Spinal fixation surgery for acute traumatic spinal cord injury

  • Review
  • Intervention

Authors


Abstract

Background

If the spine is unstable following traumatic spinal cord injury (SCI), surgical fusion and bracing may be necessary to obtain vertical stability and prevent re-injury of the spinal cord from repeated movement of the unstable bony elements. It has been suggested that this spinal fixation surgery may promote early rehabilitation and mobilisation.

Objectives

To answer the question: is there a difference in functional outcome and other commonly measured outcomes between people who have a spinal cord injury and have had spinal fixation surgery and those who have not?

Search methods

The following databases were searched: AMED, CCTR, CINAHL, DARE, EMBASE, HEED, HMIC, MEDLINE, NRR, NHS EED. Searches were updated in May 2003 and MEDLINE was searched again in May 2007. The reference lists of retrieved articles were checked.

Selection criteria

Randomised controlled trials and controlled trials that compared surgical spinal fixation, with or without decompression, to any other treatment, in patients with a traumatic SCI.

Data collection and analysis

Two reviewers independently selected studies. One reviewer assessed the quality of the studies and extracted data.

Main results

No randomised controlled trials or controlled trials were identified that compared surgical spinal fixation surgery to other treatments in patients with a traumatic SCI. All of the studies identified were retrospective observational studies and of poor quality.

Authors' conclusions

The current evidence does not enable conclusions to be drawn about the benefits or harms of spinal fixation surgery in patients with traumatic SCI. Well-designed, prospective experimental studies with appropriately matched controls are needed.

摘要

背景

急性創傷之脊髓損傷的脊柱固定手術

如果脊椎在脊髓損傷(spinal cord injury, SCI)之後是不穩定的,為了獲得垂直穩定及防止脊髓不穩定的骨成份因重複活動而再損傷,外科手術的熔合和固定可能是必要的。這種脊柱固定手術也許可以促進早期的復原及活動。

目標

為了回答此問題:脊髓損傷的病人有無執行脊柱固定手術,其功能性結果及其他常測量之結果有不同嗎?

搜尋策略

搜尋以下資料庫:AMED、CCTR、CINAHL、DARE、EMBASE、HEED、HMIC、MEDLINE、NRR、NHS EED。在2003年5月更新搜尋,且在2007年5月再次搜尋MEDLINE。也檢查所獲得文章的文獻目錄。

選擇標準

比較脊髓損傷病人中,行外科脊柱固定手術、有或沒有減壓、或任何其他治療之隨機對照臨床試驗或其他有對照組之臨床試驗。

資料收集與分析

兩位評論者獨立的檢選研究。一位評論者評估研究的品質及摘取資料。

主要結論

沒有發現比較脊髓損傷病人,行外科脊柱固定手術和其他治療的隨機對照臨床試驗或其他有對照組的臨床試驗。所有找到的研究都是回顧性的觀察研究,且品質不良。

作者結論

目前的證據,對有關脊髓損傷病人行外科脊柱固定手術的利益或傷害,尚無法做結論。需要設計良好的、前瞻性及適當的配對對照的實驗性研究。

翻譯人

本摘要由高雄榮民總醫院林麗英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

由於創傷造成脊髓損傷的病人,行外科脊柱固定手術的利益或傷害,在目前並不知道。 此評論發現,對行外科脊柱固定手術的病人群,沒有相關的控制性試驗。現存的證據品質都太差,以致無法納入此評論中,因為它多半是不可靠的。要回答這個問題,需要品質好的對照性的試驗。

Plain language summary

The benefits and harms of spinal fixation surgery for people with spinal cord injury due to trauma are not known at the moment

This review found no controlled trials of spinal fixation surgery for the patient group. The quality of the existing evidence is too poor to include in the review, as it is likely to be unreliable. Good quality controlled trials are needed to answer this question.