High Energy Spine Injury Alternate Multiple Fractures Observational Retrospective Study

Multiple alternate fractures are those that present injuries at several levels of the spine separated by at least one healthy vertebral body. A posttraumatic prevalence of up to 23% is reported. 3–5 There are no reports in Argentina. The purpose of this study is to report the prevalence of multiple alternate spine fractures in five hospitals of the City of Buenos Aires, Argentina, and evaluate its connection to other relevant characteristics. Inclusion criteria involve acute fractures of the spine. Classifications used were the following: cervical subaxial 8 and thoracolumbar 9 AO, Anderson for odontoids, 15, 16 Effendi Laurin 17 and Geweiler, 18, 19 ASIA, 20, 21 and Frankel. 22 Statistical analysis consists of two groups: “Alternate” and “Contiguous.” Sample distribution, Shapiro-Wilk or Kolmogorov Smirnov test, was used. In comparison of continuous variables, “Student’s t-test or the Mann-Whitney U test” was used. To compare the categorical variables, Chi2 test or Fisher’s exact test was used. In data analysis, IBM SPSS Macintosh software, version 24.0 (IBM Corp., Armonk, NY, USA), was used. From the five hospitals of Buenos Aires, 514 medical records were reviewed, and 120 patients included, from April 2007 to April 2017. Of the total of spine fractures, 56 (46.7%) were simple, 35 (29.2%) were multiple contiguous, and 29 (24.1%) were multiple alternate. Fifty-four (45%) patients were women, average age of the sample: 40 years old. Within the group of multiple alternate fractures, the cervical area was the most affected in 16 (55.1%) patients. Fractures of nine (31%) patients of the Alternate group were related to a labor accident (9.9% contiguous, significant p = 0.02). Fourteen (48.3%) patients of the Alternate group presented an associated injury (23 patients [25.3%] of the contiguous fractures, with significance p = 0.02). As regards the International Publications, the prevalence of multiple alternate fractures was 24.1% (17 or 19%) 4, 5, 23, 24 with similar production mechanism, male predominance, and an average of 40 years old. 3, 5, 23 The location was similar: cervico-thoracic 24.1%. One in four patients admitted in our centers, with a spine fracture, had at least other vertebrae fractured at a distance. These were associated with neurological alterations, extra-spinal injuries, and labor accidents.