Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients with Thoracolumbar Spine Trauma: Executive Summary

John E O'Toole, Michael G Kaiser, Paul A Anderson, Paul M Arnold, John H Chi, Andrew T Dailey, Sanjay S Dhall, Kurt M Eichholz, James S Harrop, Daniel J Hoh, Sheeraz Qureshi, Craig H Rabb, P B Raksin
Neurosurgery 2019 January 1, 84 (1): 2-6

BACKGROUND: The thoracic and lumbar ("thoracolumbar") spine are the most commonly injured region of the spine in blunt trauma. Trauma of the thoracolumbar spine is frequently associated with spinal cord injury and other visceral and bony injuries. Prolonged pain and disability after thoracolumbar trauma present a significant burden on patients and society.

OBJECTIVE: To formulate evidence-based clinical practice recommendations for the care of patients with injuries to the thoracolumbar spine.

METHODS: A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to thoracolumbar spinal injuries based on specific clinically oriented questions. Relevant publications were selected for review.

RESULTS: For all of the questions posed, the literature search yielded a total of 6561 abstracts. The task force selected 804 articles for full text review, and 78 were selected for inclusion in this overall systematic review.

CONCLUSION: The available evidence for the evaluation and treatment of patients with thoracolumbar spine injuries demonstrates considerable heterogeneity and highly variable degrees of quality. However, the workgroup was able to formulate a number of key recommendations to guide clinical practice. Further research is needed to counter the relative paucity of evidence that specifically pertains to patients with only thoracolumbar spine injuries. The full version of the guideline can be reviewed at:

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