Neurosurgery Resident Department of Neurosurgery, Banner University Medical Center, Tucson, AZ University of Arizona Tucson Tucson, AZ, US
Disclosure(s):
Breanna L. Sheldon, MD, MS: No financial relationships to disclose
Introduction: Studies on acute spinal cord injury (SCI) from fracture or dislocation suggest surgery within 48 hours of injury maximizes neurologic recovery. However, the optimal timing of surgery for patients suffering SCI without fracture or dislocation (SCIwoFD) has not been established. Our experience suggests a need to critically re-evaluate the need for early surgery.
Methods: We conducted a systematic meta-analysis following PRISMA 2020 guidelines examining the difference in American Spinal Injury Association Motor Scores (AMS) from baseline to most recent follow-up in patients with SCIwoFD undergoing surgery early ( < 48-96 hours from injury) versus late (>48-96 hours from injury). Demographics were collected and analyzed via Chi square or unpaired t-test. A random effect meta-analysis was performed with a subgroup analysis on early versus late surgery, with standardized mean difference (SMD) as the effect size to compare baseline AMS with most recent follow-up.
Results: Seven studies met inclusion criteria with 210 patients undergoing early surgery and 279 undergoing late surgery. Demographic characteristics were similar between the two study populartions. One patient cohort of the seven included demonstrated significantly lower baseline AMS in the early surgery group compared to late (p < 0.001). Overall, a SMD of -1.12 (95% CI from -1.33 to -0.91) was found (I²=63.5%, p< 0.001), indicating improvement in AMS after surgery at any timepoint. When comparing SMD between subgroups, there was no significant difference in the improvement in AMS from baseline to follow-up between those who underwent early surgery versus late surgery (p=0.39, df=1). Two illustrative cases are provided.
Conclusion : While there is considerable heterogeneity in the data, there is no significant difference in neurologic recovery seen patients with SCIwoFD who undergo early surgical intervention compared to those who undergo surgery in a delayed fashion. Anecdotal experience underscores the need to critically re-examine timing of surgery in this population.
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