Timing of surgical decompression and fixation of acute spinal fractures

A retrospective evaluation of 138 patients requiring operative decompression, reduction and fixation of spinal injuries between January 1986 and April 1989 was conducted. The variables of timing and method of operative intervention, level and classification of fracture, associated injuries, injury severity score (ISS), associated neurologic deficits, length of intensive care unit and hospital stays, and projected costs were analyzed for correlation with postoperative complications (pulmonary, skin, urinary, other). Four subgroups were identified: group IA patients underwent surgery within 72 h of injury and had an ISS of < 18; group IB patients underwent surgery after 72 h and had an ISS of < 18; group IIA patients underwent surgery within 72 h and had an ISS of greater than or equal to 81 and group IIB underwent surgery after 72 h and had an ISS of greater than or equal to 18. There was no statistically significant difference in the incidence of medical complications in patients comparing groups IA and IB. Group IIB patients had a statistically significant higher rate of morbidity than did group IIA. A separate group of patients with cervical spine injuries with neurologic deficit was analyzed by the same statistical analysis. Irrespective of associated injuries, all had fewer complications if they underwent surgery within 72 h. Morbidity was higher in patients with a neurological deficit compared with neurologically intact patients. Surgical decompression, reduction, and/or fixation of spinal fractures within the first 72 h is indicated in patients with multiple trauma (ISS greater than or equal to 18) and cervical injuries with a neurological deficit.