Spine Fractures

Abstract

Survival of polytrauma patients relies upon expeditious and accurate, appropriate care of multiple injured systems. These patients require coordinated, comprehensive care by several medical and surgical subspecialties. All involved parties must assume that a spinal injury exists until proven otherwise. While quick yet thorough evaluations occur, it is paramount to maintain strict spinal precautions to prevent worsening of spinal and neurological injuries. Assessment of polytrauma patients should always include a complete analysis of the spine. Following initial lifesaving measures, a secondary survey is conducted to assess the entire spinal column from occiput to sacrum. The surgeon should keep in mind the concept of “pattern-of-injury.” This may help guide more focused analysis while fully considering the entire historical context of the patient’s traumatic mechanism. A thorough neurological examination soon follows. This is documented in detail. Imaging then ensues. Obtunded patients require complete radiographic spinal analysis. Thorough imaging of an injured spinal segment should not preclude further analysis of noncontiguous spinal regions as injuries may often occur separately. Once spinal injuries have been completely identified, classification can ideally guide appropriate treatment. Injury classification and severity scores will help determine surgical versus nonsurgical treatment. Surgical approach is often left to the treating spinal surgeon’s discretion. However, basic principles apply. Surgeons work to provide spinal realignment, stable fixation, and decompression of neurological structures to facilitate early mobilization. Timing of surgical intervention must consider the complete physiological picture of the multiply injured organism. Frequently, spinal reduction and stabilization is accomplished after other damage-control-orthopedic procedures have been completed. Treatment must be coordinated with other intensive care strategies, but spinal stabilization is usually warranted to facilitate easier care for these severely injured patients. Expectations related to early spinal surgery in polytrauma victims are centered around diminished complications related to pulmonary compromise, thromboembolic events, and systemic infection. A surgeon’s ultimate goal for polytrauma patients affected by spinal injury is to maximize functional status through early and accurate recognition and diagnosis followed by swift and appropriate treatment. The centerpiece of this algorithm is seamless communication with other treating subspecialties to ensure the most coordinated approach possible for these complex patients.