• A M Bagnall, L Jones, S Duffy, and R P Riemsma.
• Leeds Metropolitan University, School of Health & Community Care, Calverley Street, Leeds, UK LS1 3HE. A.Bagnall@leedsmet.ac.uk
• Cochrane Db Syst Rev. 2008 Jan 1(1):CD004725.

BackgroundIf 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.ObjectivesTo 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 StrategyThe 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 CriteriaRandomised 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 AnalysisTwo reviewers independently selected studies. One reviewer assessed the quality of the studies and extracted data.Main ResultsNo 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' ConclusionsThe 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.

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