El Tecle Najib E, Dahdaleh Nader S, Hitchon Patrick W
Department of Neurological Surgery, St. Louis University School of Medicine, St Louis, MO.
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Spine (Phila Pa 1976). 2016 Aug 15;41(16):E995-E1004. doi: 10.1097/BRS.0000000000001517.
A systematic review of the literature for clinical and preclinical evidence related to timing of decompression following spinal cord injury (SCI).
A review of the literature in search of consensus on what constitutes the ideal time frame for surgical management of SCI.
Optimal timing for surgical management of SCI remains poorly defined. Despite multiple preclinical and clinical studies, there is still lack of consensus on the optimal time for surgery in SCI.
We systematically reviewed the literature for clinical and preclinical evidence related to timing of decompression following SCI. For clinical studies, our review included papers published in English after January 1, 1990. For preclinical studies, we limited our review to papers published after January 2001. The OVID-Medline and Web of Science databases were reviewed for preclinical studies, and the OVID-Medline, Cochrane, and Embase databases were reviewed for clinical studies.
A total of 8792 preclinical articles were identified. Of those, only 14 met our inclusion criteria and were included in the analysis. A total of 25,190 clinical articles were identified. Of those, only 30 studies met our inclusion criteria and were included for analysis. Clinical studies reported on a total of 5236 patients, of whom 1665 underwent early decompression and 3571 underwent late decompression. There was significant variability in the definition of early and late decompression in both clinical and preclinical studies. Preclinical data were in favor of early decompression. From a clinical standpoint, there was only level II evidence proving safety and feasibility of early decompression with no definite evidence of improved outcome for any of the two groups.
There is growing evidence in favor of early decompression following SCI. Early decompression was proven to be clinically safe and feasible, but there is still no definite proof that early decompression leads to improved outcomes.
对与脊髓损伤（SCI）后减压时机相关的临床和临床前证据进行文献系统综述。
回顾文献，以寻求关于SCI手术治疗理想时间框架的共识。
SCI手术治疗的最佳时机仍未明确界定。尽管有多项临床前和临床研究，但对于SCI手术的最佳时机仍缺乏共识。
我们系统回顾了与SCI后减压时机相关的临床和临床前证据的文献。对于临床研究，我们的综述包括1990年1月1日之后以英文发表的论文。对于临床前研究，我们将综述限于2001年1月之后发表的论文。对OVID-Medline和科学网数据库进行了临床前研究综述，对OVID-Medline、Cochrane和Embase数据库进行了临床研究综述。
共识别出8792篇临床前文章。其中，只有14篇符合我们的纳入标准并纳入分析。共识别出25190篇临床文章。其中，只有30项研究符合我们的纳入标准并纳入分析。临床研究共报道了5236例患者，其中1665例接受早期减压，3571例接受晚期减压。临床和临床前研究中早期和晚期减压的定义存在显著差异。临床前数据支持早期减压。从临床角度来看，只有II级证据证明早期减压的安全性和可行性，没有明确证据表明两组中的任何一组结局得到改善。
越来越多的证据支持SCI后早期减压。早期减压被证明在临床上是安全可行的，但仍没有明确证据表明早期减压能改善结局。
5级。
