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Spine (Phila Pa 1976). 2006 May 15;31(11 Suppl):S28-35; discussion S36.

The timing of surgical intervention in the treatment of spinal cord injury: a systematic review of recent clinical evidence.

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  • 1Division of Neurosurgery and Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.

Abstract

STUDY DESIGN:

Evidence-based literature review.

OBJECTIVE:

To provide updated evidence-based recommendations regarding spinal cord decompression in patients with acute spinal cord injury (SCI).

SUMMARY OF BACKGROUND DATA:

It is controversial whether early decompression following SCI conveys a benefit in neurologic outcome.

METHODS:

MEDLINE search of experimental and clinical studies showing the effect of decompression on neurologic outcome following SCI. We focused on articles published within the last 10 years, with a particular emphasis on research conducted within the past 5 years.

RESULTS:

A total of 66 articles were retrieved. Animal studies consistently show that neurologic recovery is enhanced by early decompression. There was 1 randomized controlled trial that showed no benefit to early (<72 hours) decompression. Several recent prospective series suggest that early decompression (<72 hours) can be performed safely and may improve neurologic outcomes. A recent systematic review showed that early decompression (<24 hours) resulted in statistically better outcomes compared to both delayed decompression and conservative treatment.

CONCLUSIONS:

There are currently no standards regarding the role and timing of decompression in acute SCI. We recommend urgent decompression of bilateral locked facets in a patient with incomplete tetraplegia or in a patient with SCI with neurologic deterioration. Urgent decompression in acute cervical SCI remains a reasonable practice option and can be performed safely. There is emerging evidence that surgery within 24 hours may reduce length of intensive care unit stay and reduce post-injury medical complications.

PMID:
16685233
[PubMed - indexed for MEDLINE]
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