Surgical intervention ≤ 24 hours versus > 24 hours after injury for the management of acute traumatic central cord syndrome: a systematic review and meta-analysis

Othman Bin-Alamer Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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Jumanah Qedair College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia;

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Hussam Abou-Al-Shaar Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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Arka N. Mallela Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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Kishore Balasubramanian Texas A&M University College of Medicine, Houston, Texas;

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Nada Alnefaie Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia;

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Abdul Rahman Abou Al-Shaar College of Medicine, AlMaarefa University, Dariyah, Saudi Arabia; and

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Tritan Plute Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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Victor M. Lu Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida

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David J. McCarthy Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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Daryl P. Fields Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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Nitin Agarwal Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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Peter C. Gerszten Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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D. Kojo Hamilton Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

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OBJECTIVE

The objective was to evaluate the efficacy, outcomes, and complications of surgical intervention performed within 24 hours (≤ 24 hours) versus after 24 hours (> 24 hours) in managing acute traumatic central cord syndrome (ATCCS).

METHODS

Articles pertinent to the study were retrieved from PubMed, Scopus, Web of Science, and Cochrane. The authors performed a systematic review and meta-analysis of treatment procedures and outcomes according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines.

RESULTS

Seven articles comprising 488 patients were included, with 188 (38.5%) patients in the ≤ 24-hour group and 300 (61.5%) in the > 24-hour group. Significant differences were not found between groups in terms of demographic characteristics, injury mechanism, spinal cord compression level, neuroimaging features, and the American Spinal Injury Association (ASIA) motor score at admission. Both groups had a similar approach to surgery and steroid administration. The surgical complication rate was significantly higher in the > 24-hour group (4.5%) compared to the ≤ 24-hour group (1.2%) (p = 0.05). Clinical follow-up duration was similar at 12 months (interquartile range 3–36) for both groups (p > 0.99). The ≤ 24-hour group demonstrated a not statistically significant greater improvement in ASIA motor score, with a mean difference of 12 (95% CI −20.7 to 44.6) compared to the > 24-hour group.

CONCLUSIONS

The present study indicates potential advantages of early (≤ 24 hours) surgery in ATCCS patients, specifically in terms of lower complication rates. However, further research is needed to confirm these findings and their clinical implications.

ABBREVIATIONS

ASIA = American Spinal Injury Association; ATCCS = acute traumatic central cord syndrome; IQR = interquartile range; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Supplementary Materials

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