David Timaran-Montenegro

Upper cervical spine trauma (UCST) can lead to severe morbidity and mortality, particularly when associated with craniocervical junction (CCJ) injuries. Previous studies suggest that identifying prevertebral hematomas in patients with cervical trauma may have clinical significance. However, the association between prevertebral hematomas and clinical outcomes in patients with UCST has not yet been firmly established. The purpose of this study is to investigate the association of prevertebral hematomas with the severity of upper cervical spine injury, and clinical outcomes in patients with UCST. This retrospective study analyzed patients with UCST admitted to a level I trauma center in a 3-year period. Inclusion criteria included cervical spine trauma confirmed via imaging and MRI performed within 7 days of admission. Prevertebral hematomas were assessed for size and location and correlated with injury patterns and clinical outcomes. Statistical analysis was performed by using χ² tests and logistic regression models. One hundred sixty-five patients (mean age, 40.6 ± 19.9 years; 103 men) were evaluated. Prevertebral hematomas were identified in 88 of 165 patients (53.3%). Hematomas were significantly associated with CCJ dislocations (17/23 patients; 73.9%, P = .03) and subaxial disco-ligamentous injuries (48/71 patients; 67.6%, P = .001). Surgical intervention was more likely in patients with prevertebral hematomas (39/60 patients; 65%, P = .02), with an OR of 2.08 (95% CI, 1.08-4.01). While 75 of 148 patients with neurologic disability at discharge had prevertebral hematomas (50.6%, P = .06), this association did not reach statistical significance. Prevertebral hematomas were significantly associated with CCJ dislocations, subaxial disco-ligamentous injuries, and an increased likelihood of surgical intervention in patients with UCST. These findings suggest that prevertebral hematomas can serve as a useful marker for identifying patients with more severe injury patterns.

Purpose: Oxygen 6-methylguanine-DNA methyltransferase (MGMT) promoter methylation is associated with better chemotherapy response and prognosis in glioblastoma patients. This study evaluates the prognostic value of routine MRI findings at initial diagnosis to determine MGMT promoter methylation status. Methods: A retrospective study was performed on 85 patients with histologically confirmed IDH wild-type glioblastoma. Patients were divided into two groups based on MGMT promoter status: methylated (33 [38.8%]) and unmethylated (52 [61.1%]). MRI findings were assessed using the Visually Accessible Rembrandt Imaging lexicon, and variables were analyzed using univariate analysis (X ² /Fisher’s test) and logistic regression for independent predictors of MGMT promoter methylation. Results: A thick enhancing tumoral margin (≥3 mm) was present in 67.3% of MGMT unmethylated glioblastomas and 32.7% of MGMT promoter methylated glioblastomas ( p = .05). Tumoral cortical extension was observed in 68.7% of unmethylated cases versus 31.3% in methylated cases ( p = .01). Non-enhancing tumors were predominantly MGMT methylated (83.3%). In multivariate analysis, tumoral cortical involvement and non-enhancing tumors were independent predictors of MGMT promoter methylation. In survival analysis, higher progression-free survival rates were identified in patients with MGMT promoter methylation ( p = .05) and in patients without cortical tumoral extension ( p = .05). Conclusion: Our study suggests that while the predictive power of the assessed parameters is modest, thick enhancing tumoral margins and cortical tumor extension were more frequently identified in MGMT unmethylated glioblastomas. Conversely, 83.3% of non-enhancing tumors showed MGMT promoter methylation. Furthermore, MGMT promoter methylation and cortical extension were associated with progression-free survival.

Purpose American football is considered one of the more injury-prone sports given its high-speed and high-impact nature. While much attention has been focused on chronic traumatic encephalopathy, spinal injuries represent the most common catastrophic injury incurred in football. The goal of this investigation is to describe the most common football-associated spinal lesions in a multi-center health system. Methods This is a retrospective analysis of patients with imaging evidence of spinal injuries related to American football during a 10-year period. Injuries were classified based on the anatomic level, type injury, spinal cord compromise, and therapeutic management. Chi-squared and Fisher’s exact test were used for statistical analysis of categorial variables, and simple logistic regression was used to determine individual odds ratios. Results A total of 71 patients were included, with a median age of 17 (IQR, 15–22) years. The cervical spine was the most frequently affected segment (46%), followed by lumbar spine injuries (45%), and thoracic spine injuries (10%). Discogenic injuries were identified in 45 patients (63%). Spinal cord injury was documented in 7 subjects (10%), while cauda equina compression was reported in 1 patient (1%). Conclusions Acute spinal injuries continue to represent a significant cause of morbidity among American football players. Compared to national statistics, we found a similar distribution of spinal injuries in terms of anatomic location and an alarmingly high proportion of SCI. This investigation represents the largest single-center study addressing spinal injuries among football players.

Purpose Traumatic spondylolisthesis of the axis (TSA) with bilateral pars interarticularis fracture (a pattern also known as Hangman’s fractures) accounts for 4–5% of all cervical fractures. Various classification systems have been described to assist therapeutic decision-making. The goal is to reassess the utility of these classifications for treatment strategy and evaluate additional imaging associations. Methods This is an IRB approved, retrospective analysis of patients with imaging diagnosis of TSA from 2016 to 2019. Consensus reads were performed classifying TSA into various Levine and Edwards subtypes and typical vs. atypical fractures. Other imaging findings such as additional cervical fractures, traumatic brain injury, spinal cord injury, and vertebral artery injury were recorded. Treatment strategy and outcome were reviewed from clinical charts. Fisher exact test was used for statistical analysis. Results A total of 58 patients were included, with a mean age of 62.7 ± 25 years, and male to female ratio of 1:1.2. Motor vehicle collision was the most common cause of TSA. Type I and III injuries were the most and the least common injuries, respectively. Patients with type I injuries were found to have good healing rates with conservative management (p < 0.001) while type IIa and III injuries were managed with surgical stabilization (p = 0.04 and p = 0.01, respectively). No statistical difference was observed in the treatment strategy for type II fractures (p = 0.12) and its prediction of the associated injuries. Atypical fractures were not found to have a higher incidence of SCI (p = 0.31). A further analysis revealed significantly higher-grade vertebral artery injuries (grades III and IV according to Biffl grading) in patients with type IIa and III injuries (p = 0.001) and an 11-fold increased risk of TBI compared to type I and type II fractures (p = 0.013). Conclusion TSA fracture types were not associated with any clinical outcome. Levine and Edwards type II classification itself is not enough to guide the treatment plan and does not account for associated injuries. Additional imaging markers may be needed.