Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput
Purpose Traumatic vertebral injuries have a prevalence of 4–5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures...
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Korean Society of Traumatology
2021-03-01
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| Series: | Journal of Trauma and Injury |
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| Online Access: | http://www.jtraumainj.org/upload/pdf/jti-2020-006.pdf |
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| author | Kyrillos Awad Dean Spencer Divya Ramakrishnan Marija Pejinovska Areg Grigorian Sebastian Schubl Jeffry Nahmias |
| author_facet | Kyrillos Awad Dean Spencer Divya Ramakrishnan Marija Pejinovska Areg Grigorian Sebastian Schubl Jeffry Nahmias |
| author_sort | Kyrillos Awad |
| collection | DOAJ |
| description | Purpose Traumatic vertebral injuries have a prevalence of 4–5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB). Methods In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted. Results Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+ VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤ 0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001). Conclusions No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation. |
| format | Article |
| id | doaj-art-3e9fcc3d2d56469ca17da86e08c3866c |
| institution | Kabale University |
| issn | 1738-8767 2287-1683 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-3e9fcc3d2d56469ca17da86e08c3866c2025-01-08T08:08:40ZengKorean Society of TraumatologyJournal of Trauma and Injury1738-87672287-16832021-03-01341313810.20408/jti.2020.0061055Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department ThroughputKyrillos Awad0Dean Spencer1Divya Ramakrishnan2Marija Pejinovska3Areg Grigorian4Sebastian Schubl5Jeffry Nahmias6 Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA Department of Surgery, University of California, Irvine, Center for Statistical Counseling, Irvine, CA, USA Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA Department of Surgery, University of California Irvine Medical Center, Orange, CA, USAPurpose Traumatic vertebral injuries have a prevalence of 4–5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB). Methods In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted. Results Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+ VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤ 0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001). Conclusions No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation.http://www.jtraumainj.org/upload/pdf/jti-2020-006.pdfspinesurgeryinjuryconservative treatment |
| spellingShingle | Kyrillos Awad Dean Spencer Divya Ramakrishnan Marija Pejinovska Areg Grigorian Sebastian Schubl Jeffry Nahmias Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput Journal of Trauma and Injury spine surgery injury conservative treatment |
| title | Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput |
| title_full | Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput |
| title_fullStr | Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput |
| title_full_unstemmed | Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput |
| title_short | Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput |
| title_sort | adult trauma patients with isolated thoracolumbar spinous and transverse process fractures may be managed conservatively to improve emergency department throughput |
| topic | spine surgery injury conservative treatment |
| url | http://www.jtraumainj.org/upload/pdf/jti-2020-006.pdf |
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