ATLS® and damage control in spine trauma

Abstract

Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS(R) polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS(R) protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient.

Non-operative vs. percutaneous stabilization in Magerl’s A1 or A2 thoracolumbar spine fracture in adults: is it really advantageous for a good alignment of the spine? Preliminary data from a prospective study

“…Fractures of type A1 and A2 are stable and are commonly treated with immobilized conservative treatment in extension [2]. A3 type is unstable and is treated either surgically or non-surgically [3].…”

Lesión de la médula espinal: actualización bibliográfica: fisiopatología y tratamiento inicial

“…El manejo del TRM comienza en el mismo sitio donde sucede y debe cumplir estrictamente los protocolos del ATLS [17][18] . Existen tres objetivos fundamentales en la escena del trauma: prevenir lesiones adicionales, mantener oxigenación y perfusión adecuadas, a través de las maniobras de resucitación.…”

Ocorrência de traumatismo raquidiano em doentes em coma decorrente de traumatismo cranioencefálico

“…Possibilitou também realizar a reconstrução tridimensional das imagens com excelente qualidade, mesmo em regiões da coluna vertebral em que o exame de radiografia convencional não apresenta resolução satisfatória, como ocorre nas regiões das transições craniocervical e cervicotorácica, no crânio e na face e seus conteúdos (Hunter et al, 2011;Maurer et aL., 2008;Schmidt et al, 2009;Sampson et al, 2006;Sun et al, 2010;Rosi, 2011).…”

“…A distribuição das vértebras acometidas pela(s) lesão(ões) traumática (s) identificada(s) no exame da TC foi similar à do Advanced Trauma Life Support (ATLS) (Maurer et al, 2008;Schmidt et al, 2009), ou seja, predominou o acometimento vertebral da região cervical. Na presente casuística, a sétima vértebra cervical foi a mais acometida (34,2%), possivelmente devido ao fato de localizar-se na transição entre a coluna cervical, móvel, e a torácica, menos móvel (Howard, 2001;Marcon et al, 2012;Rosi, 2011 (Bambakidis et al, 2008;Cristante e Jorge, 2012;Howard, 2001;Lutaka et al, 2012;Marcon et al, 2012;Rosi, 2011).…”

“…(Harris et al, 2008Holly et al, 2001Martins et al, 2003;Cristante e Jorge, 2012;Lutaka et al, 2012 ;Marcon et al, 2012;Miller et al, 2010;Schmidt et al, 2009;Rosi, 2011 (Kattail et al, 2009;Hunter et al, 2011;Maurer et al, 2009;Mulligan et al, 2010;Schmidt et al, 2009;Sampson et al, 2006;Sun et al, 2010).…”