Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality?
METHODS
Systematic Review.


OBJECTIVE
To determine whether early spinal stabilization in thoracolumbar spine trauma decreases morbidity and mortality.


BACKGROUND
The role of early spinal stabilization through surgical means may have a number of benefits. These include reduced morbidity and mortality because of more rapid mobilization afforded by spinal column stabilization and a reduction in the incidence and severity of sepsis and respiratory failure. There are several potential disadvantages of early surgery. The most strongly debated is the potential that the additional physiologic injury may result in an unintended increase in morbidity and mortality caused by worsening of existing injuries, such as with pulmonary or intracranial trauma. This problem may be compounded by increased hemorrhage and resulting hypotension. Operating in the presence of missed or underestimated associated injuries or under less-than-ideal conditions relative to the complexity of the surgery and resources required is also a potential disadvantage.


METHODS
A systematic review of the English-language literature was undertaken for articles published between January 1990 and December 2008. Electronic databases and reference lists of key articles were searched to identify published studies examining the timing of thoracolumbar fracture fixation. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation criteria, assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus.


RESULTS
A total of 68 articles were initially screened, and 9 ultimately met the predetermined inclusion criteria. These studies demonstrated that early stabilization of thoracic fractures reduced the mean number of days on a ventilator, the number of days in intensive care unit and in hospital, and reduced respiratory morbidity compared with late stabilization. This effect, other than the length of hospital stay, was not seen with stabilization of lumbar fractures. There is not enough evidence to determine the effect of the timing of stabilization on mortality in thoracolumbar fractures.


CONCLUSIONS
Ideally, patients with unstable thoracic fractures should undergo early (<72 hours) stabilization of their injury to reduce morbidity and, possibly, mortality.
Bellabarba
Carlo
C
Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104, USA. cbella@u.washington.edu
Fisher
Charles
C
Chapman
Jens R
JR
Dettori
Joseph R
JR
Norvell
Daniel C
DC
D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005592:Fracture Fixation / Q000379:methods / Q000401:mortality* / Q000592:standards*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D016268:Internal Fixators / Q000592:standards; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D018570:Risk Assessment; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D013997:Time Factors