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In this Viewpoint, we provide an overview of the worsening trend of traumatic injuries across the United States-Mexico border after its recent fortification and height extension to 30-feet. We further characterize the international factors driving migration and the current U.S. policies and political climate that will allow this public health crisis to progress. Finally, we provide recommendations involving prevention efforts, effective resource allocation, and advocacy that will start addressing the humanitarian and economic consequences of current U.S. border policies and infrastructure.

Objective: To determine the incidence rates (IRs) of catastrophic injuries and exertional medical events in lacrosse athletes. Methods: Catastrophic injuries and exertional medical events in lacrosse in the US among youth or amateur, high school and college athletes were analysed from the National Center for Catastrophic Sport Injury Research (NCCSI R) database from 1982/83 to 2019/20. Frequencies, IRs per 100,000 athlete-seasons (AS) with 95% confidence intervals (CIs), and incidence rate ratios (IRRs) with 95% CIs were calculated. Participation data were gathered from the National Federation of State High School Associations (NFHS), National Collegiate Athletic Association (NCAA) and USA Lacrosse. Results: Sixty-nine catastrophic events (16 youth or amateur, 36 high school and 17 college; 84% male) occurred in US lacrosse from 7/1/1982 to 6/30/2020. Thirty-six percent of all incidents were fatal. The overall IR was 0.5 per 100,000 AS (95% CI: 0.4-0.7). There were 15 cases of non-traumatic sudden cardiac arrests (SCA s) and 15 incidents of commotio cordis. Fatality rates from SCA and commotio cordis decreased 95% (IRR = 0.05; 95% CI: 0, 0.2) from 1982/83-2006/07 to 2007/08-2019/20. Incidence rates were higher for collegiate versus high school 1982/83-2019/20 (IRR = 3.2; 95% CI: 1.8, 5.7) and collegiate versus youth 2005/06-2019/20 (IRR = 8.0; 95% CI: 3.0, 21.4) level. Contact with a stick or ball (41%) and contact with another player (20%) were the primary mechanisms of injury. Conclusions: The incidence of catastrophic events during lacrosse was higher among collegiate than high school or youth athletes. SCA from an underlying cardiac condition or from commotio cordis was the most common catastrophic event. Fatality rates from catastrophic injuries have declined significantly over the study period, perhaps driven by protective measures adopted by lacrosse governing bodies. [ABSTRACT FROM AUTHOR]

Introduction: Unplanned readmissions after spine surgery are undesired, and cause significant functional, and financial distress to the patients and healthcare system. Though critical, knowledge about readmissions after surgery for traumatic spinal injuries (TSI) is scarce and under-evaluated. Methods: Consecutive patients surgically treated for TSI and who had unplanned readmission within 90 days post-discharge were studied. Peri-operative demographic and surgical variables, surgical treatment, level of injury, delay in surgery, ASIA score, other organ injuries, peri-operative complications, smoking, ICU stay, co-morbidity, and the length of hospital stay were studied and correlated with the causes for readmission. Results: Among 884 patients, 4.98% (n = 44) had unplanned readmissions within 90 days of discharge. Notably, 50% (n = 22) patients were readmitted within the first 30 days. The common causes of readmissions were urinary tract related problems (27%, n = 12), pressure ulcers (20.4%, n = 9), respiratory problems (13.6%, n = 6), surgical wound related problems (14%, n = 7,) limb injuries (11.4%, n = 5), and others (11%, n = 5). The total beds lost secondary to readmissions was 314 days, and the mean bed-days lost per patient was 7.2 ± 5.1. Thirteen peri-operative risk factors were associated with unplanned readmissions, among which, smoking (OR 2.2), diabetes (OR 2.4), and pressure sore during index admission (OR 16.7) were strong independent predictors. Conclusion: The incidence of unplanned readmissions after TSI was 5%, which was similar to elective spine surgeries but the causes and risk factors are different. Non-surgical complications related to urinary tract, respiratory care and pressure sores were the most common causes. Pre-operative smoking status, diabetes mellitus and pressure sores noted in the index admission were important independent risk factors. [ABSTRACT FROM AUTHOR]

Women's wrestling is actively practiced in many countries. While severe spinal injuries pose a threat to an athlete's career and health, research on severe spinal injuries in female wrestlers remains limited. The aim of this study was to investigate the characteristics of severe spinal injuries and post-injury management in Korean female wrestlers. We enrolled 54 female wrestlers participating in the national team selection competition. Interviews were conducted to examine the characteristics of spinal injuries that resulted in a time loss of more than three weeks from training throughout their athletic careers and their post-injury management practices. Approximately 46% of participants experienced severe spinal injuries, and 52% faced re-injuries during their wrestling careers. These injuries predominantly occurred during technical training due to overuse during tackling and standing attacks. The most frequent injuries were lumbosacral disc injuries (72%) and cervical disc injuries (20%), with 36% requiring surgery. Nearly half of the injured athletes received specialized rehabilitation, yet roughly 76% resumed training without medical clearance. Athletes injured during their student years were notably less likely to receive specialized rehabilitation compared with those injured during their professional careers (p = 0.011). On average, athletes returned to play within 2.7 to 3.0 months. Spinal injury characteristics and post-injury management were not significantly different between the light- and heavyweight classes. While Korean female wrestlers are at a high risk of experiencing severe spinal injuries and re-injuries during their careers, appropriate post-injury management is often lacking, highlighting the need for proactive intervention by healthcare professionals to prevent recurrent spinal injuries in female wrestlers and to ensure safe return to training. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a significant public health issue, leading to physical, psychological, and social complications. Machine learning (ML) algorithms have shown potential in diagnosing and predicting the functional and neurologic outcomes of subjects with SCI. ML algorithms can predict scores for SCI classification systems and accurately predict outcomes by analyzing large amounts of data. This systematic review aimed to examine the performance of ML algorithms for diagnosing and predicting the outcomes of subjects with SCI. The literature was comprehensively searched for the pertinent studies from inception to May 25, 2023. Therefore, electronic databases of PubMed, Embase, Scopus, and Web of Science were systematically searched with individual search syntax. A total of 9424 individuals diagnosed with SCI across multiple studies were analyzed. Among the 21 studies included, 5 specifically aimed to evaluate diagnostic accuracy, while the remaining 16 focused on exploring prognostic factors or management strategies. ML and deep learning (DL) have shown great potential in various aspects of SCI. ML and DL algorithms have been employed multiple times in predicting and diagnosing patients with SCI. While there are studies on diagnosing acute SCI using DL algorithms, further research is required in this area. [ABSTRACT FROM AUTHOR]

