Odontoid Screw Fixation May Produce Better Outcome than Posterior C1-2 Fixation

Comparison of Clinical Outcomes of Posterior C1-C2 Temporary Fixation without Fusion and C1-C2 Fusion for Fresh Odontoid Fractures

Guo Q, Deng Y, Wang J, Wang L, Lu X, Guo X, et al. (Neurosurgery)

In this retrospective case series, the authors compared patients with odontoid fractures undergoing posterior C1-C2 fixation using anterior odontoid screws to patients undergoing C1-C2 fixation using posterior instrumentation. In the 22 patients included in the odontoid screw group (deemed candidates for the technique and who underwent screw placement), 21 of them experienced fracture healing and motion preservation at the C1-C2 level. These 21 patients then were compared to 21 randomly selected patients who had undergone C1-C2 posterior fixation for odontoid fractures. The two groups were analyzed at the time of final follow up (varied between patients) using the visual analog scale score for neck pain and stiffness, Neck Disability Index, and 36-Item Short Form Health Survey and were analyzed for time to fracture healing. The odontoid screw group had significantly better results in all of these categories with fracture healing time being not statistically significantly different between the groups (about four and a half months on average). In patients who are candidates for odontoid screw fixation of C1-C2 with odontoid fractures and who heal well following surgery, this data suggests that these patients may have better outcomes than similar patients treated with C1-C2 fusion with posterior instrumentation.

Abstract link: http://www.ncbi.nlm.nih.gov/pubmed/26348006

Lateral Standing Dynamic Plain X-Ray is More Sensitive than MRI for Detecting Spondylolisthesis

Sensitivity of magnetic resonance imaging in the diagnosis of mobile and nonmobile L4-L5 degenerative spondylolisthesis

Kuhns BD, Kouk S, Buchanan C et al. (Spine Journal)
In this retrospective study of 103 patients with L4/5 lumbar degenerative spondylolisthesis (LDS) diagnosed by supine MRI and with standing lateral and flexion-extension (SLFE) radiographs, LDS was defined radiographically as a slip greater than 4.5mm while mobile LDS was defined as a difference of greater than 3% in slip percentage between lateral radiographs and sagittal MRIs. The authors found that MRI had a sensitivity of 78% for detecting L4/5 LDS compared to 98% for lateral standing films. Facet effusion width also was significantly larger in patients with mobile LDS.

Abstract link: http://www.ncbi.nlm.nih.gov/pubmed/25130777

Excessive hospital transfers of spine injury patients

How often are interfacility transfers of spine injury patients truly necessary?

Bible JE, Kadakia RJ, Kay HF, et Al. (The Spine)

In this retrospective study, the authors analyzed 1,427 patients who were transferred from an outside hospital emergency department to a Level 1 trauma center with any spine injury. The group found that 29 percent of the transfers consisted of neurologically intact patients without critical medical issues and with only isolated spine injuries. Of these, the authors felt that 42 percent were inappropriate transfers in that the patients had stable injuries with minimal risk of progressing to unstable and were at transferring facilities with a spine surgeon on staff. Of these, 87 percent were discharged directly from the emergency department of the receiving institution with costs of the transportation and emergency department fees averaging $1,863 and $12,895, respectively. The authors then propose solutions to the over-triage problem highlighted at their institution including increased communication and image review between the transferring and receiving institutions.

Abstract link http://www.ncbi.nlm.nih.gov/pubmed/24743061