https://scholars.lib.ntu.edu.tw/handle/123456789/597687
標題: | Early versus Late Surgical Decompression for Traumatic Spinal Cord Injury on Neurological Recovery: A Systematic Review and Meta-Analysis | 作者: | Hsieh, Yu-Lin Tay, Joyce SHU-HSIEN HSU Chen, Wei-Ting Fang, Yao-De Liew, Chiat-Qiao Chou, Eric H Wolfshohl, Jon d'Etienne, James CHIH-HUNG WANG FON-YIH TSUANG |
關鍵字: | decompression; meta-analysis; spinal cord injury; surgery; systematic review; time factor | 公開日期: | 2021 | 出版社: | MARY ANN LIEBERT, INC | 卷: | 38 | 期: | 21 | 起(迄)頁: | 2927 | 來源出版物: | Journal of neurotrauma | 摘要: | 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. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/597687 | ISSN: | 0897-7151 | DOI: | 10.1089/neu.2021.0102 | SDG/關鍵字: | American Spinal Injury Association impairment scale; cervical spine injury; clinical examination; comparative study; decompression surgery; disease severity; human; meta analysis; quality control; Review; spinal cord injury; systematic review; thoracolumb |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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