CNS releases new clinical practice guidelines for thoracolumbar spine trauma

The Congress of Neurological Surgeons (CNS) has issued new clinical practice guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma. The Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients with Thoracolumbar Spine Trauma have been published today in full text on the CNS website and as executive summaries in Neurosurgery.

Traumatic injuries of the thoracic and lumbar spine ("thoracolumbar") occur in approximately 7 percent of all blunt trauma patients and comprise 50 to 90 percent of the 160,000 annual traumatic spinal fractures in North America. Up to 25 percent of patients with thoracolumbar fractures have concomitant spinal cord injury. Long-term care of patients with persistent disability after thoracolumbar trauma represents a significant burden on society's health care resources. Additionally, thoracolumbar trauma patients often have multiple visceral and bony injuries, compounding the challenges of treatment decision-making.

These guidelines provide guidance on evaluating and treating patients with injuries to the thoracic spine, the thoracolumbar junction, and the lumbar spine. The guidelines present eighteen clinical questions pertaining to a range of issues surrounding the care of these patients including: injury classification; radiological evaluation; neurological assessment; pharmacological treatment; hemodynamic management; prophylaxis and treatment of thromboembolic events; nonoperative care; nonoperative versus operative management; choice of surgical approach; timing of surgical intervention; and novel surgical strategies.

To develop these guidelines, a multidisciplinary task force of clinical experts representing neurosurgery, neurotrauma, and orthopedic surgery systematically reviewed and analyzed the literature, and produced nine recommendations addressing the use of classification schemes, MRI, neurologic assessment scales, external bracing, timing of surgery, and surgical approaches and strategies.

"These guidelines and accompanying recommendations provide education and guidance to clinicians, patients, payers, and researchers as we seek to provide optimal care to this complex patient population," said John O'Toole, MD, co-chair of the guideline development working group. "The existing data confirms the effectiveness of both traditional and novel surgical approaches, but also highlights the clear and pressing need for future research looking specifically at patients with thoracolumbar spinal trauma."

The guidelines were developed by the CNS with support from the Section on Disorders of the Spine and Peripheral Nerves and the Section on Neurotrauma and Critical Care, and have been endorsed by the CNS and the American Association of Neurological Surgeons.

For even more information on thoracolumbar trauma guidelines, attend the Guidelines for Acute Cervical and Thoracolumbar Spine Trauma Session at the 2018 CNS Annual Meeting, October 6–10, in Houston, Texas.