Journal of Spine Research
Online ISSN : 2435-1563
Print ISSN : 1884-7137
Original Article
Evaluation of Thoracolumbar Fractures in Patients with Psychological Disorders Using Injury Severity Score
Takeshi SasagawaYoshinobu MaruhashiNoriyuki HashimotoKiyonobu FunakiKatsura KagawaTakao AikawaYuta NakamuraTakuya Nakamura
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2020 Volume 11 Issue 1 Pages 8-13

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Abstract

Introduction: Thoracolumbar fractures due to high-energy trauma occur frequently in patients with psychological disorders. The present study aimed to evaluate the features of thoracolumbar fractures in Japanese patients with psychological disorders using Injury Severity Score (ISS), for which, to the best of our knowledge, there is no report to date.

Methods: The present study included 111 patients who were hospitalized for the treatment of thoracolumbar fractures due to high-energy trauma between March 2009 and March 2019. The inclusion criterion was patients aged ≤65 years at the time of the trauma. The exclusion criterion was patients with osteoporotic or minor fractures (AO type A0). The patients' age, sex, injury mechanism, injury level, psychological disorder, ISS, Abbreviated Injury Scale (AIS) score for injured vertebrae, treatment (surgery or not), and timing of surgery were investigated.

Results: Among the 111 patients, 26 (23%) had psychological disorders: 8 had schizophrenia, 7 had adjustment disorders, 5 had depression, 5 had alcohol or drug dependence, and 1 had epilepsy. We divided the patients into two groups: the P group (n = 26) comprised patients with psychological disorders and the N group (n = 85) comprised patients without psychological disorders. The P group patients were significantly younger than the N group patients. There were no significant differences in sex between the groups. The P group patients injured themselves significantly more frequently by jumping (85%) than the N group patients. The proportion of severe trauma (ISS ≥ 16) was significantly higher in the P group patients (50%) than in the N group patients (11%). Furthermore, in patients with severely injured vertebrae (AIS score ≥ 3), the proportion of severe trauma (ISS ≥ 16) was significantly higher in the P group (55%) than in the N group (15%). By contrast, in patients with mildly injured vertebrae (AIS score = 2), there was no significant difference in the proportion of severe trauma between the groups. Similarly, there were no significant differences in the location of injured vertebrae, treatment, and timing of surgery between the groups.

Conclusions: The P group patients were significantly younger, jumped more frequently, and had a higher proportion of severe trauma than the N group patients. In patients with severely injured vertebrae, the proportion of severe trauma in the P group was significantly higher than that in the N group. Therefore, it is important to make treatment decisions for thoracolumbar fractures in patients with psychological disorders on the basis of the concept of "spine damage control."

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