The impact of a standardized “spine damage-control” protocol for unstable thoracic and lumbar spine fractures in severely injured patients

Stahel, Philip F.; VanderHeiden, Todd F.; Flierl, Michael A.; Matava, Brittany; Gerhardt, David C.; Bolles, Gene; Beauchamp, Kathryn M.; Burlew, Clay Cothren; Johnson, Jeffrey L.; Moore, Ernest E.

doi:10.1097/ta.0b013e31827d6054

Cited by 50 publications

(53 citation statements)

References 31 publications

(30 reference statements)

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“…8,9,15,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Table 1) Coluna/Columna. 2015;14(2):152-6 …”

Section: Resultsmentioning

confidence: 99%

“…It also results in fewer early postoperative complications, such as wound complications, urinary tract infections, and pulmonary complications, including pneumonia and pulmonary embolism. 8 Among the disadvantages are potential intraoperative complications, such as poor placement of the transpedicular screws, the risk of incomplete decompression of the spinal canal, and the need for a second surgery in more than 95% of patients. 8 The objective of this systematic review was to integrate the information from the studies to determine the level of evidence and the grade of recommendation regarding the application of damage control in unstable thoracic and lumbar fractures in polytraumatized patients.…”

Section: Introductionmentioning

confidence: 99%

“…7 In the case of isolated spinal fractures, the treatment regimen has been adequately defined and standardized; however, the optimum time, and the best type of fixation to use in unstable thoracolumbar fractures in polytraumatized patients, are still controversial. 8 At present, the management of unstable thoracic and lumbar fractures consists mainly of: 1) deferred fixation after the associated lesions have been resolved or 2) a more aggressive approach called "early total care" via invasive anterior approaches, corpectomy, and anterior fusion based more on purely mechanical aspects than on the physiopathology of the traumatized patient. 8 There is evidence to demonstrate a significant increase in mortality, from 2.5% to 7.6%, resulting from definitive early fixation of the spine within the first 48 hours following the trauma.…”

Section: Introductionmentioning

confidence: 99%

“…8 At present, the management of unstable thoracic and lumbar fractures consists mainly of: 1) deferred fixation after the associated lesions have been resolved or 2) a more aggressive approach called "early total care" via invasive anterior approaches, corpectomy, and anterior fusion based more on purely mechanical aspects than on the physiopathology of the traumatized patient. 8 There is evidence to demonstrate a significant increase in mortality, from 2.5% to 7.6%, resulting from definitive early fixation of the spine within the first 48 hours following the trauma. 9 On the other hand, bed rest, and insufficient mobility of the patient due to deferred stabilization of the fractures, have been associated with severe post--traumatic complications.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 The concept of "spinal damage control" is defined as a procedure carried out in stages, consisting of the immediate reduction and posterior instrumentation of unstable thoracic and lumbar fractures in severely injured patients (ISS greater than 15) within the first 24 hours, followed by complete 360º fusion during the physiological "window of opportunity", if anterior decompression and fusion have been indicated for neurological or biomechanical reasons. 8,12 The second procedure should be performed three days after the initial trauma, in order to avoid the acute hyperinflammation phase and ensure adequate recovery from bleeding and coagulopathy, reducing the risk of transoperative bleeding of the spongy bone and the epidural veins. 3 Thus, both the physiopathological state of the polytraumatized patient and the timing and nature of the surgical intervention are taken into account, avoiding "second hit" complications and reducing post-traumatic morbidity and mortality in patients in critical condition, resulting in reduced surgical and hospitalization times and fewer days of dependence on a ventilator.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Damage control in thoracic and lumbar unstable fractures in polytrauma. Systematic review

Chávez¹,

Atanasio²,

García³

et al. 2015

Coluna/Columna

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The objective of this systematic review was to integrate the information from existing studies to determine the level of evidence and grade of recommendation of the implementation of damage control in unstable thoracic and lumbar fractures in polytraumatized patients. Eighteen papers were collected from different databases by keywords and Mesh terms; the level of evidence and grade of recommendation, the characteristics of the participants, the time of fracture fixation, the type of approach and technique used, the length of stay in the intensive care unit, the days of dependence on mechanical ventilator, and the incidence of complications in patients were assessed. The largest proportion of the studies were classified as level 4 evidence and grade C of recommendation which is favorable to the implementation of damage control in unstable thoracic and lumbar fractures in polytraumatized patients as a positive recommendation, although not conclusive. Most papers advocate fracture stabilization within 72 hours of the injury which is associated with a lower incidence of complications, hospital stay, stay in the intensive care unit and lower mortality. RESUMO O objetivo desta revisão sistemática foi integrar as informações dos estudos existentes para determinar o nível de evidência e grau de recomendação da aplicação do controle de danos em fraturas torácica e lombar instáveis em pacientes com politraumatismo. Foram incluídos 18 artigos encontrados em diferentes bancos de dados, usando-se palavras-chave e termos do MeSH; avaliaram-se: nível de evidência e grau de recomendação, características dos participantes, momento em que se realizou a fixação da fratura, tipo de acesso e a técnica utilizada, dias de permanência na unidade de terapia intensiva, os dias de dependência de ventilação mecânica e a incidência de complicações dos pacientes. A maior proporção de artigos foi classificada como nível 4 de evidência, com predomínio do grau C de recomendação, o que torna favorável à implementação do controle de danos em fraturas torácicas e lombares instáveis em pacientes com politraumatismo, não sendo, contudo, concludente. A maioria dos artigos preconiza a estabilização da fratura nas primeiras 72 horas da lesão, o que está associado a menor incidência de complicações, permanência hospitalar, permanência na unidade de terapia intensiva e a menor mortalidade. Descritores: Traumatismo múltiplo; Fraturas da coluna vertebral/cirurgia; Fixação de fratura; Vértebras lombares; Vértebras torácicas. RESUMEN El objetivo de esta revisión sistemática fue integrar la información de los estudios existentes para determinar el nivel de evidencia y grado de recomendación de la aplicación del control de daños en fracturas torácicas y lumbares inestables en pacientes politraumatizados. Se incluyeron 18 artículos localizados en diferentes bases de datos a través de palabras clave y términos del

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