BACKGROUND: Vertebral fragility fractures (VFFs) commonly result from low bone mass and microarchitecture deterioration of bone tissue. spinal orthoses are common non-pharmacological options for managing vertebral fracture pain. However, the effects of spinal orthoses on pain, physical functioning, and quality of life (QoL) are still debated. OBJECTIVE: This survey aimed to investigate the patients-reported outcomes of a dynamic spinal orthosis prescribed in the routine clinical practice of VFFs management. METHODS: This multi-center national-wide prospective cohort study assessed older patients (aged > 60 years) diagnosed with acute VFFs and prescribed with a dynamic spinal orthosis (Spinfast®). A survey questionnaire was realized and included sections on patient characterization, osteoporosis characterization, spinal orthosis, clinical outcomes, pain medications, and osteoporosis medications. The questionnaire was administered at baseline and after three months. A total of 68 patients completed the questionnaire at three months. Most patients had one or two VFFs and were treated with pain medications and osteoporosis medications. Compliance and tolerability of the spinal orthosis were assessed, and clinical outcomes such as pain intensity, physical functioning, and QoL were measured. RESULTS: The results showed no significant differences in outcomes between age subgroups. Italian physical medicine and rehabilitation physicians were commonly involved in the management of VFFs patients. Sixty-six patients completed the questionnaire. The results showed that pain intensity, physical functioning and QoL improved after three months of spinal orthosis wearing (p< 0.0001). CONCLUSION: The correct management of VFFs is mandatory to improve pain and reduce disability, and our findings suggested a positive role of dynamic spinal orthosis to improve the comprehensive management of VFFs patients. However, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.
- MeSH
- bolesti zad rehabilitace terapie MeSH
- fraktury páteře * rehabilitace MeSH
- hodnocení výsledků péče pacientem MeSH
- kvalita života * MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti MeSH
- osteoporotické fraktury * rehabilitace MeSH
- prospektivní studie MeSH
- protetické prostředky * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- zpráva o sobě MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- MeSH
- lidé MeSH
- poranění páteře * diagnostické zobrazování klasifikace terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION: Pathological destruction of the axis vertebra leads to a highly unstable condition in an upper cervical spine. As surgical resection and anatomical reconstruction of the second cervical vertebrae represents a life threatening procedure, less radical approaches are preferred and only few cases of C2 prosthesis are described in literature. CASE DESCRIPTION: The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed CONCLUSION: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection.
- MeSH
- axis chirurgie zranění MeSH
- fraktury páteře * chirurgie MeSH
- fraktury spontánní chirurgie etiologie MeSH
- fúze páteře * metody MeSH
- implantace protézy metody MeSH
- krční obratle chirurgie zranění MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory páteře chirurgie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- bolesti zad diagnóza etiologie terapie MeSH
- cvičení škodlivé účinky MeSH
- kraniocerebrální traumata diagnóza etiologie terapie MeSH
- lidé MeSH
- poranění dolní končetiny diagnóza etiologie terapie MeSH
- poranění kolena diagnóza terapie MeSH
- poranění kyčle MeSH
- poranění páteře diagnóza etiologie terapie MeSH
- poranění paže diagnóza etiologie terapie MeSH
- poranění ramene MeSH
- rány a poranění * diagnóza etiologie terapie MeSH
- sporty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION AND OBJECTIVES: The objective of the study was: (1) to describe changes in the shape of the atlas during growth, including gender and side differences; (2) to assess the dimension essential for identification of the optimal entry point; (3) to determine the age limit for a safe insertion of 3.5-mm screws into the lateral masses according to our own limiting parameters. MATERIALS AND METHODS: Dimensions of the atlas were measured on 200 CT scans of the craniocervical junction in individuals aged 0-18 years and on 34 anatomical specimens of the first cervical vertebra (aged 2.5-18 years). Both series were divided according to the gender and age. The values measured on CT scans were used for statistical comparison of data in boys and girls and comparison of the right and left sides. RESULTS: The atlas reaches its maximum growth rate between 0 and 2 years of age, then the growth decelerates and continues until the age of 18 years. The proportion of dimensions of C1 vertebral foramens changes with age. The youngest children show a relatively greater distance from the left to the right medial pedicle; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater. The transverse foramen has a slightly oval shape throughout the period of growth. Statistically significant differences between boys and girls were observed primarily between 12 and 18 years of age. CONCLUSION: The study has proved adequate size of lateral masses for insertion of 3.5-mm screws in all patients from the age of 5 years. In younger children, the patient ́s anatomy should be respected and the surgical technique tailored accordingly.
