Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma: An analysis of a National Trauma Registry database.
10.1016/j.cjtee.2021.03.004
- Author:
Veacheslav ZILBERMINTS
1
;
Yehuda HERSHKOVITZ
2
;
Kobi PELEG
3
;
Joseph J DUBOSE
4
;
Adi GIVON
3
;
David ARANOVICH
5
;
Mickey DUDKIEWICZ
6
;
Boris KESSEL
5
Author Information
1. Surgical Division, Hillel Yaffe Medical Center Affiliated to Rappoport Medical School, Technion, Hadera, Israel. Electronic address: z_slava2000@yahoo.com.
2. Department of Surgery, Shamir Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
3. National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
4. University of Maryland School of Medicine, Baltimore, MD, USA.
5. Surgical Division, Hillel Yaffe Medical Center Affiliated to Rappoport Medical School, Technion, Hadera, Israel.
6. Hospital Administration, Hillel Yaffe Medical Center, Hadera, Israel.
- Collective Name:Israeli Trauma Group
- Publication Type:Journal Article
- Keywords:
Abdominal injuries;
Blunt trauma;
Spinal cord injury;
Spinal fractures
- From:
Chinese Journal of Traumatology
2021;24(3):132-135
- CountryChina
- Language:English
-
Abstract:
PURPOSE:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intra-abdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.
METHODS:A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher's exact probability test.
RESULTS:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts.
CONCLUSION:SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.
