This study aimed to investigate whether early surgical decompression was associated with favorable neurological recovery in patients with traumatic spinal cord injury (tSCI). We searched PubMed and Embase from the database inception through December 2020 and selected studies comparing the impact of early versus late surgical decompression on neurological recovery as assessed by American Spinal Injury Association Impairment Scale (AIS) for adult patients sustaining tSCI. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I² statistics. Subgroup analysis and meta-regression analysis was conducted to identify significant outcome moderator. We included 26 studies involving 3574 patients in the meta-analysis. The pooled results demonstrated significant association between early surgical decompression and an improvement of at least one AIS grade (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.41-2.41; I², 48.06%). The benefits of early surgical decompression were consistently observed across different subgroups, including patients with cervical or thoracolumbar injury and patients with complete or incomplete injury. The meta-regression analysis indicated that cut-off timing defining early versus late decompression was a significant effect moderator, with early decompression performed before post-tSCI 8 or 12 h associated with greatest benefits (OR, 3.37; 95% CI, 1.74-6.50; I², 53.52%). No obvious publication bias was detected by the funnel plot. In conclusion, early surgical decompression was associated with favorable neurological recovery for tSCI patients. However, there was a lack of high-quality evidence and the results need further examination.

中文翻译：

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创伤性脊髓损伤的早期与晚期手术减压对神经恢复的影响：系统评价和荟萃分析

本研究旨在探讨早期手术减压是否与创伤性脊髓损伤（tSCI）患者的良好神经功能恢复相关。我们检索了 PubMed 和 Embase 从数据库建立到 2020 年 12 月的数据，并选择了一些研究，比较了早期与晚期手术减压对神经功能恢复的影响，并根据美国脊柱损伤协会损伤量表 (AIS) 对持续 tSCI 的成年患者进行了评估。我们汇总了随机效应模型中的效应估计，并通过I ²统计量量化了异质性。进行亚组分析和荟萃回归分析以确定显着的结果调节因素。我们在荟萃分析中纳入了涉及 3574 名患者的 26 项研究。汇总结果表明，早期手术减压与至少一个 AIS 等级的改善之间存在显着相关性（优势比 [OR]，1.85；95% 置信区间 [CI]，1.41-2.41；I 2 ，48.06 % ^）。在不同的亚组中，包括颈椎或胸腰椎损伤的患者以及完全或不完全损伤的患者，一致地观察到早期手术减压的益处。荟萃回归分析表明，定义早期减压与晚期减压的截止时间是一个显着的效应调节因素，在 tSCI 后 8 或 12 小时之前进行早期减压与最大获益相关（OR，3.37；95% CI，1.74-6.50） ; I ² , 53.52%)。漏斗图未检测到明显的发表偏倚。总之，早期手术减压与 tSCI 患者的良好神经功能恢复相关。但缺乏高质量证据，结果有待进一步检验。