Safety of Surgical Treatment for Thoracolumbar Fracture-Dislocations According to Surgical Timing
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Published:
Feb 15, 2024
Keywords:
Complications, thoracolumbar dislocations, spinal cord injury, reduction and arthrodesis, spine surgery, safety
Main Article Content
Abstract
Introduction: Thoracolumbar fracture-dislocations account for 10% of traumatic spinal injuries and typically occur in the context of high-energy trauma. Our objective is to compare early complications in patients with thoracolumbar fracture-dislocation based on surgical timing, either before or after 24 hours from the trauma.
Materials and Methods: This is a multicenter, retrospective cohort study of patients surgically treated for thoracolumbar dislocations, from January 1, 2014 to January 1, 2023. We included adult patients (>18 years old) of any gender, surgically treated for high-energy thoracolumbar fracture-dislocations. Patients were grouped based on when they underwent spinal surgery: before or after 24 hours following trauma. Total and grouped complications were recorded.
Results: Our sample comprised 72 patients, with 64 men (88.9%) and 8 women (11.1%) at an average age of 35.94 years. Occupational health care centers were predominant (n=60; 83.3%). Road traffic accidents (n=42; 58.3%) were the most frequent cause of injury, followed by falls from height (n=26; 36.1%). Furthermore, 86% of patients had one or more associated injuries. In total, 283 complications were recorded, with 67 patients (93.1%) suffering at least one complication, and 26 patients (36.1%) experiencing surgical complications. The median number of complications was significantly higher in late-operated patients (p=0.004).
Conclusions: Patients with thoracolumbar dislocations who underwent surgery after the first 24 hours following trauma had a significantly higher median rate of complications than those who underwent early surgery.
Materials and Methods: This is a multicenter, retrospective cohort study of patients surgically treated for thoracolumbar dislocations, from January 1, 2014 to January 1, 2023. We included adult patients (>18 years old) of any gender, surgically treated for high-energy thoracolumbar fracture-dislocations. Patients were grouped based on when they underwent spinal surgery: before or after 24 hours following trauma. Total and grouped complications were recorded.
Results: Our sample comprised 72 patients, with 64 men (88.9%) and 8 women (11.1%) at an average age of 35.94 years. Occupational health care centers were predominant (n=60; 83.3%). Road traffic accidents (n=42; 58.3%) were the most frequent cause of injury, followed by falls from height (n=26; 36.1%). Furthermore, 86% of patients had one or more associated injuries. In total, 283 complications were recorded, with 67 patients (93.1%) suffering at least one complication, and 26 patients (36.1%) experiencing surgical complications. The median number of complications was significantly higher in late-operated patients (p=0.004).
Conclusions: Patients with thoracolumbar dislocations who underwent surgery after the first 24 hours following trauma had a significantly higher median rate of complications than those who underwent early surgery.
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How to Cite
Ricciardi, G. A., Pons Belmonte, R., Cirillo , J. I., Garfinkel, I., Ortiz, F., Zuliani, P., & López, F. (2024). Safety of Surgical Treatment for Thoracolumbar Fracture-Dislocations According to Surgical Timing. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(1), 42-52. https://doi.org/10.15417/issn.1852-7434.2024.89.1.1853
Section
Clinical Research
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References
1. Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J 2014;14(1):145-64.
https://doi.org/10.1016/j.spinee.2012.10.041
2. Feng Z, Xiaoqing C, Xiangdong C, Junjie G, Xingjie J, Yu Y, et al. Surgery for severe thoracolumbar fracture
dislocation via a posterior approach. J Clin Neurosci 2015;22(12):1954-8. https://doi.org/10.1016/j.jocn.2015.04.029
3. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976) 1992;17(5):528-
40. https://doi.org/10.1097/00007632-199205000-00010
4. Kumar S, Patralekh MK, Boruah T, Kareem SA, Kumar A, Kumar R. Thoracolumbar fracture dislocation (AO type
C injury): A systematic review of surgical reduction techniques. J Clin Orthop Trauma 2020;11(5):730-41.
