Early Surgery (Within 24 Hours) Benefits Patients Suffering from Acute Thoracolumbar Spinal Cord Injury: A Meta-analysis.

ABSTRACT

STUDY DESIGN: A meta-analysis of early surgery for acute thoracolumbar spinal cord injury. OBJECTIVE: To evaluate whether early surgery increases the American Spinal Injury Association (ASIA) grade of patients confronted with acute thoracolumbar spinal cord injury. SUMMARY OF BACKGROUND DATA The idea that early surgery aids the recovery of spinal cord function in patients confronted with acute thoracolumbar spinal cord injury is controversial. METHODS: All articles were retrieved from the PubMed, Embase, Web of Science and Scopus databases, which were searched from onset until 1 May 2021. All data are presented as odds ratios (ORs) and mean deviations (MDs) with 95% confidential intervals (CIs). RESULTS: Ten studies, including 6 prospective studies, 3 retrospective studies, and 1 randomized controlled trial, containing 952 patients, were included in the analysis. The results showed that early surgery significantly reduced the number of patients with ASIA grade A (OR 0.27, 95% CI 0.13-0.58, P <0.01) and B (OR 0.56, 95% CI 0.39-0.82, P <0.01) status but greatly increased the number of patients with grade E status (OR 1.44, 95% CI 1.06-1.96, P <0.01). Generally, the patients receiving early surgery achieved >1 ASIA grade improvement (OR 1.70, 95% CI 1.31-2.21, P <0.01) or >2 ASIA grade (OR 3.55, 95% CI 2.20-5.70, P <0.01) improvements. Although early surgery did not reduce the incidence of operative complications (OR 0.72, 95% CI 0.45-1.16, P <0.01), the duration of hospitalization was greatly shortened (MD-3.48, 95% CI -0.45 to-2.91, P <0.01). CONCLUSIONS: The spinal cord function of acute thoracolumbar spinal cord injury patients can benefit from early decompression. This conclusion should be further verified with randomized controlled trials.