- MeSH
- atlas (obratel) * anatomie a histologie diagnostické zobrazování chirurgie MeSH
- dítě MeSH
- fraktury páteře * diagnostické zobrazování chirurgie MeSH
- kojenec MeSH
- kostní šrouby MeSH
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- počítačová rentgenová tomografie * MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- anamnéza MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- ortopedie organizace a řízení MeSH
- páteř anatomie a histologie MeSH
- poranění páteře * chirurgie diagnostické zobrazování klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Cervical fractures are rare after non-judicial hangings. Type-III Hangman's fracture (HF) is an unstable injury caused typically by motor vehicle accidents or falls. We describe the first reported case of a Type-III HF combined with occlusion of the right vertebral artery and non-occlusive dissection of both internal carotid arteries caused by near-hanging. We performed a posterior approach open reduction of dislocated C2 facets and C1 to C3 fusion. Carotid dissections were managed conservatively with long-term antiplatelet therapy. The patient survived without any neurological deficit and without any significant restriction of cervical motion.
- MeSH
- fraktury páteře * komplikace diagnostické zobrazování chirurgie MeSH
- fúze páteře * MeSH
- krční obratle diagnostické zobrazování chirurgie zranění MeSH
- lidé MeSH
- poranění krku * MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
PURPOSE OF THE STUDY The study aimed to draw up a diagnosis and treatment guidelines for the management of the most common compression fractures of the thoracolumbar spine in children. MATERIAL AND METHODS Between 2015 and 2017, pediatric patients with a thoracolumbar injury aged 0-12 years were followed up in the University Hospital in Motol and the Thomayer University Hospital. The age and gender of the patient, injury etiology, fracture morphology, number of injured vertebrae, functional outcome (VAS and ODI modified for children), and complications were assessed. An X-ray was performed in all patients, in indicated cases also an MRI scan was done, and in more severe cases a CT scan was obtained as well. RESULTS The average vertebral body kyphosis in patients with one injured vertebra was 7.3° (range 1.1°-12.5°). The average vertebral body kyphosis in patients with two injured vertebrae was 5.5° (range 2.1°-12.2°). The average vertebral body kyphosis in patients with more than two injured vertebrae was 3.8° (range 0.2°-11.5°). All patients were treated conservatively in line with the proposed protocol. No complications were observed, no deterioration of the kyphotic shape of the vertebral body was reported, no instability occurred, and no surgical intervention had to be considered. DISCUSSION Pediatric spine injuries are in most cases treated conservatively. Surgical treatment is opted for in 7.5-18% of cases, in dependence on the evaluated group of patients, age of the patients and philosophy of the department concerned. In our group, all patients were treated conservatively. CONCLUSIONS 1. To diagnose F0 fractures, two unenhanced orthogonal view X-rays are indicated, whereas MRI examination is not routinely performed. In F1 fractures, an X-ray is indicated, and an MRI scan is considered based on the age and extent of injury. In F2 and F3 fractures, an X-ray is indicated and subsequently the diagnosis is confirmed by MRI, in F3 fractures also a CT scan is performed. 2. In young children (under 6 years of age), in whom an MRI procedure would require general anaesthesia, MRI is not routinely performed. 3. In F0 fractures, crutches or a brace are not indicated. In F1 fractures, verticalization using crutches or a brace is considered in dependence on the patient's age and extent of injury. In F2 fractures, verticalization using crutches or a brace is indicated. 4. In F3 fractures, surgical treatment is considered, followed by verticalization using crutches or a brace. In case of conservative treatment, the same procedures as in F2 fractures are applied. 5. Long-term bed rest is contraindicated. 6. Duration of spinal load reduction (restriction of sports activities, or verticalization using crutches or a brace) in F1 injuries is 3-6 weeks based on the age of the patient, it increases with the age, with the minimum being 3 weeks. 7. Duration of spinal load reduction (verticalization using crutches or a brace) in F2 and F3 injuries is 6-12 weeks based on the age of the patient, it increases with the age, with the minimum being 6 weeks. Key words: pediatric spine injury, thoracolumbar compression fractures, children trauma treatment.
- MeSH
- bederní obratle diagnostické zobrazování chirurgie MeSH
- dítě MeSH
- fraktury páteře * diagnostické zobrazování etiologie MeSH
- hrudní obratle diagnostické zobrazování chirurgie MeSH
- kojenec MeSH
- kompresivní fraktury * diagnostické zobrazování etiologie MeSH
- kyfóza * chirurgie MeSH
- lidé MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- bederní obratle patologie zranění MeSH
- fixace fraktury metody MeSH
- hrudní obratle patologie zranění MeSH
- krční obratle patologie zranění MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- páteř anatomie a histologie diagnostické zobrazování patologie MeSH
- poranění míchy diagnóza komplikace terapie MeSH
- poranění páteře * diagnóza komplikace terapie MeSH
- protetické prostředky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
