Thoracic spine type C injuries: injury profile, management and outcome

In the last years we observed an increased number of patients with multiple lesions after high energy accidents. Type C injuries of the thoracic spine are the most severe lesions, with the worse prognosis. The study analyzes the injury profile, management and outcome of all patients with thoracic spine, from T1- to T10, type C injuries treated in the Spinal Surgery Department of “Bagdsar- Arseni” Emergency Hospital, in the last 5 years. There were 26 patients admitted in the study, mostly male, 77%, with a mean age of 33.8 years. All of them were victims of high energy accidents, and all had spine injury associated with multiple lesions (head, thoracic, abdominal and limbs). We have chosen a posterior approach in all cases, with laminectomy or hemilaminectomy, permitting us to achieve all the major objectives of surgery, with the advantage of lower blood loss and a reduced operating time. The purpose of surgery was to achieve decompression of the spinal cord and stability of the thoracic spine. We treated 19 patient surgically and 4 patient conservative. Thoracic spine type C fractures remain a challenge for the spinal surgeon. These lesions require a multidisciplinary team approach for the treatment of associated lesions. The main goal of surgery is to achieve stability of the fractured segments. The timing for surgery is indicated mainly by associated respiratory problems

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial