Keywords
thoracolumbar junction
direct traumatic mechanism
surgical treatment
How to Cite
Abstract
Summary – Contusion spine injuries resulting from direct traumatic mechanisms that lead to spinal cord lesion are relatively rare during peacetime. The specific characteristics of such injuries are not extensively covered in contemporary literature. The need to optimize treatment methods for military personnel engaged in active combat operations on the territory of Ukraine necessitates an examination of this specific type of injury.
Objective: To describe the clinical presentation and explore possible therapeutic approaches for closed contusion spinal cord injuries in the thoracolumbar junction.
Materials and Methods: We conducted an analysis of patient data from those admitted for inpatient treatment at the Romodanov Neurosurgery Neurosurgery of National Academy of Medical Sciences of Ukraine, as well as patients referred to other healthcare institutions in Kyiv, from February 2022 to May 2023.
Results: We analyzed the treatment outcomes of 5 patients, aged 27 to 53 years (mean age: 37.6 years), presenting with initial neurological deficits classified as ASIA A. Surgery was performed in 3 patients. All cases underwent wide laminectomy with facetectomy at the level of injury. Large arachnoid cysts were drained, and in one case, a subdural hematoma was removed. Posterior spinal fusion using an 8-screw transpedicular system was performed in all patients, utilizing a minimally invasive percutaneous approach. At the 2-month follow- up positive dynamics were observed in all patients. Neurological status improved to ASIA B in 2 cases and ASIA C in 1. Recovery of proprioceptive sensitivity was noted, as well as an increase in the intensity of neuropathic pain (up to 5-7 points at 2 months). In 2 patients undergoing conservative therapy, the neurological impairment level remained ASIA A, with pain intensity not exceeding 2 points.
Conclusions: The findings emphasize the need for more comprehensive instrumental assessment in patients with suspected contusion spinal cord injuries. Active use of surgical treatment methods in this type of injury contributes to achieving better clinical outcomes.
References
Smith HE, Anderson DG, Vaccaro AR, Albert TJ, Hilibrand AS, Harrop JS, et al. Anatomy, Biomechanics, and Classification of Thoracolumbar Injuries. Seminars in Spine Surgery. 2010;22(1):2-7. doi: 10.1053/j.semss.2009.10.001.
den Ouden LP, Smits AJ, Stadhouder A, Feller R, Deunk J, Bloemers FW. Epidemiology of Spinal Fractures in a Level One Trauma Center in the Netherlands: A 10 Years Review. Spine (Phila Pa 1976). 2019;44(10):732-739. doi: 10.1097/BRS.0000000000002923.
Sances A, Jr., Myklebust JB, Maiman DJ, Larson SJ, Cusick JF, Jodat RW. The biomechanics of spinal injuries. Crit Rev Biomed Eng. 1984;11(1):1-76.
Allen BL, Jr., Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1-27. doi: 10.1097/00007632-198200710-00001.
Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201. doi: 10.1007/BF02221591.
Coelho DG, Brasil AV, Ferreira NP. Risk factors of neurological lesions in low cervical spine fractures and dislocations. Arq Neuropsiquiatr. 2000;58(4):1030-1034. doi: 10.1590/s0004282x2000000600009.
Bruno AG, Burkhart K, Allaire B, Anderson DE, Bouxsein ML. Spinal Loading Patterns From Biomechanical Modeling Explain the High Incidence of Vertebral Fractures in the Thoracolumbar Region. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2017;32(6):1282-1290. doi: 10.1002/jbmr.3113.
Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028-2037. doi: 10.1097/BRS.0b013e3182a8a381.
Sirko AH, Pylypenko MM, Huk AP, Komok OA. Boiova travma ta poranennia holovy, shyi ta khrebta. Suchasni pryntsypy nevidkladnoi dopomohy. Navchalnyi posibnyk. Kyiv: Medknyha; 2020.
Blair JA, Possley DR, Petfield JL, Schoenfeld AJ, Lehman RA, Hsu JR, et al. Military penetrating spine injuries compared with blunt. Spine J. 2012;12(9):762-768. doi: 10.1016/j.spinee.2011.10.009.
Maynard FM, Jr., Bracken MB, Creasey G, Ditunno JF, Jr., Donovan WH, Ducker TB, et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord. 1997;35(5):266-274. doi: 10.1038/sj.sc.3100432.
Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain. 2011;152(10):23992404. doi: 10.1016/j.pain.2011.07.005.
Moriarty HK, R OC, Moriarty PD, Stanley E, Lawler LP, Kavanagh EC. MR imaging of spinal haematoma: a pictorial review. The British journal of radiology. 2019;92(1095):20180532. doi: 10.1259/bjr.20180532.
Goodrich JT. History of spine surgery in the ancient and medieval worlds. Neurosurg Focus. 2004;16(1):E2. doi: 10.3171/foc.2004.16.1.3.
Schoenfeld AJ, Lehman RA, Jr., Hsu JR. Evaluation and management of combat-related spinal injuries: a review based on recent experiences. Spine J. 2012;12(9):817-823. doi: 10.1016/j.spinee.2011.04.028.
Reister FA, General USPHSOotS. Battle Casualties and Medical Statistics;: U.S. Army Experience in the Korean War: Surgeon General, Department of the Army; 1973.
Hardaway RM, 3rd. Viet Nam wound analysis. J Trauma. 1978;18(9):635-643. doi: 10.1097/00005373-19780900000004.
Parsons TW, 3rd, Lauerman WC, Ethier DB, Gormley W, Cain JE, Elias Z, et al. Spine injuries in combat troops - Panama, 1989. Mil Med. 1993;158(7):501-502.
Belmont PJJ, Goodman GP, Zacchilli M, Posner M, Evans C, Owens BD. Incidence and Epidemiology of Combat Injuries Sustained During «The Surge» Portion of Operation Iraqi Freedom by a U.S. Army Brigade Combat Team. Journal of Trauma and Acute Care Surgery. 2010;68(1):204-210. doi: 10.1097/ TA.0b013e3181bdcf95.
Schoenfeld AJ, Goodman GP, Belmont PJ, Jr. Characterization of combat-related spinal injuries sustained by a US Army Brigade Combat Team during Operation Iraqi Freedom. Spine J. 2012;12(9):771-776. doi: 10.1016/j.spinee.2010.05.004.
Owens BD, Kragh JF, Jr., Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008;64(2):295-299. doi: 10.1097/TA.0b013e318163b875.
Blair JA, Patzkowski JC, Schoenfeld AJ, Cross Rivera JD, Grenier ES, Lehman RA, et al. Are spine injuries sustained in battle truly different? Spine J. 2012;12(9):824-829. doi: 10.1016/j.spinee.2011.09.012.
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