Early Versus Late Stabilization of Spine Injuries A Systematic Review

Study Design. Systematic review. Objective. The objective of this study is to determine safety, benefits, outcomes, and costs of early versus late stabilization of spine injuries using data available in the current literature. Summary of Background Data. There is currently a lack of consensus regarding the timing of surgical stabilization of the injured spine. This is limited by the reality that a randomized clinical trial to evaluate early versus late surgery is difficult to design and perform. Methods. A computer-aided search using the keywords Spine or Spinal, Trauma, Spinal Cord Injury, and Surgery that included MEDLINE, EMBASE, HealthSTAR, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, from January 1990 to July 2009 was done. Results. Eleven articles directly comparing two cohorts that had early or late surgery were identified. All of the studies consistently demonstrated shorter hospital and intensive care unit length of stays, fewer days on mechanical ventilation and lower pulmonary complications in patients who are treated with early surgical spine decompression and stabilization. These advantages are more marked in patients with polytrauma. Consequently, costs associated with late surgery were higher compared with early surgery. Conclusion. There is evidence in the current literature to show that early surgical stabilization leads to shorter hospital stays, shorter intensive care unit stays, less days on mechanical ventilation and lower pulmonary complications. This effect is more evident in patients who have more severe associated injuries as measured by ISS. This benefit is seen in patients who have cord injury as well as those who do not. There is some evidence that early stabilization does not increase the complication rates compared with late surgery.