• Yihang Ma, Yuhang Zhu, Boyin Zhang, Yuntao Wu, Xiangji Liu, and Qingsan Zhu.
• Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China.
• World Neurosurg. 2020 Aug 1; 140: e185-e194.

ObjectiveThe relationship between urgent decompression and neurologic recovery for traumatic spinal cord injury (TSCI) remains controversial. This meta-analysis was conducted to determine the beneficial effects of surgery within 8 hours for patients with TSCI.MethodsA systematic search in EMBASE, MEDLINE, Cochrane Library, and PubMed for relevant studies was conducted from the earliest records until December 2019. Studies that compared outcomes of early (<8 hours) surgery versus late (≥8 hours) surgery for patients with TSCI were selected for analysis.ResultsNine cohort studies involving 716 participants met the eligibility criteria. Early (<8 hours) surgery for patients showed a more significant improvement in American Spinal Injury Association scores (standardized mean difference, 0.75, 95% confidence interval [CI], 0.51-0.99; P < 0.05). Especially for patients with initial complete TSCI, neurologic improvement rate significantly increased in the early surgery group (relative ratio [RR], 3.96; 95% CI, 2.02-7.76; P < 0.05), whereas in patients with initial incomplete TSCI, no significant differences were found between the 2 groups in neurologic improvement rate (RR, 1.41; 95% CI, 0.95-2.10; P > 0.05). There were no significant differences between the 2 groups in length of hospital stay (standardized mean difference, 0.34; 95% CI, -0.24 to 0.92; P > 0.05) and complications (RR, 0.92; 95% CI, 0.70-1.22; P > 0.05).ConclusionsThis meta-analysis provides evidence of benefits from urgent (<8 hours) decompression for patients with TSCI in terms of neurologic recovery. The improvement effect is more definite in patients with initial complete TSCI.Copyright © 2020 Elsevier Inc. All rights reserved.

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