Severe Thoracic Vertebral Spine Injury as a Complication of Component of Cardiopulmonary Resuscitation

Chest compression has been a component of cardiopulmonary resuscitation (CPR) since 1960. Performance of high-quality CPR is critical for survival; however, chest compressions are traumatic and may result in injuries such as rib and sternal fractures. Spinal fractures have rarely been reported. We present a case of a 69-year-old male who suffered a cardiac arrest at home. He underwent 16 minutes of CPR with manual chest compressions, and no electrical shock and medications with return of spontaneous circulation (ROSC). Computed tomography scan showed unstable fracture of T9-T10. The patient was transferred to our Level I trauma center for continued post-arrest management and neurosurgical evaluation. An MRI confirmed the unstable spinal fracture which would have required surgical stabilization. The patient remained comatose, thus he was transitioned to comfort measures and expired. Spinal injuries following CPR are rare but should be considered in the post-arrest management stage. Computed tomography scan is the ideal screening modality.

The improved faster-RCNN for spinal fracture lesions detection

Purpose: Reading spinal CT (Computed Tomography) images is very important in the diagnosis of spondylosis, which is time-consuming and prones to make biases. In this paper, we propose a framework based on Faster-RCNN to improve detection performances of three spinal fracture lesions: cfracture (cervical fracture), tfracture (thoracic fracture) and lfracture (lumbar fracture). Methods: First, we use ResNet50 to replace VGG16 in backbone network in Faster-RCNN to increase depth of training network. Second, we utilize soft-NMS (Non-Maximum Suppression) instead of NMS to avoid missed detection of overlapped lesions. Third, we simplify RPN (Region Proposal Network) to accelerate training speed and reduce missed detection. Finally, we modify the classifier layer in Faster-RCNN and choose appropriate length-width ratio by changing anchor sizes in sliding window, then adopt multi-scale strategy in training to improve efficiency and accuracy. Results: The experimental results show that the proposed scheme has a good performance, mAP (mean average precision) is 90.6%, IOU (Intersection of Union) is 88.5 and detection time is 0.053 second per CT image, which means our proposed method can accurately detect spinal fracture lesions. Conclusion: Our proposed method can provide assistance and scientific references for both doctors and patients in clinically.

Traumatic rupture of thoracic epidural capillary hemangioma resulting in acute neurologic deficit: illustrative case

BACKGROUND Thoracic epidural capillary hemangioma is exceedingly rare, with only a few reported cases. The typical presentation usually includes chronic, progressive symptoms of spinal cord compression in middle-aged adults. To the authors’ knowledge, this case is the first report in the literature of acute traumatic capillary hemangioma rupture. OBSERVATIONS A 22-year-old male presented with worsening lower extremity weakness and paresthesias after a fall onto his spine. Imaging showed no evidence of spinal fracture but revealed an expanding hematoma over 24 hours. Removal of the lesion demonstrated a ruptured capillary hemangioma. LESSONS This unique case highlights a rare occurrence of traumatic rupture of a previously unknown asymptomatic thoracic capillary hemangioma in a young adult.

The Shrank YoloV3-tiny for spinal fracture lesions detection

Purpose: at present, more and more deep learning algorithms are used to detect and segment lesions from spinal CT (Computed Tomography) images. But these algorithms usually require computers with high performance and occupy large resources, so they are not suitable for the clinical embedded and mobile devices, which only have limited computational resources and also expect a relative good performance in detecting and segmenting lesions. Methods: in this paper, we present a model based on Yolov3-tiny to detect three spinal fracture lesions, cfracture (cervical fracture), tfracture (thoracic fracture), and lfracture (lumbar fracture) with a small size model. We construct this novel model by replacing the traditional convolutional layers in YoloV3-tiny with fire modules from SqueezeNet, so as to reduce the parameters and model size, meanwhile get accurate lesions detection. Then we remove the batch normalization layers in the fire modules after the comparative experiments, though the overall performance of fire module without batch normalization layers is slightly improved, we can reduce computation complexity and low occupations of computer resources for fast lesions detection. Results: the experiments show that the shrank model only has a size of 13 MB (almost a third of Yolov3-tiny), while the mAP (mean Average Precsion) is 91.3%, and IOU (intersection over union) is 90.7. The detection time is 0.015 second per CT image, and BFLOP/s (Billion Floating Point Operations per Second) value is less than Yolov3-tiny. Conclusion: the model we presented can be deployed in clinical embedded and mobile devices, meanwhile has a relative accurate and rapid real-time lesions detection.

