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.
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.
Authors: C Joubert; P-J Cungi; P Esnault; A Sellier; H de Lesquen; J-P Avaro; J Bordes; A Dagain Journal: Br J Neurosurg Date: 2019-11-27 Impact factor: 1.596
Authors: Oliver Hauschild; Peter C Strohm; Ulf Culemann; Tim Pohlemann; Norbert P Suedkamp; Wolfgang Koestler; Hagen Schmal Journal: J Trauma Date: 2008-02
Authors: Markus R Konieczny; Johannes Strüwer; Birger Jettkant; Christian Schinkel; Thomas Kälicke; Gert Muhr; Thomas M Frangen Journal: Spine J Date: 2013-10-17 Impact factor: 4.166
Authors: Wenzhong Xiao; Michael N Mindrinos; Junhee Seok; Joseph Cuschieri; Alex G Cuenca; Hong Gao; Douglas L Hayden; Laura Hennessy; Ernest E Moore; Joseph P Minei; Paul E Bankey; Jeffrey L Johnson; Jason Sperry; Avery B Nathens; Timothy R Billiar; Michael A West; Bernard H Brownstein; Philip H Mason; Henry V Baker; Celeste C Finnerty; Marc G Jeschke; M Cecilia López; Matthew B Klein; Richard L Gamelli; Nicole S Gibran; Brett Arnoldo; Weihong Xu; Yuping Zhang; Steven E Calvano; Grace P McDonald-Smith; David A Schoenfeld; John D Storey; J Perren Cobb; H Shaw Warren; Lyle L Moldawer; David N Herndon; Stephen F Lowry; Ronald V Maier; Ronald W Davis; Ronald G Tompkins Journal: J Exp Med Date: 2011-11-21 Impact factor: 14.307