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Ultra-early (≤8 hours) surgery for thoracolumbar spinal cord injuries: A systematic review and meta-analysis – Lumbar Spinal Stenosis

This article is a systematic review and meta-analysis that explores the impact of ultra-early decompression surgery on clinical outcomes in thoracolumbar spinal cord injuries (tSCI). The study analyzed data from human studies and compared the outcomes of patients who underwent surgery within 8 hours of injury with those who had surgery after 8 hours. The results showed that patients in the ultra-early group had a significant improvement in mean AIS score compared to the control group. The study concludes that early interventions, such as ultra-early decompression, may play a crucial role in improving patient outcomes for tSCI

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSIONS: This study observed a significant improvement in the mean AIS score in patients undergoing decompression within 8 hours of tSCI. Given the scant literature regarding ultra-early decompression of tSCI, this study solidifies the need to further explore the role of early interventions for tSCIs to improve patient outcomes.

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N Am Spine Soc J. 2023 Oct 5;16:100285. doi: 10.1016/j.xnsj.2023.100285. eCollection 2023 Dec.ABSTRACTBACKGROUND: The impact of the timing of surgery on neurological recovery in thoracolumbar spinal cord injuries (tSCI) is still a subject of discussion. Accumulating evidence is supporting early decompression (8 hours of injury. The authors included the study data from their institutional case,

N Am Spine Soc J. 2023 Oct 5;16:100285. doi: 10.1016/j.xnsj.2023.100285. eCollection 2023 Dec.

ABSTRACT

BACKGROUND: The impact of the timing of surgery on neurological recovery in thoracolumbar spinal cord injuries (tSCI) is still a subject of discussion. Accumulating evidence is supporting early decompression (<24 hours) following tSCI. However, the potential advantages of earlier decompression remain uncertain. This systematic review and meta-analysis summarize and analyze the current evidence on the effectiveness of ultra-early decompression surgery on clinical outcomes following tSCI.

METHODS: A search was conducted in the electronic databases Medline, Embase, Scopus, and Web of Science from their inception until May 2022 for human studies. Groups were stratified into ultra-early (surgery within 8 hours of injury) vs control group operated >8 hours of injury. The authors included the study data from their institutional case series of thoracolumbar spinal cord injury from 2015 to 2018. An arm-based meta-analysis was performed on all studies using the R Studio. For studies that qualified, a contrast-based meta-analysis was also performed with a standardized mean difference (SMD). Outcomes were reported as effect size, treatment effect, and effect difference, all with 95% confidence intervals (CI).

RESULTS: Of the 133 patients, 74.4% patients were male. 76 (57.1%) underwent decompression ≤8 hours, while 57 (42.9%) underwent decompression >8 hours from injury. Quantitative analysis using the SMD model showed a significant difference in mean AIS improvement in the ultra-early group (Effect size 1.15 [0.62-1.67], p<.0001). On arm-based meta-analysis, a statistically significant treatment effect was found for the ultra-early arm (1.25 [0.91-1.67]), while > 8-hour arm did not show significance (0.30 [-0.08-0.71]). There was a statistically significant effect difference between the two arms (0.96 [0.49-1.48]).

CONCLUSIONS: This study observed a significant improvement in the mean AIS score in patients undergoing decompression within 8 hours of tSCI. Given the scant literature regarding ultra-early decompression of tSCI, this study solidifies the need to further explore the role of early interventions for tSCIs to improve patient outcomes.

PMID:37942310 | PMC:PMC10628804 | DOI:10.1016/j.xnsj.2023.100285

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Ultra-early (≤8 hours) surgery for thoracolumbar spinal cord injuries: A systematic review and meta-analysis

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N Am Spine Soc J. 2023 Oct 5;16:100285. doi: 10.1016/j.xnsj.2023.100285. eCollection 2023 Dec.ABSTRACTBACKGROUND: The impact of the timing of surgery on neurological recovery in thoracolumbar spinal cord injuries (tSCI) is still a subject of discussion. Accumulating evidence is supporting early decompression (8 hours of injury. The authors included the study data from their institutional case

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