Prioritization and Treatment of Patients with Thoracolumbar Trauma and Multiple Injuries

Abstract

Individuals with thoracolumbar trauma commonly sustain other injuries. Proper prioritization of these injuries is critical for obtaining optimal patient outcomes. Initial treatment should focus on life-threatening injuries utilizing advanced trauma life support (ATLS) and advanced cardiac life support (ACLS) protocols; when stabilized, the patient's skeletal injuries should be addressed. A thoracolumbar injury can be considered an additional long bone fracture when prioritizing treatment. Neurological status dictates which injuries are addressed initially. Worsening neurologic status, specifically cauda equina syndrome, dictates urgent (<48 hours) decompression and stabilization if necessary. Long bones (especially the femur) should be addressed definitively within 24 hours whenever possible, but complex fractures may require temporary stabilization (i.e., external fixation). Spinal surgery performed within 72 hours of injury is also recommended and can be performed concomitantly with limb injuries if the...