%0 Journal Article %T Advocating "spine damage control" as a safe and effective treatment modality for unstable thoracolumbar fractures in polytrauma patients: a hypothesis %A Philip F Stahel %A Michael A Flierl %A Ernest E Moore %A Wade R Smith %A Kathryn M Beauchamp %A Anthony Dwyer %J Journal of Trauma Management & Outcomes %D 2009 %I BioMed Central %R 10.1186/1752-2897-3-6 %X We hypothesize that the concept of "spine damage control" ¨C consisting of immediate posterior fracture reduction and instrumentation, followed by scheduled 360¡ã completion fusion during a physiological "time-window of opportunity" ¨C will be associated with less complications and improved outcomes of polytrauma patients with unstable thoracolumbar fractures, compared to conventional treatment strategies.We propose a prospective multicenter trial on a large cohort of multiply injured patients with an associated unstable thoracolumbar fracture. Patients will be assigned to one of three distinct study arms: (1) Immediate definitive (anterior and/or posterior) fracture fixation within 24 hours of admission; (2) Delayed definitive (anterior and/or posterior) fracture fixation at > 3 days after admission; (3) "Spine damage control" procedure by posterior reduction and instrumentation within 24 hours of admission, followed by anterior 360¡ã completion fusion at > 3 days after admission, if indicated. The primary and secondary endpoints include length of ventilator-free days, length of ICU and hospital stay, mortality, incidence of complications, neurological status and functional recovery.A "spine damage control" protocol may save lives and improve outcomes in severely injured patients with associated spine injuries.Polytrauma patients have a severely deranged immune response, characterized by an early excessive activation of innate immunity (hyperinflammation), followed by a delayed attenuation of adaptive immunity with decreased T-cell function (immunosuppression) and enhanced susceptibility to infection, sepsis, and multiple organ failure (MOF) [1,2]. In addition, about a third of all multiply injured patients have severe disturbances of their clotting system on arrival to the emergency department, as determined by the presence of postinjury coagulopathy [3,4]. This subset of patients has an increased incidence of MOF and death compared to severely injured patients who ar %U http://www.traumamanagement.org/content/3/1/6