Timing of Surgery for Spinal Fractures Associated with Systemic Trauma: A Need for a Strategic and Systemic Approach

IntroductionImproved use of technology resulted in an increased number of motor vehicles and higher skyscrapers which probably has a role in increased severity of trauma (25). It is well known that the spinal fractures are associated with high-energy trauma (7) and an increased incidence in systemic and spinal trauma is not striking. Dislocations and burst fractures of thoracolumbar region are associated with high energy trauma and osteoporotic fractures of the regarding region might develop even after a low energy trauma (22, 24). Spinal fractures develop after a diverse direction of high-energy forces and injury of other body systems might almost be inevitable (7). Thus clinical situation involving other systems is overwhelmingly important in the selection of treatment approach. 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 (4, 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. In the present study, plan and timing of surgical intervention were studied after admission to emergency wards in patients with systemic trauma and spinal fracture.

Material and Methods:157 patients who were admitted to Ankara Numune and Ankara Education and Research Hospitals between September 2012 and September 2014were retrospectively analyzed for systemic trauma and thoracolumbar fractures. Neurological condition at the time of diagnosis and detailed radiological analyses were thoroughly evaluated for the study. According to the multitrauma protocol at the emergency wards of our center, radiological scans of head, thorax, abdomen and major extremities were performed. The cases were categorized according to age, sex, reason of trauma, associated trauma, fracture type, neurological condition and treatment details and results were statistically analyzed. Patients who have minor fractures including transverse and spinous process fractures were all excluded from the study.Life functions including blood pressure, blood hemoglobin and oxygen levels were all evaluated in patients presenting with systemic trauma. Patients with deteriorated functions due to associated pathologies like brain or lung contusion, abdominal injury, pelvis or long extremity fractures were meticulously evaluated to attain a stable level of vital signs. Systemic influence of all regarding pathologies were corrected before surgical intervention and patients were operated after detailed radiological studies. CT and direct X-rays were evaluated for McCormack score and posterior stabilization was preferred for patients with a score between 4 and 6. Patients with a score of 7 or over were operated with posterior stabilization+anterior fusion. Patients with a score of 5 or more on MRI in accordance with TLICS classification were subjected to surgical treatment whereas patients with a score of 3 or less were treated with conservative measures. Patients with a score of 4 were subjected to conservative or surgical measures depending on other scores and associated systemic injury.All data were evaluated with SPSS 19.0 (Statistical Package for Social Sciences) for Windows. Numerical variables were further analyzed with Kolmogorov Smirnov test to check normal istribution. Descriptive statistics were defined as mean±SD(standard deviation) and categorical variables were shown as number of cases (n) and percentages (%). Categorical variables were analyzed with chi square test. P values below 0.05 (p<0.05) were accepted as significant.