Introduction: There is a lack of information on return to sport and patient-reported outcome measures (PROMs) in amateur athletes after isolated spine injuries. Methods: A single-center cohort study in amateur athletes aged 18 to 60 with isolated spine injuries; clinical data collection and follow-up via telephone interview and standardized PROMs (Short-Form 36, Oswestry and Neck Disability Index, Tampa Scale of Kinesiophobia, Hospital Anxiety and Depression Scale, Pain Visual Analog Scale). Bivariate analyses of potential influencing factors on PROMs were conducted using the Wilcoxon Signed-Rank Test. p-values < 0.05 were considered statistically significant. Results: Out of the 80 included participants, 78% (n = 62) were active in sport at follow-up. PROMs were slightly worse than those described for the age-adjusted general population. There were consistent associations of better PROMs with having reached the subjective preinjury level of performance in sport, while injury severity and surgical or conservative therapy did not show consistent associations with PROMs. Conclusion: Most amateur athletes resume their sports activity after a spine injury. Better outcomes are associated with individuals' resumption of sport and subjective level of performance, while injury severity and surgical or conservative therapy do not show consistent associations with PROMs, highlighting the importance of patient education, rehabilitation, and encouragement. [ABSTRACT FROM AUTHOR]

This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid risk-factors for their prevention, plus (2) to identify gaps in the existing research and propose suggestions for future studies. A literature search conducted with Scopus, Web of Science, MEDLINE and Cochrane Library was completed by Elsevier, SpringerLink and Google Scholar. The main neurophysiological risk factors identified leading to back problems in athletes are neuromuscular imbalance, increased muscle fatigability, muscle dysfunction and impaired motor control, whilst biomechanical risk factors include maladaptive spinal, spinopelvic and lower limb kinematics, side-to-side imbalances in axial strength and hip rotation range of motion, spinal overloading and deficits in movement pattern. However, most studies focused on back pain in the lumbar region, whereas less attention has been paid to thoracic and cervical spine problems. The range of sports where this topic has been studied is relatively small. There is a lack of research in sports in which the core muscles are highly involved in specific movements such as lifting weights or trunk rotations. A limited number of studies include female athletes and master athletes of both genders. In addition to chronic back pain patients, it is equally important to conduct research on healthy athletes with a predisposition to spine problems. Investigators should focus their empirical work on identifying modifiable risk factors, predict which athletes are at risk for back problems, and develop personalized sport-specific assessment tools and targeted prevention strategies for them.This review was registered using the Open Science Framework Registries (https://osf.io/ha5n7).

This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid risk-factors for their prevention, plus (2) to identify gaps in the existing research and propose suggestions for future studies. A literature search conducted with Scopus, Web of Science, MEDLINE and Cochrane Library was completed by Elsevier, SpringerLink and Google Scholar. The main neurophysiological risk factors identified leading to back problems in athletes are neuromuscular imbalance, increased muscle fatigability, muscle dysfunction and impaired motor control, whilst biomechanical risk factors include maladaptive spinal, spinopelvic and lower limb kinematics, side-to-side imbalances in axial strength and hip rotation range of motion, spinal overloading and deficits in movement pattern. However, most studies focused on back pain in the lumbar region, whereas less attention has been paid to thoracic and cervical spine problems. The range of sports where this topic has been studied is relatively small. There is a lack of research in sports in which the core muscles are highly involved in specific movements such as lifting weights or trunk rotations. A limited number of studies include female athletes and master athletes of both genders. In addition to chronic back pain patients, it is equally important to conduct research on healthy athletes with a predisposition to spine problems. Investigators should focus their empirical work on identifying modifiable risk factors, predict which athletes are at risk for back problems, and develop personalized sport-specific assessment tools and targeted prevention strategies for them. [ABSTRACT FROM AUTHOR]

Background: Accidental injuries sustained during helocasting remain unexamined. Methods: Conditions prevalent during a helocasting exercise performed at a still water body and the resulting casualties were analyzed. Results: Despatch from greater-than-ideal height (>7 m) and speed (>5 knots) causes a high-velocity impact of the body with water in a non-aerodynamic configuration, exposing maximal body area at penetration. The brunt is borne by the torso/back, specifically, the lungs, ribs, and posterior aspect of the spine. The injuries result from direct trauma, sudden deceleration, barotrauma, and hyperflexion. Computerized tomography (CT) is the imaging of choice in the assessment of these injuries. Prompt evacuation to an equipped center, whilst stabilizing the spine in the suspected, proves pivotal to the outcome. Conclusions: Adverse slamming dynamics cause accidental injuries in helocasting. Thorax and spine are predominantly traumatized, both directly and indirectly, and are assessed best using CT. Timely spine stabilization and evacuation prove vital. Accurate assessment of height/ speed and adherence to their ideal limits, at despatch, may avert such injuries. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess the potential of Spherical Cap Studs (SCS) as a substitute for conventional speed bumps, with a focus on limiting two wheeler speed while minimizing discomfort to riders by comparing the speed reduction capabilities and discomfort levels associated with SCS and speed bumps. The study uses experimental approach to compare the speed limiting ability and discomfort caused to rider by the proposed SCS and a standard speed bump. Speed profiles were developed for two wheelers passing over both SCS and speed bump. The parameter employed to compare speed profiles is the Mean Absolute Percentage Difference (MAPD), offering valuable insights into how effectively the two traffic calming measures reduce two wheeler speeds. To compare discomfort, the study calculates the 'Vibration Dose Value' (VDV) experienced by riders when traversing both speed bump and SCS. Additionally, 'Static Compressive Stress' (Se) applied to the spinal cord is also calculated in both scenarios. The analysis of speed profiles reveals an MAPD value of 13.70% indicating that SCS exhibits speed reduction capabilities comparable to traditional speed bump. In terms of discomfort, the VDV for two wheelers passing over a speed bump is measured at 5.92 m/s1.75, whereas the VDV for SCS is found to be 5.16 m/s1.75. Similarly, the Static Compressive Stress (Se) experienced at a speed bump is 0.60 MPa, in contrast to the 0.33 MPa recorded for SCS. This data underscores a noteworthy 12.8% reduction in VDV and a substantial 45.57% reduction in Se. The study's findings support the potential adoption of SCS as an effective alternative to conventional speed bumps for controlling two wheeler speeds. SCS demonstrate a speed reduction capability similar to that of traditional speed bumps while significantly alleviating discomfort for riders. SCS is expected to be a promising solution for traffic calming purposes in various settings, such as markets, residential areas, institutional campuses, and parking lots. [ABSTRACT FROM AUTHOR]

