Advertisement

European Spine Journal

, Volume 16, Issue 5, pp 579–587 | Cite as

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

  • Jozef Paulus Henricus Johannes Rutges
  • F. Cumhur Oner
  • Luke Peter Hendrik Leenen
Review

Abstracts

A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.

Keywords

Review Spinal fractures Timing Surgical fixation Outcome and trauma 

References

  1. 1.
    Ackery A, Tator C, Krassioukov A (2004) A global perspective on spinal cord injury epidemiology. J Neurotrauma 21:1355–1370PubMedCrossRefGoogle Scholar
  2. 2.
    Albert TJ, Kim DH (2005) Timing of surgical stabilization after cervical and thoracic trauma. J Neurosurg Spine 3:182–190PubMedGoogle Scholar
  3. 3.
    Baker SP, O’Nell B, Haddon WH, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196PubMedGoogle Scholar
  4. 4.
    Benson KBA, Hartz AJ (2000) A comparison of observational studies and randomized controlled trails. N Engl J Med 342(25):1878–1886PubMedCrossRefGoogle Scholar
  5. 5.
    Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of femoral fractures. J Bone Joint Surg Am 71:336–440PubMedGoogle Scholar
  6. 6.
    Brundage SI, McGhan R, Jurkovich GJ, Mack CD, Maier RV (2002) Timing of femur fixation: effect on outcome in patients with thoracic and head injuries. J Trauma 52(299):307Google Scholar
  7. 7.
    Carlson GD, Gordon CD, Oliff HS, Pillai JJ, LaManna JC (2003) Sustained spinal cord compression. J Bone Joint Surg Am 85:86–94PubMedGoogle Scholar
  8. 8.
    Chipman JG, Deuser WE, Beilman GJ (2004) Early surgery for thoracolumbar spine injuries decreases complications. J Trauma 56(1):52–57PubMedGoogle Scholar
  9. 9.
    Civil JD, Schwab CW (1988) The abbreviated injury scale, 1985 revision: a condensed chart for clinical use. J Trauma 28:87–90PubMedCrossRefGoogle Scholar
  10. 10.
    Croce MA, Bee TK, Pritchard E, Miller PR, Fabian TC (2001) Does optimal timing for spine fracture fixation exist? Ann Surg 233(6):851–858PubMedCrossRefGoogle Scholar
  11. 11.
    Dai LY, Yao WF, Cui YM, Zhou Q 2004 Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment—a review of 147 cases. J Trauma 56(2):348–355PubMedGoogle Scholar
  12. 12.
    De Luna ER, Kordas M, Risko Z (1989) Segmental spinal instrumentation in the early fixation of the fracture-dislocations of the dorsal and lumbar spine (S.S.1). Acta Chir Hung 30(1):45–53PubMedGoogle Scholar
  13. 13.
    Dickman CA, Fessler RG, MacMillan M, Haid RW (1992) Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases. J Neurosurg 77:860–870PubMedCrossRefGoogle Scholar
  14. 14.
    Dimar JR, Glassman SD, Raque GH, Zhang YP, Shields CB (1999) The influence of spinal canal narrowing an timing of decompression on neurologic recovery after spinal cord contusion in a rat model. Spine 24:1623–1633PubMedCrossRefGoogle Scholar
  15. 15.
    Fehlings MG, Baptiste DC (2005) Current status of clinical trails for acute spinal cord injury. Injury 36:S-B113–S-B122Google Scholar
  16. 16.
    Fehlings MG, Perrin RG (2005) The role and timing of early decompression for cervical spinal cord injury: update with a review of recent clinical evidence. Injury 36:B13–B26PubMedCrossRefGoogle Scholar
  17. 17.
    Fehlings MG, Sekhon LHS, Tator C (2001) The role and timing of decompression in acute spinal cord injury. Spine 26:s101–s110PubMedCrossRefGoogle Scholar
  18. 18.
    Fehlings MG, Tator CH (1999) An evidence-based review of decompressive surgery in acute spinal cord injury; rational, indications, and timing based on experimental and clinical studies. J Neurosurg Spine 91:1–11Google Scholar
