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Kalbas Y, Klingebiel FKL, Halvachizadeh S, Kumabe Y, Scherer J, Teuben M, Pfeifer R, Pape HC. Developments in the understanding of staging a "major fracture" in polytrauma: results from an initiative by the polytrauma section of ESTES. Eur J Trauma Emerg Surg 2024; 50:657-669. [PMID: 36820896 PMCID: PMC11249440 DOI: 10.1007/s00068-023-02245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Although the term "major fracture" is commonly used in the management of trauma patients, it is defined insufficiently to date. The polytrauma section of ESTES is trying to develop a more standardized use and a definition of the term. In this process, a standardized literature search was undertaken. We test the hypothesis that the understanding of "major fractures" has changed and is modified by a better understanding of patient physiology. METHODS A systematic literature search of the Medline and EMBASE databases was conducted in March 2022. Original studies that investigated surgical treatment strategies in polytraumatized patients with fractures were included: This included timing, sequence and type of operative treatment. A qualitative synthesis regarding the prevalence of anatomic regions of interest and core factors determining decision-making was performed. Data were stratified by decades. RESULTS 4278 articles were identified. Of these, 74 were included for qualitative evaluation: 50 articles focused on one anatomic region, 24 investigated the relevance of multiple anatomic regions. Femur fractures were investigated most frequently (62) followed by pelvic (22), spinal (15) and tibial (15) fractures. Only femur (40), pelvic (5) and spinal (5) fractures were investigated in articles with one anatomic region of interest. Before 2010, most articles focused on long bone injuries. After 2010, fractures of pelvis and spine were cited more frequently. Additional determining factors for decision-making were covered in 67 studies. These included chest injuries (42), TBI (26), hemorrhagic shock (25) and other injury-specific factors (23). Articles before 2000 almost exclusively focused on chest injury and TBI, while shock and injury-specific factors (e.g., soft tissues, spinal cord injury, and abdominal trauma) became more relevant after 2000. CONCLUSION Over time, the way "major fractures" influenced surgical treatment strategies has changed notably. While femur fractures have long been the only focus, fixation of pelvic and spinal fractures have become more important over the last decade. In addition to the fracture location, associated conditions and injuries (chest trauma and head injuries) influence surgical decision-making as well. Hemodynamic stability and injury-specific factors (soft tissue injuries) have increased in importance over time.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland.
| | - Felix Karl-Ludwig Klingebiel
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Yohei Kumabe
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Julian Scherer
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Michel Teuben
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland
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Gomez GI, Li GQ, Valido AA, Stoner AJ, Bromley-Dulfano RA, Sheira D, Gonzalez CA, Khan SI, Choi J, Zygourakis CC, Weiser TG. Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes. Am Surg 2024; 90:902-910. [PMID: 37983195 DOI: 10.1177/00031348231216479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Traumatic thoracolumbar spine injuries are associated with significant morbidity and mortality. Targeted for non-spine specialist trauma surgeons, this systematic scoping review aimed to examine literature for up-to-date evidence on presentation, management, and outcomes of thoracolumbar spine injuries in adult trauma patients. METHODS This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched four bibliographic databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. Eligible studies included experimental, observational, and evidence-synthesis articles evaluating patients with thoracic, lumbar, or thoracolumbar spine injury, published in English between January 1, 2010 and January 31, 2021. Studies which focused on animals, cadavers, cohorts with N <30, and pediatric cohorts (age <18 years old), as well as case studies, abstracts, and commentaries were excluded. RESULTS A total of 2501 studies were screened, of which 326 unique studies were fully text reviewed and twelve aspects of injury management were identified and discussed: injury patterns, determination of injury status and imaging options, considerations in management, and patient quality of life. We found: (1) imaging is a necessary diagnostic tool, (2) no consensus exists for preferred injury characterization scoring systems, (3) operative management should be considered for unstable fractures, decompression, and deformity, and (4) certain patients experience significant burden following injury. DISCUSSION In this systematic scoping review, we present the most up-to-date information regarding the management of traumatic thoracolumbar spine injuries. This allows non-specialist trauma surgeons to become more familiar with thoracolumbar spine injuries in trauma patients and provides a framework for their management.
