Timing of Decompressive Surgery in Patients With Acute Spinal Cord Injury: Systematic Review Update

Global Spine Journal, 2024 · DOI: 10.1177/21925682231197404 · Published: March 1, 2024

Spinal Cord Injury Surgery Research Methodology & Design

Simple Explanation

Traumatic spinal cord injury (SCI) leads to permanent sensorimotor impairment, decreased quality of life, and immense social as well as economic costs. Surgical decompression is a cornerstone in the management of patients with SCI; however, the inﬂuence of the timing of surgery on neurological recovery after acute SCI remains controversial. This systematic review update aims to critically appraise and summarize current evidence on the effectiveness, safety, and cost-effectiveness of early (≤24 hours) or late (>24 hours) surgery in patients with acute traumatic SCI, for all levels of the spine.

Study Duration

Not specified

Participants

Twenty-one studies

Evidence Level

Systematic review and meta-analysis

Key Findings

1
Patients were 2 times more likely to recover by ≥2 grades on the ASIA Impairment Score (AIS) at 6 months and 12 months if they were decompressed within 24 hours compared to after 24 hours.
2
Patients receiving early decompression had an additional 4.50 point improvement on the ASIA motor score.
3
Early decompression may decrease acute hospital length of stay.

Research Summary

This review provides an evidence base to support the update on clinical practice guidelines related to the timing of surgical decompression in acute SCI. Overall, the strength of evidence was moderate that early surgery (≤24 hours from injury) compared to late (>24 hours) results in clinically meaningful improvements in neurological recovery. Further studies are required to delineate the role of ultra-early surgery in patients with acute SCI.

Practical Implications

Clinical Practice Guidelines

The evidence supports updating clinical practice guidelines to reflect the benefits of early surgical decompression (≤24 hours) for acute SCI.

Surgical Timing

Early surgical decompression (≤24 hours) should be considered to improve neurological recovery in patients with acute SCI.

Future Research

Further research is needed to determine the role of ultra-early surgery (earlier than 24 hours from injury) in patients with acute SCI.

Study Limitations

1
Variability in injury levels and severity of SCI across studies
2
Limited and unclear reporting of some major adverse events in studies
3
Possibility of publication bias and/or selective outcome reporting cannot be ruled out

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