Women’s wrestling is actively practiced in many countries. While severe spinal injuries pose a threat to an athlete’s career and health, research on severe spinal injuries in female wrestlers remains limited. The aim of this study was to investigate the characteristics of severe spinal injuries and post-injury management in Korean female wrestlers. We enrolled 54 female wrestlers participating in the national team selection competition. Interviews were conducted to examine the characteristics of spinal injuries that resulted in a time loss of more than three weeks from training throughout their athletic careers and their post-injury management practices. Approximately 46% of participants experienced severe spinal injuries, and 52% faced re-injuries during their wrestling careers. These injuries predominantly occurred during technical training due to overuse during tackling and standing attacks. The most frequent injuries were lumbosacral disc injuries (72%) and cervical disc injuries (20%), with 36% requiring surgery. Nearly half of the injured athletes received specialized rehabilitation, yet roughly 76% resumed training without medical clearance. Athletes injured during their student years were notably less likely to receive specialized rehabilitation compared with those injured during their professional careers (p = 0.011). On average, athletes returned to play within 2.7 to 3.0 months. Spinal injury characteristics and post-injury management were not significantly different between the light- and heavyweight classes. While Korean female wrestlers are at a high risk of experiencing severe spinal injuries and re-injuries during their careers, appropriate post-injury management is often lacking, highlighting the need for proactive intervention by healthcare professionals to prevent recurrent spinal injuries in female wrestlers and to ensure safe return to training.

Introduction: There is a lack of information on return to sport and patient-reported outcome measures (PROMs) in amateur athletes after isolated spine injuries. Methods: A single-center cohort study in amateur athletes aged 18 to 60 with isolated spine injuries; clinical data collection and follow-up via telephone interview and standardized PROMs (Short-Form 36, Oswestry and Neck Disability Index, Tampa Scale of Kinesiophobia, Hospital Anxiety and Depression Scale, Pain Visual Analog Scale). Bivariate analyses of potential influencing factors on PROMs were conducted using the Wilcoxon Signed-Rank Test. p-values < 0.05 were considered statistically significant. Results: Out of the 80 included participants, 78% (n = 62) were active in sport at follow-up. PROMs were slightly worse than those described for the age-adjusted general population. There were consistent associations of better PROMs with having reached the subjective preinjury level of performance in sport, while injury severity and surgical or conservative therapy did not show consistent associations with PROMs. Conclusion: Most amateur athletes resume their sports activity after a spine injury. Better outcomes are associated with individuals’ resumption of sport and subjective level of performance, while injury severity and surgical or conservative therapy do not show consistent associations with PROMs, highlighting the importance of patient education, rehabilitation, and encouragement.

Objective: To describe the prevalence of spine injuries among US service members with combat-related concussion. Design and Participants: A retrospective review of medical records for US service members injured during combat operations in Iraq and Afghanistan between 2002 and 2020. The study sample included 27 897 service members categorized into 3 groups: concussion with loss of consciousness (LOC, n = 4631), concussion non-LOC (n = 5533), and non-concussion (n = 17 333). Main Measures: Spine injuries were identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and classified by body region and nature of injury using the Barell injury diagnosis matrix. Differences in prevalence of spine injuries by concussion group were evaluated using χ² tests. Results: Spine injuries were most prevalent among service members with concussion LOC (31.1%), followed by concussion non-LOC (18.3%), and non-concussion (10.0%, P<.001). Sprains and strains were the most prevalent spine injury category, with injuries to the cervical, thoracic, and lumbar regions significantly more prevalent in the concussion groups (P values < .001), particularly individuals with LOC compared with non-concussion. Conclusion: The US military personnel with combat-related concussion, especially individuals with LOC, may also have spine injuries. Routine assessment for spine injury is recommended during concussion screening because this may impact clinical management and rehabilitation. [ABSTRACT FROM AUTHOR]

Acute traumatic intervertebral disc herniation of the thoracic spine is a rather rare injury with only a few reported cases to date. In this manuscript, we present a case of a 58-year-old male patient who sustained a car accident-related high-energy trauma, resulting in a disc herniation of the thoracic spine. Furthermore, we also discuss the possible implications of late diagnosis of such condition. The patient was initially referred from the Emergency Department as a case of head contusion with a left upper limb paresis. Due to only minimal bony trauma visible on the initial spine CT scan, the neurological deficit was attributed to the cranial trauma. The diagnosis of a traumatic disc herniation was therefore established only after the rapid onset of paraparesis, which gradually progressed into paraplegia, and a following spine MRI scan. Despite the subsequent urgent spinal decompression, the neurological functions of the lower limbs were not restored. This manuscript addresses the indications for performing MRI scans in polytrauma patients with a CT-verified spine trauma. Although it may be complicated to perform routine MRI scans in all such patients in daily practice, it can certainly help diagnose such injuries earlier and thus prevent potential permanent neurological damage to the patients. [ABSTRACT FROM AUTHOR]

Vertebral are not easily injured due to both the strength of the bone structure and the anatomical protection of the soft tissues. Traumas that cause damage to the vertebral column are often high-energy traumas such as traffic accidents. In our study, vertebral fractures seen in patients who applied for a report for disability determination; were aimed to evaluate the fracture site in terms of its sequelae and its provisions in the disability determination charts. In our study, the reports of the cases that were examined by us after applying for disability assessment in Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Forensic Medicine between the years 2019-2021 were examined. Cases with vertebral injuries were included in the study and were examined in terms of age, gender, spine region, additional traumatic findings, sequelae, treatment method, how many points they got from which disability scale, and duration of incapacity. As a result of joint range of motion examinations, in cervical vertebral fractures, limitation of cervical extension movement, in thoracic vertebral fractures, limitation of thoracic flexion movement, in lumbar vertebral fractures, it was determined that the limitation of lumbar extension movement was observed mostly. In our study, vertebral injuries were seen in 17% of the patients who applied for disability detection procedures after a traffic accident. In addition, vertebral injuries are important injuries in terms of public health and health expenditures, as well as important causes of disability and incapacity to work. Vertebral injuries resulting from traffic accidents can cause significant limitations and adversely affect people's lives. [Med-Science 2023; 12(1.000): 175-9]

Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.

