EPIDEMIOLOGY OF SPINAL TRAUMA SURGICALLY TREATED AT THE UNICAMP HOSPITAL DAS CLÍNICAS

SILVA, OTÁVIO TUROLO DA; GHIZONI, ENRICO; TEDESCHI, HELDER; JOAQUIM, ANDREI FERNANDES

doi:10.1590/S1808-185120181701179262

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REVISION ARTICLE • Coluna/Columna 17 (01) • Jan-Mar 2018 • https://doi.org/10.1590/S1808-185120181701179262 copy

EPIDEMIOLOGY OF SPINAL TRAUMA SURGICALLY TREATED AT THE UNICAMP HOSPITAL DAS CLÍNICAS

EPIDEMIOLOGIA DO TRAUMATISMO RAQUIMEDULAR TRATADO CIRURGICAMENTE NO HOSPITAL DAS CLÍNICAS DA UNICAMP

EPIDEMIOLOGÍA DEL TRAUMATISMO RAQUIMEDULAR TRATADO QUIRÚRGICAMENTE EN EL HOSPITAL DAS CLÍNICAS DE UNICAMP

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To report the epidemiological profile of patients operated for treatment of spinal trauma in the UNICAMP Hospital das Clínicas.

Methods:

Patients older than 14 years with spinal trauma operated in the service from 2012 to 2017 with complete radiological and clinical data were evaluated.

Results:

A total of 143 patients were included, 120 men and 23 women, with a mean age of 37.8 years. Falls from height (32%), motorcycle (26%) and car accidents (24%) were the most common trauma mechanisms. The most affected vertebral level was C6 (11%) and most patients (55%) had some neurological deficits. The overall postoperative complication rate was 23%.

Conclusions:

Spinal trauma has a high socioeconomic impact due to its high morbidity and mortality, and it is necessary to study its epidemiology for the development of public policies for prevention and treatment financing. Level of Evidence: III. Type of study: Retrospective study.

Keywords:
Spinal cord injury; Spine; Surgery; Treatment; Epidemiology

Authorship

OTÁVIO TUROLO DA SILVA

. Department of Neurology, division of Neurosurgery of Unicamp - Campinas, SP, Brazil.UnicampBrazilCampinas, SP, Brazil. Department of Neurology, division of Neurosurgery of Unicamp - Campinas, SP, Brazil.

https://orcid.org/0000-0001-6015-0199

ENRICO GHIZONI

https://orcid.org/0000-0001-8684-1780

HELDER TEDESCHI

https://orcid.org/0000-0003-3347-3886

ANDREI FERNANDES JOAQUIM

https://orcid.org/0000-0003-2645-0483

Correspondence: Universidade Estadual de Campinas. Rua: Tessália Vieira de Camargo, 126, Departamento Neurologia, Cidade Universitária. Campinas, SP, Brasil. 13083-887. andjoaquim@yahoo.com

All authors declare no potential conflict of interest related to this article.

CONTRIBUTION OF THE AUTHORS:

Each author made significant individual contributions to this manuscript. Patient data was evaluated by AFJ (0000-0003-2645-0483)* and OTS (0000-0001-6015-0199)*. The article was written by) OTS and AFJ. The final review was done by AFJ, HT(0000-0003-3347-3886)*, and EG (0000-0001-8684-1780)*. *ORCID (Open Researcher and Contributor ID).

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (3)
Tables (3)

Thumbnail

Figure 1
Shows the distribution of the 143 patients in relation to neurological damage according to the AIS. Most patients (45%) had no neurological deficits in the initial evaluation (E), followed by 35% with partial deficits (D, C, and B), and 20% with full sensory and motor deficit (A).

Thumbnail

Figure 2
The figure shows the distribution of the 204 fractures found in these patients. Most of the fractures (53.9%) were in the thoracolumbar region, L1 being the most affected level (9%) in this segment. However, of the total number of fractures, those of C6 were the most predominant at 11%, even though subaxial fractures accounted for 36% of all the fractures.

