259 Ultra-early (8 Hours) Surgery for Thoracic Spinal Cord Injuries: A Systematic Review and Meta-analysis

Abstract

INTRODUCTION: The impact of the timing of surgery on neurological recovery in thoracic 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. 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 2015-2018. 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 standardized mean difference (SMD). Outcomes were reported as effect size, treatment effect, and effect difference, all with 95% confidence intervals (CI). RESULTS: 133 patients were included from 5 studies. 76 (57.1%) underwent decompression = 8 hrs, 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 < 0.0001]. On arm-based meta-analysis, a statistically significant treatment effect was found for 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 two arms [0.96(0.49-1.48)]. CONCLUSIONS: This study observed a significant improvement in mean AIS score in patients undergoing decompression within 8 hours of tSCI. Given the scanty 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.