A. R. Poynton

Trends in RTA related spinal injuries: the post penalty points era

BackgroundOn October 31st 2002 a system of cumulative penalty points for road traffic offences was introduced. Early evidence suggested a reduction in road traffic accident (RTA) related morbidity.AimsTo evaluate the persistence of the initial reduction in RTA related spinal injuries following penalty points introduction.MethodsRetrospective review of all acute spinal trauma admissions to the NSIU between November 1st 1998 and October 31st 2004 (n=966). Patient demographics and injury aetiology were assessed. Follow-up questionnaires evaluated RTA circumstances.ResultsRTA related spinal injuries accounted for 39.3% of NSIU admissions. These injuries were significantly more common in males aged 16–24, drivers (70.8%), on routine journeys (77.5%) and rural roads (48.8%). The highest proportion of accidents occurred during weekends (64.3% from Fri-Sun) and from midnight to 6am (29.3%).ConclusionsThe initial reduction in RTA related spinal injuries has not been sustained. Young male drivers are the greatest at risk group.

Lateral C1–C2 dislocation complicating a type II odontoid fracture

We describe a unique C1-C2 lateral dislocation complicating a displaced type II odontoid fracture. We report a 63-year-old female pedestrian involved in a motor vehicle accident who required posterior open reduction and segmental C1-C2 instrumentation and fusion. Radiological examination of the cervical spine demonstrated a lateral dislocation of the atlantoaxial joint with a displaced type II fracture of the odontoid, fracture of the right lateral mass of C1 and left superior articular facet of C2. Neurological examination revealed the patient to be myelopathic and closed halo traction failed to achieve reduction. Due to the irreducible nature of the dislocation, posterior open reduction and segmental C1-C2 instrumentation and fusion was performed. The dislocated C1-C2 articulation was successfully reduced surgically with subsequent bony fusion and resolution of all neurological symptoms and signs at final follow-up. To our knowledge, this the first report of this type of injury. We also review the related literature on this unique injury pattern.

Acute Nontraumatic Spinal Intradural Hematoma in a Patient on Warfarin

BACKGROUND Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences. OBJECTIVE The aim here was to report a case of this rare phenomenon and discuss the etiology, imaging, management, and outcome of intradural hematomas. CASE REPORT We describe the case of a 76-year-old man on warfarin therapy who presented with severe lower back pain and flaccid paraparesis. Blood tests revealed an international normalized ratio of 6.0. A magnetic resonance imaging result suggested an intradural hematoma extending from L1 to L4 and compressing the spinal cord and cauda equina. Emergency surgical decompression revealed an extensive intradural extramedullary hematoma, which was evacuated. The patient showed only minor neurologic improvement 6 months postoperatively. CONCLUSIONS Coagulopathy-induced spinal hemorrhage should be included in the differential diagnosis for patients presenting with signs of acute spinal cord compression.