Validation of the AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting.

Purpose: To evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting.

Methods: Patients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center.

The Influence of Comminution and Posterior Ligamentous Complex Integrity on Treatment Decision Making in Thoracolumbar Burst Fractures Without Neurologic Deficit?

Study Design: A prospective study.

Objective: to evaluate the impact of vertebral body comminution and Posterior Ligamentous Complex (PLC) integrity on the treatment recommendations of thoracolumbar fractures among an expert panel of 22 spine surgeons.

Methods: A review of 183 prospectively collected thoracolumbar burst fracture computed tomography (CT) scans by an expert panel of 22 trauma spine surgeons to assess vertebral body comminution and PLC integrity.

Expert Opinion, Real-World Classification, and Decision-Making in Thoracolumbar Burst Fractures Without Neurologic Deficits?

Study Design: Retrospective analysis of prospectively collected data.

Objectives: To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making.

Methods: This study is a sub-analysis of a prospective observational study in TL fractures.

The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit.

Study Design: Prospective Observational Study.

Objective: To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making.

Methods: 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts.

Interobserver Reliability in the Classification of Thoracolumbar Fractures Using the AO Spine TL Injury Classification System Among 22 Clinical Experts in Spine Trauma Care.

Study Design: Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations.

Objectives: To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier.

Methods: Kappa and Intraclass correlation coefficients were produced.

Understanding Decision Making as It Influences Treatment in Thoracolumbar Burst Fractures Without Neurological Deficit: Conceptual Framework and Methodology.

Study Design: This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue.

Objectives: Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoracolumbar burst fractures (TL) fractures.

Methods: We will describe the methodology used in the AO Spine TL A3/4 Study prospective observational study and how the radiographs collected for this study were utilized to study the relationships between various variables that factor into surgeon decision making.

Predictive Algorithm for Surgery Recommendation in Thoracolumbar Burst Fractures Without Neurological Deficits.

Study Design: Predictive algorithm via decision tree.

Objectives: Artificial intelligence (AI) remain an emerging field and have not previously been used to guide therapeutic decision making in thoracolumbar burst fractures. Building such models may reduce the variability in treatment recommendations.

Thoracic costotransversectomy characteristics and 90-day complications vary based on underlying diagnosis.

Objective: Thoracic costotransversectomies are among the most invasive spinal procedures performed and are associated with unanticipated medical and surgical complications. Few studies have specifically assessed medical and surgical complications after a thoracic corpectomy via a costotransversectomy approach (TCT) or compared complications between different diagnoses. The purpose of this study was to describe the differences in operative characteristics and rates of 90-day surgical and medical complications in patients undergoing TCTs based on underlying diagnosis.

The Diagnostic Process of Spinal Post-traumatic Deformity: An Expert Survey of 7 Cases, Consensus on Clinical Relevance Does Exist.

Study Design: Survey of cases.

Objective: To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD).

Summary Of Background Data: SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment.

Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System.

Objective: The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery).

Methods: A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval.

"Floating Cervical Spine Injuries": Craniocervical Dissociation with Associated, Noncontiguous, Unstable Cervical or Cervicothoracic Spine Fracture.

Background: Advances in prehospital life support of patients who have sustained high-energy trauma have resulted in an increase in the number of patients with craniocervical dissociations (CCDs) surviving. With better imaging and more severely injured patients surviving, we are now seeing other associated injuries. CCDs in association with unstable, noncontiguous, subaxial spine injuries have not been described.

Incidence and degrees of neurologic decline following thoracic costotransversectomy.

Background Context: Thoracic costotransversectomies (TCT) are amongst the most invasive spine procedures performed. Of greatest concern to the patient and surgeon is the risk of iatrogenic neurologic injury associated with these procedures. Most available studies limit their assessment of neurologic function to nonspecific scales such as the broader ASIA scoring system of A to E and have not comprehensively described the rates of iatrogenic injury following these procedures by looking more precisely with ASIA motor scoring (0-100) which allows for more in-depth analysis.

The mandible-C2 angle: a new radiographic assessment of occipitocervical alignment.

Background Context: Occipitocervical fusion is a rare and often challenging surgical procedure. Significant morbidity can result if care is not taken to achieve physiologic alignment. This is especially true for patients needing occipitocervical fusion in the setting of trauma where preoperative alignment is unknown.

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery.

