Early Surgery for Thoracolumbar Spine Injuries Decreases Complications

Chipman, Jeffrey G.; Deuser, William E.; Beilman, Greg J.

doi:10.1097/01.ta.0000108630.34225.85

Cited by 103 publications

(76 citation statements)

References 13 publications

(19 reference statements)

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“…There is consensus that nonneurological outcome measures such as hospital and ICU length of stay (LOS), duration of mechanical ventilation, and pneumonia and other complications improve in patients undergoing early surgical stabilization 13,16 -more markedly in patients with polytrauma and thoracic injuries. 13 Whether early surgical intervention improves neurological outcomes is less clear.…”

Section: Surgical Timingmentioning

confidence: 99%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord. There is general evidence for the maintenance of mean arterial pressure of > 85 mm Hg during immediate and acute care to optimize neurological outcome; however, the selection of vasopressor type and duration should be judicious, with considerations for level of injury and risks of increased cardiogenic complications in the elderly. Level II recommendations exist for early decompression, and additional time points of neurological assessment within the first 24 hours and during acute care are warranted to determine the temporality of benefits attributable to early surgery. Venous thromboembolism prophylaxis using low-molecular-weight heparin is recommended by current guidelines for SCI. For these patients, titration of tidal volumes is important to balance the association of earlier weaning off the ventilator, with its risk of atelectasis, against the risk for lung damage from mechanical overinflation that can occur with prolonged ventilation. Careful evaluation of infection risk is a priority following multisystem trauma for patients with relative immunosuppression or compromise. Although patients with polytrauma may experience longer rehabilitation courses, long-term neurological recovery is generally comparable to that in patients with isolated SCI after controlling for demographics. Bowel and bladder disorders are common following SCI, significantly reduce quality of life, and constitute a focus of targeted therapies. Emerging biomarkers including glial fibrillary acidic protein, S100β, and microRNAs for traumatic SCIs are presented. Systematic management approaches to minimize sources of secondary injury are discussed, and areas requiring further research, implementation, and validation are identified.

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Section: Surgical Timingmentioning

confidence: 99%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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“…Advantages of early femur fracture fixation are well known and reported by several studies [5,6,10,20,24,40,47]. Clinical research in the past decade suggests that early stabilization of spinal fractures may improve neurological outcome, reduce complications, ICU and hospital stay [8,10,11,19,26,30,32,36,41,45,49]. Early stabilization is considered safe but a recent study by Kerwin et al [26] reports a trend to higher mortality in early-operated patients.…”

Section: Introductionmentioning

confidence: 99%

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

2006

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Abstracts A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.

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“…Early surgical decompression was associated with a shorter hospital length of stay in eight studies [7,14,16,27,32,37,40,42] (although Guest et al [27] reported no p values), whereas the other only recorded the length of stay in the ICU [52]. A subset of these studies further divided overall length of stay with the duration of stay in the ICU [14,16,27,32] and found this time point was also less in patients receiving early decompressive surgery. Only one study [32] that measured these values found no correlation between timing of surgical decompression and the length of stay in the ICU.…”

Section: Histopathologic Correlationmentioning

confidence: 99%

“…Four studies [7,36,37,41] reported no difference in the rate of medical complications between the early and late surgical groups, whereas four studies found overall fewer complications in the persons receiving early surgical decompression. Specifically, Mirza et al [42] reported fewer complications in persons receiving surgery within 72 hours of injury; Croce et al [16] reported lower rates of pneumonia and DVT in persons receiving surgery within 24 hours; Chipman et al [14] reported a lower frequency of all complications in patients with an Injury Severity Score (ISS) greater than 15 and receiving surgery within 72 hours of injury (although this same group reports equal medical complications in persons with low ISS [less than 15] regardless of the time of decompression); McKinley et al [40] report higher rates of pneumonia in the late surgery group but equal rates of other complications (DVT, pulmonary embolism, ulcers).…”

Section: Histopathologic Correlationmentioning

confidence: 99%

“…Of the 22 clinical studies identified in this review, nine Level III studies measured the length of stay [7,11,14,16,27,32,37,40,42,52]. Early surgical decompression was associated with a shorter hospital length of stay in eight studies [7,14,16,27,32,37,40,42] (although Guest et al [27] reported no p values), whereas the other only recorded the length of stay in the ICU [52]. A subset of these studies further divided overall length of stay with the duration of stay in the ICU [14,16,27,32] and found this time point was also less in patients receiving early decompressive surgery.…”

Section: Histopathologic Correlationmentioning

confidence: 99%

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Spinal Cord Injury: A Systematic Review of Current Treatment Options

Cadotte

Fehlings

2011

Clinical Orthopaedics &Amp; Related Research

117

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Background Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be able to offer improved recovery after SCI. Questions/purposes In this review, we highlight advances in the field of SCI by framing three questions: (1) What is the preclinical evidence for the neuroprotective agent riluzole that has allowed this agent to move into clinical trials? (2) What is the preclinical evidence for Rho antagonists that have allowed this group of compounds to move into clinical trials? (3) What is the evidence for early surgical decompression after SCI?Methods We conducted a systematic review of MEDLINE and EMBASE-cited articles related to SCI to address these questions.

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Early Surgery for Thoracolumbar Spine Injuries Decreases Complications

Abstract: Early surgery in severely injured patients with thoracolumbar spine trauma was associated with fewer complications and shorter hospital and intensive care unit lengths of stay, required less ventilator support for noninfectious reasons, and did not increase neurologic deficits.

Cited by 103 publications

References 13 publications

Update on critical care for acute spinal cord injury in the setting of polytrauma

Update on critical care for acute spinal cord injury in the setting of polytrauma

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

Spinal Cord Injury: A Systematic Review of Current Treatment Options

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