Predictors of Complications After Spinal Stabilization of Thoracolumbar Spine Injuries

Background: The management of complications after major traumatic spinal injury and surgical stabilization is a challenge. The purpose of this study is to identify factors predictive of a complication after surgical stabilization of thoracolumbar spine injuries. Methods: A review of subjects prospectively enrolled in a multicenter database for spine trauma was performed. Standard demographic data, Glasgow Coma Scores, Injury Severity Score, American Spinal Injury Association score, Charlson Comorbiditiy Index (CCI), mechanism of injury, administration of methylprednisolone (National Acute Spinal Cord Injury II, III), time from injury to surgery, and surgical approach were evaluated. All perioperative complications within 6 months of surgery were recorded. Multivariate logistic regression analysis was performed to identify factors predictive of the occurrence of a complication after surgical stabilization of a thoracolumbar injury. Results: There were 230 patients (57 women, 173 men), 35% were smokers. The mean age at injury was 41.8 +/- 17.8 years. The majority of patients (52%) had no neurologic deficits. Nineteen percent had complete cord injuries whereas 29% had incomplete cord injuries. The mean admission ISS was 9.2 +/- 7.8, mean CCI was 0.2 +/- 0.7, mean Glasgow Coma Score was 14.6 +/- 1.6. NASCIS II and III was instituted in 15.5% and 4.2% of all patients, respectively; mean time from injury to surgery was 8.9 +/- 59 days. The incidence of complications was 79% (minor 30%, major 49%). No factors predictive of a minor complication were identified. Factors predictive of the occurrence of a major complication were administration of high-dose steroids, ASIA score, and CCI. Conclusion: The severity of neurologic injury, number of comorbidities, and use of the high-dose steroids independently increase the risk of having a major complication after surgical stabilization of thoracolumbar spine fractures.