Analysis of factors influencing the prognosis of spinal injury surgical treatment in polytraumatized patients

LIU Yu-qi; SUN Xiang-yao; WANG Wei-liang; GAN Li-meng; CAO Li; WANG Ju-yong; HUANG Jiang; CHEN Yu-tao; ZHANG Hu-yi; WANG Ning

doi:10.3969/j.issn.2095-252X.2026.03.008

Abstract：Objective To analyze the diagnosis and treatment of polytraumatized patients with spinal injuries,and clarify the site of initial surgical intervention,optimal timing for surgery,prognostic factors,and ultimately providing references for the treatment of spinal injuries in severely polytraumatized patients.Methods This study collected and analyzed data from polytrauma patients with spinal injuries who were treated between January 2017 and January 2023.Data collected primarily included patient demographics,treatment-related information,clinical scoring systems,imaging parameters,prognosis,etc.Pearson correlation analysis was used to compare the correlation between independent quantitative variables,while Spearman correlation analysis was used to compare the correlation among count data.Logistic regression analysis was conducted to compare the correlation between independent variables and the dependent variable.Kaplan-Meier survival analysis was performed to compare the impact of relevant variables on postoperative survival of patients.A P-value<0.05 was considered statistically significant.Results This study included a total of 60 patients,among whom the number of surgeries and injuries involving extraspinal injuries was significantly higher than those involving spinal injuries(P=0.026 for surgeries,P<0.001 for injuries).Compared to preoperative values,the Cobb's angle significantly decreased postoperatively(P<0.001).The majority of patients underwent their first spinal surgery within 12 hours of admission(60.0%),with hemorrhagic shock being the most common factor delaying surgery(16.7%).The most common type of surgery was posterior thoracic spinal fixation(25.0%).Limb surgery was the most common type of initial surgery(35.0%).There was no significant change in ASIA grade E patients at 90 days post-admission(53.3%),while the number of grade D patients increased significantly(16.7%,P<0.001).In the group with surgery performed within 12 hours,the majority of patients was ASIA grade A(33.3%),while in the group with surgery performed after 48 hours,the majority was ASIA grade E(83.3%)(P<0.001).Among patients undergoing their first spinal surgery,the survival rate at 12-48 hours was significantly better than that of patients operated on within less than 12 hours or more than 48 hours(P=0.047).The survival rate was lowest among patients who experienced postoperative hemorrhagic shock(P<0.001).Only age(B=0.152,P=0.004;B=1.246,P=0.033)and the number of extraspinal surgeries as covariates were significantly associated with patient mortality(R2=0.519).Conclusions Performing spinal surgery either too early or too late can adversely affect patient outcomes.Therefore,it is essential to select the appropriate timing for surgery based on the specific characteristics of each patient.In emergency situations involving polytrauma patients,efforts should be made to minimize the use of combined surgical treatments to prevent the occurrence of a"second hit"phenomenon.Patients who develop hemorrhagic shock postoperatively have the poorest survival outcomes and should take targeted treatment upon admission.