Early versus late surgical stabilisation of unstable thoracolumbar spine fractures in adult polytrauma patients: A systematic review and meta-analysis

Abstract

Controversy remains with regards to the timing of surgical stabilisation of unstable thoracolumbar fractures in adult polytrauma patients. We aimed to compare early versus late fixation of thoracolumbar spine fractures focusing on length of hospital stay (HLOS), length of stay in ICU (ICULOS), respiratory complications, mortality, and long-term functional outcome measures. Electronic database search was conducted on PubMed, Cochrane, CENTRAL, and Embase spanning 1999 to 2023 using a developed search strategy. The time cut off used to distinguish between early and late stabilisation was 72 h from injury. Statistical analysis of primary outcome data was performed with Comprehensive Meta-analysis software using the standardised difference in means as the effect size index. 2082 articles were retrieved, eighty screened by full text and a final eleven studies comprising 3874 patients deemed eligible for inclusion in this review. The overall level of evidence of included studies was low with only one prospective cohort study. A subgroup meta-analysis using a random effects model showed that early fixation of unstable thoracolumbar spinal fractures leads to a statistically significant decrease in HLOS compared to late fixation with a mean effect size of -0.502. Early fixation was also associated with reduced ICULOS and respiratory complications. Early surgical stabilisation of unstable thoracolumbar spine fractures within 72h of injury is safe and associated with favorable short-term outcomes in adult polytrauma patients with unstable thoracolumbar spine fractures. Further high-level prospective studies are recommended to investigate whether the short-term gains shown can translate to superior long-term functional outcomes.