Timing of surgical stabilization after cervical and thoracic trauma

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

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  • 1 Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute of Orthopaedic Surgery, Philadelphia, Pennsylvania; and The Boston Spine Group, New England Baptist Hospital, Boston, Massachusetts
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✓ Appropriate timing for surgical intervention following destabilizing cervical or thoracic spine trauma remains controversial. Clinical investigators have failed to provide convincing evidence that the timing of surgery significantly affects neurological outcome in most situations. Nevertheless, early surgical stabilization of the injured spine has been shown to provide significant nonneurological benefits such as more rapid patient mobilization, facilitation of treating associated injuries, reduction in rates of pulmonary and pressure sore complications, reduction in duration of intensive care unit and hospital stays, and a decrease in overall medical costs.

The findings of basic science studies have improved our understanding of the molecular and cellular events surrounding initial and secondary spinal cord injury (SCI), and analysis of these findings suggests that the early postinjury period may present a unique opportunity for meaningful intervention. This possibility has been supported by results obtained in animal studies that demonstrate the potential for improving functional outcome when surgical intervention is performed within a few hours following experimental SCI. Despite the absence of significant neurological recovery in most clinical studies, the results of most recent clinical studies strongly support the overall clinical benefits of early surgical intervention, particularly in the setting of unstable thoracic spinal column injury with associated SCI. Based on the best available scientific and clinical evidence, the authors report that it is therefore recommended that surgical stabilization be performed in as timely a fashion as possible, particularly for unstable thoracic spine trauma, within the constraints of the patient's overall medical condition and availability of appropriate resources.

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Contributor Notes

Address reprint requests to: Todd J. Albert, M.D., Rothman Institute of Orthopaedics, 925 Chestnut Street, Philadelphia, Pennsylvania 19107-1216. email: tjsurg@aol.com.
  • 1.

    Aebi M, , Etter C, , Kehl T, & Thalgott J: Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system. Indications, techniques, and first results of treatment. Spine 12:544551, 1987 Aebi M, Etter C, Kehl T, Thalgott J: Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system. Indications, techniques, and first results of treatment. Spine 12:544–551, 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Aebi M, , Mohler J, , Zach GA, & Morscher E: Indication, surgical technique, and results of 100 surgically-treated fractures and fracture-dislocations of the cervical spine. Clin Orthop Relat Res 203:244257, 1986 Aebi M, Mohler J, Zach GA, Morscher E: Indication, surgical technique, and results of 100 surgically-treated fractures and fracture-dislocations of the cervical spine. Clin Orthop Relat Res 203:244–257, 1986

    • Search Google Scholar
    • Export Citation
  • 3.

    Bone LB, , Johnson KD, , Weigelt J, & Scheinberg R: Early versus delayed stabilization of femoral fractures: a prospective randomized study. 1989. Clin Orthop Relat Res 422:1116, 2004 Bone LB, Johnson KD, Weigelt J, Scheinberg R: Early versus delayed stabilization of femoral fractures: a prospective randomized study. 1989. Clin Orthop Relat Res 422:11–16, 2004

    • Search Google Scholar
    • Export Citation
  • 4.

    Bradford DS, , Akhbarnia BA, & Winter RB, et al: Surgical stabilization of fracture and fracture-dislocations of the thoracic spine. Spine 2:185196, 1977 Bradford DS, Akhbarnia BA, Winter RB, et al: Surgical stabilization of fracture and fracture-dislocations of the thoracic spine. Spine 2:185–196, 1977

    • Search Google Scholar
    • Export Citation
  • 5.

    Campagnolo DI, , Esquieres RE, & Kopacz KJ: Effect of timing of stabilization on length of stay and medical complications following spinal cord injury. J Spinal Cord Med 20:331334, 1997 Campagnolo DI, Esquieres RE, Kopacz KJ: Effect of timing of stabilization on length of stay and medical complications following spinal cord injury. J Spinal Cord Med 20:331–334, 1997

    • Search Google Scholar
    • Export Citation
  • 6.

    Chipman JG, , Deuser WE, & Beilman GJ: Early surgery for thoracolumbar spine injuries decreases complications. J Trauma 56:5257, 2004 Chipman JG, Deuser WE, Beilman GJ: Early surgery for thoracolumbar spine injuries decreases complications. J Trauma 56:52–57, 2004

    • Search Google Scholar
    • Export Citation
  • 7.

    Clohisy JC, , Akbarnia BA, , Bucholz RD, , Burkus JK, & Backer RJ: Neurologic recovery associated with anterior decompression of spine fractures at the thoracolumbar junction (T12—11). Spine 17:S325S330, 1992 Clohisy JC, Akbarnia BA, Bucholz RD, Burkus JK, Backer RJ: Neurologic recovery associated with anterior decompression of spine fractures at the thoracolumbar junction (T12—11). Spine 17:S325–S330, 1992

    • Search Google Scholar
    • Export Citation
  • 8.

    Croce MA, , Bee TK, , Pritchard E, , Miller PR, & Fabian TC: Does optimal timing for spine fracture fixation exist? Ann Surg 233:851858, 2001 Croce MA, Bee TK, Pritchard E, Miller PR, Fabian TC: Does optimal timing for spine fracture fixation exist? Ann Surg 233:851–858, 2001

    • Search Google Scholar
    • Export Citation
  • 9.

    Dickson JH, , Harrington PR, & Erwin WD: Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. J Bone Joint Surg Am 60:799805, 1978 Dickson JH, Harrington PR, Erwin WD: Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. J Bone Joint Surg Am 60:799–805, 1978

    • Search Google Scholar
    • Export Citation
  • 10.

    Edwards CC, & Levine AM: Early rod-sleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am 17:121145, 1986 Edwards CC, Levine AM: Early rod-sleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am 17:121–145, 1986

    • Search Google Scholar
    • Export Citation
  • 11.

    Eismont FJ, , Green BA, & McGuire E: Comparison of stability provided to the unstable spine using the kinetic therapy table and the stryker frame. Neurosurgery 22:842845, 1988 Eismont FJ, Green BA, McGuire E: Comparison of stability provided to the unstable spine using the kinetic therapy table and the stryker frame. Neurosurgery 22:842–845, 1988

    • Search Google Scholar
    • Export Citation
  • 12.

    Fehlings MG, , Sekhon LH, & Tator C: The role and timing of decompression in acute spinal cord injury: what do we know? What should we do? Spine 26:S101S110, 2001 Fehlings MG, Sekhon LH, Tator C: The role and timing of decompression in acute spinal cord injury: what do we know? What should we do? Spine 26:S101–S110, 2001

    • Search Google Scholar
    • Export Citation
  • 13.

    Fehlings MG, & Tator CH: An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neurosurg (Spine 1) 91:111, 1999 Fehlings MG, Tator CH: An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neurosurg (Spine 1) 91:1–11, 1999

    • Search Google Scholar
    • Export Citation
  • 14.

    Gaebler C, , Maier R, , Kutscha-Lissberg F, , Mrkonjic L, & Vecsei V: Results of spinal cord decompression and thoracolumbar pedicle stabilisation in relation to the time of operation. Spinal Cord 37:3339, 1999 Gaebler C, Maier R, Kutscha-Lissberg F, Mrkonjic L, Vecsei V: Results of spinal cord decompression and thoracolumbar pedicle stabilisation in relation to the time of operation. Spinal Cord 37:33–39, 1999

    • Search Google Scholar
    • Export Citation
  • 15.

    Glaser JA, , Jaworski BA, , Cuddy BG, , Albert TJ, , Hollowell JP, & McLain RF, et al: Variation in surgical opinion regarding management of selected cervical spine injuries. A preliminary study. Spine 23:975983, 1998 Glaser JA, Jaworski BA, Cuddy BG, Albert TJ, Hollowell JP, McLain RF, et al: Variation in surgical opinion regarding management of selected cervical spine injuries. A preliminary study. Spine 23:975–983, 1998

    • Search Google Scholar
    • Export Citation
  • 16.