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Affiliation(s)
- Giselle I Gomez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Guan Q Li
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Austin A Valido
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | | | - Rebecca A Bromley-Dulfano
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Dina Sheira
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Cayo A Gonzalez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Suleman I Khan
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Jeff Choi
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | | | - Thomas G Weiser
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
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Cabrera JP, Carazzo CA, Guiroy A, White KP, Guasque J, Sfreddo E, Joaquim AF, Yurac R. Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine. World Neurosurg 2023; 170:e520-e528. [PMID: 36402303 DOI: 10.1016/j.wneu.2022.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unstable thoracolumbar spinal injuries benefit from surgical fixation. However, perioperative complications significantly affect outcomes in surgicallytreated spine patients. We evaluated associations between risk factors and postoperative complications in patients surgically treated for thoracolumbar spine fractures. METHODS We conducted a retrospective multicenter study collating data from 21 spine centers across 9 countries on the treatment of AOSpine types B and C injuries of the thoracolumbar spine treated via a posterior approach. Comparative analysis was performed between patients with postoperative complications and those without. Univariate and multivariable analyses were performed. RESULTS Among 535 patients, at least 1 complication occurred in 43%. The most common surgical complication was surgical-site infection (6.9%), while the most common medical complication was urinary tract infection (13.8%). Among 136 patients with American Spinal Injury Association (ASIA) Impairment Scalelevel A disability, 77.9% experienced at least 1 complication. The rate of complications also rose sharply among patients waiting >3 days for surgery (P<0.001), peaking at 68.4% among patients waiting ≥30 days. On multivariable analysis, significant predictors of complications were surgery at a governmental hospital (odds ratio = 3.38, 95% confidence interval = 1.73-6.60), having ≥1 comorbid illness (2.44, 1.61-3.70), surgery delayed due to health instability (2.56, 1.50-4.37), and ASIA Impairment Scalelevel A (3.36, 1.78-6.35), while absence of impairment (0.39, 0.22-0.71), ASIAlevel E (0.39, 0.22-0.67) and, unexpectedly, delay caused by operating room unavailability (0.60, 0.36-0.99) were protective. CONCLUSIONS Types B and C thoracolumbar spine injuries are associated with a high risk of postoperative complications, especially common at governmental hospitals, and among patients with comorbidity, health instability, longer delays to surgery, and worse preoperative neurologic status.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, and Faculty of Medicine, University of Concepción, Concepción, Chile.
| | - Charles A Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, RS, Brazil
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Kevin P White
- Science Right Research Consulting, London, Ontario, Canada
| | | | - Ericson Sfreddo
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
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Sreeharsha P, Kanna RM, Milton R, Shetty AP, Rajasekaran S. Risk factors for thirty-day morbidity and mortality after spinal trauma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:110-117. [PMID: 36443511 DOI: 10.1007/s00586-022-07476-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic Spinal Injuries (TSI) often follow high velocity injuries and frequently accompanied by polytrauma. While most studies have focussed on outcomes of spinal cord injuries, the incidence and risk factors that predict morbidity and mortality after TSI has not been well-defined. METHODS Data of consecutive patients of TSI (n = 2065) treated over a 5-year-period were evaluated for demographics, injury mechanisms, neurological status, associated injuries, timing of surgery and co-morbidities. The thirty-day incidence and risk factors for complications, length of stay and mortality were analysed. RESULTS The incidence of spinal trauma was 6.2%. Associated injuries were seen in 49.7% (n = 1028), and 33.5% (n = 692) patients had comorbidities. The 30-day mortality was 0.73% (n = 15). Associated chest injuries (p = 0.0001), cervical spine injury (p = 0.0001), ASIA-A neurology (p < 0.01) and ankylosing spondylitis (p = 0.01) correlated with higher mortality. Peri-operative morbidity was noted in 571 patients (27.7%) and were significantly associated with age > 60 (p = 0.043), ASIA-A neurology (p < 0.05), chest injuries (p = 0.042), cervical and thoracic spine injury (p < 0.0001). The mean length of stay in hospital was 8.87 days. Cervical spine injury (p < 0.0001), delay in surgery > 48 h (p = 0.011), Diabetes mellitus (p = 0.01), Ankylosing spondylitis (p = 0.009), associated injuries of chest, head, pelvis and face (p < 0.05) were independent risk factors for longer hospital stay. CONCLUSION Key predictors of mortality after spinal trauma were cervical spine injury, complete neurological deficit, chest injuries and ankylosing spondylitis, while additionally higher age and thoracic injuries contributed to higher morbidity and prolonged hospitalisation. Notably multi-level injuries, higher age, co-morbidities and timing of surgery did not influence the mortality.
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Sousa A, Rodrigues C, Barros L, Serrano P, Rodrigues-Pinto R. Early Versus Late Spine Surgery in Severely Injured Patients-Which Is the Appropriate Timing for Surgery? Global Spine J 2022; 12:1781-1785. [PMID: 33472431 PMCID: PMC9609529 DOI: 10.1177/2192568221989292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study conducted at tertiary spinal trauma referral center. OBJECTIVE We aimed to determine if early definitive management of spine fractures in patients admitted to the Intensive Care Unit (ICU) shortens the intubation time and the length of stay (LOS), without increasing mortality. METHODS The medical records of all patients admitted to the ICU and submitted to surgical stabilization of spine fractures were reviewed over a 10-year period. Time to surgery, number of fractured vertebrae, degree of neurological injury, Simplified Acute Physiology Score (SAPS II), ASA score and associated trauma were evaluated. Surgeries performed on the first 72 hours after trauma were defined as "early surgeries." Intubation time, LOS on ICU, overall LOS and mortality rate were compared between patients operated early and late. RESULTS Fifty patients were included, 21 with cervical fractures, 23 thoracic and 6 lumbar. Baseline characteristics did not differ between patients in both groups. Patients with early surgical stabilization had significantly shorter intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. After multivariate adjustments overall LOS was significantly shorter in patients operated earlier. CONCLUSIONS Early spinal stabilization (<72 hours) of severely injured patients is beneficial and shortens the intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. Although some patients may require a delay in treatment due to necessary medical stabilization, every reasonable effort should be made to treat patients with unstable spinal fractures as early as possible. LEVEL OF EVIDENCE OF THE STUDY Level III.
