Is early spine stabilisation effective and safe?

Release date: 19-May-2011

Organisation: Norton Leatherman Spine Center, Louisville, KY 40202, USA

The Issue There can be no denying that a patient presenting to a hospital with an unstable spine should, if medically feasible, have their spine stabilised, either through surgery or some form of external immobilisation. The most important question is “When is the best time to act?” Apart from the obvious issues around transportation of the injured person to a suitable hospital, availability of the spinal trauma team and resources such as operating theatres and medical imaging, there are a number of factors that can affect the decision about when to operate on an unstable spinal injury. These mainly relate to the severity of other injuries and the overall health condition of the patient, which often varies widely in the multiple trauma patient. Due to this variability it is difficult to design the definitive study to answer the question of timing of stabilisation. As a result we are left with case series presenting relatively low quality evidence as the best data that can be used to inform this decision.

This Paper The major debate has focused on the role of surgical decompression on improving neurological outcomes after spinal cord injury. However this paper attempts to take a wider view, looking at duration of stay and  “in hospital” complication rates in multiple trauma patients, to determine if evidence exists that early surgery leads to better patient outcomes.

This paper is a systematic review of all the available literature on the topic. The authors considered the results of 11 papers, two of which presented prospective evidence while 9 were either retrospective or cohort (registry) based studies. In general the cutoff between early and late stabilisation was taken to be 72 hrs, though the authors agree that there is little scientific evidence for choosing this time. Nevertheless, when all these studies are taken in combination they show that early stabilisation surgery provides a significant advantage in reducing the length of hospital stay, time in intensive care and time on mechanical ventilation, and that this effect is more pronounced with more severe injuries.

The Conclusions The argument often made against operating at times soon after injury is that post-operative complications are more common. The available evidence presented in this review suggests that mortality and infection rates were the same regardless of when the injury was treated.

Overall, this paper combines the available evidence to strengthen the argument that early intervention in unstable spinal injuries is safe and can result in significant benefit to the patient. Especially in reducing the time in intensive care and ultimately in leaving hospital sooner. This is true whether the spinal cord is injured or only the bony spinal column, and for patients with other severe injuries. 

Dr Ben Goss
Research Fellow
School of Engineering Systems, QUT, Brisbane
Member of the Spinal Cord Injury Network’s Research Development Committee

May 2011

Reference
Dimar JR.  et al. (2010) Early versus Late Stablization of the Spine in The Polytrauma Patient.  Spine, 35(21s); S187-s192.

Link to abstract - www.ncbi.nlm.nih.gov/pubmed/20881461
 



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