Performing surgery to take pressure off the spine soon after a traumatic injury could prevent or reverse secondary damage caused by swelling and decreased blood flow to the injured spine. However, strong evidence to support early surgery is lacking because available data cannot be easily compared, according to a recent study published in the Journal of Neurotrauma.
In their systematic review and quality-adjusted meta-analysis, researchers examined the MEDLINE database from 1966 to August 2012 and used a 15-item, tailored scoring system to assess the included studies’ susceptibility to bias.
In 18 studies analyzed, early spinal surgery was significantly associated with a higher total motor score improvement in seven studies, neurological improvement rate in six studies and shorter length of hospital stay in six studies when compared with later surgery. However, researchers found a profound lack of robustness among pooled estimates through one-way and criterion-based sensitivity analyses, due to various sources of bias within the studies and heterogeneity among the studies.
“Despite the fact that “early” spinal surgery was significantly associated with improved neurological and length of stay outcomes, none of these positive associations were robust, as demonstrated through sensitivity analyses. Moreover, funnel plots showed significant proof of publication bias. Therefore, the authors’ verdict is that because of different sources of heterogeneity within and between original studies, there is no robust evidence supporting “early” spinal surgery after tSCI [traumatic spinal cord injury],” the researchers concluded. “However, what evidence there is clearly supports early intervention. Where properly powered [randomized control trials] have proven to be an almost unfeasible study design for acute, surgical tSCI management… several approaches can be implemented in future nonrandomized studies, and subsequently diminish their susceptibility to bias.”
For more information:
van Middendorp JJ. J Neurotrauma. 2013;30:1781-1794.
Disclosure: The researchers have no relevant financial disclosures.