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Affiliation(s)
- Arnaldo Sousa
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Cláudia Rodrigues
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Luís Barros
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Pedro Serrano
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal,Ricardo Rodrigues-Pinto, Spinal Unit/Unidade
Vertebro-Medular (UVM), Department of Orthopaedics, Centro Hospitalar
Universitário do Porto, Largo Prof. Abel Salazar 4099-001, Porto, Portugal.
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Complicaciones posoperatorias de fracturas toracolumbares en pacientes con traumatismo múltiple según el momento de la cirugía. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T371-T379. [DOI: 10.1016/j.recot.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
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Mun S, Han K, Hyun JK. The Time Sequence of Gene Expression Changes after Spinal Cord Injury. Cells 2022; 11:cells11142236. [PMID: 35883679 PMCID: PMC9324287 DOI: 10.3390/cells11142236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 02/01/2023] Open
Abstract
Gene expression changes following spinal cord injury (SCI) are time-dependent, and an accurate understanding of these changes can be crucial in determining time-based treatment options in a clinical setting. We performed RNA sequencing of the contused spinal cord of rats at five different time points from the very acute to chronic stages (1 hour, 1 day, 1 week, 1 month, and 3 months) following SCI. We identified differentially expressed genes (DEGs) and Gene Ontology (GO) terms at each time point, and 14,257 genes were commonly expressed at all time points. The biological process of the inflammatory response was increased at 1 hour and 1 day, and the cellular component of the integral component of the synaptic membrane was increased at 1 day. DEGs associated with cell activation and the innate immune response were highly enriched at 1 week and 1 month, respectively. A total of 2841 DEGs were differentially expressed at any of the five time points, and 18 genes (17 upregulated and 1 downregulated) showed common expression differences at all time points. We found that interleukin signaling, neutrophil degranulation, eukaryotic translation, collagen degradation, LGI–ADAM interactions, GABA receptor, and L1CAM-ankyrin interactions were prominent after SCI depending on the time post injury. We also performed gene–drug network analysis and found several potential antagonists and agonists which can be used to treat SCI. We expect to discover effective treatments in the clinical field through further studies revealing the efficacy and safety of potential drugs.
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Affiliation(s)
- Seyoung Mun
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea;
- Center for Bio Medical Engineering Core Facility, Dankook University, Cheonan 31116, Korea;
| | - Kyudong Han
- Center for Bio Medical Engineering Core Facility, Dankook University, Cheonan 31116, Korea;
- Department of Microbiology, College of Science & Technology, Dankook University, Cheonan 31116, Korea
| | - Jung Keun Hyun
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea;
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea
- Correspondence: ; Tel.: +82-10-2293-3415
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Spiegl UJ, Osterhoff G, Bula P, Hartmann F, Scheyerer MJ, Schnake KJ, Ullrich BW. Concomitant injuries in patients with thoracic vertebral body fractures-a systematic literature review. Arch Orthop Trauma Surg 2022; 142:1483-1490. [PMID: 33649914 PMCID: PMC7919626 DOI: 10.1007/s00402-021-03830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and to give evidence of the timing of surgery in severely injured patients with unstable thoracic vertebral body fractures. METHODS This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to November 2020 dealing with unstable fractures of the mid-thoracic spine. RESULTS Altogether, 1109 articles were retrieved from the literature search. A total of 1095 articles were excluded. Thus, 16 remaining original articles were included in this systematic review depicting the topics timing of surgery in polytraumatized patients, outcome neurologic deficits, and impact of concomitant injuries. The overall level of evidence of the vast majority of studies is low. CONCLUSION The evidence of the available literature is low. The cited studies reveal that thoracic spinal fractures are associated with a high number of neurological deficits and concomitant injuries, particularly of the thoracic cage and the lung. Thereby, diagnostic algorithm should include computer tomography of the whole thoracic cage if there is any clinical sign of concomitant injuries. Patients with incomplete neurologic deficits benefit from early surgery consisting of decompression and long-segmental stabilization.
