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ObjectivesThis study aimed to determine the feasibility of ultrasonography (US) in the assessment of cervical vertebral artery (VA) injury compared with computed tomography angiography (CTA) in the emergency room.MethodsA total of 50 VAs from 25 consecutive patients with cervical spine injury admitted to the emergency room in our hospital were analyzed in this study. US and CTA were performed to assess the VA in patients with cervical spine injury, and the sensitivity and specificity of US for CTA was clarified.ResultsThe agreement between US and CTA was 98% (49/50) with 0.92 Cohen's Kappa index. The sensitivity, specificity, and positive and negative predictive values of US were 100%, 97.7%, 85.7%, and 100%, respectively.ConclusionsUS had a sensitivity of 100% compared with CTA in assessment of the VA. It can be used as an initial screening test for VA injury in the emergency room.

Background Many surgeons have encountered patients who could not immediately undergo surgery to treat spinal fractures because they had associated injuries and/or because a complete diagnosis was delayed. For such patients, practitioners might assume that delays could mean that the eventual reduction would be insufficient. However, no report covered risk factors for insufficient reduction of fractured vertebra including duration from injury onset to surgery. The purpose of this study is to investigate the risk factors for insufficient reduction after short-segment fixation of thoracolumbar burst fractures. Methods Our multicenter study included 253 patients who sustained a single thoracolumbar burst fracture and underwent short-segment fixation. We measured the local vertebral body angle (VBA) on roentgenograms, before and after surgery, and then calculated the reduction angle and reduction rate of the fractured vertebra by using the following formula: $$\left[ {\left( {{\text{Preoperative}}\;{\text{VBA }}{-}{\text{ Postoperative}}\;{\text{VBA}}} \right)/{\text{Preoperative}}\;{\text{VBA}}} \right] \, \times \, 100.$$ Preoperative VBA - Postoperative VBA / Preoperative VBA × 100 . A multiple logistical regression analysis was performed to identify risk factors for insufficient reduction. The factors that we evaluated were age, gender, affected spine level, time elapsed from injury to surgery, inclusion of vertebroplasty with surgery, load-sharing score (LSS), AO classification (type A or B), preoperative VBA, and the ratio of canal compromise before surgery. Results There were 140 male and 113 female patients, with an average age of 43 years, and the mean time elapsed between injury and surgery was 3.8 days. The mean reduction angle was 12°, and the mean reduction rate was 76%. The mean LSS was 6.4 points. Multiple linear regression analysis revealed that a higher LSS, a larger preoperative VBA, a younger age, and being female disposed patients to having a larger reduction angle and reduction rate. The time elapsed from injury to surgery had no relation to the quality of fracture reduction in the acute period. Conclusions Our findings indicate that if there is no neurologic deficit, we might not need to hurry surgical reduction of fractured vertebrae in the acute phase.

Studies have suggested a relationship between sagittal malalignment of the spine and low back pain (LBP). The Wakayama Spine Study investigated the relationship between spinal alignment, LBP, and physical performance in 1491 individuals who attended a second follow-up visit as part of the ROAD Study and for whom standing lateral spinal radiographs were available. The sagittal vertical axis at C7 (C7 SVA) was measured by a spinal surgeon. LBP in the previous month was determined by the Oswestry Disability Index (ODI), and indicators of physical performance were measured. The mean C7 SVA was 11.0 ± 42.7 mm and significantly greater in older subjects (p