Does timing of thoracic spine stabilization influence perioperative lung function after trauma?

Background. Proper timing of stabilization for spine injuries is discussed controversially. Whereas early repair of long bone fractures is known to reduce complications. Patients and methods. We investigated retrospectively 48 patients who were stabilized in a ventrodorsal approach for fractures of the thoracic spine. Patients were divided into three groups. All patients in groups I and II presented radiological or clinical signs of lung contusion. Patients were stabilized in the prone position via single-step dorsal stabilization with internal transpedicular fixation and ventral fusion with titanium cage or autologous bone graft using a minimally invasive video-assisted thoracotomy. Results. The average duration of the procedures in group I was 213 +/- 40 min, in group II 250 +/- 75 min, and in group III 255 +/- 65 min (p: n.s.). Intraoperative blood loss did not differ significantly between the three groups. The PaO2/FiO(2) ratio improved in groups I and III, whereas in group II an significant impairment of lung function occurred peri operatively. Postoperative ICU stay was comparable in groups I and II (1: 10 5 days; II: 9 7 days); overall ICU stay tended to be shorter in group I versus II. The postoperative dependence on ventilator support did not differ significantly among the three groups. The mortality rate was 0% in this series. Conclusion. Our data provide further evidence that early stabilization of combined thoracic and thoracic spine injuries is safe, does not alter perioperative lung function, and results in a reduced overall ICU stay.