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Affiliation(s)
- Ulrich J. Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Philipp Bula
- Department of Orthopaedics and Trauma Surgery, Klinikum Gütersloh, Gütersloh, Germany
| | - Frank Hartmann
- Center for Trauma and Orthopedic Surgery, Gemeinschaftsklinikum Mittelrhein, Ev. Stift, Koblenz, Germany
| | - Max J. Scheyerer
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Klaus J. Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus, St. Marien, Erlangen, Germany
| | - Bernhard W. Ullrich
- Department of Trauma Surgery and Reconstructive Surgery, BG Klinikum Bergmannstrost, Halle, Germany
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Ricciardi GA, Garfinkel IG, Carrioli GG, Svarzchtein S, Cid Casteulani A, Ricciardi DO. Early postoperative complications of thoracolumbar fractures in patients with multiple trauma according to the surgical timing. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:371-379. [PMID: 34362700 DOI: 10.1016/j.recot.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION AND OBJETCTIVES Our objective was to compare the rate of complications in thoracolumbar fractures that occurred during the early postoperative period in patients with multiple high-energy trauma according to the time of surgery. As a secondary objective, to estimate which variables were associated with surgery before 72h. MATERIAL AND METHODS Retrospective analysis of a series of patients with thoracolumbar fractures and multiple associated injuries in other anatomical regions due to high energy trauma. Surgically treated in an occupational trauma referral center, by the same surgical team and during the period between January 2013 and December 2019. RESULTS We analyzed a sample of 40 patients (39 men and 1 woman). The rate of complications was independent of surgical delay (before and after 72h) (p=0.827). There were statistically significant differences between early and later surgery groups in the variables age, systolic blood pressure, initial SOFA score and presence of neurological damage (p=0.014; p=0.029; p=0.032; p=0.012). The overall surgical delay was correlated with the SOFA score (p=0.007). CONCLUSION The rate of early postoperative complications did not show significant differences between the early and late surgery groups. We observed that the patients who had been operated before 72h from trauma were younger, had more association with neurological syntoms, presented higher blood pressure values and less physiological damage. Surgical delay was positively correlated with SOFA score on arrival.
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Affiliation(s)
- G A Ricciardi
- Spine Team - Centro Médico Integral Fitz Roy, Acevedo 865, Postal Code 1414 Ciudad Autónoma de Buenos Aires, Argentina.
| | - I G Garfinkel
- Spine Team - Centro Médico Integral Fitz Roy, Acevedo 865, Postal Code 1414 Ciudad Autónoma de Buenos Aires, Argentina
| | - G G Carrioli
- Spine Team - Centro Médico Integral Fitz Roy, Acevedo 865, Postal Code 1414 Ciudad Autónoma de Buenos Aires, Argentina
| | - S Svarzchtein
- Pelvis and Hip Trauma and Reconstruction Team - Centro Médico Integral Fitz Roy, Acevedo 865, Postal Code 1414 Ciudad Autónoma de Buenos Aires, Argentina
| | - A Cid Casteulani
- Pelvis and Hip Trauma and Reconstruction Team - Centro Médico Integral Fitz Roy, Acevedo 865, Postal Code 1414 Ciudad Autónoma de Buenos Aires, Argentina
| | - D O Ricciardi
- Spine Team - Centro Médico Integral Fitz Roy, Acevedo 865, Postal Code 1414 Ciudad Autónoma de Buenos Aires, Argentina
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Sharif S, Shaikh Y, Peev NA. In Reply to the Letter to the Editor Regarding "Minimally Invasive Spinal Surgery: How to Keep out of Trouble". World Neurosurg 2021; 152:252. [PMID: 34340294 DOI: 10.1016/j.wneu.2021.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan.
| | - Yousuf Shaikh
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | - Nikolay Angelov Peev
- Consultant Neurosurgeon and Spinal Surgeon, Belfast HSC Trust, Belfast, Northern Ireland, United Kingdom
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Mugesh Kanna R, Prasad Shetty A, Rajasekaran S. Timing of intervention for spinal injury in patients with polytrauma. J Clin Orthop Trauma 2021; 12:96-100. [PMID: 33716434 PMCID: PMC7920207 DOI: 10.1016/j.jcot.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The optimal timing of surgical intervention of spinal fractures in patients with polytrauma is still controversial. In the setting of trauma to multiple organ systems, an inappropriately timed definitive spine surgery can lead to increased incidence of pulmonary complications, hemodynamic instability and potentially death, while delayed surgical stabilisation has its attendant problems of prolonged recumbency including deep vein thrombosis, organ-sp ecific infection and pressure sores. METHODS A narrative review focussed at the epidemiology, demographics and principles of surgery for spinal trauma in poly-traumatised patients was performed. Pubmed search (1995-2020) based on the keywords - polytrauma OR multiple trauma AND spine fracture AND timing, present in "All the fields" of the search tab, was performed. Among 48 articles retrieved, 23 articles specific to the management of spinal fracture in polytrauma patients were reviewed. RESULTS Spine trauma is noted in up to 30% of polytrauma patients. Unstable spinal fractures with or without spinal cord injury in polytrauma require surgical intervention and are treated based on the following principles - stabilizing the injured spine during resuscitation, acute management of life-and limb-threatening organ injuries, "damage control" internal stabilisation of unstable spinal injuries during the early acute phase and, definitive surgery at an appropriate window of opportunity. Early spine fracture fixation, especially in the setting of chest injury, reduces morbidity of pulmonary complications and duration of hospital stay. CONCLUSION Recognition and stabilisation of spinal fractures during resuscitation of polytrauma is important. Early posterior spinal fixation of unstable fractures, described as damage control spine surgery, is preferred while a delayed definitive 360° decompression is performed once the systemic milieu is optimal, if mandated for biomechanical and neurological indications.