    Goris RJA, , Gimbrere JSF, , van Niekirk JLM, , Schoots FJ, & Booy LH: Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 22:895903, 1982 Goris RJA, Gimbrere JSF, van Niekirk JLM, Schoots FJ, Booy LH: Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 22:895–903, 1982

    • Search Google Scholar
    • Export Citation
  • 17.

    Hadley MN, , Fitzpatrick BC, , Sonntag VK, & Browner CM: Facet fracture-dislocation injuries of the cervical spine. Neurosurgery 30:661666, 1992 Hadley MN, Fitzpatrick BC, Sonntag VK, Browner CM: Facet fracture-dislocation injuries of the cervical spine. Neurosurgery 30:661–666, 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Hadley MN, , Walters BC, , Grabb PA, , Oyesiku NM, , Przybylski GJ, & Resnick DK, et al: Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg 49:407498, 2002 Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, et al: Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg 49:407–498, 2002

    • Search Google Scholar
    • Export Citation
  • 19.

    Heiden JS, , Weiss MH, , Rosenberg AW, , Apuzzo ML, & Kurze T: Management of cervical spinal cord trauma in Southern California. J Neurosurg 43:732736, 1975 Heiden JS, Weiss MH, Rosenberg AW, Apuzzo ML, Kurze T: Management of cervical spinal cord trauma in Southern California. J Neurosurg 43:732–736, 1975

    • Search Google Scholar
    • Export Citation
  • 20.

    Holdsworth F: Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 52:15341551, 1970 Holdsworth F: Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 52:1534–1551, 1970

    • Search Google Scholar
    • Export Citation
  • 21.

    Jackson AB, & Groomes TE: Incidence of respiratory complications following spinal cord injury. Arch Phys Med Rehabil 75:270275, 1994 Jackson AB, Groomes TE: Incidence of respiratory complications following spinal cord injury. Arch Phys Med Rehabil 75:270–275, 1994

    • Search Google Scholar
    • Export Citation
  • 22.

    Johnson KD, , Cadambi A, & Seibert GB: Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 25:375384, 1985 Johnson KD, Cadambi A, Seibert GB: Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 25:375–384, 1985

    • Search Google Scholar
    • Export Citation
  • 23.

    Kerwin AJ, , Frykberg ER, , Schinco MA, , Griffen MM, , Murphy T, & Tepas JJ: The effect of early spine fixation on non-neurologic outcome. J Trauma 58:1521, 2005 Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Murphy T, Tepas JJ: The effect of early spine fixation on non-neurologic outcome. J Trauma 58:15–21, 2005

    • Search Google Scholar
    • Export Citation
  • 24.

    Kirshblum SC, , Groah SL, , McKinley WO, , Gittler MS, & Stiens SA: Spinal cord injury medicine. 1. Etiology, classification, and acute medical management. Arch Phys Med Rehabil 83:S5057, S90–S98, 2002 Kirshblum SC, Groah SL, McKinley WO, Gittler MS, Stiens SA: Spinal cord injury medicine. 1. Etiology, classification, and acute medical management. Arch Phys Med Rehabil 83:S50–57, S90–S98, 2002

    • Search Google Scholar
    • Export Citation
  • 25.

    Kiwerski JE: Early anterior decompression and fusion for crush fractures of cervical vertebrae. Int Orthop 17:166168, 1993 Kiwerski JE: Early anterior decompression and fusion for crush fractures of cervical vertebrae. Int Orthop 17:166–168, 1993

    • Search Google Scholar
    • Export Citation
  • 26.

    Krengel WF III, , Anderson PA, & Henley MB: Early stabilization and decompression for incomplete paraplegia due to a thoraciclevel spinal cord injury. Spine 18:20802087, 1993 Krengel WF III, Anderson PA, Henley MB: Early stabilization and decompression for incomplete paraplegia due to a thoraciclevel spinal cord injury. Spine 18:2080–2087, 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Levi L, , Wolf A, , Rigamonti D, , Ragheb J, , Mirvis S, & Robinson WL: Anterior decompression in cervical spine trauma: does the timing of surgery affect the outcome? Neurosurg 29:216222, 1991 Levi L, Wolf A, Rigamonti D, Ragheb J, Mirvis S, Robinson WL: Anterior decompression in cervical spine trauma: does the timing of surgery affect the outcome? Neurosurg 29:216–222, 1991

    • Search Google Scholar
    • Export Citation
  • 28.

