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Timing of Decompression in Patients With Acute Spinal Cord Injury: A Systematic Review
| Content Provider | SAGE Publishing |
|---|---|
| Author | Wilson, Jefferson R. Tetreault, Lindsay A. Kwon, Brian K. Arnold, Paul M. Mroz, Thomas E. Shaffrey, Christopher Harrop, James S. Chapman, Jens R. Casha, Steve Skelly, Andrea C. Holmer, Haley K. Brodt, Erika D. Fehlings, Michael G. |
| Copyright Year | 2017 |
| Abstract | Study Design:Systematic review.Objective:To conduct a systematic review and synthesis of the literature to assess the comparative effectiveness, safety, and cost-effectiveness of early (≤24 hours) versus late decompression (>24 hours) in adults with acute spinal cord injury (SCI).Methods:A systematic search was conducted of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar to identify studies published through November 6, 2014. Studies published in any language, in humans, and with an abstract were considered for inclusion. Included studies were critically appraised and the overall strength of evidence was determined using methods proposed by the Grading of Recommendation Assessment, Development and Evaluation working group.Results:The search yielded 449 potentially relevant citations. Sixteen additional primary studies were identified through other sources. Six studies met inclusion criteria. All but 2 studies were considered to have moderately high risk of bias. Across studies and injury levels, the impact of early surgical decompression (≤24 hours) on clinically important improvement in neurological status was variable. Isolated studies reported statistically significant and clinically important improvements at 6 months (cervical injury, low strength of evidence) and following discharge from inpatient rehabilitation (all levels, very low strength of evidence) but not at other time points; another study observed a statistically significant 6 point improvement in ASIA Impairment Scale (AIS) among patients with AIS B, C, or D, but not for those with AIS A (very low strength of evidence). In one study of acute central cord syndrome without instability, a clinically and statistically meaningful improvement in total motor scores was reported at 6 and 12 months in patients treated early (versus late). There were, however, no significant differences in AIS improvement between early and late surgical groups at 6- or 12-months (very low strength of evidence). One of 3 studies found a shorter length of hospital stay associated with early surgical decompression. Of 3 studies reporting on safety, no significant differences in rates of complications (including mortality, neurologic deterioration, pneumonia or pressure ulcers) were noted between early and late decompression groups.Conclusions:Results surrounding the efficacy of early versus late decompressive surgery, as well as the quality of evidence available, were variable depending on the level of SCI, timing of follow-up, and specific outcome considered. Existing evidence supports improved neurological recovery among cervical SCI patients undergoing early surgery; however, evidence regarding remaining SCI populations and clinical outcomes was inconsistent. |
| Related Links | https://journals.sagepub.com/doi/pdf/10.1177/2192568217701716?download=true |
| Starting Page | 95 |
| Ending Page | 115 |
| Page Count | 21 |
| ISSN | 21925682 |
| Issue Number | 3_suppl |
| Volume Number | 7 |
| Journal | Global Spine Journal (GSJ) |
| e-ISSN | 21925690 |
| DOI | 10.1177/2192568217701716 |
| Language | English |
| Publisher | Sage Publications CA |
| Publisher Date | 2017-09-05 |
| Publisher Place | Los Angeles |
| Access Restriction | Open |
| Rights Holder | © The Author(s) 2017 |
| Subject Keyword | spinal cord injury systematic review timing of surgery |
| Content Type | Text |
| Resource Type | Article |
| Subject | Orthopedics and Sports Medicine Neurology (clinical) Surgery |
