Document Type : Systematic Review
Authors
1
MD, Brain and Spain Surgeon, Trauma and Injury Research center, Tehran, Iran
2
Department of Anesthesiology and Critical Care, School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran, Assistant professor of Anesthesiology, Tehran University of Medical
3
Department of Anesthesiology and Critical Care, School of Medicine, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
4
Emergency Medicine Specialist، Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
5
PhD of Anatomy, Trauma and Injury Research center, Iran University of medical sciences, Tehran, Iran
10.5281/zenodo.22286215
Abstract
Background: Acute spinal cord compression following traumatic spinal cord injury (SCI) represents a neurosurgical emergency with profound implications for patient outcomes. The optimal timing of surgical decompression remains a subject of considerable debate despite growing evidence supporting early intervention. This systematic review and meta-analysis evaluates the comparative effectiveness of early (≤24 hours) versus delayed (>24 hours) surgical decompression performed under general anesthesia on neurological recovery, complication rates, and mortality in patients with acute spinal cord compression.
Methods: A comprehensive literature search conducted across PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from database inception through April 2024. Studies comparing early versus delayed surgical decompression in adult patients with acute traumatic spinal cord compression were included. The primary outcome was neurological improvement measured by changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and ASIA Motor Score (AMS). Secondary outcomes included postoperative complications and all-cause mortality.
Results: Fourteen studies comprising 2,505 patients met inclusion criteria. Early surgical decompression demonstrated a non-significant trend toward improved neurological recovery (MD 3.64 points in AMS; 95% CI: -0.05 to 7.33; p=0.05) and a 37% higher odds of achieving at least one-grade AIS improvement (OR 1.37; 95% CI: 0.90-2.10; p=0.14). Early surgery significantly reduced postoperative complications (RR 0.42; 95% CI: 0.20-0.88; p=0.02) and shortened hospital length of stay. Mortality rates were comparable between groups (OR 1.27; 95% CI: 0.30-5.38; p=0.75). Subgroup analyses revealed greater benefits in patients with complete SCIs.
Conclusion: Early surgical decompression within 24 hours of injury appears safe and may confer neurological benefits, with significant reductions in complications and hospital stay. These findings support institutional protocols prioritizing expedited surgical intervention when clinically feasible.
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