Assessment of three year experience of a strategy for patient selection and timing of operation in the management of acute thoracic and lumbar spine fractures: a prospective study.
BACKGROUND
The purpose of this article is to report experience gained over three years of the use of a protocol for patient selection and timing of operation for acute thoracic and lumbar fractures.


METHODS
At admission, all patients underwent neurological and imaging exams. All patients with a spinal cord lesion scored as ASIA A at any level inferior to T10 and as ASIA B, C or D at any level, were categorized as emergency and operated on within eight hours from trauma. ASIA A cases in the T1-T10 tract and ASIA E cases at any level were treated in the ordinary operative work schedule.


RESULTS
Ninety-four patients with surgically treated lumbar or thoracic fractures took part in this study. On the imaging studies, 12 patients were classified as A, 50 as B and 32 as C following the AO classification. At the neurological exam, 39 patients were scored as ASIA A, nine as B, six as C, two as D and 38 as E. At follow-up, of the 39 patients scored as ASIA A, 13 (33%) improved at least one grade and of the 17 scored as ASIA B, C or D, 11 (64.7%) improved. None of the 38 patients scored as ASIA E deteriorated.


CONCLUSIONS
The findings show that the strategy in the protocol was safe and followed by satisfactory rates of neurological outcome. Larger prospective studies, preferably randomized, are needed to establish definitively its place in the management of patients with spinal injury.
Mouchaty
H
H
Department of Neurosurgery, University of Florence, Florence, Italy. dilorenzo@unifi.it
Conti
P
P
Conti
R
R
Aito
S
S
D'Andrea
M
M
Marinelli
C
C
Di Lorenzo
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002985:Clinical Protocols / Q000592:standards; D019299:Decompression, Surgical / Q000379:methods / Q000592:standards; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000592:standards; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome