Timing of surgical fixation in traumatic spinal fractures: A systematic review

Surgeon. 2020 Feb;18(1):37-43. doi: 10.1016/j.surge.2019.04.002. Epub 2019 May 4.


Background: The optimal timing of fracture fixation following spinal injury is controversial. Many spinal fractures occur as part of polytrauma requiring a complex management strategy. Whilst the decision to stabilize unstable spinal column injuries is without debate, the duration between injury and definitive fixation can impact on the incidence of post-operative complications. This study was designed to systemically summarize and compare the complication profile of early vs late stabilization of spinal injuries, in an attempt to unveil an appropriate treatment protocol for traumatic spinal fractures.

Methods: A comprehensive search strategy was performed on the PubMed, Cochrane, and Google Scholar databases using key words. The search strategy provided 1120 results. Forty-six articles were reviewed for full-text. Reference lists were analysed for potential additional texts.

Results: Sixteen articles met the inclusion criteria and were included for systematic review. Studies were controversial and the overall result was inconclusive. Several studies favour early stabilisation to reduce post-surgical complication rates, especially in cases of patients with high Injury Severity Scale (ISS) scores. However, this is challenged by a small number of studies reporting a higher mortality rate in the early-stabilisation cohort.

Conclusion: Due to limited studies and a small overall cohort, the authors would cautiously recommend the early surgical fixation of unstable spine fractures in the stable trauma patient. For severely injured patients, the discordance among literature warrants the need for further investigation.

Keywords: Complication rates; Early total care; Orthopaedic surgery; Patient outcomes; Spinal fracture fixation; Spinal surgery; Surgical timing; ‘Second-hit’ phenomenon.

Publication types

  • Systematic Review

MeSH terms

  • Fracture Fixation, Internal / methods*
  • Humans
  • Injury Severity Score
  • Lumbar Vertebrae / injuries*
  • Spinal Fractures / surgery*
  • Thoracic Vertebrae / injuries*
  • Time Factors
  • Time-to-Treatment*