TRAUMATIC CERVICAL SPINAL CORD INJURY. IS URGENT INTERVENTION SUPERIOR TO DELAYED INTERVENTION? A META-ANALYSIS EVALUATION
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Introduction: Cervical spine is the most mobile part of the human spine, thus making it the most vulnerable compared to all the other vertebral structures. Surgical procedures are usually performed within the first 24 hours, or 4-6 weeks after trauma in order to prevent any secondary trauma. The research was conducted to evaluate the amount of time of the surgical procedure towards the effectivity and improvement of the neurological status in the cervical injury or acute spinal cord injury (ASCI).
Methods: A meta-analysis research which evaluate the effectivity of surgical procedure on cervical trauma/ASCI, with the database procured from PubMed, Embase, and Cochrane. The main parameter is the decompression procedure and the clinical outcome which were categorized. The time of surgery or decompression are categorized into "<24 hours” and ">24 hours”, the neurological outcome is categorized into "improvement” and "no improvement”. The data was presented in odd ratio (OR) and confidence interval (CI) and were further analyzed by forest plot.
Results: From PubMed, there were 353 articles, Embase 2 articles, and Cochrane 594 articles, but only 3 articles which fulfilled the inclusion criteria. The comparison between the surgical procedure in the cervical <24 hours with the surgical procedure >24 hours was identified for this research. Statistically, there was a significant difference on the neurological status (OR=1,85; 95%CI=1,21-2,84; p<0,01).
Conclusion: With meta-analysis background, early decompressive procedure <24 hours for cervical trauma patients produced a significantly better result in improving the neurological status compared to the late decompressive procedure >24 hours.Hadley MN, Walters BC, Aarabi B, Dhal SS, Gelb DE, Hurlbert RJ, et al. Clinical assessment following acute cervical spinal cord injury. Neurosurgery. 2013; 72 (2): 40–53.
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