• Journal of Trauma and Injury
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• v.30 no.3
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• pp.103-106
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• 2017

A traumatic Braun-Sequard syndrome of the cervical spine is reported in a 53-year-old male. The patient recovered spontaneously over several days with surgical intervention. The diagnosis was made on magnetic resonance imaging with physical examination, which also demonstrated subsequent resolution of bone marrow intensity. The etiological factors of spinal Braun-Sequard syndrome are reviewed.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.158-165
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• 2017

Purpose: The purpose of this study was to evaluate the diagnostic accuracy of X-rays in patients with acute traumatic vertebral fractures visiting the emergency department and to analyze the diagnostic value of X-rays for each spine level. Methods: We retrospectively analyzed basal characteristics by reviewing medical records of 363 patients with adult traumatic vertebral fractures, admitted to the emergency center from March 1, 2014 to February 28, 2017. We analyzed spine X-rays and magnetic resonance imaging (MRI) scans to determine distribution according to the vertebral level, and we evaluated the efficacy of X-rays by comparing discrepancies between X-rays and MRI scans. Results: For a total of 363 patients, the mean age was 56.65 (20-93) and 214 (59%) were males. On the basis of X-rays, 67 cases (15.1%) were of the cervical spine, 133 cases (30.0%) were of the thoracic spine, and 243 cases (54.9%) were of the lumbar spine. In particular, the thoracolumbar region (T11-L2) was the most common, with 260 cases (58.7%). In X-rays, fractures were the least in the upper thoracic region (T1-T3), whereas MRI scans revealed fairly uniform distribution across the thoracic spine. Sensitivity of X-rays was lowest in the upper thoracic spine and specificity was almost always greater than 98%, except for 94.7% in L1. Positive predictive value was lower in the mid-thoracic region (T4-T9) and negative predictive value was slightly lower in C6, T2, and T3 than at other sites. Diagnostic accuracy of X-rays by vertebral body, transverse process, and spinous process according to fractured vertebral structures was significantly different according to vertebral level. Conclusions: Diagnostic accuracy of X-rays was lower in the upper thoracic region than in other parts. Further studies are needed to identify better methods for diagnosis considering cost and neurological prognosis.

• Journal of Trauma and Injury
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• v.30 no.2
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• pp.51-54
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• 2017

We here report a case of long-term fistula formation due to bullet retention for 30 years in the lumbar spine after a gunshot injury, and describe its treatment. A 62-year-old male visited our hospital due to pus-like discharge from his left flank. The discharge had been present for 30 years, since his recovery from an abdominal gunshot injury. A spine radiography showed radiopaque material in the body of the third lumbar vertebra. Foreign body was removed using an anterolateral retroperitoneal approach. The postoperative course was uneventful. The patient was discharged 7 days after the operation and was followed-up for 8 months, during which time, the fistula did not reoccur. A bullet retained long term in the vertebral body may cause obstinate osteomyelitis and fistula formation. A fistula caused by a foreign body in the spine can be effectively treated by surgical removal.

• Korean Journal of Radiology
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• v.20 no.6
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• pp.909-915
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• 2019

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed a primary imaging test for suspected traumatic thoracolumbar spine injury. This guideline was developed using an adaptation process involving collaboration between the development committee and the working group. The development committee, consisting of research methodology experts, established the overall plan and provided support on research methodology. The working group, composed of radiologists with expertise in musculoskeletal imaging, wrote the recommendation. The guidelines recommend that thoracolumbar spine computed tomography without intravenous contrast enhancement be the first-line imaging modality for diagnosing traumatic thoracolumbar spine injury in adults.

• Journal of Trauma and Injury
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• v.34 no.4
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• pp.279-283
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• 2021

Traumatic spinal cord infarction is a rare condition that causes serious paralysis. The regulation of spinal cord blood flow in injured spinal cords remains unknown. Spinal cord infarction or ischemia has been reported after cardiovascular interventions, scoliosis correction, or profound hypotension. In this case, a 52-year-old man revisited the emergency center with motor and sensory abnormalities in all four extremities 56 hours after a motor vehicle collision. Despite the clinical presentation and imaging examination, there were no specific findings on the patient's first visit to the trauma center. Cervical spine computed tomography angiography showed a narrow vertebral artery, and diffusion-weighted imaging revealed spinal cord infarction from C3 to C5 with high signal intensity. It should be kept in mind that delayed-onset spinal cord infarction may occur in minor or major trauma patients as a result of head and neck injuries.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.3
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• pp.183-187
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• 2018

Complex cervical spine fractures are a serious complications of maxillofacial trauma and associated with high mortality and neurological morbidity. Strict vigilance in preventing further insult to the cervical spine is a crucial step in managing patients who are at risk for neurologic compromise. We report a rare case of a right transverse process of atlas fracture with right-sided vertebral artery injury that was associated with a comminuted fracture of the body and angle of the mandible, which restricted mouth opening. Airway management was performed by an awake fiber-optic nasotracheal intubation, where neck movement was avoided with a cervical collar. Vertebral artery injuries may have disastrous consequences, such as basilar territory infarction and death, and should be suspected in patients with head and neck trauma. After mandibular plating, the patient was on cervical collar immobilization for 12 weeks and anti-coagulant therapy.

• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.649-656
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• 2020

Objective : Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods : A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results : Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS (p=0.000). Conclusion : WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.37-43
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• 2009

Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had three-site fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was $50.12{\pm}18.54$ years in the diagnosis group and $57.38{\pm}16.88$ years in the missed fracture group. For the diagnosis group, the mean ISS was $9.03{\pm}8.26$, but in the missed fracture group it was $17.53{\pm}9.69$. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high (ISS$ ISS{\geq}16$) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.790-794
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• 2001

Spinal osteochondroms are very rare, and are thought to arise through a process of progressive endochondral ossification of aberrant cartilage of a growth plate, as a consequence of congenital defect or trauma. A case of diffuse type osteochondroma involving the posterior elements of L1-L5 that progressed after laminectomy in a 33-year-old man is reported. Usually, the spinal osteochondroma shows clear demarcation between tumor margin and normal spine elements, and can be exised completely. However, there was no clear demarcation between tumor and normal spine element in our case and therefore it was not possible to removal completely.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.254-256
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• 2012

Intracranial hypotension syndrome typically occurs spontaneously or iatrogenically. It can be associated with headache, drowsy mentality and intracranial heamorrhage, Iatrogenic intracranial hypotension can occur due to dural pucture, trauma and spine surgery. Treatment may include conservative therapy and operation. We report a case of a 54-year-old man who was successfully treated with epidural blood patches for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the lumbosacral area after spine surgery.