Timing of surgical fixation in traumatic spinal fractures: A systematic review

Ahern, Daniel P; McDonnell, Jake; Doinn, Tiarnán Ó; Butler, Joseph S.

doi:10.1016/j.surge.2019.04.002

Cited by 7 publications

(6 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rationale: A 48-study systematic review recommends early surgical fixation for thoracolumbar injury, especially if evidence of neurological impairment. 42 One retrospective study (N = 58) found that early decompression (within 8 h) compared to late decompression was associated with improved American Spinal Injury Association Impairment Scale (AIS) grades ( P < .04) and improved bladder outcome (SCIM-6; P < .021). 43 Meanwhile, a meta-analysis across eleven studies (N = 948) failed to show a difference in AIS grade in early vs late decompression.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes

Gomez,

Li,

Valido

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

“…screw fixation. 33,[35][36][37][38][39][40][41][42][43]47,51 Percutaneous fixation may be performed for patients who do not require open surgery and has superior outcomes. [55][56][57] Long-term quality of life is comparable to the general population, but burden is significant, especially for those with neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes

Gomez,

Li,

Valido

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…38 In a recent review on this subject, Ahern et al have reviewed sixteen articles on timing of spine surgery in polytrauma and conclude that though studies specific to the topic are limited with small study samples, early surgical fixation of unstable spinal fractures can be cautiously recommended. 39 The primary fixation can also be a percutaneous fixation where the risks of blood loss and tissue damage could be mitigated. Scaramuzzo et al evaluated twenty-four polytrauma patients with spine injury out of whom nine patients underwent percutaneous pedicle screw fixation and twelve underwent open fusion.…”

Section: Management Of Spine Trauma In Poly-traumatised Patientmentioning

confidence: 99%

Timing of intervention for spinal injury in patients with polytrauma

Kanna

Shetty

Rajasekaran

2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

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 (1995e2020) based on the keywords e 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.

show abstract

“…While the efficacy of telemedicine is evident throughout literature, it does not encompass the trauma cohort which represents a significant proportion of referrals to our institution [4][5][6]. Due to the neurological and vascular sequelae reported with delayed surgery in spine trauma patients, appropriate strategies must be implemented to ensure adequate orthopaedic spine care can be maintained and delivered in the trauma setting [7]. Notably, preoperative preparation of the operating theatre has changed considerably, with an increased need for personal protective equipment (PPE) and lengthy theatre decontamination protocols following procedures on COVID-19-positive or COVID-19 query patients, resulting in logistical delays [7].…”

Section: Introductionmentioning

confidence: 99%

“…Due to the neurological and vascular sequelae reported with delayed surgery in spine trauma patients, appropriate strategies must be implemented to ensure adequate orthopaedic spine care can be maintained and delivered in the trauma setting [7]. Notably, preoperative preparation of the operating theatre has changed considerably, with an increased need for personal protective equipment (PPE) and lengthy theatre decontamination protocols following procedures on COVID-19-positive or COVID-19 query patients, resulting in logistical delays [7]. Such obstacles coupled with increased demand for ventilators, anaesthetic staff, and hospital space for COVID-19 patients are greatly limiting operating capabilities and requiring constant modification to the daily logistics of the spinal unit [8].…”

Section: Introductionmentioning

confidence: 99%

The impact of the SARS-CoV-2 pandemic on referral characteristics in a national tertiary spinal injuries unit

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The SARS-CoV-2 pandemic has had profound implications on healthcare institutions. Aims This study aims to assess and compare referral patterns during COVID-19 to corresponding dates for the preceding 3 years (2017–2019), in order to preemptively coordinate the logistics of the surgical unit for similar future experiences. Methods Retrospective review for our institution, a national tertiary referral centre for spine pathology. Two distinct time-points were chosen to represent the varied levels of social restriction during the current pandemic: (i) study period 1 (SP1) from 11 November 2020 to 08 June 2020 represents a national lockdown, and (ii) study period 2 (SP2) from 09 June 2020 to 09 September 2020 indicates an easing of restrictions. Both periods were compared to corresponding dates (CP1: 11 March–08 June and CP2 09 June–09 September) for the preceding 3 years (2017–2019). Data collected included age, gender, and mechanism of injury (MOI) for descriptive analyses. MOIs were categorised into disc disease, cyclist, road-traffic-accident (RTA), falls < 2 m, falls > 2 m, malignancy, sporting injuries, and miscellaneous. Results All MOI categories witnessed a reduction in referral numbers during SP1: disc disease (−29%), cyclist (−5%), RTAs (−66%), falls < 2 m (−39%), falls > 2 m (−17%), malignancy (−33%), sporting injuries (−100%), and miscellaneous (−58%). Four of 8 categories (RTAs, falls < 2 m, malignancy, miscellaneous) showed a trend towards return of pre-lockdown values during SP2. Two categories (disc disease, falls > 2 m) showed a further reduction (−34%, −27%) during SP2. One category (sporting injuries) portrayed a complete return to normal values during SP2 while a notable increase in cyclist-related referrals was witnessed (+ 63%) when compared with corresponding dates of previous years. Conclusion Spinal injury continues to occur across almost all categories, albeit at considerably reduced numbers. RTAs and falls remained the most common MOI. Awareness needs to be drawn to the reduction of malignancy-related referrals to dissuade people with such symptoms from avoiding presentation to hospital over periods of social restrictions.

show abstract

Timing of surgical fixation in traumatic spinal fractures: A systematic review

Cited by 7 publications

References 27 publications

Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes

Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes

Timing of intervention for spinal injury in patients with polytrauma

The impact of the SARS-CoV-2 pandemic on referral characteristics in a national tertiary spinal injuries unit

Contact Info

Product

Resources

About