Study Design: 

A meta-analysis of early surgery for acute thoracolumbar spinal cord injury.

Objective: 

To evaluate whether early surgery increases the American Spinal Injury Association (ASIA) grade of patients confronted with acute thoracolumbar spinal cord injury.

Summary of Background Data: 

The idea that early surgery aids the recovery of spinal cord function in patients confronted with acute thoracolumbar spinal cord injury is controversial.

Methods: 

All articles were retrieved from the PubMed, Embase, Web of Science and Scopus databases, which were searched from onset until 1 May 2021. All data are presented as odds ratios (ORs) and mean deviations (MDs) with 95% confidential intervals (CIs).

Results: 

Ten studies, including 6 prospective studies, 3 retrospective studies, and 1 randomized controlled trial, containing 952 patients, were included in the analysis. The results showed that early surgery significantly reduced the number of patients with ASIA grade A (OR 0.27, 95% CI: 0.13–0.58, P<0.01) and B (OR 0.56, 95% CI: 0.39–0.82, P<0.01) status but greatly increased the number of patients with grade E status (OR 1.44, 95% CI: 1.06–1.96, P<0.01). Generally, the patients receiving early surgery achieved >1 ASIA grade improvement (OR 1.70, 95% CI: 1.31–2.21, P<0.01) or >2 ASIA grade (OR 3.55, 95% CI: 2.20–5.70, P<0.01) improvements. Although early surgery did not reduce the incidence of operative complications (OR 0.72, 95% CI: 0.45–1.16, P<0.01), the duration of hospitalization was greatly shortened (MD−3.48, 95% CI: −0.45 to−2.91, P<0.01).

Conclusions: 

The spinal cord function of acute thoracolumbar spinal cord injury patients can benefit from early decompression. This conclusion should be further verified with randomized controlled trials.

中文翻译：

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早期手术（24 小时内）对急性胸腰段脊髓损伤患者有益：荟萃分析

学习规划： 

急性胸腰段脊髓损伤早期手术的荟萃分析。

客观的： 

评估早期手术是否会提高急性胸腰段脊髓损伤患者的美国脊柱损伤协会 (ASIA) 分级。

背景数据摘要： 

早期手术有助于急性胸腰段脊髓损伤患者恢复脊髓功能的观点存在争议。

方法： 

所有文章均从 PubMed、Embase、Web of Science 和 Scopus 数据库中检索，检索时间为从开始到 2021 年 5 月 1 日。所有数据均以比值比 (OR) 和平均偏差 (MD) 形式呈现，置信区间 (CI) 为 95% ）。

结果： 

分析纳入 10 项研究，包括 6 项前瞻性研究、3 项回顾性研究和 1 项随机对照试验，共纳入 952 名患者。结果显示，早期手术显着减少了 ASIA A 级（OR 0.27，95% CI：0.13–0.58，P <0.01）和 B 级（OR 0.56，95% CI：0.39–0.82，P <0.01）患者的数量。但 E 级状态的患者数量大大增加（OR 1.44，95% CI：1.06–1.96，P <0.01）。一般来说，接受早期手术的患者获得>1 ASIA等级改善（OR 1.70，95% CI：1.31-2.21，P <0.01）或>2 ASIA等级改善（OR 3.55，95% CI：2.20-5.70，P <0.01）改进。虽然早期手术并没有降低手术并发症的发生率（OR 0.72，95% CI：0.45～1.16，P <0.01），但住院时间大大缩短（MD−3.48，95% CI：−0.45～−2.91，P <0.01）。

结论： 

急性胸腰段脊髓损伤患者的脊髓功能可受益于早期减压。这一结论还需通过随机对照试验进一步验证。