The indication for operative stabilization is somewhat controversial and varies from institution to institution. Those favoring an aggressive approach stress the importance of early mobilization of the multiply injured patient as it helps decrease pulmonary problems, skin breakdown, deep venous thrombosis, and pulmonary embolus. Early stabilization allows for this early mobilization. Rigid fixation may also decrease time in hospital as well as long-term pain and deformities.
Those advocating a nonoperative approach point out the possibility of worsening neurologic performance by operative manipulation. In addition, the long-term results with operative intervention may not be substantially better than with nonoperative therapy.
All would agree that progressive neurologic deterioration is an indication for urgent surgery. In addition, spinal instability should most often be managed operatively even in the case of a complete spinal cord level. This helps prevent long-term deformity.
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