BACKGROUND: Persisting back pain is a frequent consequence after severe trauma including injury to the spine. Reports on the incidence and relevance of back pain in severely injured patients in the absence of direct injury to the spine are scarce. OBJECTIVE: To assess the frequency of relevant back pain and its effect on health-related quality of life (HRQoL) in trauma patients with spine injury compared to patients without direct impact to spine postdischarge and two years after trauma within an observational study. METHODS: A two-year follow-up survey by using the Polytrauma Outcome Chart (PoloChart) and a set of specific questionnaires on socioeconomic and other HRQoL aspects was conducted among adult patients that had been treated for severe traumatic injuries (ISS ⩾ 9) at a German level 1 trauma center between 2008 and 2017. Patient subgroups included patients with relevant (VAS ⩾ 3) versus non-relevant back pain (VAS < 3) stratified by visual analogue scale (VAS 0–10). Patients with relevant back pain were separated into patients with (AIS spine ⩾ 1) and without spine injury (AIS spine = 0) according to the Abbreviated Injury Score (AIS). RESULTS: 543/1010 questionnaires were returned yielding a response rate of 54%. Patients were predominantly male (n = 383/543; 71%) with a mean age 45 ± 19 years, mostly blunt trauma (n = 524/543; 97%) and a mean ISS 18 ± 12 points. 32.4% of patients had sustained a spine injury defined by an AIS spine ⩾ 1 (n = 176/543). Half of these patients suffered from relevant back pain two years after trauma (n = 90/176; 51.1%); in contrast, in non-spine injured patients one in three patients reported relevant back pain (n = 127/367; 34.6%). Patients with relevant back pain reported significantly lower HRQoL as measured by the 36-Item Short Form Health Survey and the Trauma Outcome Profile. The use of pain medication after discharge and at two years after trauma was significantly higher in patients with relevant back pain (n = 183/211; 86.7% vs. n = 214/318; 75.8%; p < 0.001; pain medication 2 years after trauma: n = 113/210, 53.8% vs. 68/317, 21.5%, p < 0.001). CONCLUSION: Persisting back pain is frequent at two years after trauma independent of presence or absence of initial injury to the spine and associated with lower HRQoL in almost every dimension including physical, mental and social domains. [ABSTRACT FROM AUTHOR]

Vertebral are not easily injured due to both the strength of the bone structure and the anatomical protection of the soft tissues. Traumas that cause damage to the vertebral column are often high-energy traumas such as traffic accidents. In our study, vertebral fractures seen in patients who applied for a report for disability determination; were aimed to evaluate the fracture site in terms of its sequelae and its provisions in the disability determination charts. In our study, the reports of the cases that were examined by us after applying for disability assessment in Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Forensic Medicine between the years 2019-2021 were examined. Cases with vertebral injuries were included in the study and were examined in terms of age, gender, spine region, additional traumatic findings, sequelae, treatment method, how many points they got from which disability scale, and duration of incapacity. As a result of joint range of motion examinations, in cervical vertebral fractures, limitation of cervical extension movement, in thoracic vertebral fractures, limitation of thoracic flexion movement, in lumbar vertebral fractures, it was determined that the limitation of lumbar extension movement was observed mostly. In our study, vertebral injuries were seen in 17% of the patients who applied for disability detection procedures after a traffic accident. In addition, vertebral injuries are important injuries in terms of public health and health expenditures, as well as important causes of disability and incapacity to work. Vertebral injuries resulting from traffic accidents can cause significant limitations and adversely affect people's lives. [ABSTRACT FROM AUTHOR]

Abstract Background Pelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical outcome of pelvic fracture. Methods We performed a retrospective analysis of data of patients registered in the German Pelvic Registry between January 2003 and December 2017. Clinical characteristics, surgical parameters, and outcomes were compared between patients with isolated pelvic fracture (group A) and patients with pelvic fracture plus spine injury (group B). We also compared apart patients with isolated acetabular fracture (group C) versus patients with acetabular fracture plus spine injury (group D). Results Surgery for pelvic fracture was significantly more common in group B than in group A (38.3% vs. 36.6%; p = 0.0002), as also emergency pelvic stabilizations (9.5% vs. 6.7%; p

Research on spinal cord injuries is an important and living topic that raises many critical questions that need to be addressed. While numerous articles have compiled and compared various models of spinal cord injuries, there is limited comprehensive guide with clear instructions available for researchers who are unfamiliar with clip compression model. This model creates acute compression damage in spinal cord, which aims to mimic the nature of traumatic spinal cord damage in humans. Purpose of this article is to share our experience on clip compression model, with experience gained from more than 150 animals, and to provide guidance for researchers with lack of experience who wish to design studies with this model. We have defined several key variables, as well as the difficulties that may arise when applying this model. − Proper preparation, good infrastructure and necessary tools and knowledge of anatomy related is essential to the success of this model. − Good exposure with non-bleeding surgical site is key factor for surgical step. − Postoperative care is particularly challenging, and researchers should consider extending their studies over a reasonable time period to ensure that appropriate care could be provided.

Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor. [ABSTRACT FROM AUTHOR]

Context: Athletes have routine activity programs, and better physical health is expected among them. There is limited information about the connection between athletes' injuries during sports activity and their future health status. Objectives: The prevalence of spine changes related to sports activities and what risk factors were associated with these events in athletes. Method: SCOPUS, EMBASE, and Web of Science were used for article searching. Results: Sports injuries in sports happen frequently. Our data is limited to introducing sports with the highest risk of injury. A history of sports injury, an intense training program, and years of sports activities are factors predicting injury. It has been seen that former top male athletes have more activity than age-matched control individuals. Conclusions: Spinal injury management in athletes needs a proper diagnosis, work-up, and complex rehabilitation plans; otherwise, it can lead to spinal complaints in the future. Rest, appropriate analgesia, and rehabilitation are the three main primary treatments. The usage of orthoses is not recommended for these injuries in general. [ABSTRACT FROM AUTHOR]

Backgrounds and Aims: We aimed to determine the incidence and severity of spine injuries among severely injured trauma patients (Injury Severity Score (ISS)/New Injury Severity Score (NISS) > 15) treated in a single tertiary trauma center over 15 years. We also wanted to compare the demographics between patients with and without spine injuries and to determine the mortality of spine-injury patients., Methods: Data from the years 2006-2020 from the Helsinki Trauma Registry (HTR), a local trauma registry of the trauma unit of the Helsinki University Hospital (HUH), were reviewed. We divided patients into two groups, namely those with traumatic spine injury (TSI) and those without traumatic spine injury (N-TSI). TSI patients were further subdivided into groups according to the level of injury (cervical, thoracolumbar, or multilevel) and the presence of neurological symptoms., Results: We included 2529 patients: 1336 (53%) had a TSI and 1193 (47%) had N-TSI. TSI patients were injured more frequently by a high-fall mechanism (37% vs 21%, p < 0.001). Among TSI patients, 38% of high-fall injuries were self-inflicted. High falls, young age, and female gender were overrepresented in spine-injury patients with a self-inflicted injury mechanism. Cervical spine-injury patients were mostly elderly persons injured by a low-energy mechanism., Conclusions: Unlike other severely injured trauma patients, severely injured trauma patients with spine injuries are more frequently injured by a high-fall mechanism and self-injury., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Pelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical outcome of pelvic fracture.Methods: We performed a retrospective analysis of data of patients registered in the German Pelvic Registry between January 2003 and December 2017. Clinical characteristics, surgical parameters, and outcomes were compared between patients with isolated pelvic fracture (group A) and patients with pelvic fracture plus spine injury (group B). We also compared apart patients with isolated acetabular fracture (group C) versus patients with acetabular fracture plus spine injury (group D).Results: Surgery for pelvic fracture was significantly more common in group B than in group A (38.3% vs. 36.6%; p = 0.0002), as also emergency pelvic stabilizations (9.5% vs. 6.7%; p < 0.0001). The mean time to emergency stabilization was longer in group B (137 ± 106 min vs. 113 ± 97 min; p < 0.0001), as well as the mean time until definitive stabilization of the pelvic fracture (7.3 ± 4 days vs. 5.4 ± 8.0 days; p = 0.147). The mean duration of treatment and the morbidity and mortality rates were all significantly higher in group B (p < 0.0001). Operation time was significantly shorter in group C than in group D (176 ± 81 min vs. 203 ± 119 min, p < 0.0001). Intraoperative blood loss was not significantly different between the two groups with acetabular injuries. Although preoperative acetabular fracture dislocation was slightly less common in group D, postoperative fracture dislocation was slightly more common. The distribution of Matta grades was significantly different between the two groups. Patients with isolated acetabular injuries were significantly less likely to have neurological deficit at discharge (94.5%; p < 0.0001). In-hospital complications were more common in patients with combined spine plus pelvic injuries (groups B and D) than in patients with isolated pelvic and acetabular injury (groups A and C).Conclusions: Delaying definitive surgical treatment of pelvic fractures due to spinal cord injury appears to have a negative impact on the outcome of pelvic fractures, especially on the quality of reduction of acetabular fractures. [ABSTRACT FROM AUTHOR]

Background: Electric bicycles related collisions could lead to severe consequences in spine injuries, while no study had comprehensively investigated the epidemiology and demography of spine injuries in electric bicycles related collisions.Questions/purposes: The aim of this study is to (1) describe the epidemiological characteristics of spine injuries in electric bicycles related collisions, (2) develop clinical guideline of spine injuries in electric bicycles related collisions and (3) support the new road safety policy for electric bicycle riders.Methods: A retrospective review of spine injuries in electric bicycle related collisions was performed from 86 patients in an urban trauma center between 2018 and 2020. The variables including gender, age, radiographic findings, associated injuries, neurologic injuries, treatment, average length of stay were fully collected. Chi-square test and paired sample mean t-test were used to test for statistically significant differences. All statistical analyses were performed using Statistical Product and Service Solutions 20.0.0 software. A P<0.001 was considered as significant.Results: A total of 86 cases were involved in electric bicycles related collisions lead to spine injuries. The spine injuries victims were predominantly male (79.07%) and middle-aged (41-60years, 44.19%). The most common spine injuries were L1 fractures (10.48%). The most common fracture type was AO Fracture Classification type A (71.40%). Age and multivertebral fractures had significant difference between patients who suffered from an ASOI and from those who did not (P-value: 0.005, 0.005). There was significant difference between patients who suffered from neurologic injuries and from those who did not in AO Classification, multivertebral fractures and ASOI (P-value: 0.0001, 0.001, 0.032). Age, AO Classification, multivertebral fractures, ASOI and neurologic injuries had significant difference to influence patients' ISS and ALOS.Conclusions: Spine injuries in electric bicycles related collisions may make patients suffer from severe consequences including their potential permanent disability, economic cost, or even life safety. Patients with spine injuries in electric bicycles related collisions should be paid close attention to avoid missed diagnosis and misdiagnosis. Helmet, protective clothing or other safety gear should be required to use to provide greater protection for electric bicycle riders. [ABSTRACT FROM AUTHOR]

The experience of the neurosurgical department specializing in the treatment of patients with injuries and diseases of the spine is presented. The paper describes the links of regional and in-hospital reorganization of the current system of spine pathology care that provided the increase in the efficiency of medical care and improvement of treatment outcomes.

