The timing of spinal stabilization in polytrauma and in patients with spinal cord injury.

PURPOSE OF REVIEW: Despite improved care of multiple injured patients, controversial data about the best time point for decompression and stabilization of spine fractures and spinal cord injuries are published. Some studies even question the value of surgical management.

RECENT FINDINGS: In several mostly retrospective studies and a meta-analysis, there is growing evidence that early decompression and stabilization of spine injuries seems to be beneficial, especially in more severely injured patients. Early stabilization seems to reduce length of stay and pulmonary complications. Some studies report on improved neurological outcome and improved survival; however, other new studies add controversial data.

SUMMARY: Most studies support the hypothesis that early decompression and stabilization of spine injuries is beneficial in terms of reducing length of stay at the ICU, as well as improving neurological and overall outcome. Good prospective clinical trials are still missing, thus the level of evidence remains low.