Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Thoracolumbar spine injuries are commonly encountered in patients with trauma, accounting for almost 90% of all spinal fractures. Thoracolumbar burst fractures comprise a high percentage of these traumatic fractures (45%), and approximately half of the patients with this injury pattern are neurologically intact. However, a debate over complication rates associated with operative versus nonoperative management of various thoracolumbar fracture morphologies is ongoing, particularly concerning those patients presenting without a neurological deficit.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A MEDLINE search for pertinent literature published between 1966 and December 2013 was conducted by 2 authors (G.G. and R.D.), who used 2 broad search terms to maximize the initial pool of manuscripts for screening. These terms were “operative lumbar spine adverse events” and “nonoperative lumbar spine adverse events.”</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In an advanced MEDLINE search of the term “operative lumbar spine adverse events” on January 8, 2014, 1459 results were obtained. In a search of “nonoperative lumbar spine adverse events,” 150 results were obtained. After a review of all abstracts for relevance to traumatic thoracolumbar spinal injuries, 62 abstracts were reviewed for the “operative” group and 21 abstracts were reviewed for the “nonoperative” group. A total of 14 manuscripts that met inclusion criteria for the operative group and 5 manuscripts that met criteria for the nonoperative group were included.</jats:p> <jats:p>There were a total of 919 and 436 patients in the operative and nonoperative treatment groups, respectively. There were no statistically significant differences between the groups with respect to age, sex, and length of stay. The mean ages were 43.17 years in the operative and 34.68 years in the nonoperative groups. The majority of patients in both groups were Frankel Grade E (342 and 319 in operative and nonoperative groups, respectively). Among the studies that reported the data, the mean length of stay was 14 days in the operative group and 20.75 in the nonoperative group.</jats:p> <jats:p>The incidence of all complications in the operative and nonoperative groups was 300 (32.6%) and 21 (4.8%), respectively (p = 0.1065). There was no significant difference between the 2 groups with respect to the incidence of pulmonary, thromboembolic, cardiac, and gastrointestinal complications. However, the incidence of infections (pneumonia, urinary tract infection, wound infection, and sepsis) was significantly higher in the operative group (p = 0.000875). The incidence of instrumentation failure and need for revision surgery was 4.35% (40 of 919), a significant morbidity, and an event unique to the operative category (p = 0.00396).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Due to the limited number of high-quality studies, conclusions related to complication rates of operative and nonoperative management of thoracolumbar traumatic injuries cannot be definitively made. Further prospective, randomized studies of operative versus nonoperative management of thoracolumbar and lumbar spine trauma, with standardized definitions of complications and matched patient cohorts, will aid in properly defining the risk-benefit ratio of surgery for thoracolumbar spine fractures.</jats:p></jats:sec>

Timing of surgery for spinal fractures associated with systemic trauma: a need for a strategic and systemic approach

“…Ghobrial et al reported that burst fractures constitute as high as 45% of all thoracolumbar fractures (13). Another study by Been and Bouma reported a rate of 49% (4).…”

“…Distinctive factors in the treatment of traumatic spinal fractures can be defined as the presence of neurological deficit and progression of the regarding injury (7). It is widely accepted that a relatively urgent surgical approach might be associated with decreased risk of complications regarding immobility (5,13,22). On the other hand, preservation of critical life measures after systemic trauma aids in balanced systemic status and diminished risk of successive interventions.…”

Low‐Intensity Pulsed Ultrasound Accelerates Traumatic Vertebral Fracture Healing by Coupling Proliferation of Type H Microvessels

“…Conservative treatments or surgery and commonly accepted procedures for vertebral fractures . However, these treatment strategies are associated with major postoperative morbidities, such as postoperative embolism, pneumonia, healing failure, kyphosis, and infection . The most severe postoperative complication of vertebral fracture is healing failure, leading to thoracolumbar kyphosis and spinal cord injury, which require revision surgery.…”

“…4,5 However, these treatment strategies are associated with major postoperative morbidities, such as postoperative embolism, pneumonia, healing failure, kyphosis, and infection. [6][7][8] The most severe postoperative complication of vertebral fracture is healing failure, leading to thoracolumbar kyphosis and spinal cord injury, which require revision surgery. Recently, the potential therapeutic applications of low-intensity pulsed ultrasound (US) have been reported in clinical trials as a noninvasive adjuvant treatment modality in fracture healing.…”

Posterior Fixation with Unilateral Same Segment Pedicle Fixation and Contralateral Hook in Surgical Treatment of Thoracolumbar Burst Fractures

“…Although some authors believe that in more stable thoracolumbar burst fractures associated with normal neurologic examination, nonoperative treatment provided the same long-term advantages as surgery, in the patients with more severe injuries and neurologic deficit, early fusion and instrumentation can promote earlier mobilization and neurologic rehabilitation [4][5][6][7]. In spinal surgery of lumbar area, literature reveals that spondylodesis of the freely moving lumbar vertebrae is strongly correlated with functional disability in activities of daily living [8].…”