Long-Term Impact of Timing on Spinal Implantation for Lumbar Fractures in Polytrauma Patients: A Systematic Review.

Abstract

The timing of osteosynthesis in polytrauma patients with lumbar spine fractures may influence key clinical outcomes, including hospital length of stay (HLOS), ICU length of stay (ICULOS), and mechanical ventilation duration (VENT DAYS). This systematic review aimed to evaluate how surgical timing affects these outcomes. A systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, and CENTRAL was completed in February 2025. Inclusion criteria involved studies on adult polytrauma patients (> 18 years) with lumbar spine fractures from blunt trauma, requiring surgical fixation, comparing early ( 72 h) surgery. Studies had to report Injury Severity Scores (ISS), outcomes of interest (HLOS, ICULOS, and VENT DAYS), include statistical comparisons between groups, and meet a minimum of "moderate" risk of bias based on the ROBINS-I tool. Out of 588 studies initially identified, three fulfilled the inclusion criteria, involving 1,111 patients-759 underwent early fixation and 352 late. The weighted average age was 39.1 years in the early group and 41.2 years in the late group. The weighted average ISS was 27.3 (early) and 29.2 (late). The weighted average VENT DAYS was 4.9 in the early group and 7.8 in the late group. The weighted average ICULOS was 10.9 d (early) and 13.7 d (late). The weighted average HLOS was 37.9 d (early) and 36.8 d (late). The impact of osteosynthesis on VENT DAYS and ICULOS remains uncertain, while HLOS shows no clinically relevant difference. ISS significantly influences outcomes.