Analysis of factors influencing the surgical treatment outcomes of spinal injuries in polytrauma patients.

Background: This study aims to analyze the diagnosis and treatment conditions of polytrauma patients with spinal injuries, to clarify the site of the first surgical intervention, the timing of the surgery, and factors influencing prognosis.

Methods: This study collected and analyzed data on polytrauma patients with spinal injuries who were treated from January 2017 to January 2023. Data collected primarily included basic patient information, treatment strategy-related information, clinical scoring systems, imaging parameters, and prognosis. The impacts of relevant variables on postoperative survival outcomes were analyzed.

Results: This study included 60 patients. There was no significant change in the number of patients rated ASIA grade E after 90 days of admission, while there was a significant increase in those rated grade D (P<0.001). Among the groups, patients operated on within less than 12 h had the highest number of ASIA grade A, while those operated on after more than 48 h had the highest number of ASIA grade E (P=0.003). The survival rate of patients who underwent their first spinal surgery between 12 and 48 h was significantly better than those operated earlier than 12 h or later than 48 h (P=0.047). Patients who experienced hemorrhagic shock postsurgery had the lowest survival rate (P<0.001). Only age (P=0.004) and the number of surgeries outside the spine (P=0.033), as covariates, were significantly correlated with patient mortality (R²=0.519).

Conclusions: Performing spinal surgery too early or too late can adversely affect patient outcomes; the appropriate timing of surgery should be chosen based on the specific characteristics of the patient. In polytrauma patients under emergency conditions, the use of combined surgical treatments should be minimized to prevent the occurrence of a 'second hit'. Patients who experience hemorrhagic shock have the worst postsurgical survival; targeted treatment should be administered upon hospital admission.