Non contiguous dual level spinal injuries - A tertiary care centre institutional experience

Non-contiguous Dual level spine injuries (NDSI) are not uncommon in cases of high energy trauma and can carry very high morbidity if not recognized and treated. There is lack of literature and proper guidelines on such injuries.

In this study, we plan to understand the demographics, clinical characteristics, management, outcome and prognosis of NDSI in patients presenting to our tertiary care trauma centre from 2015 to 2024.

We retrospectively reviewed the online and offline database of AIIMS to search for cases of NDSI. Total of 38 patients were found whose data were studied.

SPSS version 23 was used to carry out statistical analysis.

3.01% of total patients with spine injury had NDSI. 28 patients (73.7 %) were male while 10 patients (26.3 %) female. Mean age of patients was 37.86 years (range - 16 years - 60 years). Out of 38 patients, 22 patients (57.9 percent) had history of Fall from height and 16 patients (42 percent) had history of Road traffic accident (High velocity). Most common injury pattern was Cervicothoracic (15 patients, 39.5 %) followed by thoracolumbar (13 patients, 34.2 %), cervicocervical (4 patients, 10%), cervicolumbar (2 patient, 5.3 %). Associated injuries included head injury finding in 5 patients, chest injuries in 15, extremity injuries in 7 and abdominal injuries in 2. Out of 38, 30 patients had total of 2 noncontigous segment involvement, 6 had 3 and 2 had 4 non-contiguous segment involvement. Out of 38, 16 patients were managed with fixation aimed at 1 segment, whereas 21 patients required fixation of both the non-contiguous segments. Surgical management of unstable cervical, thoracic, and lumbar fractures involved stabilization through spinal fusion, decompression to relieve pressure on neural elements, and instrumentation with screws, rods, or plates. Procedures done included Anterior odontoid screw for odontoid fracture, ACDF (Anterior cervical discectomy and fusion), ACCF (Anterior cervical corpectomy and fusion), posterior LMSRF (Lateral mass screw rod fixation) for cervical fractures, and posterior decompression and pedicle screw fixation for unstable thoracic and lumbar fractures. Minor injuries and stable compression fractures were managed conservatively. The approach depends on fracture type, location, clinical neurology of patient, finally aiming to restore alignment, stabilize the spine, and prevent neurological deficits. At admission, 13 patients (34%) were ASIA A, 4 ASIA B(10.5%), 6 ASIA C(15.8%), 5 ASIA D (13.2%) and 10 ASIA E(26.3%). 10 patients required tracheostomy. 4 patients developed pneumonia during their hospital course. 36 patients were discharged, but 2 patients died due to associated sepsis, dyselectrolytemia, pneumonia. Out of 38 patients, 4 patients showed improvement in neurological deficit postoperatively. One patient improved from ASIA C to ASIA D and one from ASIA A to ASIA B, 2 patients improved from ASIA D to ASIA E. 2 patients deteriorated and died due to associated sepsis, dyselectrolytemia, pneumonia.

Non-contiguous Dual spine injuries pose unique challenges, unstable segment need to be fixed before, while taking into account the neurology of the patient. Lengthy and complex procedures can be staged. Early fixation and mobilization is best for the patients with intact or partially intact neurology.