introduction: Surgical management of upper cervical spine (UCS) unstable injuries may be challenging as the number of cases requiring this surgery collected in every single center is small. This retrospective study was conducted to analyze the radiographic and clinical results in 12 patients undergoing a posterior occipito-cervical fusion by a polyaxial screws-rod-plate system.

Methods: There were eight male and four female patients with a mean age of 73.

Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures.

Minimally invasive stabilization of thoracic and lumbar fractures without neurologic involvement is becoming a more frequent alternative to open fusion and conservative treatment. The authors analyzed the complication rate and limits of this technique in a consecutive series of 99 patients (127 thoracolumbar vertebral fractures) who underwent this technique between May 2005 and November 2009. Eighty-three patients had only spine injuries, whereas 16 had polytrauma injuries (mean Injury Severity Score, 25.

Minimal invasive percutaneous fixation of thoracic and lumbar spine fractures.

We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months), and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine.

Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity.

Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases.

Background: This prospective mixed cohort study was designed to evaluate the middle- to long-term purchase of cement-augmented pedicular screws in patients with poor bone quality. The growing number of surgical procedures performed in the spine has highlighted the problem of screws loosening in patients with poor bone stock due to osteoporosis and/or tumors. Different methods of increasing screw purchase have been reported in the literature, including polymethylmethacrylate (PMMA) augmentation.

Diagnosis and planning in the management of musculoskeletal tumors: surgical perspective.

The evaluation of musculoskeletal tumors requires a close interaction between the orthopedic oncologist, radiologist, and the pathologist. Successful outcome can be achieved in a considerable number of patients by following the appropriate diagnostic strategies and staging studies. The aim of this article is to outline the presentation, imaging, and staging of the primary and metastatic bone and soft tissue tumors.

Transpharyngeal bone grafting for a dens delayed union in a toddler.

The authors report a case of dens fracture and complete quadriplegia in a 14-month-old child. Three months after reduction with a halo vest, there was no evidence of callus formation, so transoral transpharyngeal bone grafting and Minerva immobilization was performed, resulting in prompt healing without complications after 2 months, and a full neurological recovery and normal cervical spine motion at the 4-year follow-up.