ANALYSIS OF SECONDARY CARE PROVIDED TO TRAUMA VICTIMS WITH THORACIC AND LUMBAR SPINE INJURIES IN A SETTING OF AN URBAN CENTRE FOR ACUTE SPINAL SURGERY

Background. Foundation of specialised centres or units of acute spinal surgery in general acute hospitals is to be considered a tendency of much importance in development of metropolitan systems for management of trauma victims with spinal injuries.

Objective. To analyse size and structure of the patient inflow, contents and outcomes of treatment of trauma victims with thoracic and lumbar spine injuries in a setting of a specialised centre for acute spinal surgery located in a major city in our country.

Material and methods. 1,760 trauma victims with thoracic and lumbar spine injuries admitted to an urban centre for acute spinal surgery of St. Petersburg in 2010 through 2016: 1,204 (68.4%) – isolated neurologically intact, 410 (23.3%) – isolated with spinal cord injury, 146 (8.3%) – spinal injuries in polytraumatised patients. An analysis of health administrative and clinical data was performed using non-parametric statistics.

Results. During the period the centre worked, the number of annually admitted trauma victims increased 3.44 times, while notably, in the annual structure of the inflow, of which a fraction of isolated neurologically intact injuries decreased from 75.4% to 64.5%, there was an increase in fractions of persons with isolated spine and cord injuries (from 20.2 to 25.0%; р=0.2878) and with spinal injuries and polytrauma (from 4.4 to 10.5%; р=0.0718). The surgical rate was observed to increase from 69.3% to 81.9% (р = 0.0036), especially in trauma victims with unstable isolated neurologically intact injuries. In the annual structure of surgical work, a fraction of early procedures constantly increased (from 27.8 to 91.6%; р=0.0001), the increase rate appearing most stable in neurologically intact patients with isolated injuries. The treatment outcomes showed high values by all measures.

Conclusion. The setting of a specialised secondary care centre for acute spinal surgery of a major city delivers high effectiveness and favourable outcomes of treatment of trauma victims with spinal injuries owing to the centralisation of their inflow, broad use of modern medical technology, and the tactic of early surgery. 

1. Dulaev A. K., Manukovskiy V. A., Kutyanov D. I., Bulakhtin Y. Y., Brizhan’ S. L., Zhelnov P. V. Development of management of emergency surgical care for patients with acute traumatic and nontraumatic spinal pathologies in conditions of megapolis. Vestnik khirurgii imeni I. I. Grekova. 2017;176(4):39–43. (In Russ.).

2. Noonan V. K., Wolfe D. L., Thorogood N. P., Park S. E., Hsieh J. T., Eng J. J., SCIRE Research Team. Knowledge translation and implementation in spinal cord injury: a systematic review. Spinal Cord. 2014;52(8):578–587. Doi: 10.1038/sc.2014.62.

3. Maharaj M. M., Hogan J. A., Phan K., Mobbs R. J. The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review. Eur. Spine J. 2016;25(6):1813–1820. Doi: 10.1007/s00586-016-4545-x.

4. Shcherbuk Y. A., Bagnenko S. F., Dulaev A. K., Dulaeva N. M., Alikov Z. Y. Scientifically and practical substantiation of expediency of creation of branches (centers) of urgent surgery of the backbone in megacities. Skoraya meditsinskaya pomoshch. 2011;12(1):45–52. (In Russ.).

5. Shcherbuk Y. A., Bagnenko S. F., Dulaev A. K., Dulaeva N. M., Alikov Z. Y. Organization of specialized medical care to patients with urgent surgical pathology of the spine. Khirurgia pozvonochnika. 2011;(2):67–73. Doi: 10.14531/ ss2011.2.67-73. (In Russ.).

6. Cherepanov E. A. Russian version of the Oswestry Disability Index: cross-cultural adaptation and validity. Khirurgia pozvonochnika. 2009;(3):93–98. Doi: 10.14531/ss2009.3.9398. (In Russ.).

7. Lee D. Y., Park Y. J., Kim H. J., Ahn H. S., Hwang S. C., Kim D. H. Early surgical decompression within 8 hours for traumatic spinal cord injury: is it beneficial? A meta-analysis. Acta Orthop. Traumatol. Turc. 2018;52(2):101–108. Doi: 10.1016/j.aott.2017.12.001.

8. Richard-Denis A., Beausйjour M., Thompson C., Nguyen B.H., Mac-Thiong J. M. Early predictors of global functional outcome after traumatic spinal cord injury: a systematic review. J. Neurotrauma. 2018;35(15):1705–1725. Doi: 10.1089/neu.2017.5403.

9. Anikeev N. V., Shchedrenok V. V., Zuev I. V., Potemkina E. G., Sebelev K. I., Moguchaya O. V. Experience of use of tactics «damage control» in craniocerebral and spinal trauma. Politravma. 2013;(1):12–18. (In Russ.).

10. Giorgi H., Blondel B., Adetchessi T., Dufour H., Tropiano P., Fuentes S. Early percutaneous fixation of spinal thoracolumbar fractures in polytrauma patients. Orthop. Traumatol. Surg. Res. 2014;100(5):449–454. Doi: 10.1016/j. otsr.2014.03.026.