Clinical Study Incidence, impact, and risk factors of adverse events in thoracic and lumbar spine fractures: an ambispective cohort analysis of 390 patients R. Andrew Glennie, MD, FRCSC a , Tamir Ailon, MD, MPH, FRCSC a , Kayiun Yung, MD a , Juliet Batke, MSc a , Alexander R. Vaccaro, MD, PhD b,c , Michael G. Fehlings, MD, PhD, FRCSC d , Paul Arnold, MD e , James S. Harrop, MD b,c , John T. Street, MD, PhD, FRCSI a, * a Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 818 West 10th Ave., Vancouver, British Columbia, Canada V5Z1M9 b Department of Orthopedic Surgery, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA c Department of Neurological Surgery, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA d Department of Surgery and Spinal Program, University of Toronto and University Health Network, 585 University Ave. Toronto, Ontario M5G2C4, Canada e Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA Received 18 April 2014; revised 15 October 2014; accepted 21 November 2014 Abstract BACKGROUND CONTEXT: Adverse events (AEs) in thoracic and lumbar spine fractures are common, but little is known about the type of AEs that are specific to this population. Furthermore, very little is known about the incidence and clinical impact of these AEs on patients in the presence of traumatic spinal cord injury and whether they are treated operatively or nonoperatively. PURPOSE: The purpose of this study was to determine primarily the incidence of AEs in patients with thoracic or lumbar spine fractures treated both operatively and nonoperatively and their impact on length of stay (LOS) and secondarily the difference in the incidence of AEs in both neurolog- ically intact and compromised patients. STUDY DESIGN/SETTING: This is an ambispective cohort study at a quaternary referral center. PATIENT SAMPLE: Patients admitted at our institution with thoracic or lumbar fractures from January 2009 to December 2013 were identified. Patients with full Spine Adverse Events Severity FDA device/drug status: Not applicable. Author disclosures: RAG: Nothing to disclose. TA: Nothing to disclose. KY: Nothing to disclose. JB: Research Support (Investigator Salary, Staff/Materials): Medtronic (F, Paid directly to institution); Fel- lowship Support: Medtronic (D, Paid directly to institution). ARV: Roy- alties: DePuy (C), Medtronics (H), Stryker Spine (G), Biomet Spine (C), Globus (F), Nuvasive (B), Aesculap (B); Stock Ownership: Replication Medica (15,000 shares, B), Globus (123,398 shares, L), K-2 Medical, Paradigm Spine (97,500 units, F), Stout Medical (1% company, E), Spine Medica (25,000 stock options, value unknown), Computational Biody- namics (50% ownership, value unknown), Progressive Spinal Technolo- gies (30% ownership, value unknown), Spinology (8,125 shares, value unknown), Small Bone Innovations (15,000 shares, value unknown), Cross Current (62,500 shares, D), Syndicom (2,750 shares, B), In Vivo (123,935 shares, value unknown), Flagship Surgical (Invested 50,000, D), Advanced Spinal Intellectual Properties (30% ownership, value un- known), Cytonics (25,000 shares, value unknown), Bonovo Orthopedics (100,000 shares, paid F), Electrocore (50,000 shares, value unknown), Gamma Spine (15% ownership, value unknown), Location-Based Intelli- gence (20% ownership, value unknown), Flowpharma (nonqualified stock options 200,000, value unknown), R.S.I. (50% ownership, value un- known), Rothman Institute and Related Properties (practice, value un- known), Innovative Surgical Design (30% ownership, value unknown), Spinicity (53,000 shares, 3.4% ownership); Consulting: Gerson Lehrman Group (B), Guidepoint Global (B), Medacorp (B), Stout Medical (B), Innovative Surgical Design (B), Orthobullets (A); Board of Directors: AO spine, Innovative Surgical Design, Association of Collaborative Spine Research, Spinicity; Grants: Stryker Spine, Cerapedics, Nuvasive (C). MGF: Nothing to disclose. PA: Stock Ownership: Z-plasty (A); Consulting: Medtronic, Lifespine (A), Integra life (B), Spinewave, Stryker Spine (C), Fziomed (B), MIEMS (B), AO Spine North America (B), Cerapedics-past relationship (B); Speaking and/or Teaching Ar- rangements: University of Missouri (A); Board of Directors: AO Spine North America-past relationship; Grants: AO Spine North America (E). JSH: Consulting: Depuy Spine (D, Paid directly to institution); Scientific Advisory Board/Other Office: Tejin (Paid directly to institution); Scien- tific Advisory Board/Other Office: Bioventus (Paid directly to institu- tion). JTS: Speaking and/or Teaching Arrangements (Medtronic, B); Research Support (Investigator Salary, Staff/Materials): Medtronic (F, Paid directly to institution); Fellowship Support: Medtronic (D, Paid di- rectly to institution). The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. No funding was received or used in this study. * Corresponding author. Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Colum- bia, 818 West 10th Ave., Vancouver, British Columbia, Canada V5Z1M9. Tel.: (1) 604-875-5328; fax: (1) 604-875-8223. E-mail address: john.street@vch.ca (J.T. Street) http://dx.doi.org/10.1016/j.spinee.2014.11.016 1529-9430/Ó 2015 Elsevier Inc. All rights reserved. The Spine Journal - (2015) -