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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
ORTHOPEDIC TRAUMA UPDATE PART I
Minerva Ortopedica e Traumatologica 2009 October;60(5):431-6
Thoracic and lumbar spine fractures in multiple injured patients. Does timing of surgery influences outcome?
Department of Surgery, BG Kliniken Bergmannsheil, Ruhr University Bochum, Germany
The question about the optimal timing of surgical stabilization after spine injuries with or without neurological symptoms in multiple injured patients still remains yet unanswered. There is no algorithm and no standard approach in the treatment – a fact that might be explained by the complexity and the individuality of trauma. No larger well performed prospective randomized multi-center clinical trials are available keeping us at a low level of evidence. Early surgical treatment of spine injuries within the first 3 days after trauma seems to be favored by most authors, because of shorter ICU and hospital stay, fewer complications, and better cost management. Mortality rate reduction due to early stabilization is not yet well proven. Overall, the positive effects of early stabilization outnumber studies that show no effects or even a negative impact on outcome in subgroups. According to best available scientific and clinical evidence one can conclude that surgical stabilization, if needed, should be performed as soon as possible, particularly for unstable thoracic spine trauma within the constraints of the patient's overall medical condition.