  19. 19.
    Gaebler C, Maier R, Kutscha-Lissberg (1999) Results of spinal cord decompression and thoracolumbar pedicle stabilization in relation to the time of operation. Spinal Cord 37:33–39PubMedCrossRefGoogle Scholar
  20. 20.
    Giannoudis PV, Veysi VT, Pape HC, Krettek C, Smith MR 2002 When should we operate on major fractures in patients with severe head injuries. Am J Surg 183:261–267PubMedCrossRefGoogle Scholar
  21. 21.
    Grauer JN, Vaccaro AR, Beiner JM, Kwon BK, Hilibrand AS, Harrop JS et al (2004) Similarities and differences in the treatment of spine trauma between surgical specialties and location of practice. Spine 29:685–696PubMedCrossRefGoogle Scholar
  22. 22.
    Guest J, Eleraky MA, Apostolides PJ, Dickman CA, Sonntag VKH (2002) Traumatic central cord syndrome: results of surgical management. J Neurosurg Spine 97:25–32Google Scholar
  23. 23.
    Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine 21:492–499PubMedCrossRefGoogle Scholar
  24. 24.
    Johnson KD, Cadambi A, Seibert GB (1985) Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 25:375–384PubMedGoogle Scholar
  25. 25.
    Keel M, Trentz O (2005) Pathophysiology of polytrauma. Injury 36:691–709PubMedCrossRefGoogle Scholar
  26. 26.
    Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Murphy T, Tepas JJ (2005) The effect of early spine fixation on non-neurologic outcome. J Trauma 58(1):15–21PubMedGoogle Scholar
  27. 27.
    Kompanje EJO, Maas AIR, Hilhorst MT, Slieker FJA, Teasdale GM (2005) Ethical considerations on consent procedures for emergency research in severe and moderate traumatic brain injury. Acta Neurochir 147:633–640CrossRefGoogle Scholar
  28. 28.
    La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F (2004) Does early decompression improve neurological outcome of spinal cord injured patients? Aprailsa of the literature using an meta-analytical approach. Spinal Cord 42:1362–4393CrossRefGoogle Scholar
  29. 29.
    Magerl F (1980) Early surgical therapy of traumatic injuries of the spinal cord. Orthopade 9:34–44PubMedGoogle Scholar
  30. 30.
    McKinley W, Meade MA, Kirshblum S, Barnard B (2004) Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil 85(11):1818–1825PubMedCrossRefGoogle Scholar
  31. 31.
    McLain RF (2004) Functional outcome after surgery for spinal fractures: return to work and activity. Spine 29:470–477PubMedCrossRefGoogle Scholar
  32. 32.
    McLain RF, Benson DR (1999) Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine 24(16):1646–1654PubMedCrossRefGoogle Scholar
  33. 33.
    McLain RF, Burkus JK, Benson DR (2001) Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J 1:310–323PubMedCrossRefGoogle Scholar
  34. 34.
    McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg 75-A:162–167Google Scholar
  35. 35.
    Mirza SK, Krengel WF, Chapman JR, Anderson PA, Bailey JC, Grady MS et al (1999) Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res 359:104–114PubMedCrossRefGoogle Scholar
  36. 36.
    No authors listed (2002) Management of acute central cervical spinal cord injuries. Neurosurgery 50:S166–S172Google Scholar
  37. 37.
    Norenberg MD, Smith J, Marcillo A (2004) The pathology of human spinal cord injury: defining the problems. J Neurotrauma 21:429–440PubMedCrossRefGoogle Scholar
  38. 38.
    Oertel J, Niendorf WR, Darwish N, Schroeder HWS, Gaab MR (2004) Limitations of dorsal transpedicular stabilization in unstable fractures of the lower thoracic and lumbar spine: an analysis of 133 patients. Acta Neurochir 146:771–777Google Scholar