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Affiliation(s)
- Rishi Mugesh Kanna
- Corresponding author. Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
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Ninomiya K, Kuriyama A, Uchino H. Massive hemothorax due to bleeding from thoracic spinal fractures: a case series and systematic review. Scand J Trauma Resusc Emerg Med 2020; 28:92. [PMID: 32917249 PMCID: PMC7488342 DOI: 10.1186/s13049-020-00783-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Massive hemothorax secondary to thoracic spinal fractures is rare, and its clinical characteristics, treatment, and prognosis are unknown. We present two cases of thoracic spinal fracture-induced massive hemothorax and a systematic review of previously reported cases. METHODS This study included patients with traumatic hemothorax from thoracic spinal fractures at a Japanese tertiary care hospital. A systematic review of published cases was undertaken through searches in PubMed, EMBASE, and ICHUSHI from inception to October 13, 2019. RESULTS Case 1: An 81-year-old man developed hemodynamic instability from a right hemothorax with multiple rib fractures following a pedestrian-vehicle accident; > 1500 mL blood was evacuated through the intercostal drain. Thoracotomy showed hemorrhage from a T8-burst fracture, and gauze packing was used for hemostasis. Case 2: A 64-year-old man with right hemothorax and hypotension after a fall from height had hemorrhage from a T7-burst fracture, detected on thoracotomy, which was sealed with bone wax. Hypotension recurred during transfer; re-thoracotomy showed bleeding from a T7 fracture, which was packed with bone wax and gauze for hemostasis. The systematic review identified 10 similar cases and analyzed 12 cases, including the abovementioned cases. Inferior part of thoracic spines was prone to injury and induced right-sided hemothorax. Most patients developed hemodynamic instability, and some sustained intra-transfer hemorrhage; direct compression (gauze packing, bone wax, and hemostatic agents) was the commonest hemostatic procedure. The mortality rate was 33.3%. CONCLUSIONS Hemothorax due to thoracic spinal fracture can be fatal. Thoracotomy with direct compression is necessary in hemodynamically unstable patients.
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Affiliation(s)
- Kohei Ninomiya
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Hayaki Uchino
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
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13
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Hager S, Eberbach H, Lefering R, Hammer TO, Kubosch D, Jäger C, Südkamp NP, Bayer J. Possible advantages of early stabilization of spinal fractures in multiply injured patients with leading thoracic trauma - analysis based on the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med 2020; 28:42. [PMID: 32448190 PMCID: PMC7245984 DOI: 10.1186/s13049-020-00737-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the chest and concomitant immobilization due to spinal instability, pain or neurological dysfunction, impairing the respiratory system individually and together. Thus, we proposed that an early stabilization of thoracolumbar spine fractures will result in significant benefits regarding respiratory organ function, multiple organ failure and length of ICU / hospital stay. Methods Patients documented in the TraumaRegister DGU®, aged ≥16 years, ISS ≥ 16, AISThorax ≥ 3 with a concomitant thoracic and / or lumbar spine injury severity (AISSpine) ≥ 3 were analyzed. Penetrating injuries and severe injuries to head, abdomen or extremities (AIS ≥ 3) led to patient exclusion. Groups with fractures of the lumbar (LS) or thoracic spine (TS) were formed according to the severity of spinal trauma (AISspine): AISLS = 3, AISLS = 4–5, AISTS = 3 and AISTS = 4–5, respectively. Results 1740 patients remained for analysis, with 1338 (76.9%) undergoing spinal surgery within their hospital stay. 976 (72.9%) had spine surgery within the first 72 h, 362 (27.1%) later on. Patients with injuries to the thoracic spine (AISTS = 3) or lumbar spine (AISLS = 3) significantly benefit from early surgical intervention concerning ventilation time (AISLS = 3 only), ARDS, multiple organ failure, sepsis rate (AISTS = 3 only), length of stay in the intensive care unit and length of hospital stay. In multiple injured patients with at least severe thoracic spine trauma (AISTS ≥ 4) early surgery showed a significantly shorter ventilation time, decreased sepsis rate as well as shorter time spend in the ICU and in hospital. Conclusions Multiply injured patients with at least serious thoracic trauma (AISThorax ≥ 3) and accompanying spine trauma can significantly benefit from early spine stabilization within the first 72 h after hospital admission. Based on the presented data, primary spine surgery within 72 h for fracture stabilization in multiply injured patients with leading thoracic trauma, especially in patients suffering from fractures of the thoracic spine, seems to be beneficial.
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Affiliation(s)
- Sven Hager
- Department of Surgery, Bautzen Hospital, Oberlausitz-Kliniken gGmbH, Am Stadtwall 3, 02625, Bautzen, Germany
| | - Helge Eberbach
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Health, Ostmerheimer Str. 200, 51109, Köln, Germany
| | - Thorsten O Hammer
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - David Kubosch
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christoph Jäger
- Department of Anesthesiology and Critical Care, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Jörg Bayer
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany.
