Factors for complications following thoracolumbar injury stabilization identified

SAN FRANCISCO — Data from a large prospectively collected multi-centered trauma database indicate that the severity of neurologic injury, the number of comorbidities and the use of high-dose steroids increase the risk of major complications following surgical stabilization of the thoracolumbar spine.

“If you know that you have the predictors of complications, you can plan and hopefully be prevented from having them,” John Dimar II, MD said at the 24th Annual Meeting of the North American Spine Society, here. “The identification of these high-risk groups is one of the first things you can do in an attempt to prevent complications.”

He said this is one of the first studies from a large multi-centered database (The Epidemiology, Process, and Outcomes of Spine Trauma – EPOST) that combines the Injury Severity Score (ISS), the Charlson Comorbidity Index (CCI), the American Spinal Injury Association (ASIA score), and Glasgow Coma Score (GCS) classifications systems.

In addition, the database also contained standard demographic data, the method of injury, time from injury to surgery, type of surgery, approach and the use of steroids.

All perioperative complications were recorded in the 6-month period following surgical stabilization of thoracolumbar injuries and a multivariant logistical analysis identified factors predictive of the occurrence of a complication.

There were 230 patients studied, the majority were men. The mean age of the group was 42 years old, more than one-third were smokers and the mean body mass index (BMI) was 25.7.

The most common injury method was a fall followed by motor vehicle accidents and sports injuries.

“The total incidence of complications was 79 with 30 being major and 49 being minor,” Dimar said. “Average days to surgery were 8.9.”

There were no factors that were predictive of a minor complication, he said.

“The CCI, ASIA scores and steroid use seemed to be predictive of having complications,” Dimar reported.

“Patients who received high-dose steroids had 2.3 times the risk of developing a complication. It also increased 2.5 times for each step down the patient was on the ASIA score, and each point increase in the GCI increased the odds by 1.9 times,” he said.

Reference:
Dimar J, Fisher C, Vaccaro A, et al. Predictors of complications following spinal stabilization of thoracolumbar spine injuries. Paper #70. Presented at the 24th Annual Meeting of the North American Spine Society. Nov. 10-14, 2009. San Francisco.