The Morel-Lavallée lesion (MLL) is an internal degloving injury typically associated with high-energy trauma and is suspected to be underdiagnosed in a majority of cases. Here, we illustrate the typical clinical and radiological characteristics of an extensive peripelvic MLL in a 50-year-old patient presenting to our trauma outpatient clinic with peripelvic pain, bruising and swelling six weeks after severe spine trauma caused by a high-energy car accident. Using this case study as an example, current therapeutic approaches are discussed. Therapeutic decisions should be based on clinical symptoms, lesion size, severity, age and co-morbidities. Extensive, symptomatic and chronic lesions should be addressed with early débridement, irrigation and drainage in order to prevent complications like infection or soft tissue necrosis.

This case report explores the use of blood flow restriction (BFR) training to improve body composition in a 26-year-old male with L5-S1 disc protrusion and nerve root compression. BFR training, involving low-intensity exercises with restricted blood flow, offers a promising alternative for patients unable to engage in high-intensity workouts. The patient, a recreational gymgoer with a history of a significant lower back injury from a maximal deadlift event 20 months ago, presented with chronic pain, weight gain, and decreased stamina. Two attempts at spinal steroid injections during the 20-month period yielded only temporary relief, prompting the implementation of a 12-week BFR training regimen. The program combined BFR exercises with a calorie-deficit diet, resulting in substantial improvements in body composition and strength. Over 12 weeks, the patient lost 11.68 kg, reduced his body mass index from 26.50 to 22.85, and decreased his total body fat percentage from 28% to 22.43%. His lower back pain also significantly improved. This case highlights the effectiveness of BFR training in managing obesity and enhancing physical fitness in spinal injury patients, emphasizing the need for further research on its broader application., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Saveetha Medical College and Hospital Institutional Ethics committee issued approval N/A. The participant was explained about the potential benefits and risks associated with the treatment. It was brought to his knowledge that he would receive no monetary remuneration for this case study. He was also informed about the alternate available treatments. Post this information, he gave his willingness to receive the treatment by signing an informed consent form. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Thirugnana Sambandam et al.)

Background: Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries.Objectives: The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries.Methods: This was a retrospective review of patients in a single Level I trauma center before and after a change in spinal injury protocols. A two-step review of the record was used to classify spinal cord injuries as disabling or not disabling. A binary logistic regression was used to determine the effects of protocol, gender, age, level of injury, and mechanism of injury (MOI) on the incidence of significant disability from a spinal cord injury.Results: A total of 549 patients in the SI period and 623 patients in the SMR period were included in the analysis. In the logistic regression, the change from an SI protocol to an SMR protocol did not demonstrate a significant effect on the incidence of disabling spinal injuries (OR: 0.78; 95% CI, 0.44 - 1.36).Conclusion: This study did not demonstrate an increase in disabling spinal cord injuries after a shift from an SI protocol to an SMR protocol. This finding, in addition to existing literature, supports the introduction of SMR protocols and the decreased use of the backboard. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the quality of articles utilizing large administrative databases to answer questions related to pediatric spinal neurosurgery by quantifying their adherence to standard reporting guidelines. Methods: A systematic literature search was conducted with search terms including "pediatric" and "neurosurgery," associated neurosurgical diagnoses, and the names of known databases. Study abstracts were reviewed to identify clinical studies involving pediatric populations, spine-related pathology or procedures, and large administrative databases. Included studies were graded using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Results: A total of 28 papers of the initial 1496 identified met inclusion criteria. These papers involved 10 databases and had a mean study period of 11.46 ± 12.27 years. The subjects of these research papers were undergoing treatment of scoliosis (n = 5), spinal cord injury (n = 5), spinal cord tumors (n = 9), and spine surgery in general (n = 9). The mean STROBE score was 19.41 ± 2.02 (out of 22). Conclusion: Large administrative databases are commonly used within pediatric spine-related neurosurgical research to cover a broad spectrum of research questions and study topics. The heterogeneity of research to this point encourages the continued use of large databases to better understand treatment and diagnostic trends, perioperative and long-term outcomes, and rare pathologies within pediatric spinal neurosurgery. [ABSTRACT FROM AUTHOR]

Purpose: Thoracolumbar fractures are the most common kind of spine injury in children. Several types of spine injury can occur, and for this reason, treatment algorithms have been put in place for the management of these patients. At present, the thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AOSpine injury score (AOSpine score) aimed at providing treatment recommendations. We aimed to assess the reliability, in children, of the TLICS scoring and AOSpine scoring systems, and to define the superiority of one of the methods of scoring, to spread its use in routine clinical management in the pediatric spine trauma. Methods: A retrospective chart review of consecutive children admitted to a Level 1 trauma center for traumatic thoracolumbar fractures, between 2006 and 2019, was performed. We compared the management we performed in clinical practice in children with spine trauma, to the decisional algorithms based on the TLICS and AOSpine scores. According to these scores, surgical treatment should be performed when the TLICS score ≥ 5 and the AOSpine score > 5; and surgical or conservative treatment was considered reasonable when the TLICS score = 4 and the AOSpine score = 4 or 5. Surgical indications were based on the clinical status, the anatomy of the fracture, and the risk of sagittal imbalance of the growing spine. Results: Fifty-four patients met the inclusion criteria. We demonstrated that both the AOSpine score and the TLICS scores had a significant correlation for surgical management decision of spine trauma (p < 0.0001). We found a high concordance between surgical decision making in the pediatric clinical practice and the TLICS score. In our pediatric cohort, there were significantly more patients with TLICS ≥ 5 (n = 47, 87%) than with AOSpine score > 5 (n = 26, 46%, p < 0.0001). There were significantly more patients with TLICS ≥ 4 (n = 53, 98%), than with AOSpine score ≥ 4 (n = 42, 77%, p = 0.001). ConclusionsThe TLICS score was significantly more appropriate than the AOSpine score, for the surgical treatment decision in children, especially when considering the future risk of sagittal imbalance. [ABSTRACT FROM AUTHOR]

