Timing of decompression in patients with acute spinal cord injury: a systematic review

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dc.contributor.authorWilson, Jefferson R.
dc.contributor.authorTetreault, Lindsay A.
dc.contributor.authorKwon, Brian K.
dc.contributor.authorArnold, Paul M.
dc.contributor.authorMroz, Thomas E.
dc.contributor.authorShaffrey, Christopher
dc.contributor.authorHarrop, James S.
dc.contributor.authorChapman, Jens R.
dc.contributor.authorCasha, Steve
dc.contributor.authorSkelly, Andrea C.
dc.contributor.authorHolmer, Haley K.
dc.contributor.authorBrodt, Erika D.
dc.contributor.authorFehlings, Michael G.
dc.contributor.funderAOSpine
dc.contributor.funderAmerican Association of Neurological Surgeons
dc.contributor.funderCongress of Neurological Surgeons
dc.contributor.funderGerald and Tootsie Halbert Chair in Neural Repair and Regeneration
dc.contributor.funderDeZwirek Family Foundation
dc.contributor.funderKrembil Foundation
dc.date.accessioned2018-06-15T11:47:13Z
dc.date.available2018-06-15T11:47:13Z
dc.date.issued2017
dc.description.abstractStudy 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.en
dc.description.sponsorshipKrembil Foundation (Postdoctoral Fellowship Award); American Association of Neurological Surgeons/Congress of Neurological Surgeons (Neurotrauma and Critical Care)en
dc.description.statusPeer reviewed
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationWilson, J. R., Tetreault, L. A., Kwon, B. K., Arnold, P. M., Mroz, T. E., Shaffrey, C., Harrop, J. S., Chapman, J. R., Casha, S., Skelly, A. C., Holmer, H. K., Brodt, E. D. and Fehlings, M. G. (2017) 'Timing of decompression in patients with acute spinal cord injury: a systematic review', Global Spine Journal, 7(3S), pp. 95S-115S. doi: 10.1177/2192568217701716en
dc.identifier.doi10.1177/2192568217701716
dc.identifier.endpage115S
dc.identifier.issn2192-5682
dc.identifier.journaltitleGlobal Spine Journalen
dc.identifier.startpage95S
dc.identifier.urihttps://hdl.handle.net/10468/6334
dc.identifier.volume7
dc.language.isoenen
dc.publisherSage Publishingen
dc.relation.urihttp://journals.sagepub.com/doi/10.1177/2192568217701716
dc.rights© 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).en
dc.rights.urihttp://www.creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectTiming of surgeryen
dc.subjectSpinal cord injuryen
dc.subjectSystematic reviewen
dc.titleTiming of decompression in patients with acute spinal cord injury: a systematic reviewen
dc.typeReviewen
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