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14
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Fochtmann U, Jungbluth P, Zimmermann W, Lefering R, Lendemans S, Hussmann B. Spinal Injury Without Neurological Symptoms in Severely Injured Patients: Impact on the Length of Stay? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:421-429. [PMID: 32392596 DOI: 10.1055/a-1121-7989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The impact of spinal injuries on clinical outcome in most severely injured patients is currently being controversially discussed. At the same time, most of the studies examine patients with post-traumatic neurological disorders. The aim of this study was therefore to analyse severely injured patients with spinal injuries but without neurological symptoms with regard to their clinical outcome. Here the focus was then on the question, whether spinal injury is an independent risk factor increasing length of stay in the intensive care unit and in the hospital in total. MATERIAL AND METHODS Data of the TraumaRegister DGU® were retrospectively analysed. Inclusion criteria were: Injury Severity Score ≥ 16, primary admission, age ≥ 16 years, time interval 2009 - 2016, and a full data set on length of stay in the hospital and the intensive care unit, respectively. Following a univariate analysis in the first step, independent risk factors for the length of stay in the intensive care unit and in the hospital in total were investigated using a multivariate regression analysis. RESULTS 98,240 patients met the inclusion criteria. In this population, patients with Abbreviated Injury Scale (AIS) 2 and 3 spinal injuries were significantly younger (up to 60 years), and injuries were significantly more commonly caused by falls from a great height and traffic accidents (age ≤ 60 years: AISSpine 0: 58.4%, AISSpine 3: 65%; p < 0.001). Multivariate analysis showed that spinal injury without neurological symptoms is an independent risk factor for increased length of stay in the intensive care unit (odds ratio: + 1.1 d) and in the hospital in total (AIS 3 odds ratio: + 3.4 d). CONCLUSION It has been shown for the first time that spinal injury without initial neurological symptoms has a negative impact on the length of stay of most severely injured patients in the intensive care unit and in the hospital in total and thus represents an independent risk factor in this group of patients.
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Affiliation(s)
- Ulrike Fochtmann
- Klinik für Unfallchirurgie und Orthopädie, Alfried Krupp Krankenhaus Steele, Essen
| | - Pascal Jungbluth
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf
| | - Werner Zimmermann
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus Rüttenscheid, Essen
| | - Rolf Lefering
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, IFOM Köln
| | - Sven Lendemans
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus Rüttenscheid, Essen.,Universität Duisburg-Essen
| | - Bjoern Hussmann
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus Rüttenscheid, Essen
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15
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Abstract
Aims The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation. Methods All patients transferred to a national tertiary spinal referral centre for primary surgical fixation of unstable spinal injuries without preoperative neurological deficit between 1 July 2016 and 20 October 2017 were eligible for inclusion. Data were collected retrospectively. Patients were divided into early and late cohorts based on timing from initial trauma to first spinal operation. Early fixation was defined as within 72 hours, and late fixation beyond 72 hours. Results In total, 86 patients underwent spinal surgery in this period. Age ranged from 16 to 88 years. Mean Injury Severity Score (ISS) was higher in the early stabilization cohort (p = 0.020). Age was the sole significant independent variable in predicting morbidity on multiple regression analysis (p < 0.003). There was no significant difference in complication rates based on timing of surgical stabilization (p = 0.398) or ISS (p = 0.482). Conclusion Our results suggest that these patients are suitable for early appropriate care with spinal precautions and delayed definitive surgical stabilization. Earlier surgery conferred no morbidity benefit and had no impact on length of stay. Cite this article: Bone Joint J 2020;102-B(5):627–631.
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Affiliation(s)
- John Mahon
- National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Daniel P. Ahern
- National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Shane R. Evans
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jake McDonnell
- Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin, Ireland
| | - Joseph S. Butler
- National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland, UCD School of Medicine & Medical Science, Dublin, Ireland
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16
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Joubert C, Cungi PJ, Esnault P, Sellier A, de Lesquen H, Avaro JP, Bordes J, Dagain A. Surgical management of spine injuries in severe polytrauma patients: a retrospective study. Br J Neurosurg 2019; 34:370-380. [PMID: 31771363 DOI: 10.1080/02688697.2019.1692787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Optimal surgical management of spinal injuries as part of life-threatening multiple traumas remains challenging. We provide insights into the surgical management of spinal injuries in polytrauma patients. Methods: All patients from our polytrauma care network who both met at least one positive Vittel criteria and an injury severity score (ISS) >15 at admission and who underwent surgery for a spinal injury were included retrospectively. Demographic data, clinical data demonstrating the severity of the trauma and imaging defining the spinal and extraspinal number and types of injuries were collected.Results: Between January 2012 and December 2016, 302 (22.2%) patients suffered from spinal injury (143 total injuries) and 83 (6.1%) met the inclusion criteria. Mean ISS was 36.2 (16-75). Only 48 (33.6%) injuries led to neurological impairment involving the thoracic (n = 23, 16.1%) and lower cervical (n = 15, 10.5%) spine. The most frequent association of injuries involved the thoracic spine (n = 42). 106 spinal surgeries were performed. The 3-month mortality rate was 2.4%.Conclusions: We present data collected on admission and in the early postoperative period referring to injury severity, the priority of injuries, and development of multi-organ failure. We revealed trends to guide the surgical support of spinal lesions in polytrauma patients.