    Marshall LF, , Knowlton S, , Garfin SR, , Klauber MR, , Eisenburg HM, & Kopaniky D, et al: Deterioration following spinal cord injury. A multicenter study. J Neurosurg 66:400404, 1987 Marshall LF, Knowlton S, Garfin SR, Klauber MR, Eisenburg HM, Kopaniky D, et al: Deterioration following spinal cord injury. A multicenter study. J Neurosurg 66:400–404, 1987

    • Search Google Scholar
    • Export Citation
  • 29.

    McAfee PC, , Bohlmann HH, & Yuan HA: Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach. J Bone Joint Surg Am 67:89104, 1985 McAfee PC, Bohlmann HH, Yuan HA: Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach. J Bone Joint Surg Am 67:89–104, 1985

    • Search Google Scholar
    • Export Citation
  • 30.

    McLain RF, & Benson DR: Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine 24:16461654, 1999 McLain RF, Benson DR: Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine 24:1646–1654, 1999

    • Search Google Scholar
    • Export Citation
  • 31.

    Mirza SK, , Krengel WF III, , Chapman JR, , Anderson PA, , Bailey JC, & Grady MS, et al: Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res 359:104114, 1999 Mirza SK, Krengel WF III, Chapman JR, Anderson PA, Bailey JC, Grady MS, et al: Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res 359:104–114, 1999

    • Search Google Scholar
    • Export Citation
  • 32.

    Papadopoulos SM, , Selden NR, , Quint DJ, , Patel N, , Gillespie B, & Grube S: Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome. J Trauma 52:323332, 2002 Papadopoulos SM, Selden NR, Quint DJ, Patel N, Gillespie B, Grube S: Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome. J Trauma 52:323–332, 2002

    • Search Google Scholar
    • Export Citation
  • 33.

    Riska EB, , von Bonsdorff H, , Hakkinen S, , Jaroma H, , Kiviluoto O, & Paavilainen T: Primary operative fixation of long bone fractures in patients with multiple injuries. J Trauma 17:111121, 1977 Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T: Primary operative fixation of long bone fractures in patients with multiple injuries. J Trauma 17:111–121, 1977

    • Search Google Scholar
    • Export Citation
  • 34.

    Schlegel J, , Bayley J, , Yuan H, & Fredricksen B: Timing of surgical decompression and fixation of acute spinal fractures. J Orthop Trauma 10:323330, 1996 Schlegel J, Bayley J, Yuan H, Fredricksen B: Timing of surgical decompression and fixation of acute spinal fractures. J Orthop Trauma 10:323–330, 1996

    • Search Google Scholar
    • Export Citation
  • 35.

    Seibel R, , LaDuca J, , Hassett JM, , Babikian G, , Mills B, & Border DO, et al: Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg 202:283295, 1985 Seibel R, LaDuca J, Hassett JM, Babikian G, Mills B, Border DO, et al: Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg 202:283–295, 1985

    • Search Google Scholar
    • Export Citation
  • 36.

    Vaccaro AR, , Daugherty RJ, , Sheehan TP, , Dante SJ, , Cotler JM, & Balderston RA, et al: Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine 22:26092613, 1997 Vaccaro AR, Daugherty RJ, Sheehan TP, Dante SJ, Cotler JM, Balderston RA, et al: Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine 22:2609–2613, 1997

    • Search Google Scholar
    • Export Citation
  • 37.

    Wagner FC Jr, & Chehrazi B: Early decompression and neurological outcome in acute cervical spinal cord injuries. J Neurosurg 56:699705, 1982 Wagner FC Jr, Chehrazi B: Early decompression and neurological outcome in acute cervical spinal cord injuries. J Neurosurg 56:699–705, 1982

    • Search Google Scholar
    • Export Citation

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