title: Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series.
abstract: OBJECTIVE
  The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions.
  
  
  METHODS
  Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8-67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management.
  
  
  RESULTS
  Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues.
  
  
  CONCLUSIONS
  Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.
authors.affiliation: Medical Faculty, University of Adelaide, Australia j.rosenfeld@alfred.org.au
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Rosenfeld
authors.forename: Rebecca
authors.initials: R
authors.lastname: Limb
authors.forename: Patrick
authors.initials: P
authors.lastname: Chan
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: William Pierre Litherland
authors.initials: WP
authors.lastname: Bradley
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed