The spine journal : official journal of the North American Spine Society
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Little is known about the incidence of spinal cord injury (SCI) in polytrauma patients. ⋯ Spinal cord injury with a neurologic deficit could be found in every 13th patient with polytrauma. Over half of the patients with SCI suffer from complete cord lesion. In polytrauma patients, SCI only has a limited influence on the mortality, with exception of AIS 6 lesions. Complications such as multiorgan failure or sepsis and extended hospital length of stay are more frequent in SCI.
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Spinal gunshot injuries (spinal GSIs) are a major cause of morbidity and mortality in both military and civilian populations. These injuries are likely to be encountered by spine care professionals in many treatment settings. A paucity of resources is available to summarize current knowledge of spinal GSI evaluation and management. ⋯ Treatment of spinal GSI requires a multidisciplinary approach with the goal of maintaining or restoring spinal stability and neurologic function and minimizing complications. Concomitant injuries and complications after spinal GSI can present immediate and ongoing challenges to the medical, surgical and rehabilitative care of the patient.
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The influence of nonmedical factors on the disposition of spine trauma patients, initially seen in less specialized institutions, remains an issue of debate. ⋯ In summary, lack of insurance was associated with increased possibility of transfer to higher level of care institutions, after evaluation in a Level III or IV trauma center ED for spine trauma. The same was true for African-Americans with milder injuries.
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Revision adult spinal deformity surgery (RASDS) is a particularly high-risk intervention. ⋯ Perioperative complication rate associated with RASDS is lower when patients are treated by high-volume surgeons at high-volume centers. As complex cases requiring osteotomy and combined approaches are more frequent at high-volume centers, an operative complexity index helps predict the likelihood of volume-dependent complication rates. Future interhospital and intersurgeon comparisons should account for these case characteristics so that similar case complexity is compared in these analyses.