Early surgical decompression within 8 hours for traumatic spinal cord injury: Is it beneŞcial? A meta-analysis

Introduction: The aim of this study is to evaluate whether early (<8 h) surgical decompression is better inimproving neurologic outcomes than late ( 8 h) surgical decompression for traumatic spinal cord injury(tSCI).Methods: The various electronic databases were used to detect relevant articles published up until May2016 that compared the outcomes of early versus late surgery for tSCI. Data searching, extraction,analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. Theresults are presented as relative ratio (RR) for binary outcomes and mean difference (MD) for continuousoutcomes with 95% conŞdence intervals (CIs).Results: Seven studies wereŞnally included in this meta-analysis. There were signiŞcant differencesbetween the 2 groups in neurologic improvement (MD¼ 0.54, 95% CI ¼ 18.52 to 7.02, P < 0.0001) andlength of hospital stay (MD¼ 12.77, 95% CI ¼ 0.34e0.74, P < 0.00001). However, no signiŞcant differences were found between the 2 groups in perioperative complications (OR¼ 0.95, 95% CI ¼ 0.35e2.61, P ¼ 0.92).Conclusions: Early surgical decompression within 8 h after tSCI was beneŞcial in terms of neurologicimprovement compared with late surgery. Early surgical decompression (within 8 h) is recommended forpatients with tSCI.Level of evidence: Level III, therapeutic study.

___

1. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord. 2006;44(9):523e529.

2. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. results of the second national acute spinal cord injury study. N Engl J Med. 1990;322(20):1405e1411.

3. Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. results of the third national acute spinal cord injury randomized controlled trial. National acute spinal cord injury study. JAMA. 1997;277(20):1597e1604.

4. Amar AP, Levy ML. Pathogenesis and pharmacological strategies for mitigating secondary damage in acute spinal cord injury. Neurosurgery. 1999;44(5): 1027e1039.

5. Liu JM, Long XH, Zhou Y, Peng HW, Liu ZL, Huang SH. Is urgent decompression superior to delayed surgery for traumatic spinal cord Injury? A meta-analysis. World Neurosurg. 2016;87:124e131.

6. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):e32037.

7. Cengiz SL, Kalkan E, Bayir A, Ilik K, Basefer A. Timing of thoracolomber spine stabilization in trauma patients; impact on neurological outcome and clinical course. a real prospective (rct) randomized controlled study. Arch Orthop Trauma Surg. 2008;128(9):959e966.

8. Chen Qi, Li Feng, Fang Zhong, et al. Timing of surgical decompression for acute traumatic cervical spinal cord injury: a multicenter study. Neurosurg Q. 2012;22:61e68.

9. McCarthy MJ, Gatehouse S, Steel M, Goss B, Williams R. The influence of the energy of trauma, the timing of decompression, and the impact of grade of SCI on outcome. Evid Base Spine Care J. 2011;2(2):11e17.

10. Gaebler C, Maier R, Kutscha-Lissberg F, Mrkonjic L, Vecsei V. Results of spinal cord decompression and thoracolumbar pedicle stabilisation in relation to the time of operation. Spinal Cord. 1999;37(1):33e39.

11. Grassner L, Wutte C, Klein B, et al. Early decompression (_____8 h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year. J Neurotrauma. 2016;33(18): 1658e1666.

12. Jug M, Kejzar N, Vesel M, et al. Neurological recovery after traumatic cervical spinal cord injury is superior if surgical decompression and instrumented fusion are performed within 8 hours versus 8 to 24 hours after injury: a single center experience. J Neurotrauma. 2015;32(18):1385e1392.

13. Umerani MS, Abbas A, Sharif S. Clinical outcome in patients with early versus delayed decompression in cervical spine trauma. Asian Spine J. 2014;8(4): 427e434.

14. El Tecle NE, Dahdaleh NS, Hitchon PW. Timing of surgery in spinal cord injury. Spine (Phila Pa 1976). 2016;41(16):E995eE1004.

15. Donnelly DJ, Popovich PG. Inflammation and its role in neuroprotection, axonal regeneration and functional recovery after spinal cord injury. Exp Neurol. 2008;209(2):378e388.

16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603e605.

17. Pointillart V, Petitjean ME, Wiart L, et al. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord. 2000;38(2):71e76.

18. Chehensse C, Bahrami S, Denys P, Clement P, Bernabe J, Giuliano F. The spinal control of ejaculation revisited: a systematic review and meta-analysis of anejaculation in spinal cord injured patients. Hum Reprod Update. 2013;19(5): 507e526.

19. Qin W, Bauman WA, Cardozo C. Bone and muscle loss after spinal cord injury: organ interactions. Ann N Y Acad Sci. 2010;1211:66e84.

20. Ackery A, Tator C, Krassioukov A. A global perspective on spinal cord injury epidemiology. J Neurotrauma. 2004;21(10):1355e1370.

21. Greene KA, Marciano FF, Sonntag VK. Pharmacological management of spinal cord injury: current status of drugs designed to augment functional recovery of the injured human spinal cord. J Spinal Disord. 1996;9(5):355e366.

22. van Middendorp JJ, Hosman AJ, Doi SA. The effects of the timing of spinal surgery after traumatic spinal cord injury: a systematic review and metaanalysis. J Neurotrauma. 2013;30(21):1781e1794.

23. Carreon LY, Dimar JR. Early versus late stabilization of spine injuries: a systematic review. Spine (Phila Pa 1976). 2011;36(11):E727eE733.