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Affiliation(s)
- C Joubert
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - P-J Cungi
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France
| | - P Esnault
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France
| | - A Sellier
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - H de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon, France
| | - J-P Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
| | - J Bordes
- Department of Intensive Care, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
| | - A Dagain
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France.,Val-de-Grâce French Military Health Service Academy, Paris, France
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17
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Ahern DP, McDonnell J, Ó Doinn T, Butler JS. Timing of surgical fixation in traumatic spinal fractures: A systematic review. Surgeon 2019; 18:37-43. [PMID: 31064710 DOI: 10.1016/j.surge.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/05/2019] [Accepted: 04/12/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The optimal timing of fracture fixation following spinal injury is controversial. Many spinal fractures occur as part of polytrauma requiring a complex management strategy. Whilst the decision to stabilize unstable spinal column injuries is without debate, the duration between injury and definitive fixation can impact on the incidence of post-operative complications. This study was designed to systemically summarize and compare the complication profile of early vs late stabilization of spinal injuries, in an attempt to unveil an appropriate treatment protocol for traumatic spinal fractures. METHODS A comprehensive search strategy was performed on the PubMed, Cochrane, and Google Scholar databases using key words. The search strategy provided 1120 results. Forty-six articles were reviewed for full-text. Reference lists were analysed for potential additional texts. RESULTS Sixteen articles met the inclusion criteria and were included for systematic review. Studies were controversial and the overall result was inconclusive. Several studies favour early stabilisation to reduce post-surgical complication rates, especially in cases of patients with high Injury Severity Scale (ISS) scores. However, this is challenged by a small number of studies reporting a higher mortality rate in the early-stabilisation cohort. CONCLUSION Due to limited studies and a small overall cohort, the authors would cautiously recommend the early surgical fixation of unstable spine fractures in the stable trauma patient. For severely injured patients, the discordance among literature warrants the need for further investigation.
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Affiliation(s)
- Daniel P Ahern
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Jake McDonnell
- Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin, Ireland
| | - Tiarnán Ó Doinn
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph S Butler
- Spine Service, Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland; National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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18
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Ghajarzadeh M, Saberi H. Transportation mode and timing of spinal cord decompression and stabilization in patients with traumatic spinal cord injury in Iran. Spinal Cord 2018; 57:150-155. [PMID: 30201998 DOI: 10.1038/s41393-018-0189-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 07/05/2018] [Accepted: 07/23/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional retrospective study. OBJECTIVE To describe the transportation mode to hospital and timing of spinal cord decompression and stabilization (D&S), length of hospital stay, frequency of pressure injuries, and sepsis during hospitalization. SETTING Brain and Spinal Injury Research Center, Tehran, Iran. METHODS Eight hundred and thirty patients with traumatic spinal cord injury (TSCI) were enrolled. Mode of transportation and length of time to reach the first hospital, length of hospital stay (LOS), and the time span between hospital arrival and decompression and stabilization (D&S) were recorded. RESULTS Fifty-nine percent of the enrolled individuals were transported to the first hospital by ambulance, while 41% were transferred by vehicles without medical equipment and personnel. Median length of time to reach the first hospital was 1 h for both ambulance and non-equipped car groups, with no statistically significant difference (p = 0.1). Median LOS, frequencies of pressure injuries, and sepsis based on the injury levels were not significantly different between two transportation modalities. One hundred and seventy-seven individuals had early surgery, and 254 had late surgery. Median LOS was 13 days in the early surgery group and 20 days in the late surgery group (p = 0.002). Frequencies of pressure injuries and sepsis were not significantly different between the late and early surgery groups for various injury levels. CONCLUSION About 59% of our patients had been transported to a hospital by non-medical personnel. Those with late surgery had significantly longer LOS. Improving TSCI patients' transportation method and early surgical interventions, if possible, may be considered.
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Affiliation(s)
- Mahsa Ghajarzadeh
- Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Saberi
- Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
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19
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Kim EJ, Wick JB, Stonko DP, Chotai S, Freeman Jr TH, Douleh DG, Mistry AM, Parker SL, Devin CJ. Timing of Operative Intervention in Traumatic Spine Injuries Without Neurological Deficit. Neurosurgery 2018. [DOI: 10.1093/neuros/nyx569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Numerous studies have demonstrated the benefits of early decompression and stabilization in unstable spine injuries with incomplete neurological deficits. However, a clear consensus on timing to operative intervention still does not exist in those with a normal neurological exam and unstable spine.
OBJECTIVE
To determine the optimal timing of operative intervention in traumatic spine injuries without neurological deficit.
METHODS
Retrospective chart review at a single institution was performed including patients with traumatic spine injuries without neurological deficit admitted from December 2001 to August 2012. Estimated intraoperative blood loss (EBL), in-hospital complications, postoperative hospital length of stay (HLOS), intensive care unit length of stay (ICULOS), and ventilator days were recorded. Delayed surgery was defined as surgery 72 h after admission.
