ATLS？ and damage control in spine trauma

Polytraumatized patients often suffer from associated injuries of the spinal column following a major trauma (1st hit) from direct and indirect mechanical forces that generated soft tissue-, organ injuries and fractures. The consecutive host reaction is characterized by a local and systemic expression and release of a vast array of pro-inflammatory mediators [1-4] misbalancing the immune system often resulting in a systemic inflammatory response syndrome (SIRS).The extent of the trauma-induced first hit is the major prognostic parameter for the clinical outcome of the patient following multiple trauma. Nevertheless, secondary events including septic complications, and single or multiple organ dysfunction (MOD/MOF) like acute lung injury or acute respiratory distress syndrome (ARDS) determine the beneficial or adverse outcome of polytraumatized patients. These secondary events are often associated with surgical procedures, since increased interventional (surgery-related) antigenic load of the beforehand impaired immune system can aggravate systemic immunologic disturbances [5-16]. In fact, definitive (total care) spine surgery in polytraumatized patients, is accompanied by higher mortality rates in early vs. secondary operated patients [7].This is where the ATLS？ protocol's proposition "do not further harm" comes into play and accelerates transfer of damage control surgery into damage control orthopaedics in traumatology [17-20].This article reviews literature on spinal injury assessment and treatment principles in the polytraumatized patient and gives advice for diagnostic and therapeutic approaches with a special focus as well as ATLS？ and spine and damage control. The goal of treatment should be to balance necessary stabilization procedures and simultaneously limit secondary surgery-related iatrogenic trauma in search for the optimized outcome of the severely injured spine patient.The primary physician working on a severely injured patient should have a high suspi