Skip to main content
SpringerLink
Log in

Spine Fractures

  • Chapter
  • First Online:
Textbook of Polytrauma Management

  • 1572 Accesses

Abstract

Spine fractures in polytrauma patients represent challenging injuries due to the risk of permanent neurological injury. Established alpha-numeric classification systems define the severity of spine fractures and provide guidance for treatment. The timing of surgical stabilization of unstable spinal fractures in polytrauma patients is paramount for preventing post-injury complications related to prolonged bed rest. The novel and proactive approach of “spine damage control” outlines a standardized protocol to early spinal fixation within 24 h and unrestricted mobilization to care for associated injuries, including severe thoracic trauma and traumatic brain injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184–201.

    Article  CAS  PubMed  Google Scholar 

  2. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):S1–133.

    Article  CAS  PubMed  Google Scholar 

  3. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1–S170.

    Article  PubMed  Google Scholar 

  4. Stahel PF, Flierl MA, Matava B. Traumatic spondylolisthesis. In: Vincent JL, Hall J, editors. Encyclopedia of intensive care medicine. Heidelberg: Springer; 2012. p. 2325–9.

    Google Scholar 

  5. Stahel PF, Dorenkamp BC, Janssen ME. Spinal cord and spine. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 9th ed. New York, NY: McGraw-Hill; 2021. p. 545–59.

    Google Scholar 

  6. American College of Surgeons, Committee on Trauma. Advanced trauma life support (ATLS) student course manual. 10th ed. Chicago, IL: ACS-COT; 2018.

    Google Scholar 

  7. Stahel PF, Flierl MA, Heyde CE. Initial trauma management: spine precautions. In: Vincent JL, Hall J, editors. Encyclopedia of intensive care medicine. Heidelberg: Springer; 2012. p. 1244–6.

    Google Scholar 

  8. Stahel PF. Initial management of patients with traumatic spinal cord injuries. Orthopedics. 2012;35(9):777–8.

    Article  PubMed  Google Scholar 

  9. Winegar BA, Kay MD, Taljanovich M. Magnetic resonance imaging of the spine. Pol J Radiol. 2020;85:e550–74.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stahel PF, Heyde CE, Wyrwich W, Ertel W. Current concepts of polytrauma management: from ATLS to "damage control". Orthopade. 2005;34(9):823–36.

    Article  CAS  PubMed  Google Scholar 

  11. Vanderheiden TF, Smith SE, Stahel PF. Spine trauma: diagnosis, clearance, and mobility. In: Pieracci FM, Moore EE, editors. Handbook of surgical critical care: the practice and the evidence. Hackensack, NJ: World Scientific Publishing; 2015. p. 57–71.

    Google Scholar 

  12. VanderHeiden T, Stahel PF. Spinal cord injury. In: McIntyre Jr R, Schulick RD, editors. Surgical decision making. 6th ed. St. Louis, MO: Elsevier; 2019. p. 442–6.

    Google Scholar 

  13. Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-radiography utilization study (NEXUS). Ann Emerg Med. 1998;32(4):461–9.

    Article  CAS  PubMed  Google Scholar 

  14. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841–8.

    Article  CAS  PubMed  Google Scholar 

  15. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510–8.

    Article  CAS  PubMed  Google Scholar 

  16. Rabb CH, Johnson JL, VanSickle D, Beauchamp K, Bolles G, Moore EE. Are upright lateral cervical radiographs in the obtunded trauma patient useful? A retrospective study. World J Emerg Surg. 2007;2:4.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Patel MB, Humble SS, Cullinane DC, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;78(2):430–41.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: a prospective Western Trauma Association Multi-Institutional Trial and Survey. J Trauma Acute Care Surg. 2017;83(6):1032–40.

    Article  PubMed  Google Scholar 

  19. Stahel PF, VanderHeiden T, Finn MA. Management strategies for acute spinal cord injury: current options and future perspectives. Curr Opin Crit Care. 2012;18(6):651–60.

    Article  PubMed  Google Scholar 

  20. Vanderheiden TF, Stahel PF. Spine fracture-dislocations. In: Hak DJ, Ipaktchi KR, Morgan SJ, editors. Orthopaedic trauma call for the attending surgeon. Thorofare, NJ: SLACK; 2013. p. 319–28.

    Google Scholar 

  21. Botolin S, VanderHeiden TF, Moore EE, Fried H, Stahel PF. The role of pre-reduction MRI in the management of complex cervical spine fracture-dislocations: an ongoing controversy? Patient Saf Surg. 2017;11:23.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Yoshihara H, VanderHeiden TF, Weckbach S, Stahel PF. Vertebral burst fractures. In: Hak DJ, Ipaktchi KR, Morgan SJ, editors. Orthopaedic trauma call for the attending surgeon. Thorofare, NJ: SLACK; 2013. p. 307–17.

