Introduction: The management of complications following major traumatic spinal injury and surgical stabilization is a challenge for spine specialists. The purpose of this study is to report on the incidence of complications following surgical stabilization of thoracolumbar spine injuries and to identify factors predictive of occurrence of a major complication.
Methods: A retrospective review of subjects enrolled in a multicenter database for spine trauma (EPOST) was done. Standard demographic data, Glasgow Coma Scores (GCS), Injury Severity Score (ISS), ASIA score, Charleson CoMorbiditiy Index (CCI), mechanism of injury, administration of methylprednisolone (NASCIS II, III), time from injury to surgery, and surgical approach were evaluated. All postoperative and perioperative complications within six months of surgery were recorded. Multivariate regression analysis was done to identify factors predictive of the occurrence of a major complication after surgical stabilization of a thoracolumbar injury.
Results: There were 230 patients (57 females, 173 males), 35% were smokers. The mean age at injury was 41.8±17.8 years and the mean body mass index was 25.7±4.2 kg/m2. The most common injury mechanism was a fall (52%) followed by MVA (36%) and sports injury (10%). The mean admission ISS was 9.2±7.8, mean CCI was 0.2±0.7, mean GCS was 14.6±1.6. NASCIS II & III was instituted in 15.5% & 4.2% of patients respectively; mean time from injury to surgery was 8.9±59 days; surgical approach was anterior only in 30 (13%), posterior only in 154 (65%), and anteroposterior in 52 (22%) patients. The total incidence of complications was 79% (minor 30%, major 49%). The different complications are summarized in Table 1. The complications listed as “other” are singular incidents of a specific complication. Factors predictive of the occurrence of a major complication were administration of high dose steroids (NASCIS II)( Odds Ratio:2.3; CI: 1.1–4.8, p=0.030) ASIA score (OR:0.7; CI:0.6–0.8, p=0.000) and CCI (OR:1.9; Cl:1.2–3.0, p=0.001).
Conclusion: The severity of neurologic injury, number of comorbidities and use of the high dose steroids independently increase the risk of having a major complication following surgical stabilization of thoracolumbar spine fractures.