Résumé
The surgical management of traumatic spine injuries may not be possible in early phase case of severe trauma because of severe extraspinal injuries, emergent procedure need or altered clinical status.The main goal of present study was to describe in a severe trauma population, characteristics of vertebral fractures, presence of associated injuries (spine cord and extraspinal injuries), and clinical status within first days. PATIENTS AND METHODS: all severe trauma patients admitted between january 2015 and december 2018 with a vertebral fracture were retrospectively analysed. The fractures characteristics were determined by the AO Spine classification as stable (A0, A1, and A2-types) or unstable (A3, A4, B and C-types). Clinical status was defined as stable, intermediate and unstable regarding to clinico-biological parameters and anatomic injuries. Associated severe injuries and emergent procedure were specifically studied. Three groups were thus defined: stable fracture (Stab-F) group, unstable fracture (Un-F) group, and spine cord injury (SCI) group. These groups were specifically compared in terms of epidemiologic, associated severe injuries and clinical status. RESULTS: a total of 425 patients were included in present study (mean age 43.8 ± 19.6, median ISS 22 [IQR 17−34], 72% of male); 72 (17%) in SCI group, 116 (27%) in Un-F group, and 237 (56%) in Stab-F group. Among them, 62% (95% CI 57−67%) had not a stable clinical status on admission (unstable 30%, intermediate 32%), regardless the groups (P=0.38). This rate decreased to 31% (95% CI 27−35%) on D3 and 23% (95% CI 19−27%) on D5, regardless the groups (P=0.27 and P=0.25). The proportion of progression toward stable clinical status between D1 and D5 was 63% (95% CI 58−68%) in cohort, statistically lower in SCI group. Severe extraspinal injuries (85% [95% CI 82−89%]) and extraspinal emergent procedures (56% [95% CI 52−61%]) were numerous and comparable between the 3 groups. Only abdominal injuries and haemostatic procedures significantly differed (P=0.003 and P=0.009). CONCLUSIONS: in our severe trauma population, more than the half of patients had severe extraspinal injuries or an altered initial clinical status that was not compatible with a safe early surgical management for the vertebral fracture. These observations observed independently of fractures stability or presence of SCI.