RESULTS
A total of 456 patients were included for analysis. There was a trend towards statistical significance between the time to operative intervention and EBL in bivariate analysis (P = .07). In the risk-adjusted multivariable analysis delayed vs early surgery was not associated with increased EBL or complications. Delayed surgery was associated with increased ICULOS (odds ratio [OR] = 2.19; 95% confidence interval [CI]: 1.38-3.51; P = .001), ventilator days (OR = 2.09; 95% CI: 1.28-3.43; P = .004), and increased postoperative HLOS (OR = 1.84; 95% CI: 1.22-2.76; P = .004).
CONCLUSION
Earlier operative intervention was associated with decreased ICULOS, ventilator days, and postoperative HLOS and did not show a statistically significant increase in EBL or complications. Earlier operative intervention for traumatic spine injuries without neurological deficit provides better outcomes compared to delayed surgery.
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Affiliation(s)
- Elliott J Kim
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph B Wick
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Stonko
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Silky Chotai
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas H Freeman Jr
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Diana G Douleh
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Akshitkumar M Mistry
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Parker
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clinton J Devin
- Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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20
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Fujino S, Miyagi M, Tajima S, Imura T, Tazawa R, Inoue G, Nakazawa T, Saito W, Shirasawa E, Minehara H, Matsuura T, Kawamura T, Uchida K, Takahira N, Takaso M. Surgical treatment for suicidal jumper's fracture (unstable sacral fracture) with thoracolumbar burst fracture: a report of three cases. Spine Surg Relat Res 2017; 1:100-106. [PMID: 31440620 PMCID: PMC6698561 DOI: 10.22603/ssrr.1.2016-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/04/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Suicidal jumper's fracture (unstable sacral fracture) is characterized not only by multiple fractures including thoracolumbar fractures, but also major chest and abdominal injuries. Early stabilization of these fractures and early ambulation are required for the treatment and management of chest and abdominal injuries. We present 3 cases of suicidal jumper's fracture with thoracolumbar burst fracture, treated with minimally invasive posterior fixation surgery, which is a combination of percutaneous pedicle screws (PPS) and the mini-open Galveston technique. Case reports Case 1. A 50-year-old woman was injured by a fall from the 5th floor of a building as the result of a suicide attempt. Computed tomography revealed an H-shaped unstable sacral fracture and thoracolumbar fractures with major chest and abdominal injuries. For early stabilization of spinopelvic instability and early ambulation, we treated the patient with PPS and the mini-open Galveston technique. Her early postoperative emergence from bedrest contributed to the improvement of her general condition. One year after surgery at the final follow-up, she was able to walk with a T-cane without any motor, bladder, or bowel dysfunction (BBD) and achieved almost complete healing of the fractures. Cases 2 and 3. A 25-year-old woman (Case 2) and a 43-year-old woman were injured in falls. They had multiple injuries including unstable sacral fractures, and thoracolumbar fractures with major chest and abdominal injuries. We treated these patients with PPS and the mini-open Galveston technique. One year after surgery, they were able to walk with a T-cane and achieved almost complete healing of thoracolumbar fractures, but delayed healing of an unstable sacral fracture in Case 2, and remaining BBD in Case 3. Conclusion PPS and the mini-open Galveston technique is a good approach to fixation because they are minimally invasive and provide moderately rigid fixation, especially in patients with multiple trauma whose general condition is poor.
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Affiliation(s)
- Shotaro Fujino
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Shuichiro Tajima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Ryo Tazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Hiroaki Minehara
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Terumasa Matsuura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Tadashi Kawamura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Naonobu Takahira
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan.,Departments of Biomedical Engineering and Rehabilitation, Kitasato University School of Allied Health Sciences, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
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21
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Abstract
Although less common than other musculoskeletal injuries, spinal trauma may lead to significantly more disability and costs. During the last 2 decades there was substantial improvement in our understanding of the basic patterns of spinal fractures leading to more reliable classification and injury severity assessment systems but also rapid developments in surgical techniques. Despite these advancements, there remain unresolved issues concerning the management of these injuries. At this moment there is persistent controversy within the spinal trauma community, which can be grouped under 6 headings. First of all there is still no unanimity on the role and timing of medical and surgical interventions for patients with associated neurologic injury. The same is also true for type and timing of surgical intervention in multiply injured patients. In some common injury types like odontoid fractures and burst type (A3-A4) fractures in thoracolumbar spine, there is wide variation in practice between operative versus nonoperative management without clear reasons. Also, the role of different surgical approaches and techniques in certain injury types are not clarified yet. Methods of nonoperative management and care of elderly patients with concurrent complex disorders are also areas where there is no consensus. In this overview article the main reasons for these controversies are reviewed and the possible ways for resolutions are discussed.
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22
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Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture. Case Rep Orthop 2016; 2016:6295817. [PMID: 26989542 PMCID: PMC4775781 DOI: 10.1155/2016/6295817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/21/2016] [Accepted: 01/31/2016] [Indexed: 11/18/2022] Open
Abstract
We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.
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23
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Surgery for severe thoracolumbar fracture dislocation via a posterior approach. J Clin Neurosci 2015; 22:1954-8. [DOI: 10.1016/j.jocn.2015.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 04/28/2015] [Indexed: 11/23/2022]
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