Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

Abstract

Study design: Definitive and unequivocal evidence to support the practice of early or late surgery is still lacking in clinical studies. Accordingly, meta-analysis is one of the few methods that offer a rational, statistical approach to management decision. A review of the clinical literature on spinal cord injury with emphasis on the role of early surgical decompression and a meta-analysis of results was performed. Objectives: To determine whether neurological outcome is improved in traumatic spinal cordinjured patients who had surgery within 24 h as compared with those who had late surgery or conservative treatment. Methods: A Medline search covering the period 1966-2000, supplemented with manual search, was used to locate studies containing information on indication, rationale and timing of surgical decompression after spinal cord injuries. The analysis included a total of 1687 eligible patients. Results: Statistically, early decompression resulted in better outcome compared with both conservative (Po0.001) and late management (Po0.001). Nevertheless, analysis of homogeneity showed that only data regarding patients with incomplete neurological deficits who had early surgery were reliable. Conclusions: Although statistically the percentage of patients with incomplete neurological deficits improving after early decompression appear 89.7% (95% confidence interval: 83.9, 95.5%), to be better than with the other modes of treatment when taking into consideration the material available for analysis and the various other factors including clinical limitations; early surgical decompression can only be considered as practice option for all groups of patients.

Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery

“…Nevertheless, patients of this study with a pronounced spinal canal encroachment did have a significantly higher risk of neurological deficits and confirmed by a majority of relevant literature [25,55,61,81]. Experimental [17,24,77] and clinical studies [19,27,49,68] substantiated that a rapid surgical decompression and spinal canal clearance from bony fragments in patients with incomplete neurological deficits renders beneficial results with a better outcome [12,40,55].…”

Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation

“…CSCI traumatic cervical spinal cord injury without major fracture or dislocation, HV healthy volunteers Compared with CSCI and HV * P \ 0.05, ** P \ 0.01, *** P \ 0.001 compression at the injured segment [18][19][20][21]. La Rosa and colleagues [19], in particular, reported that early decompression surgery within 24 h of trauma had a significantly better outcome, compared with late surgical management.…”

“…La Rosa and colleagues [19], in particular, reported that early decompression surgery within 24 h of trauma had a significantly better outcome, compared with late surgical management. On the other hand, Kawano and colleagues [22] reported that surgical treatment was not found to be superior to conservative treatment for traumatic CSCI without major fracture or dislocation with spinal cord compression in the acute phase.…”

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

“…Therefore, extrapolation of these results to the human clinical situation is doubtful since in patients surgical decompression is rarely preformed within several hours, the injury is never standardized and there is no diagnostic means to determine the exact type and severity of the neurologic injury. Nevertheless, several LOE I and II clinical studies support these findings in patients with spinal cord injury [17,18,28,35,39,55] and reviews recommend early surgery in spinal cord injury [2,16,36,41,44]. But there are also articles that report no difference in neurological outcome between early and late decompression [22,42,54].…”