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Effect of instrumented spinal fixation on outcome in polytrauma patients in the ICU

Introduction

Spinal injuries in polytrauma patients carry high morbidity and mortality often necessitating intensive care admission. A review of polytrauma patients admitted to the ICU at The Royal Liverpool University Hospital was undertaken to investigate the effect of spinal instrumentation on outcome in the ITU.

Methods

A retrospective review of all polytraumatized patients admitted to the RLUH ICU over 3 years with a thoraco-lumbar spinal fracture. Clinical records, laboratory results and radiological records were accessed. Patients were grouped according to the use of instrumented spinal fixation versus conservative management and outcomes compared.

Results

Fourteen polytrauma patients with spinal fractures were admitted to the ICU over 3 years, five managed conservatively with a TLSO brace and nine managed operatively with instrumented spinal fixation. The degree of injury as graded by the Injury Severity Scale (ISS) was lower in the nonoperative group (mean: 27, range: 14 to 59) compared to the operative group (mean: 36.1, range: 14 to 57). Mortality was significantly higher in patients conservatively managed (nonoperative: 60%, operative: 0%) (P < 0.01). The intubation time was lower in patients who underwent spinal instrumentation (mean: 12.3 days, range: 1 to 27 days), when compared to conservative management (mean: 16 days, range: 11 to 27 days), and similarly the ITU length of stay was reduced in the operative group (operative: mean 20.6 days, nonoperative: 32.25 days). Development of respiratory failure was decreased in patients treated with instrumented fixation (operative 33.3%, nonoperative: 71%).

Conclusion

Surgical stabilization of spinal fractures avoids restrictive spinal braces and permits mobilization. Surgical fixation of spinal fractures appears to decrease mortality and ITU stay and has a beneficial effect on respiratory function, with regards to degree of ventilatory support and development of respiratory failure.

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Correspondence to G Simpson.

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Simpson, G., Menakaya, C., Bidwai, A. et al. Effect of instrumented spinal fixation on outcome in polytrauma patients in the ICU. Crit Care 16, P456 (2012). https://doi.org/10.1186/cc11063

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Keywords

  • Respiratory Failure
  • Conservative Management
  • Operative Group
  • Ventilatory Support
  • Spinal Injury