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

  • Alessandro Landi
  • Nicola Marotta
  • Angela Ambrosone
  • Emiliano Prizio
  • Cristina Mancarella
  • Fabrizio Gregori
  • Giuseppe La Torre
  • Antonio Santoro
  • Roberto Delfini
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 124)



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.


Thoracolumbar fracture early surgery Spinal trauma Neurological recovery Spine surgery Vertebral fractures 


Conflicts of Interest Statement

Ethical Standards

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

All persons gave their informed consent prior to their inclusion in the study. Any details that might disclose the identity of the subjects under study have been omitted.

The first author is

Alessandro Landi

Disclaimer Landi

We certify that this manuscript is a unique submission and is not being considered for publication with any other source in any medium.

We certify that the work has not been previously published or submitted elsewhere for review.

We certify that we do not have any financial relationships with any manufacturers of equipment used during the study’ and there is no conflict of interests.

The first author

Alessandro Landi


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Alessandro Landi
    • 1
  • Nicola Marotta
    • 1
  • Angela Ambrosone
    • 1
  • Emiliano Prizio
    • 1
  • Cristina Mancarella
    • 1
  • Fabrizio Gregori
    • 1
  • Giuseppe La Torre
    • 2
  • Antonio Santoro
    • 1
  • Roberto Delfini
    • 1
  1. 1.Department of Neurology and Psychiatry, Division of Neurosurgery“Sapienza” University of RomeRomeItaly
  2. 2.Department of Public Health and Infectious Disease“Sapienza” University of RomeRomeItaly

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