Timing of Surgery in Spinal Cord Injury.

STUDY DESIGN A systematic review of the literature for clinical and preclinical evidence related to timing of decompression following spinal cord injury (SCI). OBJECTIVE A review of the literature in search of consensus on what constitutes the ideal time frame for surgical management of SCI. SUMMARY OF BACKGROUND DATA Optimal timing for surgical management of SCI remains poorly defined. Despite multiple preclinical and clinical studies, there is still lack of consensus on the optimal time for surgery in SCI. METHODS We systematically reviewed the literature for clinical and preclinical evidence related to timing of decompression following SCI. For clinical studies, our review included papers published in English after January 1, 1990. For preclinical studies, we limited our review to papers published after January 2001. The OVID-Medline and Web of Science databases were reviewed for preclinical studies, and the OVID-Medline, Cochrane, and Embase databases were reviewed for clinical studies. RESULTS A total of 8792 preclinical articles were identified. Of those, only 14 met our inclusion criteria and were included in the analysis. A total of 25,190 clinical articles were identified. Of those, only 30 studies met our inclusion criteria and were included for analysis. Clinical studies reported on a total of 5236 patients, of whom 1665 underwent early decompression and 3571 underwent late decompression. There was significant variability in the definition of early and late decompression in both clinical and preclinical studies. Preclinical data were in favor of early decompression. From a clinical standpoint, there was only level II evidence proving safety and feasibility of early decompression with no definite evidence of improved outcome for any of the two groups. CONCLUSION There is growing evidence in favor of early decompression following SCI. Early decompression was proven to be clinically safe and feasible, but there is still no definite proof that early decompression leads to improved outcomes. LEVEL OF EVIDENCE 5.