Minimal Invasive Fluoroscopic Percutaneous Lateral Stabilization of Thoracolumbar Spinal Fractures and Luxations Using Unilateral Uniplanar External Skeletal Fixators in Dogs and Cats

Objective The aim of this study was to describe minimally invasive spinal stabilization using a unilateral uniplanar external skeletal fixator (ESF, type 1a) with polymethylmethacrylate, and to review short- and long-term outcomes and complications in a clinical case series. Materials and Methods Medical records from animals affected by spinal fracture luxation were reviewed. The data included breed, age, gender, body weight, aetiology, preoperative and postoperative neurological state, radiographic findings, surgical treatment, pin size, number of pins and stabilized vertebrae, intra- and postoperative complications and neurological state at re-examinations. Results Thirty-two animals were identified; three were treated conservatively, 19 surgically and 10 were euthanatized. In eight dogs and six cats, the injured spinal column was treated with a laterally applied percutaneous type 1a ESF under fluoroscopic guidance. Positive profile end-threaded pins inserted were from 1.6/1.9 to 3.5/4.3 mm in dogs and 1.6/1.9 to 2/2.3 mm in cats and were placed into two to five vertebral bodies. At the re-examinations, the neurological status had improved in 12 animals, deteriorated in one, and was unchanged in another one. In eight cases, no complications were detected. The most common complications included erythema, exudation and pin loosening. Conclusion The present work shows that type 1a ESF can be successfully and minimally invasively applied to fractures and luxations of the spine in dogs and cats with minimal major complications.

Study on the Value of the Theory of Protection Motivation in the Nursing of Spinal Fracture to the Quality of Life

Objective: To analyze the effect of protection motivation theory on the quality of life of patients with spinal fracture. Methods: From August 2019 to September 2020, 72 patients with spinal fracture were selected and randomly divided into two groups. The routine nursing group was the routine nursing group, and the combined nursing with the theory of protective motivation was the dynamic nursing group. Results: The hospitalization time, detumescence time, healing time and muscle strength recovery time of group A were shorter than those of group B (P < 0.05). The VAS score and Barthel index score of the dynamic group were better than those of the conventional group (P < 0.05); The score of SF-36 in the group A was higher than that in the group B (P < 0.05). Conclusions: The application of protection motivation theory in the nursing of patients with spinal fracture can shorten the healing time of fracture, promote the recovery of muscle strength, relieve the pain of fracture, and then improve the ability of daily life and quality of life of patients.

Pre-Operative Modified Glasgow Prognostic Score 2 For The Prediction of Poor Post-Operative Performance Status Following Palliative Surgery For Pathological Spinal Fracture: A Retrospective Cohort Study

Background: Skeletal-related events due to spinal metastasis in cancer significantly impair patients’ activities of daily living and quality of life. Most of these events occur suddenly. To reduce their impairment occurred suddenly, and to allow them to return to their normal life immediately, many patients undergo palliative surgery; however, some patients do not improve their performance status (PS) as expected. There is little evidence regarding the factors influencing a patient’s PS after palliative surgery. We aimed to investigate the pre-operative predictors of poor PS 1 month after surgery.Methods: The study included a consecutive series of 71 patients with pathological spinal fracture who underwent palliative surgery. Pre-operative predictors of poor post-operative PS were investigated. The participants were categorized into two groups according to PS; the Good group (PS 0, 1, or 2) and the Poor group (PS 3 or 4). We performed univariate and multivariable logistic regression analyses on demographic information, unidentified primary site, AIS grade, poor PS, spinal instability neoplastic score, revised Tokuhashi score, New Katagiri score, modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio(NLR), and prognostic nutrition index (PNI). Results: Post-operatively, the Poor group included 38.0% of the patients. Univariate analysis revealed that the following pre-operative factors were related to poor outcomes (p<0.05): BMI<18.5; AIS grade C; poor PS; revised Tokuhashi score 0−8; New Katagiri score 7−10; mGPS 2; and PNI. In the multivariate analysis, mGPS 2 (OR = 22.8, 95% CI = 2.59−202.00, p<0.01) was a significant pre-operative predictor of poor post-operative PS. Conclusion: mGPS 2 was a predictive clinical factor that influenced PS 1 month after surgery. Patients with mGPS 2 should be carefully evaluated to determine their treatment, especially whether they should undergo palliative surgery.