Purpose
To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty.
Methods
A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1–F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries.
Results
A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment.
Conclusion
Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
Study design Prospective randomized placebo controlled double blind trial. Objective To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. Methodology Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). Results In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357 mg in ESP group and 8.607 mg in placebo group ( P = .004). Average VAS during first 24 hour was 3.944 in ESP group and 5.193 in placebo group ( P = .046). Blood loss was 14.8 g per screw in ESP group and 15.4 g in placebo group ( P = .387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group ( P = .008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group ( P = .036). No significant differences in ODI were detected. Conclusion The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing.
OBJECTIVES: The implementation of patient-reported outcome measurements has become a standard component of evaluating the effect of treatment. For spine injuries, an evaluation tool AOSpine Patient Reported Outcome for Spinal Trauma (AOSpine PROST) has been developed. The aim of this study was to translate, interculturally adapt and validate the Slovak version of AOSpine PROST. METHODS: Based on methodologies we translated and culturally adapted the AOSpine PROST into Slovak. We then validated it on a representative sample of patients treated at a single level-one trauma center in the Slovak Republic. Content validity was assessed by evaluating the number of inapplicable or missing questions. Internal consistency was assessed by calculating Cronbach's alpha and Corrected item-total correlations. RESULTS: 37 patients were included in the study. The questionnaire was understandable to patients. The mean T-score across questions and participants in the questionnaire was 79.6 with a narrow range of 70.4 to 97.3 for all questions, which is relatively high. The internal consistency of total score was excellent with Cronbach´s alpha of 0.92. Total correlation across questions revealed relatively good results ranging from 0.17 to 0.90. CONCLUSIONS: The results indicate that the Slovak version of AOSpine PROST is reliable and valid and can be used in practice (Tab. 2, Ref. 14).
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