Impact of Time to Surgery on Neurological Recovery Following Traumatic Spinal Cord Injury: Systematic Review and Meta-analysis

Introduction: Traumatic spinal cord injury (TSCI) remains a leading cause of disability worldwide. The role of surgical timing regarding neurological recovery following acute TSCI remains unclear in the literature.

Methods: A comprehensive search of five databases (Ovid-Medline, Embase, Scopus, Web-of-Science, Cochrane Database of Systematic Reviews) was performed on October 12, 2023, to identify studies investigating neurological recovery depending on time to surgery following TSCI. Random-effects model meta-analysis was performed, with neurological improvement by time to surgery being our primary endpoint. Subgroup analysis by anatomic location was performed to assess neurological recovery in patients suffering cervical and thoracic TSCI.

Results: Thirty-six studies yielding 4,380 patients were identified, and time to surgery was reported based on the 24-hour timeframe in 2,373 patients. Mean age at the time of injury was 45.5 ± 165.9 years, and female patients comprised 22.5% (95%CI: 20.2 – 25%). The mean number of spinal cord segments affected was 2.9. The most common injury mechanisms included motor vehicle accidents (43.6%, 95%CI: 36.1 – 51.3%), and falls (41.7%, 95%CI: 34.5 – 49.2%). Arthrodesis was performed in 58.3% of patients (95%CI: 29.5 – 84.4%). Neurological improvement was observed in 51.9% (95%CI: 39-64.6%) of patients treated within 24 hours, and 36.8% (95%CI: 26-48.1%) of patients treated later (p=0.09). Neurological recovery rates did not significantly differ between patients with cervical (p=0.09) and thoracic TSCI (p=0.4) treated within 24 hours versus later. Lastly, no significant differences were noted regarding other surgical timeframes, including surgery within 8 hours versus later (p=0.1), and surgery within 48 hours versus later (p=0.5).

Conclusion : Among patients undergoing surgery following TSCI, and given the limitations pertaining to the quality of data in the published literature, we did not detect a statistically significant difference in neurological recovery rates between patients treated within 24 hours after TSCI versus later. Our analysis highlights the need to reconsider the benefits of early versus late surgery in patients suffering TSCI.