Acute Colonic Pseudo-obstruction Following Spinal Fixation for Trauma

Abstract

Acute colonic pseudo-obstruction (ACPO) is a potentially highly morbid surgical complication. The incidence of ACPO following spinal trauma is unknown, but is likely higher than after elective spinal fusion. The purpose of this study was to establish the incidence of ACPO in patients with major trauma undergoing spinal fusion for unstable thoracic and lumbar fracture. Secondly, to characterise the nature of ACPO in this group, including treatment and complications. A metropolitan hospital prospective trauma database was utilised to identify all patients from November 2015 to December 2021 meeting major trauma criteria and undergoing thoracic or lumbar spinal fusion for fracture. Individual records were then evaluated for occurrence of ACPO. ACPO was defined as radiological evidence of colonic dilation without mechanical obstruction in symptomatic patients undergoing dedicated abdominal imaging. After exclusions, 456 patients with major trauma undergoing thoracic or lumbar spinal fusion were identified. ACPO occurred in 34; an incidence rate of 7.5%. There was no evidence of difference in terms of the spinal fracture type, level, surgical approach or number of segments fused. There were no perforations; only two patients required colonoscopic decompression and none required surgical resection. ACPO occurred at a high frequency in this group of patients, although it required relatively simple treatment. High vigilance for ACPO should be maintained in trauma patients requiring thoracic or lumbar fixation, with a view to early intervention. The aetiology driving the high rates of ACPO in this cohort is not understood and would benefit from further investigation.