https://doi.org/10.1016/j.jcot.2019.09.016
5. Wang XB, Yang M, Li J, Xiong GZ, Lu C, Lü GH. Thoracolumbar fracture dislocations treated by posterior
reduction, interbody fusion and segmental instrumentation. Indian J Orthop 2014;48(6):568-73.
https://doi.org/10.4103/0019-5413.144219
6. Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, et al. Operative treatment of 733 patients with
acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J 2010;19(10):1657-76. https://doi.org/10.1007/s00586-010-1451-5
7. Pape HC, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited:
An international consensus process and proposal of the new ‘Berlin definition’. J Trauma Acute Care Surg 2014;77(5):780-6. https://doi.org/10.1097/TA.0000000000000453
8. Badhiwala JH, Wilson JR, Witiw CD, Harrop JS, Vaccaro AR, Aarabi B, et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol 2021;20(2):117-26. https://doi.org/10.1016/S1474-4422(20)30406-3
9. Haldrup M, Schwartz OS, Kasch H, Rasmussen MM. Early decompressive surgery in patients with traumatic spinal cord injury improves neurological outcome. Acta Neurochir (Wien) 2019;161(10):2223-8.
https://doi.org/10.1007/s00701-019-04031-y
10. Badhiwala JH, Lebovic G, Balas M, da Costa L, Nathens AB, Fehlings MG, et al. Variability in time to surgery for
patients with acute thoracolumbar spinal cord injuries. Sci Rep 2021;11(1):13312. https://doi.org/10.1038/s41598-021-92310-z
11. Ruddell JH, DePasse JM, Tang OY, Daniels AH. Timing of surgery for thoracolumbar spine trauma: Patients with neurological injury. Clin Spine Surg 2021;34(4):E229-E236. https://doi.org/10.1097/BSD.0000000000001078
12. Agostinello J, Battistuzzo CR, Skeers P, Bernard S, Batchelor PE. Early spinal surgery following thoracolumbar
spinal cord injury: Process of care from trauma to theater. Spine (Phila Pa 1976) 2017;42(10):E617-E623. https://doi.org/10.1097/BRS.0000000000001903
13. Guiroy A, Carazzo CA, Zamorano JJ, Cabrera JP, Joaquim AF, Guasque J, et al. Time to surgery for unstable
thoracolumbar fractures in Latin America-A multicentric study. World Neurosurg 2021;148:e488-e494.
https://doi.org/10.1016/j.wneu.2021.01.010
14. Bellabarba C, Fisher C, Chapman JR, Dettori JR, Norvell DC. Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality? Spine (Phila Pa 1976) 2010;35(9 Suppl):S138-45.
https://doi.org/10.1097/BRS.0b013e3181d830c1
15. Ricciardi GA, Garfinkel IG, Carrioli GG, Svarzchtein S, Cid Casteulani A, Ricciardi DO. Complicaciones
posoperatorias de fracturas toracolumbares en pacientes con traumatismo multiple según el momento de la cirugía. Rev Esp Cir Ortop Traumatol 2022;66(5):371-9. https://doi.org/10.1016/j.recot.2021.04.001
16. Cabrera JP, Carazzo CA, Guiroy A, White KP, Guasque J, Sfreddo E, et al. Risk factors for postoperative
complications after surgical treatment of type B and C injuries of the thoracolumbar spine. World Neurosurg
2023;170:e520-e528. https://doi.org/10.1016/j.wneu.2022.11.059
17. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 2013;38(23):2028-37. https://doi.org/10.1097/BRS.0b013e3182a8a381
18. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification
of surgical complications: five-year experience. Ann Surg 2009;250(2):187-96. https://doi.org/10.1097/SLA.0b013e3181b13ca2
19. Kirshblum SC, Biering-Sorensen F, Betz R, Burns S, Donovan W, Graves DE, et al. International Standards for Neurological Classification of Spinal Cord Injury: cases with classification challenges. J Spinal Cord Med 2014;37(2):120-7. https://doi.org/10.1179/2045772314Y.0000000196
20. Schmidt OI, Gahr RH, Gosse A, Heyde CE. ATLS(R) and damage control in spine trauma. World J Emerg Surg
2009;4:9. https://doi.org/10.1186/1749-7922-4-9
21. Kanna RM, Raja DC, Shetty AP, Rajasekaran S. Thoracolumbar fracture dislocations without spinal cord injury:
Classification and principles of management. Global Spine J 2021;11(1):63-70. https://doi.org/10.1177/2192568219890568
22. Ahuja CS, Badhiwala JH, Fehlings MG. “Time is spine”: the importance of early intervention for traumatic spinal cord injury. Spinal Cord 2020;58(9):1037-9. https://doi.org/10.1038/s41393-020-0477-8
23. Haghnegahdar A, Behjat R, Saadat S, Badhiwala J, Farrokhi MR, Niakan A, et al. A randomized controlled trial
of early versus late surgical decompression for thoracic and thoracolumbar spinal cord injury in 73 patients.
Neurotrauma Rep 2020;1(1):78-87. https://doi.org/10.1089/neur.2020.0027
24. TerWengel PV, de Gendt EEA, Martin E, Adegeest CY, Stolwijk-Swuste JM, Fehlings MG, et al. Impact of surgical
timing on motor level lowering in motor complete traumatic spinal cord injury patients. J Neurotrauma 2022;39(9-10):651-7. https://doi.org/10.1089/neu.2021.0428
25. Lambrechts MJ, D’Antonio ND, Karamian BA, Kanhere AP, Dees A, Wiafe BM, et al. Does displacement of
cervical and thoracolumbar dislocation-translation injuries predict spinal cord injury or recovery? J Neurosurg Spine 2022;37(6):821-7. https://doi.org/10.3171/2022.6.SPINE22435
https://doi.org/10.1016/j.spinee.2012.10.041
2. Feng Z, Xiaoqing C, Xiangdong C, Junjie G, Xingjie J, Yu Y, et al. Surgery for severe thoracolumbar fracture
dislocation via a posterior approach. J Clin Neurosci 2015;22(12):1954-8. https://doi.org/10.1016/j.jocn.2015.04.029
3. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976) 1992;17(5):528-
40. https://doi.org/10.1097/00007632-199205000-00010
4. Kumar S, Patralekh MK, Boruah T, Kareem SA, Kumar A, Kumar R. Thoracolumbar fracture dislocation (AO type
C injury): A systematic review of surgical reduction techniques. J Clin Orthop Trauma 2020;11(5):730-41.
https://doi.org/10.1016/j.jcot.2019.09.016
5. Wang XB, Yang M, Li J, Xiong GZ, Lu C, Lü GH. Thoracolumbar fracture dislocations treated by posterior
reduction, interbody fusion and segmental instrumentation. Indian J Orthop 2014;48(6):568-73.
https://doi.org/10.4103/0019-5413.144219
6. Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, et al. Operative treatment of 733 patients with
acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J 2010;19(10):1657-76. https://doi.org/10.1007/s00586-010-1451-5
7. Pape HC, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited:
An international consensus process and proposal of the new ‘Berlin definition’. J Trauma Acute Care Surg 2014;77(5):780-6. https://doi.org/10.1097/TA.0000000000000453
8. Badhiwala JH, Wilson JR, Witiw CD, Harrop JS, Vaccaro AR, Aarabi B, et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol 2021;20(2):117-26. https://doi.org/10.1016/S1474-4422(20)30406-3
9. Haldrup M, Schwartz OS, Kasch H, Rasmussen MM. Early decompressive surgery in patients with traumatic spinal cord injury improves neurological outcome. Acta Neurochir (Wien) 2019;161(10):2223-8.
