Meta-analysis of early versus late fixation of traumatic unstable thoracolumbar spine fractures in patients with or without spinal cord injury

Abstract

Background and objectives: Timing of surgical fixation for unstable thoracolumbar Fractures in polytrauma patients remains controversial. We performed a meta-analysis to quantitatively evaluate the impact of early (< 72 h) versus late (> 72 h) thoracolumbar stabilization on in-hospital outcomes, including hospital and ICU length of stay, mortality, ventilator dependency, and complication rates.

Methods: Studies comparing early and late surgical stabilization of traumatic thoracolumbar fractures were included. Outcomes analyzed included hospital length of stay (HLOS), ICU length of stay (ICULOS), days on a ventilator (VENTDAYS), complication rates, and in-hospital mortality. Complications included intraoperative hemorrhage, sepsis, postoperative neurological deterioration, and respiratory complications. Subset analysis was performed for non-SCI patients. Data were pooled using fixed or random-effects models based on heterogeneity.

Results: Twelve studies met inclusion criteria. Early fixation was associated with shorter HLOS (mean difference [MD] = -3.59 days; 95 % confidence interval [CI]: -6.44 to -0.75, I² = 31 %), shorter ICULOS (MD = -1.21 days; 95 % CI: -2.0 to -0.41, I² = 0 %), and fewer VENTDAYS (MD = -3.43 days; 95 % CI: -6.07 to -0.78, I² = 90 %). Early fixation also reduced the odds of perioperative complications (odds ratio [OR] = 0.61; 95 % CI: 0.49 to 0.75, I² = 13 %) without increasing in-hospital mortality (OR = 1.04; 95 % CI: 0.73 to 1.46, I² = 2 %). Subset analysis of non-SCI patients showed no differences in mortality (OR = 1.1; 95 % CI: 0.41 to 2.93, I² = 0 %) or complication rates (OR = 0.79; 95 % CI: 0.36 to 1.73, I² = 28 %).

Conclusion: Early fixation of traumatic thoracolumbar fractures is associated with decreased HLOS, ICULOS, complication rates, and ventilator dependency. Further prospective trials are required to confirm these findings and refine the role of SCI status in clinical decision-making for thoracolumbar fixation.

Keywords: Spine fracture; Spine stabilization; Thoracolumbar; Trauma.