OBJECTIVETo examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain.

METHODSAll patients who presented to our emergency department following blunt trauma were enrolled in this study, except those with schiwora, neurological deficits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.

RESULTSA total of 200 cases were reviewed, of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.

CONCLUSIONSOur results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

Cervical Vertebrae ; injuries ; Humans ; Radiography ; Range of Motion, Articular ; Spinal Injuries ; Wounds, Nonpenetrating ; diagnostic imaging

OBJECTIVETo determine the frequency of altered findings on repeat cranial tomography (CT) in patients with mild head injury along with stable neurological examination at tertiary care hospital.

METHODSCross-sectional study was done in the Department of Radiology, Liaquat National Hospital, Karachi from January 2008 to September 2010. All patients with mild head injury in terms of Glasgow Coma Scale (GCS) who underwent repeat scan without clinical or neurological deterioration in the emergency department of a tertiary care centre were included. The collected data were accordingly entered and analyzed by the principal investigator using Statistical Package for Social Sciences (SPSS) version 16.0.

RESULTSIn all 275 patients, only 17 (6%) of the patients were found worseing on repeat CT, 120 (43.63%) scans improved, 138 (50.18%) unchanged and 17 (6.18%) worsened. None of these patients showed signs of clinical deterioration.

CONCLUSIONOur results suggest that for patients with mild head injury and stable neurological examination, only 6% of them show deterioration on repeat CT, especially when patients'GCS is below 13.

Craniocerebral Trauma ; diagnostic imaging ; Cross-Sectional Studies ; Developing Countries ; Glasgow Coma Scale ; Humans ; Neurologic Examination ; Tomography, X-Ray Computed

Objective: The objective of this study to assess the comparative effectiveness of exposure and response prevention (GERP) and cognitive-behaviour therapy (GCBT) in a group of Iranian patients with obsessive-compulsive disorder (OCD) and comorbid depression symptoms (CDS). Methods: Ninety OCD patients were selected (both genders, married or unmarried and ages from 18-65 years) using a non-probability sampling (availability sampling) procedure. The respondents subsequently sampled via cluster randomization into three equal groups: a control group (n = 30) that did not receive any treatment intervention during the study and two other groups who received 12 weeks of psychotherapy in the form of GERP (n=30) or GCBT (n=30). This study obtained the required data through a clinical interview with all participants based on the diagnostic and statistical manual of mental disorders text revision (DSM-IV-TR). The statistical analysis was performed using analysis of variance (ANOVA), Bonferroni correction and Pearson correlations. Result: We found that GCBT and GERP are effective treatments for alleviating OCD symptoms among patients. The results demonstrated that OCD scores were significantly reduced among participants after receiving GCBT and GERP treatments, with mean (standard deviation, SD) changes of 0.829 (0.287) and 0.970 (0.258), respectively. The study measured CDS through the Persian-language version of the Beck Depression Inventory-II (BDI-II-PERSIAN). The study further found a significant correlation between OCD and CDS. The findings suggested that GCBT and GERP improved comorbid depression symptoms (CDS) significantly with mean (SD) changes of 13.57 (3.92) and 12.85 (4.50) respectively. Conclusion: GCBT and GERP separately produced equivalent improvements for OCD and CDS.

STUDY DESIGN: This is a case series. PURPOSE: We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders. OVERVIEW OF LITERATURE: Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders. METHODS: A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant. RESULTS: Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury. CONCLUSIONS: Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.
Consensus ; Discitis ; Diskectomy ; Electronic Mail ; Korea ; Orthopedics ; Orthotic Devices ; Private Practice ; Spinal Cord ; Spinal Cord Injuries ; Spinal Injuries ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Steroids ; Tertiary Care Centers ; Surveys and Questionnaires

STUDY DESIGN: Retrospective case series. PURPOSE: The objective of our study was to determine the change in management brought about by magnetic resonance imaging (MRI) of the cervical spine in alert and awake patients with facet dislocation and spinal cord injury presenting within 4 hours after injury. OVERVIEW OF LITERATURE: Spinal cord injury is a common clinical entity. The role of MRI is well established in evaluating spinal trauma. However, the time at which MRI should be used is still controversial. METHODS: Retrospective data from 2002-2010 was evaluated. All of the alert and awake patients with spinal cord injury, based on clinical examination with facet dislocation diagnosed on lateral cervical spine X-rays, were included. A questionnaire was also conducted, the data of which consisted of demographic details including age and sex, the mechanism of injury, clinical examination, X-ray findings, MRI findings, whether or not surgery was performed and the time elapsed since injury. Data was analyzed using SPSS ver. 17.0. Continuous variables such as age were expressed in terms of mean +/- standard deviation. Categorical variables such as change in management, X-ray/MRI findings and neurological motor level were assessed in terms of percentage. RESULTS: Fifty patients participated in our study. All these patients had spinal cord injury with defined motor levels. The mean age was 35.5 +/- 8.95 years (range, 20 to 52 years). Fifty percent showed a motor level at C6 level. None of the patients required any change in management based on the MRI. CONCLUSIONS: MRI of the spine in awake patients within 4 hours after injury does not change the management of patients. However, we can hypothesize that such patients can proceed to traction without waiting for the MRI.
Dislocations ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Retrospective Studies ; Spinal Cord Injuries ; Spine ; Traction ; Surveys and Questionnaires