Oral Posters: Thoraco-lumbar Degenerative

Presented by: N. Anandasivam - View Audio/Video Presentation (Members Only)

Author(s):

N. Anandasivam(1), N. Ondeck(1), A. Samuel(2), D. Bohl(3), J. Grauer(1)

(1) Yale University, Orthopedics and Rehabilitation, New Haven, CT, United States
(2) Hospital for Special Surgery, Orthopedics, New York, NY, United States
(3) Rush University Medical Center, Orthopedics, Chicago, IL, United States

Abstract

Summary: In the present study, over 70,000 patients from the National Trauma Data Bank (NTDB) sustaining injuries to the thoracic spine were identified and studied. Nearly two-thirds of the population was male. As age increased, there was a gradual decline in injury severity score and transition from motor vehicle accidents (MVAs) to falls. 83% of patients had associated injuries with local injuries being the most common (26% of patients with noncontiguous lumbar spine injuries, 25% of patients with noncontiguous cervical spine injury and 36% of patients with lung injuries). A multivariate analysis found that when controlling for age and comorbidity burden, an injury severity score higher than 30 significantly increases risk of mortality. The results of this study indicate the need for thoracic and abdominal imaging in patients sustaining traumatic thoracic spine injury.

Objectives: This study used the NTDB, a national, multi-center trauma database, to update the field on the demographics, mechanisms of injury, injury severity, and associated injuries of patients who present to the emergency department with thoracic spine injuries.

Materials and Methods: Patients contained in the NTDB between 2011 and 2012 who presented with a thoracic spinal injury were identified. Comorbidity burden, injury severity score, mechanism of injury, and associated injuries were assessed.

Results: A total of 70,382 patients (45,987 males and 24,395 females) with thoracic spine injuries were identified. Mean age (± standard deviation) was 49.8 ± 20.5 years. Local peaks occur in the age distribution at three age points (early 20s, early 50s, and early 80s). As expected with age increase, comorbidity burden increased and injury severity score marginally decreased. MVAs comprised the predominant category of mechanism of injury among ages 18-39 (70.1%), while falls were the most common in those over age 65 (62.5%). Over 80% of patients with thoracic spine injury had at least one associated injury. The most common locations were local to the index thoracic injury (26% of patients having noncontiguous lumbar spine injury, 25% of patients with noncontiguous cervical spine injury and 36% of patients having lung injury). In addition, over one third of patients had associated head injuries (24% with intracranial injury and 16% with skull injury). Among other skeletal associated injuries, the most common were upper extremity injuries (28%), and lower extremity fracture (14%). A multivariate mortality analysis revealed that increased injury severity was strongly correlated with mortality (odds ratio of 51 for injury severity score greater than 30).

Conclusion: This study profiles the population of thoracic spine injury patients in a large, national sample. The three local peaks in the age distribution may signify different types of injury patterns occurring by different mechanisms in these age groups. The comorbidity, injury severity, and associated injury frequency data presented here by age supports this idea. Furthermore, the associated injury analysis suggests that, in addition to thoracic imaging, thoracic spine patients should routinely obtain a head CT, since it was found that head injury occurs in one-third of thoracic spine patients. Lastly, the associated injury frequencies and mortality risk factor analysis presented will be useful for patient assessment and counseling after trauma.