    Google Scholar 

  23. Fernandez-de Thomas RJ, De Jesus O. Thoracolumbar spine fracture. Treasure Island, FL: StatPearls; 2020.

    Google Scholar 

  24. Haschtmann D, Stahel PF, Heyde CE. Management of a multiple trauma patient with extensive instability of the lumbar spine as a result of a bilateral facet dislocation and multiple complete vertebral burst fractures. J Trauma. 2009;66(3):922–30.

    PubMed  Google Scholar 

  25. Laubach M, Pishnamaz M, Scholz M, et al. Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons. Eur J Trauma Emerg Surg. 2020; [Sept 12, online ahead of print].

    Google Scholar 

  26. Kandziora F, Scholz M, Pingel A, et al. Treatment of atlas fractures: recommendations of the spine section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018;8(2 Suppl):5S–11S.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Anderson LD, D'Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56(8):1663–74.

    Article  CAS  PubMed  Google Scholar 

  28. Harr JN, Stahel PF. Hangman’s fracture. In: Vincent JL, Hall J, editors. Encyclopedia of intensive care medicine. Heidelberg: Springer; 2012. p. 1009–12.

    Google Scholar 

  29. Turtle J, Kantor A, Spina NT, France JC, Lawrence BD. Hangman's fracture. Clin Spine Surg. 2020;33(9):345–54.

    Article  PubMed  Google Scholar 

  30. Thakur JD, Wild E, Menger R, et al. George Chance and Frank Holdsworth: understanding spinal instability and the evolution of modern spine injury classification systems. Neurosurgery. 2020;86(6):E509–16.

    Article  PubMed  Google Scholar 

  31. Hak DJ, Baran S, Stahel P. Sacral fractures: current strategies in diagnosis and management. Orthopedics. 2009;32(10)

    Google Scholar 

  32. Stahel PF, Moore EE. Modern strategies for the management of high-energy pelvic fractures in the twenty-first century. In: Aseni P, De Carlis L, Mazzola A, Grande AM, editors. Operative techniques and recent advances in acute care and emergency surgery. Heidelberg: Springer; 2019. p. 261–71.

    Chapter  Google Scholar 

  33. Stahel PF, Flierl MA, Moore EE, Smith WR, Beauchamp KM, Dwyer A. Advocating "spine damage control" as a safe and effective treatment modality for unstable thoracolumbar fractures in polytrauma patients: a hypothesis. J Trauma Manag Outcomes. 2009;3:6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Croce MA, Bee TK, Pritchard E, Miller PR, Fabian TC. Does optimal timing for spine fracture fixation exist? Ann Surg. 2001;233(6):851–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Schmidt OI, Gahr RH, Gosse A, Heyde CE. ATLS® and damage control in spine trauma. World J Emerg Surg. 2009;4:9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Stahel PF, VanderHeiden T, Flierl MA, et al. The impact of a standardized "spine damage-control" protocol for unstable thoracic and lumbar spine fractures in severely injured patients: a prospective cohort study. J Trauma Acute Care Surg. 2013;74(2):590–6.

    Article  PubMed  Google Scholar 

  37. Rutges JP, Oner FC, Leenen LP. Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome. Eur Spine J. 2007;16(5):579–87.

    Article  PubMed  Google Scholar 

  38. Eichholz KM, Rabb CH, Anderson PA, et al. Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: timing of surgical intervention. Neurosurgery. 2019;84(1):E53–5.

    Article  PubMed  Google Scholar 

  39. Bliemel C, Lefering R, Buecking B, et al. Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the trauma registry of DGU: treatment of spine injuries in polytrauma patients. J Trauma Acute Care Surg. 2014;76(2):366–73.

    Article  PubMed  Google Scholar 

  40. Vallier HA, Super DM, Moore TA, Wilber JH. Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course. J Orthop Trauma. 2013;27(7):405–12.

    Article  PubMed  Google Scholar 

  41. Wutte C, Klein B, Becker J, et al. Earlier decompression (<8 hours) results in better neurological and functional outcome after traumatic thoracolumbar spinal cord injury. J Neurotrauma. 2019;36(12):2020–7.

    Article  PubMed  Google Scholar 

  42. Vallier HA, Wang X, Moore TA, Wilber JH, Como JJ. Timing of orthopaedic surgery in multiple trauma patients: development of a protocol for early appropriate care. J Orthop Trauma. 2013;27(10):543–51.

    Article  PubMed  Google Scholar 

  43. Afshari FT, Choi D, Russo A. Controversies regarding mobilisation and rehabilitation following acute spinal cord injury. Br J Neurosurg. 2020;34(2):123–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

  2. NeuroSpineZürich, Zurich, Switzerland

    Sebastian Weckbach

Authors
  1. Philip F. Stahel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Weckbach
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Stahel, P.F., Weckbach, S. (2022). Spine Fractures. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-95906-7_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95905-0

  • Online ISBN: 978-3-030-95906-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation