Sat., 10/16/10 Pelvis & Spine, Paper #85, 4:28 pm OTA-2010
Spine Damage Control: A Safe and Effective Treatment Modality for Unstable Spine Fractures in Multiply Injured Patients
Philip F. Stahel, MD; Michael A. Flierl, MD; Ernest E. Moore, MD;
Kathryn M. Beauchamp, MD;
Denver Health Medical Center, Denver, Colorado, USA
Purpose: The ideal timing and modality of spine fracture fixation in multiply injured patients remains controversial. While the concept of “damage control orthopaedics” has been widely implemented for pelvic and long-bone fractures, a “spine damage control” (SDC) approach for unstable spine injuries in polytrauma patients remains largely unexplored. This prospective study was designed to evaluate the safety and efficacy of a mandatory institutional SDC protocol for multiply injured patients with unstable spine fractures.
Patients and Methods: Our institutional SDC protocol mandates operative stabilization of unstable spine fractures within 24 hours of admission, followed by a delayed completion fusion, if indicated, once patients are fully resuscitated. From October 2008 to October 2009, 50 consecutive polytrauma patients with unstable spine fractures were prospectively entered into a spine database. 19 patients were treated by SDC, while 31 patients underwent definitive operative spine fixation in a delayed fashion (>24 hours, “delayed surgery” [DS] group). The two cohorts were analyzed for demographics, length of operative time, intraoperative blood loss, total hospital length of stay, ventilator-dependent days, and postoperative complications.
Results: Both cohorts were comparable with regard to age, spine fracture level, amount of intraoperative blood loss, and injury severity score. The mean time to initial spine fixation was significantly decreased in the SDC group (14.4 ± 1.2 hours vs 95.9 ± 20.4 hours, P < 0.01). The SDC cohort had significantly reduced mean operative time (2.7 ± 0.3 hours vs 3.5 ± 0.3 hours, P < 0.05), significantly reduced mean length of hospital stay (17.1 ± 2.5 days vs 31.4 ± 6.6 days, P < 0.05), ventilator-dependent days (2.3 ± 1.3 days vs 8.4 ± 2.2 days, P < 0.05), and incidence of urinary tract infections (5% vs 22%, P < 0.05). The SDC group furthermore displayed a nonsignificant trend towards reduction of pulmonary complications (16% vs 23%, P = 0.72) and pressure sores (6% vs 0%, P = 0.52), compared to the DS cohort. The lack of statistical significance is likely due to a type II error related to the small sample size in the subgroups.
Conclusion: A standardized SDC approach represents a safe and efficacious treatment strategy for multiply injured patients with unstable spine fractures. Larger multicenter trials will have to be designed to formally validate the safety and efficacy profile related to the implementation of an institutional SDC protocol.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.