Literature and field data from CIREN database have shown that lumbar spine injuries occur during car crashes. There are multiple hypotheses regarding how they occur; however, there is no biomechanical explanation for these injuries during collisions with road safety barriers (RSBs). Therefore, the objective of this study was to investigate the mechanics of vertebral fractures during car collisions with concrete RSBs. The finite element method was used for the numerical simulations. The global model of the car collision with the concrete RSB was created. The lumbar spine kinematics were extracted from the global simulation and then applied as boundary conditions to the detailed lumbar spine model. The results showed that during the collision, the occupant was elevated, and then dropped during the vehicle landing. This resulted in axial compression forces 2.6 kN with flexion bending moments 34.7 and 37.8 Nm in the L2 and L3 vertebrae. It was shown that the bending moment is the result of the longitudinal force on the eccentricity. The lumbar spine index for the L1–L5 section was 2.80, thus indicating a lumbar spine fracture. The minimum principal strain criterion of 7.4% and damage variable indicated L2 and L3 vertebrae and the inferior part of L1, as those potentially prone to fracture. This study found that lumbar spine fractures could occur as a consequence of vehicle landing during a collision with a concrete RSB mostly affecting the L1–L3 lumbar spine section. The fracture was caused by a combination of axial forces and flexion bending moments.

Objective: Only a few studies in the literature have evaluated chest injuries accompanying blunt spinal trauma. We aimed to evaluate chest injuries observed concomitantly with spine injuries as well as reveal their clinical importance. Materials and Methods: Eighty-eight patients, who were treated and followed up by the authors after being admitted to the emergency department because of severe blunt spinal trauma, were evaluated retrospectively. Results: Data from a total of 55 patients [30 (54.5%) male and 25 (45.5%) female] who met the study criteria were included. The mean age of patients was 58±15.8. Falling from height was the most common cause of trauma in 32 patients (58.2%) and was significantly more frequent than other causes such as traffic accident, assault, non-vehicle traffic accident, and motorcycle accident (p<0.001). Spinal fracture was observed in 38 patients with severe blunt spinal trauma (69.1%), while ligament and other soft tissue damage was found in 17 patients (30.9%). Spinal fractures were significantly more frequent in the thoracic vertebra (n=28; 50.9%) compared to other regions such as the cervical and lumbar spine (p<0.001). It was observed that chest injury accompanied 33 (60%) patients who experienced blunt spinal trauma. When the thoracic region was classified as per injured tissues; rib fracture (n=10; 30.3%) and pulmonary contusion (n=6; 18.2%) were observed most frequently. Conclusion: Patients with thoracic spinal fractures should be considered at a high risk for chest injury, and this group of patients should be prioritized because of the possible life-threatening complications. In our study, we concluded that the rate of falling from height increased in the elderly group, as well as neurological losses. Moreover, the rate of neurological deficit following thoracic vertebral damage due to falling from height kept increasing, especially in the elderly group. [ABSTRACT FROM AUTHOR]

Introduction: Back pain is one of the most common problems of the movement system. The physiotherapist's physiotherapist's long-term commitment to static body positioning and high-intensity motion, often also the height-weight divergence between the therapist and the patient, leads to the painful role of the patient. The aim of the study: Determining whether physiotherapists suffer from back pain, what the nature of those ailments are, and how their seniority affects them. Determining whether the area of ​​discomfort associated with regular sports or severe spinal injuries and the impact of sports on the intensity of pain. Material: There were 35 participants (21 women and 14 men) - physiotherapist, aged 25-63 (mean 38 years). Methodology: The survey questionnaire (questions on age, sex, height, weight, length of service, occupational specificity, spine pain, VAS scale and modified Laitinen questionnaire) were used in the study group. Results: Statistical analysis revealed the incidence of pain in the spine and their dependence on length of service, the area of the most frequently reported pain and their nature. The impact of physical activity and previous injuries to the spine on the episode in which the pain was present was not shown. Conclusions: Occupational physiotherapist is associated with chronic spinal-backbone ligament dominance, which may be related to the standing position of the work most commonly found in the study group. There was no relationship between the regular exercise of sport and the intensity of the pain experienced, as well as the dependence of the painful spine and sport or previous spinal injuries.

Spinal cord injury (SCI) is a devastating neurological disorder that affects thousands of individuals each year. Previously, our study in non-human primates with SCI demonstrated that methylprednisolone (MP) resulted in the dysfunction of neural stem cells (NSCs), which may help to explain the controversial roles of MP in SCI. However, the detailed mechanism is still unclear. In this manuscript, we investigated the LncRNA and mRNA expression profiles of NSCs treated with MP. A total of 63 differentially expressed LncRNAs and 174 differentially expressed mRNAs were identified. Gene ontology (GO) analysis showed that differentially expressed mRNAs were highly associated with terms related to regulation of external stimulation, secretion, and migration. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis results indicated that the PI3K–Akt signaling pathway contributed to the functions of MP treated NSCs. Besides, 3899 co-expression pairs were constructed among the differentially expressed LncRNA and mRNA, among which five predicted target mRNAs with the differentially expressed LncRNAs were identified. These results provide greater insight into the precise mechanisms of MP mediating NSC dysfunction in SCI.

Spinal cord injury (SCI) is a devastating neurological disorder that affects thousands of individuals each year. Previously, our study in non-human primates with SCI demonstrated that methylprednisolone (MP) resulted in the dysfunction of neural stem cells (NSCs), which may help to explain the controversial roles of MP in SCI. However, the detailed mechanism is still unclear. In this manuscript, we investigated the LncRNA and mRNA expression profiles of NSCs treated with MP. A total of 63 differentially expressed LncRNAs and 174 differentially expressed mRNAs were identified. Gene ontology (GO) analysis showed that differentially expressed mRNAs were highly associated with terms related to regulation of external stimulation, secretion, and migration. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis results indicated that the PI3K–Akt signaling pathway contributed to the functions of MP treated NSCs. Besides, 3899 co-expression pairs were constructed among the differentially expressed LncRNA and mRNA, among which five predicted target mRNAs with the differentially expressed LncRNAs were identified. These results provide greater insight into the precise mechanisms of MP mediating NSC dysfunction in SCI. [ABSTRACT FROM AUTHOR]

Background: C1-C2 injury represents 25–40% of cervical injuries and predominantly occurs in the geriatric population. Methods: A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. Results: A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61–80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. Conclusions: C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect. [ABSTRACT FROM AUTHOR]

