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Entrapment of intestine in spinal fracture — Clinical Guidelines

Overview

Entrapment of intestine in spinal fractures, often seen in severe thoracolumbar injuries, involves bowel loops being compressed or displaced within the fractured vertebral column, potentially leading to bowel ischemia or necrosis. This complication requires urgent surgical intervention to decompress and prevent severe morbidity 1 9.

Diagnosis

Clinical Presentation: Severe back pain, neurological deficits, and signs of bowel obstruction or ischemia.

Imaging: CT and MRI are crucial for identifying fractures and entrapped bowel loops 1.

Grading: Neurological status assessed using the Frankel classification 1.

Management

Surgical Intervention: Anterior corpectomy and prosthetic reconstruction for precise decompression and stabilization 1.

Postoperative Care: Monitoring for thromboembolic events; routine screening for deep venous thrombosis lacks strong evidence for routine implementation 3.

Adjunctive Treatments: No specific drug dosing mentioned; focus on supportive care and prevention of complications like disk degeneration post-fusion 4 6.

Special Populations

Pediatrics: Calcium phosphate cement kyphoplasty appears safer than PMMA in adolescents, though long-term outcomes on adjacent disk degeneration need further study 2.

Elderly: Caution with PMMA kyphoplasty due to potential adjacent disk degeneration; consider alternatives like calcium phosphate cement 2.

Key Recommendations

Surgical Decompression and Stabilization: For unstable spinal fractures with entrapped bowel, surgical approaches like corpectomy are recommended to prevent severe complications (Evidence: Strong 1).

Routine VTE Screening Unclear: Insufficient evidence to mandate routine screening for deep venous thrombosis in all patients with thoracic and lumbar fractures (Evidence: Insufficient 3).

Consider Fusion vs. Conservative Management: Conservative management may be appropriate for isolated burst fractures of L5 without neurological deficits, but fusion reduces risk of subsequent disc degeneration and surgery (Evidence: Moderate 4 7).

References

1 Sowa D, Guzik G, Bronisz M, Merkiel D, Biega P. Functional and Surgical Outcomes of Corpectomy in Patients with Unstable Spinal Fractures. Ortopedia, traumatologia, rehabilitacja 2023. link 2 Tschauner S, Singer G, Weitzer CU, Castellani C, Till H, Sorantin E et al.. Does Calcium Phosphate Cement Kyphoplasty Cause Intervertebral Disk Degeneration in Adolescents?. Cartilage 2022. link 3 Raksin PB, Harrop JS, Anderson PA, Arnold PM, Chi JH, Dailey AT et al.. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: Prophylaxis and Treatment of Thromboembolic Events. Neurosurgery 2019. link 4 D'Oro A, Spoonamore MJ, Cohen JR, Acosta FL, Hsieh PC, Liu JC et al.. Effects of fusion and conservative treatment on disc degeneration and rates of subsequent surgery after thoracolumbar fracture. Journal of neurosurgery. Spine 2016. link 5 Harris MB. Commentary: Thoracolumbar spine fractures: is more knowledge better?. The spine journal : official journal of the North American Spine Society 2013. link 6 Su YS, Ren D, Wang PC. Comparison of biomechanical properties of single- and two-segment fusion for Denis type B spinal fractures. Orthopaedic surgery 2013. link 7 Verlaan JJ, Dhert WJ, Oner FC. Intervertebral disc viability after burst fractures of the thoracic and lumbar spine treated with pedicle screw fixation and direct end-plate restoration. The spine journal : official journal of the North American Spine Society 2013. link 8 Blanco JF, De Pedro JA, Hernández PJ, Paniagua JC, Framiñán A. Conservative management of burst fractures of the fifth lumbar vertebra. Journal of spinal disorders & techniques 2005. link 9 Ferree BA, Wieser M, Clarke RP. Hyperextension spinal fracture. Orthopaedic review 1989. link 10 Leslie IJ. Fracture-dislocation of the ankylosed thoracic spine. Injury 1977. link90050-x)

Entrapment of intestine in spinal fracture