  39. 39.
    Papadopoulus SM, Selden NR, Quint DJ, Patel N, Gillespie B, Grube S (2002) Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome. J Trauma 52(323):332Google Scholar
  40. 40.
    Pape HC, Giannoudis P, Krettek C (2002) The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg 183:622–629PubMedCrossRefGoogle Scholar
  41. 41.
    Patel RV, DeLong W, Vresilovic EJ (2004) Evaluation and treatment of spinal injuries in the patient with polytrauma. Clin Orthop Relat Res 422:43–54PubMedCrossRefGoogle Scholar
  42. 42.
    Pollard ME, Apple DF (2003) Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine 28:33–38PubMedCrossRefGoogle Scholar
  43. 43.
    Prasad VS, Vidyasagar JV, Purohit AK, Dinakar I (1995) Early surgery for thoracolumbar spinal cord injury: initial experience from a developing spinal cord injury centre in India. Paraplegia 33(6):350–353PubMedGoogle Scholar
  44. 44.
    Rapado A (1996) General management of vertebral fractures. Bone 18:191S–196SPubMedCrossRefGoogle Scholar
  45. 45.
    Rath SA, Kahamba JF, Kretschmer T, Neff U, Richter HP, Antoniadis G (2005) Neurological recovery and its influencing factors in thoracic and lumbar spine fractures after surgical decompression and stabilization. Neurosurg Rev 28(1):44–52PubMedGoogle Scholar
  46. 46.
    Ruzek IR, Zatzick DF (2000) Ethical considerations in research participation among acutely injured trauma survivors; an empirical investigation. Gen Hosp Psychiatry 22:27–36PubMedCrossRefGoogle Scholar
  47. 47.
    Scalea TM, Boswel SA, Scott JD, Mitchel KA, Kramer ME, Pollak AN (2000) External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma 48:613–621PubMedGoogle Scholar
  48. 48.
    Schinkel C, Greiner-Perth R, Schwienhorst-Pawlowsky G, Frangen TM, Muhr G, Bohm H (2006) Does timing of thoracic spine stabilization influence perioperative lung function after trauma? Orthopade 35:331–336PubMedCrossRefGoogle Scholar
  49. 49.
    Schlegel J, Bayley J, Yuan H, Fredericksen B (1996) Timing of surgical decompression and fixation of acute spinal fractures. Orthop Trauma 10(5):323–330Google Scholar
  50. 50.
    Sekhon LHS, Fehlings MG (2001) Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 26:S2–S12PubMedCrossRefGoogle Scholar
  51. 51.
    Section 6 (no authors listed): Assessment of study quality. In: Higgins JPT, Green S (eds) Cochrane hankbook for systematic reviews of interventions 4.2.4 [updated March 2005]. http://www.cochrane.org
  52. 52.
    Shields CB, Zhang YP, Shields LBE, Han Y, Burke DA, Mayer NW (2005) The therapeutic window for spinal cord decompression in a rat spinal cord injury model. J Neurosurg Spine 3:302–307PubMedCrossRefGoogle Scholar
  53. 53.
    Trivedi JM (2002) Spinal trauma: therapy—options and outcomes. Eur J Radiol 42:127–134PubMedCrossRefGoogle Scholar
  54. 54.
    Vaccaro AR, Daugherty RJ, Sheehan TP, Dante SJ, Cotler JM, Balderston RA et al (1997) Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine 22:2609–2613PubMedCrossRefGoogle Scholar
  55. 55.
    Yamazaki T, Yanaka K, Fujita K, Kamezaki T, Uemura K, Nose T (2005) Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol 63:95–100PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Jozef Paulus Henricus Johannes Rutges
    • 1
  • F. Cumhur Oner
    • 1
  • Luke Peter Hendrik Leenen
    • 2
  1. 1.Department of Orthopaedic SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands
  2. 2.Department of SurgeryUniversity Medical Centre UtrechtUtrechtThe Netherlands

Personalised recommendations