Eficacia de la descompresión medular precoz versus tardía en la recuperación neurológica tras lesión medular traumática. Revisión sistemática y metaanálisis

Abstract

Study design

Systematic review and meta-analysis.

Objective

To compare early (<24 h) versus late (>24 h) spinal cord decompression on neurological recovery in patients with acute spinal cord injury.

Methods

A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022.

Prospective cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the «forest plot» graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools.

Results

Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events.

Five studies showed significant differences in favor of early decompression (risk difference 0.10, 95% confidence interval 0.07–0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries.

Conclusion

There is scientific evidence to recommend early decompression in the first 24 h after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.