Table 1.
Summary Table of Neurological Outcomes Between Early (≤24 Hours) and late (>24 Hours) Decompression by Neurological Level of Injury (Modified From Wilson JR, Tetreault LA, Kwon BK, et al. Global Spine J. 2017;7(3 suppl):95S-115S).
| First Author, Year Study Design |
Measure | Early (≤24 Hours) | Late (>24 Hours) | Effect Size |
|---|---|---|---|---|
| Cervical SCI | ||||
| Fehlings, 2012 | AIS Improvement at 6 | n = 131 | n = 91 | ORadj a: |
| Prospective cohort study months | ≥1 grade improvement | 74 (56.5) | 45 (49.5) | 1.37 (95% CI 0.80 to 2.57), P = .31 |
| ≥2 grade improvement | 26 (19.8) | 8 (8.8) | 2.83 (95% CI 1.10 to 7.28), P = .03 | |
| Cervical and thoracic and lumbosacral SCI | ||||
| Dvorak, 2015 | AIS Improvement | Adjusted estimatesb | ||
| Prospective cohort study | “Improved score” in AIS A patients | n = NR | n = NR | Beta: 0.068 (95% CI −0.625 to 0.76); P = .848 |
| IRR: 1.07 (95% CI 0.54 to 2.14) | ||||
| “Improved score” in AIS B, C, and D patients | n = NR | n = NR | Beta: 6.258 (95% CI 0.618 to 11.897); P = .03 | |
| IRR: 522.17 (95% CI 1.855 to 146825.5) | ||||
| Wilson, 2012 | AIS improvement (preoperative to acute care discharge [mean 24.8 ± 29.2 days]) | n = 33 | n = 49 | Unadjusted RR |
| Prospective cohort study | ≥1 grade improvement, n (%) | 7 (21.2) | 9 (18.4) | 1.15 (95% CI 0.48 to 2.79), P = .7499 |
| ≥ 2 grade improvement, n (%) | 3 (9.1) | 1 (2.0) | 4.45 (95% CI 0.48 to 41.0), P = .2974 | |
| AIS improvement (preoperative to inpatient rehabilitation discharge [mean 89.6 ± 47.4 days]) | n = 22 | n = 33 | Unadjusted RR: | |
| ≥1 grade AIS improvement, n (%) | 9 (40.9) | 10 (30.3) | 1.33 (95% CI 0.61 to 2.93), P = .4700 | |
| ≥2 grade AIS improvement, n (%) | 6 (27.2) | 1 (3.0) | 8.9 (95% CI 1.12 to 70.64), P= .0154 | |
| AIS Motor Score improvement (mean) | 6.2 | 9.7 | P = .18 | |
| Multivariate analysis predicting change in AIS Motor Score at rehabilitation discharge | NR | NR | Adjusted effect estimatec = 13.0, P = .01 | |
| Thoracolumbar SCI | ||||
| Rahimi-Movghar, 2014 | ASIA Impairment Grade at 12 months | n = 16 | n = 19 | RR: |
| RCT | ≥1 grade improvement, n (%) | 5 (31.2) | 7 (44) | 0.85 (95% CI 0.33 to 2.16) |
| ≥2 grade improvement, n (%) | 3 (18.1) | 1 (5.2) | 3.56 (95% CI 0.41 to 30.99) | |
| Difference in means | ||||
| Mean change (±SD) from baseline in motor score improvementd | 15 (±14.34) | 14 (±13.3) | 1 (95% CI −8.5 to 10.5, P = .8320) | |
| Wilson, 2018 Retrospective cohort study involving prospective data |
Total Motor Score improvement at mean of 8 months | n = 25 | N = 43 | Unadjusted Beta: 7.74 (95% CI: 0.58 to 14.88), P = .03 |
| eAdjusted Beta: 7.01 (95% CI: 1.14-13.03), P = .02 | ||||
| Acute central cord injury without instability | ||||
| Lenehan, 2010 | n = 17 | n = 56 | ORadj f | |
| Prospective observational study | AIS improvement at 6 monthsc | NR | NR | 3.39 (95% CI 0.75 to 15.34), P = .1131 |
| AIS improvement at 12 monthsc |
NR | NR | 2.81 (95% CI 0.48 to 16.60), P= .2548 | |
| Total Motor Score improvement at 6 months | NR | NR | Group differencef: | |
| 7.47 (95% CI −0.04 to 14.91), P = .0511 | ||||
| Total Motor Score improvement at 12 months | NR | NR | 6.31 (95% CI 0.44 to 12.18), P = .0359 | |
Abbreviations: ASIA, American Spinal Injury Association; AIS, ASIA Impairment Score; CI, confidence interval; NR, not reported; OR, odds ratio; IRR, incidence rate ratio; RR, risk ratio; SCI, spinal cord injury.
aOdds ratio adjusted for preoperative neurological status and steroid administration.
bAuthors reported estimates adjusted for age, injury severity score, and injury type.
cControlling for neurological level of injury and baseline neurological status, an additional 13 points in motor recovery was seen in patients treated within 24 hours of injury compared with those who underwent late decompression.
dAuthors report no improvement in mean AIS motor score for either early or late decompression in patient with complete SCI. In contrast, improvement was observed in both groups in patients with incomplete SCI; data are not provided for comparison between early and late.
eAdjusted for baseline AIS grade and MPSS (methylprednisolone sodium succinate) administration.
fAuthors report that regression with propensity scoring was done to adjust for potential selection bias; however, details were not provided.