Abstract
BackgroundMajor 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.MethodsPatients 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.Results1740 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.ConclusionsMultiply 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.
Highlights
Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma
After applying the inclusion and exclusion criteria, a total of 1740 patients remained for analysis
Concerning the operative procedures, posterior minimally invasive spine surgery, as a damage control measure, seems to be performed safely concerning neurologic outcome and operative risk [44,45,46]. Based on these findings and our data, we suggest a primary minimally invasive posterior stabilization in multiply injured patients (MIP) with leading thoracic trauma within 72 h, especially in patients suffering from fractures of the thoracic spine with an indication for surgical stabilization and concomitant relevant thoracic injury
Summary
Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. 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. There is an ongoing discussion in the current literature on the optimal timing of stabilization for thoracolumbar spine fractures in multiply injured patients (MIP). Patients with thoracic spine or upper lumbar spine trauma very likely suffer from concomitant relevant thoracic trauma, respectively rip fractures (30%), lung contusion (30–64%), pneumothorax (24–26%) and pleural effusion / hemothorax (39%) altogether conditions often associated with significant impairment of the respiratory system [6,7,8]. Concerning the lower lumbar spine, injuries to that region commonly involve pelvic (25%) and abdominal trauma (30–51%) and consecutive bleeding [9,10,11]
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