https://doi.org/10.1007/s00701-019-04031-y
10. Badhiwala JH, Lebovic G, Balas M, da Costa L, Nathens AB, Fehlings MG, et al. Variability in time to surgery for
patients with acute thoracolumbar spinal cord injuries. Sci Rep 2021;11(1):13312. https://doi.org/10.1038/s41598-021-92310-z
11. Ruddell JH, DePasse JM, Tang OY, Daniels AH. Timing of surgery for thoracolumbar spine trauma: Patients with neurological injury. Clin Spine Surg 2021;34(4):E229-E236. https://doi.org/10.1097/BSD.0000000000001078
12. Agostinello J, Battistuzzo CR, Skeers P, Bernard S, Batchelor PE. Early spinal surgery following thoracolumbar
spinal cord injury: Process of care from trauma to theater. Spine (Phila Pa 1976) 2017;42(10):E617-E623. https://doi.org/10.1097/BRS.0000000000001903
13. Guiroy A, Carazzo CA, Zamorano JJ, Cabrera JP, Joaquim AF, Guasque J, et al. Time to surgery for unstable
thoracolumbar fractures in Latin America-A multicentric study. World Neurosurg 2021;148:e488-e494.
https://doi.org/10.1016/j.wneu.2021.01.010
14. Bellabarba C, Fisher C, Chapman JR, Dettori JR, Norvell DC. Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality? Spine (Phila Pa 1976) 2010;35(9 Suppl):S138-45.
https://doi.org/10.1097/BRS.0b013e3181d830c1
15. Ricciardi GA, Garfinkel IG, Carrioli GG, Svarzchtein S, Cid Casteulani A, Ricciardi DO. Complicaciones
posoperatorias de fracturas toracolumbares en pacientes con traumatismo multiple según el momento de la cirugía. Rev Esp Cir Ortop Traumatol 2022;66(5):371-9. https://doi.org/10.1016/j.recot.2021.04.001
16. Cabrera JP, Carazzo CA, Guiroy A, White KP, Guasque J, Sfreddo E, et al. Risk factors for postoperative
complications after surgical treatment of type B and C injuries of the thoracolumbar spine. World Neurosurg
2023;170:e520-e528. https://doi.org/10.1016/j.wneu.2022.11.059
17. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 2013;38(23):2028-37. https://doi.org/10.1097/BRS.0b013e3182a8a381
18. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification
of surgical complications: five-year experience. Ann Surg 2009;250(2):187-96. https://doi.org/10.1097/SLA.0b013e3181b13ca2
19. Kirshblum SC, Biering-Sorensen F, Betz R, Burns S, Donovan W, Graves DE, et al. International Standards for Neurological Classification of Spinal Cord Injury: cases with classification challenges. J Spinal Cord Med 2014;37(2):120-7. https://doi.org/10.1179/2045772314Y.0000000196
20. Schmidt OI, Gahr RH, Gosse A, Heyde CE. ATLS(R) and damage control in spine trauma. World J Emerg Surg
2009;4:9. https://doi.org/10.1186/1749-7922-4-9
21. Kanna RM, Raja DC, Shetty AP, Rajasekaran S. Thoracolumbar fracture dislocations without spinal cord injury:
Classification and principles of management. Global Spine J 2021;11(1):63-70. https://doi.org/10.1177/2192568219890568
22. Ahuja CS, Badhiwala JH, Fehlings MG. “Time is spine”: the importance of early intervention for traumatic spinal cord injury. Spinal Cord 2020;58(9):1037-9. https://doi.org/10.1038/s41393-020-0477-8
23. Haghnegahdar A, Behjat R, Saadat S, Badhiwala J, Farrokhi MR, Niakan A, et al. A randomized controlled trial
of early versus late surgical decompression for thoracic and thoracolumbar spinal cord injury in 73 patients.
Neurotrauma Rep 2020;1(1):78-87. https://doi.org/10.1089/neur.2020.0027
24. TerWengel PV, de Gendt EEA, Martin E, Adegeest CY, Stolwijk-Swuste JM, Fehlings MG, et al. Impact of surgical
timing on motor level lowering in motor complete traumatic spinal cord injury patients. J Neurotrauma 2022;39(9-10):651-7. https://doi.org/10.1089/neu.2021.0428
25. Lambrechts MJ, D’Antonio ND, Karamian BA, Kanhere AP, Dees A, Wiafe BM, et al. Does displacement of
cervical and thoracolumbar dislocation-translation injuries predict spinal cord injury or recovery? J Neurosurg Spine 2022;37(6):821-7. https://doi.org/10.3171/2022.6.SPINE22435