Thumbnail

Figure 3
Flowchart for the evaluation of the instability of high cervical lesions. Adapted from Joaquim et al.²³23 Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro, AR, et al. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med. 2014;37(2):139-51.^-²⁴24 Joaquim AF, Ghizoni E, Tedeschi H, Yacoub AR, Brodke DS, Vaccaro AR, et al. Upper cervical injuries: Clinical results using a new treatment algorithm. J Craniovertebr Junction Spine. 2015;6(1):16-20.

Thumbnail

Table 1
Neurological grading according to the AIS (ASIA Impairment Scale).⁸8 Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017;475(5):1499-504.

Thumbnail

Table 2
Subaxial Cervical Spine Injury Classification System (SLICS). Adapted from Patel et al.²¹21 Patel AA, Hurlbert RJ, Bono CM, Bessey JT, Yang N, Vaccaro AR. Classification and surgical decision making in acute subaxial cervical spine trauma. Spine (Phila Pa 1976). 2010;35(21 Suppl):S228-34.

Thumbnail

Table 3
Thoracolumbar Injury Classification System and Injury Severity Score (TLICS). Adapted from Patel et al.²²22 Patel AA, Dailey A, Brodke DS, Daubs M, Harrop J, Whang PG, et al. Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples. J Neurosurg Spine. 2009;10(3):201-6.

Figure 1 Shows the distribution of the 143 patients in relation to neurological damage according to the AIS. Most patients (45%) had no neurological deficits in the initial evaluation (E), followed by 35% with partial deficits (D, C, and B), and 20% with full sensory and motor deficit (A).

Figure 2 The figure shows the distribution of the 204 fractures found in these patients. Most of the fractures (53.9%) were in the thoracolumbar region, L1 being the most affected level (9%) in this segment. However, of the total number of fractures, those of C6 were the most predominant at 11%, even though subaxial fractures accounted for 36% of all the fractures.

Figure 3 Flowchart for the evaluation of the instability of high cervical lesions. Adapted from Joaquim et al.²³23 Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro, AR, et al. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med. 2014;37(2):139-51.^-²⁴24 Joaquim AF, Ghizoni E, Tedeschi H, Yacoub AR, Brodke DS, Vaccaro AR, et al. Upper cervical injuries: Clinical results using a new treatment algorithm. J Craniovertebr Junction Spine. 2015;6(1):16-20.

Table 1 Neurological grading according to the AIS (ASIA Impairment Scale).⁸8 Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017;475(5):1499-504.

A	Full neurological deficit, including the sacral segment.
B	Full motor deficit, feeling preserved (sacral segments present).
C	Partial motor deficit, loss of >50% (or <3/5).
D	Partial motor deficit, loss of <50% (or >3/5).
E	No deficit, however presented a temporary deficit, including nerve root deficit.

Table 2 Subaxial Cervical Spine Injury Classification System (SLICS). Adapted from Patel et al.²¹21 Patel AA, Hurlbert RJ, Bono CM, Bessey JT, Yang N, Vaccaro AR. Classification and surgical decision making in acute subaxial cervical spine trauma. Spine (Phila Pa 1976). 2010;35(21 Suppl):S228-34.

Morphology	Points
Without changes	0
Compression (A)	1
Burst (A +1)	+1
Distraction (B)	3
Translation/Rotation (C)	4
Posterior ligament complex integrity
Intact	0
Undetermined	1
Ruptured	2
Neurological status
Intact	0
Radicular lesion	1
Full deficit	2
Partial deficit	3
Persistent compression of the canal*	+1

Table 3 Thoracolumbar Injury Classification System and Injury Severity Score (TLICS). Adapted from Patel et al.²²22 Patel AA, Dailey A, Brodke DS, Daubs M, Harrop J, Whang PG, et al. Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples. J Neurosurg Spine. 2009;10(3):201-6.

Morphology	Points
Without changes	0
Compression (A)	1
Burst (A +1)	+1
Translation/Rotation (C)	3
Distraction (B)	4
Posterior ligament complex integrity
Intact	0
Undetermined	2
Ruptured	3
Neurological status
Intact	0
Radicular lesion	2
Full deficit	2
Partial deficit	3
Cauda Equina Syndrome	3

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[1] Correspondence: Universidade Estadual de Campinas. Rua: Tessália Vieira de Camargo, 126, Departamento Neurologia, Cidade Universitária. Campinas, SP, Brasil. 13083-887. andjoaquim@yahoo.com