24. Liu Y, Shi CG, Wang XW, et al. Timing of surgical decompression for traumatic cervical spinal cord injury. Int Orthop. 2015;39(12):2457e2463.

25. Sapkas GS, Papadakis SA. Neurological outcome following early versus delayed lower cervical spine surgery. J Orthop Surg (Hong Kong). 2007;15(2):183e186.

26. Rahimi-Movaghar V, Yazdi A, Karimi M, et al. Effect of decompression on complete spinal cord injury in rats. Int J Neurosci. 2008;118(10):1359e1373.

27. Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine (Phila Pa 1976). 2003;28(1): 33e39.

28. McLain RF, Benson DR. Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine (Phila Pa 1976). 1999;24(16):1646e1654.

29. Fehlings MG, Agrawal S. Role of sodium in the pathophysiology of secondary spinal cord injury. Spine (Phila Pa 1976). 1995;20(20):2187e2191.

30. Genovese T, Mazzon E, Esposito E, et al. Role of endogenous glutathione in the secondary damage in experimental spinal cord injury in mice. Neurosci Lett. 2007;423(1):41e46.

31. Carlson SL, Parrish ME, Springer JE, Doty K, Dossett L. Acute inflammatory response in spinal cord following impact injury. Exp Neurol. 1998;151(1):77e88.

32. Dimar 2nd JR, Glassman SD, Raque GH, Zhang YP, Shields CB. The influence of spinal canal narrowing and timing of decompression on neurologic recovery after spinal cord contusion in a rat model. Spine (Phila Pa 1976). 1999;24(16): 1623e1633.

33. Rabinowitz RS, Eck JC, Harper CM, et al. Urgent surgical decompression compared to methylprednisolone for the treatment of acute spinal cord injury: a randomized prospective study in beagle dogs. Spine (Phila Pa 1976). 2008;33(21):2260e2268.

34. Fehlings MG, Tator CH. An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neurosurg. 1999;91(Suppl. 1):1e11.

35. Delamarter RB, Sherman J, Carr JB. Pathophysiology of spinal cord injury. recovery after immediate and delayed decompression. J Bone Joint Surg Am. 1995;77(7):1042e1049.

36. Guha A, Tator CH, Endrenyi L, Piper I. Decompression of the spinal cord improves recovery after acute experimental spinal cord compression injury. Paraplegia. 1987;25(4):324e339.

37. Grossman RG, Frankowski RF, Burau KD, et al. Incidence and severity of acute complications after spinal cord injury. J Neurosurg Spine. 2012;17(Suppl.1): 119e128.

38. McKinley W, Meade MA, Kirshblum S, Barnard B. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil. 2004;85(11):1818e1825.

39. Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Murphy T, Tepas JJ. The effect of early spine fixation on non-neurologic outcome. J Trauma. 2005;58(1): 15e21.

40. Tator CH. Review of treatment trials in human spinal cord injury: issues, dif- ficulties, and recommendations. Neurosurgery. 2006;59(5):957e982.
Acta Orthopaedica et Traumatologica Turcica-Cover
  • ISSN: 1017-995X
  • Başlangıç: 2015
  • Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
Sayıdaki Diğer Makaleler

Long-term functional, subjective and psychological results after single digit replantation

Jing CHENA, Ai Xian ZHANGB, Qing Zhong CHENA, Jun TANA

Proinflammatory biomarkers' level and functional genetic polymorphisms in periprosthetic joint infection

Bülent ERDEMLİA, Emre Anıl OZBEKA, Kerem BASARİRA, Zeynep Ceren KARAHANB, Duygu OCALC, Derya BİRİKENB, Received April APRİL, Accepted November NOVEMBER

Single-incision Eden-Lange procedure in trapezius muscle paralysis: A report of 11 cases

Morteza Nakhaei AMROODİ, Mostafa SALARİYEH

Incredible position of broken sliding dynamic hip screw implant in the medial of thigh

Saeed SOLOOKİ, Amir Reza VOSOUGHİ

Do subscapularis tears really result in superior humeral migration?

Mehmet CETİNKAYAA, Muhammet Baybars ATAOGLUB, Mustafa OZERC, Tacettin AYANOGLUD, Ali Yusuf ONERE, Ulunay KANATLI

Radiological and clinical outcomes of medial approach open reduction by using two intervals in developmental dysplasia of the hip

Afsar T. OZKUTA, Yusuf IYETİNB, Omer K. UNALC, M. Salih SOYLEMEZD, Esat UYGURE, Irfan ESENKAYAE

Impact of echocardiography on one-month and one-year mortality of intertrochanteric fracture patients

MAHMUT KALEM, HAKAN KOCAOĞLU, ERCAN ŞAHİN, Merve H. KOCAOGLU, KEREM BAŞARIR, HÜSEYİN HAKAN KINIK

Brucella infection following total joint arthroplasty: A systematic

Jong Hun KİM, Dong-Woo LEE, Hyun-Soo a a PARK, Seung-Ju KİM

Anatomy of Master Knot of Henry: A morphometric study on cadavers

ORHAN BEGER, ÖZLEM ELVAN, Mert KESKİNBORA, Burçin ÜN, DENİZ UZMANSEL, ZELİHA KURTOĞLU OLGUNUS

The ultrasonography evaluation of talar dysplasia as a potential prognostic factor for predicting the course and outcomes of clubfoot deformity treatment using Ponseti technique

Jirí JOCHYMEK, Jakub TUREK