OBJECTIVEThe purpose of this study was to compare total cost and length of stay (LOS) between spine surgery patients enrolled in an enhanced perioperative care (EPOC) pathway and patients receiving traditional perioperative care (TRDC).METHODSAll spine surgery candidates were screened for inclusion in the EPOC pathway. This cohort was compared to a retrospective cohort of patients who received TRDC and a concurrent group of patients who met inclusion criteria but did not receive the EPOC (no pathway care [NOPC] group).

The impact of stenosis and translation on spinal cord injuries in traumatic cervical facet dislocations.

Background Context: Although facet dislocations account for only 6% of cervical trauma, the consequences are often devastating. Cervical facet dislocations are associated with a disproportionate amount of spinal cord injuries; however, neurologic examination of patients is often difficult, as patients commonly present with reduced levels of consciousness. There are limited studies that have investigated the impact of spinal canal diameter and translation on neurologic injury following facet dislocations.

Is routine MRI of the spine necessary in trauma patients with ankylosing spinal disorders or is a CT scan sufficient?

Background: Ankylosing spinal disorder (ASD) patients are at a greater risk for spinal fractures due to osteoporosis and rigidity of the spinal column. These fractures are associated with a high risk of neurologic compromise resulting from delayed or missed diagnoses. Although computed tomography (CT) is usually the initial imaging modality, magnetic resonance imaging (MRI) has been proposed as mandatory to help identify spinal injuries in ASD patients with unexplained neck or back pain or known injuries to help identify noncontiguous fractures.

Medial external fixation for staged treatment of closed calcaneus fractures: Surgical technique and case series.

The derangement in calcaneal morphology after a fracture can be significant and is often associated with severe soft tissue envelop problems. Medial calcaneal external fixation is useful for early restoration of calcaneal morphology and the corresponding soft tissue envelop. When performed in a stepwise fashion, external fixation can successfully restore normal calcaneal height, length, width, and coronal plane alignment.

Traumatic Cervical Unilateral and Bilateral Facet Dislocations Treated With Anterior Cervical Discectomy and Fusion Has a Low Failure Rate.

Study Design: Retrospective radiographic and chart review.

Objective: To define the rate and associated risk factors of treatment failure of anterior cervical fusion for treatment of cervical facet dislocations.

Methods: Between 2004 and 2014, a retrospective review at a single level 1 trauma center identified 38 patients with unilateral or bilateral dislocated facet(s) treated with anterior cervical discectomy and fusion (ACDF).

Methylprednisolone Therapy in Acute Traumatic Spinal Cord Injury: Analysis of a Regional Spinal Cord Model Systems Database.

Background: The objective of this study was to assess the relationship between exposure to methylprednisolone (MP) and improvements in motor function among patients with acute traumatic spinal cord injury (TSCI). MP therapy for patients with TSCI is controversial because of the current conflicting evidence documenting its benefits and risks.

Methods: We conducted a retrospective cohort study from September 2007 to November 2014 of 311 patients with acute TSCI who were enrolled into a model systems database of a regional, level I trauma center.

Cervical facet dislocations in the adolescent population: a report of 21 cases at a Level 1 trauma center from 2004 to 2014.

Purpose: The purpose of this study was to present a series of adolescent patients with cervical facet dislocations to identify the mechanism of injury, severity of neurological injury and rate of neurological recovery.

Methods: Between 2004 and 2014, a retrospective review at a level I trauma center identified patients with unilateral or bilateral dislocated facet(s). Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed.

Occult Cranial Cervical Dislocation: A Case Report and Brief Literature Review.

Study Design. Retrospective case report and review. Objective.

A Technique to Allow Prone Positioning in the Spine Surgery Patient With Unstable Spine Fracture and Flail Segment Rib Fractures.

Two patients with unstable thoracic spine and flail segment rib fractures initially failed prone positioning on a Jackson spinal table used for posterior spinal instrumentation and fusion surgery. Both patients experienced rapid hemodynamic collapse. We developed a solution using the anterior portions of a thoracolumbosacral orthosis brace as chest supports to use during prone positioning, allowing both patients to undergo uncomplicated posterior spinal instrumentation and fusion surgeries with greater hemodynamic stability.

Floating Lateral Mass Fractures of the Cervical Spine.

Study Design: Level I trauma center case series.

Objective: The purpose of this study was (i) to characterize the floating lateral mass (FLM) fracture with the mechanism of injury, anatomical injury pattern, associated vascular injuries, neurological deficits, and key radiographic features; and (ii) to better understand the most effective method of treatment.

Summary Of Background Data: An uncommon and poorly described subset of unilateral lateral mass fractures is FLM with fractures of the adjacent pedicle and lamina.