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Andrew H. Milby, Casey H. Halpern, Wensheng Guo, and Sherman C. Stein

Q uadriplegia due to spinal cord injury is a devastating consequence of trauma to the cervical spine, involving numerous functional, psychosocial, and economic ramifications. 7 , 12 , 13 , 24 , 25 , 27–29 , 45 , 49 , 61 Identification of unstable CSI is therefore an essential aspect of the trauma evaluation in preventing subsequent neurological damage. 6 , 22 , 71 , 72 , 75 , 76 This task is especially difficult in patients who are not clinically evaluable (unevaluable group) because of intoxication or concomitant head injury, and has led to the use of

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William W. Winternitz and James A. Dzur

trauma should have plasma cortisol determinations daily for the first 2 or 3 days. Patients with basal fractures or diabetes insipidus should be followed especially carefully. 2) Patients receiving steroid therapy (dexamethazone) should have cortisols followed when therapy is discontinued. 3) Patients exhibiting poor recovery, posttraumatic psychoses, or general malaise and failure to thrive should have screening tests to insure that their hypothalamic pituitary axis is intact. References 1. Altman R , Pruzanski W : Post

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Richard C. E. Anderson, Eric R. Scaife, Stephen J. Fenton, Peter Kan, Kris W. Hansen, and Douglas L. Brockmeyer

C urrently , no national guidelines exist for clearance of the cervical spine in children after trauma. Even after a comprehensive scientific review was conducted and published in Neurosurgery as the “Management of Pediatric Cervical Spine and Spinal Cord Injuries” guidelines in 2002, 2 insufficient evidence was found to support diagnostic standards of care. Traditionally, clearance of the cervical spine after trauma has been performed by specialists in multiple disciplines including emergency department physicians, orthopedic surgeons, trauma surgeons

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Sarah T. Garber and Jay K. Riva-Cambrin

lesions. 13 To our knowledge, a ruptured ABC as a result of head trauma has not been reported in the pediatric literature, and only one case report in the adult literature describes a similar phenomenon. 1 We present the case of a 3-year-old girl who had a previously undiagnosed ABC at the foramen magnum that ruptured in the form of an acute compressive epidural hematoma (EDH) after head trauma. We review the presenting symptoms, imaging features, treatment, and natural history of these rare lesions. Case Report History and Presentation A previously healthy

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Charles E. Mackel, Brent C. Morel, Jesse L. Winer, Hannah G. Park, Megan Sweeney, Robert S. Heller, Leslie Rideout, Ron I. Riesenburger, and Steven W. Hwang

L evel I and II trauma centers receive patients by either direct transport or transfer to offer immediate access to centralized and comprehensive regional specialty trauma services. For designation, Level I and Level II trauma services require the same level of clinical care, with Level I trauma centers additionally required to meet admission volume requirements, maintain a surgically directed critical care service as well as a residency program, and perform trauma research. 1 Moderately to severely injured patients treated at Level I trauma centers either

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Michael J. Cools, Wajd N. Al-Holou, William R. Stetler Jr., Frank La Marca, and Juan M. Valdivia-Valdivia

S acral fractures are uncommon injuries usually caused by a significant trauma. 17 Most often these fractures occur below S-2, as both S-1 and S-2 are rigidly fixed to the pelvis. 12 Neurological injury occurs in 15%–25% of cases, with the majority of neurological injuries being radiculopathies. 8 , 16 , 21 Cauda equina syndrome also occurs, but is much rarer. 2 , 7 , 8 , 16 , 21 Overall, traumatic fractures involving the lumbosacral spine can result in pseudomeningoceles; however, this is most commonly seen at L-4 and L-5 as a result of nerve root

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Alexander Winkler-Schwartz, José A. Correa, and Judith Marcoux

T he clivus is the deepest bone of the skull base and is rarely injured, with a fracture incidence reported between 0.21% and 0.56% among head traumas. 7 , 29 , 32 , 33 Because of its rare presentation, much of the literature on clival fractures (CFs) is in the form of case reports, 1 , 3–5 , 8 , 9 , 11 , 12 , 14 , 15 , 17 , 19 , 21–26 , 28 , 34–37 , 39 , 41–45 , 47 , 48 with only 5 additional studies describing case series ranging from 9 to 41 cases. 7 , 20 , 29 , 32 , 33 Clival fractures carry a high mortality rate; between 24% and 31%. 29 , 33

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Jason Lifshutz, Zvi Lidar, and Dennis Maiman

because of its complex effects on the spine, extraarticular organ manifestations, and the potential neurological and functional sequelae. Aortitis is a known sequela of AS. Adventitial scarring, intimal proliferation, and fibrous thickening of the aortic wall are commonly seen in patients with AS. 3, 11, 20 Traumatic thoracic and lumbar injuries in this patient population may be associated with injury to the aorta either due to direct mechanical trauma or to blunt forces associated with the spinal fracture. 3, 11, 13, 21 This associated complication is thought to be

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Shunji Matsunaga, Takashi Sakou, Kyoji Hayashi, Yasuhiro Ishidou, Masataka Hirotsu, and Setsuro Komiya

ossification does not always lead to myelopathy. 7 It is difficult to predict the course of future neurological deterioration in patients in whom there is radiographic evidence of OPLL. Severe myelopathy can be induced by minor cervical trauma in patients with OPLL. Surgery-related results in patients with this condition are far from satisfactory. Some experts have recommended that preventive surgery be performed prior to the onset of myelopathy in patients with OPLL and potential spinal stenosis secondary to ossified ligaments. To justify the efficacy of preventive surgery

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Ethan A. Winkler, John K. Yue, Harjus Birk, Caitlin K. Robinson, Geoffrey T. Manley, Sanjay S. Dhall, and Phiroz E. Tarapore

management strategies for spinal trauma in this group. Much of the literature for elderly traumatic spine fractures has been confined to the cervical spine. Independent reports have demonstrated a higher rate of medical complications and worse prognosis following traumatic cervical spine injury in the elderly. 14 , 32 In the lumbar spine, a single report has identified age < 80 years as a predictor of the level of functioning following thoracolumbar spine fracture. 44 Bone healing following thoracolumbar compression and/or burst fracture appears to be reduced in the