Spinal injury is among the most severe and feared injuries an athlete may face. We present an up-to-date review of the recent literature, stratifying recommendations based on injury location (cervical, thoracic, and lumbar spine) and type, as well as, the level of competitive play (high school, collegiate, professional). A literature search was completed to identify all publications reporting return to play guidelines for athletic injuries or injury-related surgery irrespective of the study design. Publication dates were not restricted by year. Search terms used included "return to play" and "spinal injury" on National Library of Medicine (PubMed) and Google Scholar. Selection criteria for literature included axial spine injury guidelines for athletic participation post-injury or post-surgery. Literature found from the search criteria was sorted based on level of competition and location of axial spine injury involved. It was found that professional athletes are more likely to suffer severe spinal injuries, require surgery, and necessitate a longer return to play (RTP), with high school and college athletes usually returning to play within days or weeks. Injuries occur mainly within contact sports and concordance exists between initial and subsequent spinal injuries. Adequate rest, rehabilitation, and protective equipment alongside the education of athletes and coaches are recommended. In conclusion, a multidisciplinary approach to patient management is required with consideration for the emotional, social, and perhaps financial impact that spinal injury may have upon the athlete. Consensus from the literature states that in order for an athlete to safely return to play, that athlete should not be actively suffering from pain, should have a full range of motion, and complete return of their strength in the absence of neurological deficit. [ABSTRACT FROM AUTHOR]

Neck injury fractures are commonly associated with high-impact trauma, such as motor vehicle accidents or falls from heights. However, this case underscores that it is possible to sustain such a fracture even from minor falls. As of now, there are no such reported cases. This case report highlights the importance of a thorough medical history when assessing patients with neck pain following falls. A 59-year-old male experienced a fainting episode after suffering from vomiting and diarrhea, resulting in him hitting his head. The patient attributed his neck pain to a sudden twisting of his neck. The pain originated from the base of his skull, primarily on the left side, extending to the scalp and the left shoulder. After enduring four days of intense pain that limited his ability to rotate his neck and bend to tie his shoes, he sought medical attention and underwent a neck CT scan, which led to the diagnosis of a "hangman's fracture." This injury was diagnosed in a clinical setting. Healthcare providers should inquire about the circumstances of the fall, the patient's position, associated symptoms, and any relevant pre-existing conditions. This approach ensures an accurate diagnosis and timely treatment. Comprehensive history-taking is essential for identifying high-risk situations and preventing complications that may arise from overlooked minor falls, ultimately enhancing patient safety, especially in cases of neck and spine injuries., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Frezza et al.)

With modern civilization and the rise in literacy, cases of human sacrifice are rarely encountered by forensic practitioners. Human sacrifice, also called 'Narabali' in India, involves an act of deliberately killing an individual due to ritualistic beliefs for the appeasement of the Gods, spirits, or ancestors. Human sacrifice and ritual murder are often considered synonymous, but ritual murder further involves offering the body part to the deity after killing. Diverse methods were historically adopted for human sacrifice across the globe, strongly influenced by their superstitious, religious, and cultural beliefs. Cases of human sacrifice mostly involve children. We report the rare case of human sacrifice involving an adult victim assaulted by a sharp weapon over the posterior aspect of the neck. The deceased succumbed due to the transection of the cervical spine and corresponding spinal cord. Corroboration of circumstances of death and profiles of the deceased and the perpetrator with autopsy findings were essential in the investigation. This case report discusses extreme superstitions and beliefs, resulting in homicide., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Outcome of spine injury treated in resource constrained regions may not be the same as in developed nations. The aim of the present study was to study the epidemiological characteristics, delay, complications, and outcome of surgically treated dorsal and lumbar trauma. Methods: Retrospective study of dorsal and lumbar spine injury patients treated between December 2015 and August 2017. Patients were segregated into four groups based on the timing of surgery: 0-2 days, 3-7 days, 8-30 days, and more than 31 days. Only one operating room twice a week was allotted to spine surgery, and spine had to compete with orthopedic and surgical trauma for admission and surgery. Results: Ninety-one patients (male 61) with mean age 33 years were operated for dorsal and lumbar spine injuries. 84% of the total patients sustained a fall, and 86.8% were from the periphery. Though 69.2% presented within 2 days, only 4.4% were operated within 2 days. Majority of the delay was due to unavailability of the operating room followed by financial constraints. Twenty-seven patients had complete deficit, 32 incomplete deficit, and 32 normal neurology. Four patients operated within 2 days improved their neurology, 7 incomplete deficit patients in 3-7 days group improved, 6 in 8-30 days group improved, whereas no patient in more than 31 days group improved. Overall 53.1% of neurologically incomplete deficit patients improved if operated within 30 days. No neurological improvement was seen in the 27 complete deficit patients. Wound infection, pulmonary contusion, and deep vein thrombosis were seen in 3 patients. Conclusions: As expected 95.6% of our patients were treated more than 3 days after injury and 60% more than a week later, which may not be acceptable in advanced countries. Despite the delay, 53.1% had an improvement in neurology when operated within 30 days. Hence, surgery still holds the hope of neurological recovery and quicker rehabilitation.

All sports come with a risk of injury, and in general, the more contact involved in the sports, the higher the risk of a more significant or traumatic injury. The most frequent types of sports injuries are sprains (ligament injuries), strains (muscle injuries), and stress fractures (bone injuries). In sports medicine, a catastrophic injury is defined as severe trauma to the human head, spine, or brain. Concussions in sports became a major issue in the 2000s as evidence connected repeated concussions and subconcussive hits with chronic traumatic encephalopathy and increased suicide risk. Overuse and repetitive stress injury problems associated with sports include jumper's knee, tennis elbow, and tendinosis. In this review article, we have made an attempt to describe the head to toe spectrum of sports-related injuries including traumatic injuries of the head and face, extremity injuries, soft-tissue injuries, and contact sports-related injuries.

Sport-related spine injury can be devastating and have longlasting effects on athletes and their families. Providing evidencebased care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidencebased medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations. [ABSTRACT FROM AUTHOR]