Spinal Trauma in the Pediatric Polytrauma Patient.

Pediatric spine trauma, although relatively uncommon, encompasses several spinal injuries that may be associated with substantial neurologic injury and multiple traumatic injuries. Spinal injuries may have considerable lifelong effects on pediatric patients; therefore, early diagnosis and management of spinal injuries in pediatric patients is imperative to ensure optimal outcomes. Anatomic features unique to the pediatric spine predispose pediatric patients to injury patterns that are not frequently observed in adults. Careful assessment of the injury pattern and the associated anatomy aids in selection of the optimal treatment method for pediatric patients with a spinal injury.

Subaxial Cervical Spine Injuries in the Polytrauma Patient.

Management of cervical spine injuries in polytrauma patients involves a comprehensive assessment that consists of a physical examination and imaging studies to identify substantial injury. The management of diagnosed cervical spine injuries in polytrauma patients should be coordinated with the management of other injuries. Timely management is required in polytrauma patients with a spinal cord injury. A high oxygen saturation level must be maintained and a mean arterial blood pressure of 85 mm Hg is recommended. Reduction via traction or urgent surgical decompression, as indicated, should be considered. Reduction that is performed within a few hours postinjury may reverse neurologic deficits, and decompression that is performed within 24 hours postinjury increases the likelihood of substantial recovery. Neuroprotection with the use of methylprednisolone is not recommended in polytrauma patients with a cervical spine injury. Early surgical treatment is safe in polytrauma patients with a cervical spine injury who are adequately resuscitated. The surgical approach is directed by the fracture type and the requirements for decompression. Anterior surgical approaches are preferred in polytrauma patients with a cervical spine injury, and definitive surgical treatment may be delayed.

Management of Unstable Fracture-Dislocations of the Spine in Polytrauma Patients.

A multidisciplinary and systematic approach is required for the treatment of polytrauma patients with a thoracolumbar fracture-dislocation to provide timely care and prevent iatrogenic injury. Thoracolumbar fracture-dislocations frequently occur in patients who sustain a high-energy mechanism of injury; therefore, they are associated with other orthopaedic and visceral injuries that need to be identified via a systematic protocol. Orthopaedic surgeons must obtain a thorough patient history, perform an appropriate physical examination, and obtain adequate imaging studies to expeditiously treat polytrauma patients with a thoracolumbar fracture-dislocation.

Severity and Outcome of Neurologic Deficits in Patients with Pyogenic Spondylodiscitis: A Systematic Review.

Patients with advanced pyogenic spondylodiscitis can present with neurologic deficits. However, the prevalence, severity, and outcome of the neurologic deficits are not well known. A systematic review was performed to improve the knowledge of this commonly encountered clinical scenario. The considerable number of severe neurologic deficits in addition to their poor recovery, even after surgical intervention, demonstrates that the early diagnosis of pyogenic spondylodiscitis is crucial. Prompt surgical intervention is likely associated with a greater chance of improvement of neurologic status than nonsurgical treatment.

Hidden blood loss following 2- to 3-level posterior lumbar fusion.

BACKGROUND CONTEXT: Patients undergoing single-level posterior lumbar decompression and fusion (PLDF) usually do not need transfusions. However, patients undergoing two or three-level PLDF occasionally require transfusion postoperatively even when estimated blood loss (EBL) or blood loss from drains appears acceptable. Estimating the volume of HBL is critical in perioperative fluid management. PURPOSE: To determine the volume of hidden blood loss (HBL) in two- or three-level PLDF. STUDY DESIGN: Single-center, multisurgeon, secondary analysis from a prospective randomized clinical trial of cell saver use. PATIENT SAMPLE: Patients enrolled in a prospective randomized trial of cell saver undergoing two- or three-level PLDF were included in this analysis. METHODS: Total blood loss was calculated using four estimation formulas including Bourke's, Gross', Camarasa's, and Lopez-Picado's formulas. HBL was determined by subtracting the visible loss (EBL and blood loss from drains) from the calculated total blood loss. RESULTS: A total of 89 patients (36 males, mean age 62 years) were included. Seventy-five patients underwent open two-level fusion while 14 had three-level fusions. Intervertebral fusion was performed in 20 patients. Mean surgical time was 261 minutes, and EBL was 685 mL. Mean blood loss from drains was 824 mL. Seventy patients received allogenic blood whereas 47 cell saver blood reinfused intraoperatively. HBL was calculated to be 678 mL, 963 mL, 1,267 mL, and 819 mL using each formula. CONCLUSIONS: HBL following two or three-level PLDF was substantial and more than EBL. Postoperative management of blood loss should take HBL into account.