title: Correlation Between Timing of Surgery and Outcome in ThoracoLumbar Fractures: Does Early Surgery Influence Neurological Recovery and Functional Restoration? A Multivariate Analysis of Results in Our Experience.
abstract: Treatment for spinal trauma is affected by both nonmodifiable and modifiable variables. The aim of this study was to compare early surgery with intermediate and late surgery to determine the benefits of spinal reconstruction in neurological recovery and functional restoration in patients with thoracolumbar fractures.
  
  
  
  In order to identify correlations between treatment timing, fracture site, neurological recovery, American Spinal Injury Association (ASIA) score restoration, and rehabilitation prognosis in patients with thoracic and lumbar fractures, we conducted a multivariate analysis of the results of surgery, at our institution, in 166 consecutive patients with unstable thoracolumbar fractures with or without neurological impairment. We conducted a literature review (1988-2012) and compared our results with those already published.
  
  
  
  Regardless of the location and type of fracture, early surgery resulted in a reduction of median hospital and intensive care unit (ICU) length of stay, as well as a reduction of nosocomial complications. Regardless of the type of fracture and preoperative ASIA score, thoracic fractures had the worst outcome. Early treatment seemed to have better results, depending on the preoperative ASIA score.
  
  
  
  Early surgery in patients with thoracolumbar fractures with incomplete neurological damage could positively affect neurological recovery, functional restoration, length of hospital and ICU stay, and associated comorbidity. Thoracic fractures had the worst outcome. Early surgery seemed to have better results if the initial ASIA score was good. The better the ASIA score on admission, the better was the outcome. Surgical timing did not affect the outcome when the ASIA score was A or E.
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. dott.alessandro.landi@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Landi
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Marotta
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Ambrosone
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Prizio
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mancarella
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gregori
authors.affiliation: Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Delfini
mesh_terms: D000328:Adult; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Neurological recovery; Spinal trauma; Spine surgery; Thoracolumbar fracture early surgery; Vertebral fractures