title: Early versus late spinal decompression surgery in treatment of traumatic spinal cord injuries; a systematic review and meta-analysis.
abstract: BACKGROUND
  Despite the vast number of surveys, no consensus has been reached on the optimum timing of spinal decompression surgery. This systematic review and meta-analysis aimed to compare the effects of early and latespinal decompression surgery on neurologic improvement and post-surgical complications in patients with traumatic spinal cord injuries.
  
  
  METHODS
  Two independent reviewers carried out an extended search in electronic databases. Data of neurological outcome and post-surgery complication were extracted. Finally, pooled relative risk (RR) with a 95% confidence interval (CI) was reported for comparing of efficacy of early and late surgical decompression.
  
  
  RESULTS
  Eventually 22 studies were included. The pooled RRwas 0.77 (95% CI: 0.68-0.89)for at least one grade neurological improvement, and 0.84 (95% CI: 0.77-0.92)for at least two grade improvement. Pooled RR for surgical decompression performed within 12 hours after the injury was 0.26 (95% CI: 0.13-0.52; p<0.001), while it was 0.75 (95% CI: 0.63-0.90; p=0.002) when the procedure was performed within 24 hours, and 0.93 (95% CI: 0.76-1.14; p=0.48) when it was carried out in the first 72 hours after the injury. Surgical decompression performed within 24 hours after injury was found to be associated with significantly lower rates of post-surgical complications (RR=0.77; 95% CI: 0.68-0.86; p<0.001).
  
  
  CONCLUSIONS
  The findings of this study indicate that early spinal decompression surgery can improve neurologic recovery and is associated with less post-surgical complications. The optimum efficacy is observed when the procedure is performed within 12 hours of the injury.
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University ofMedical Sciences, Tehran, Iran.; Physiology Research Center and Department of Physiology, Faculty ofMedicine, Iran University ofMedical Sciences, Tehran, Iran.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Yousefifard
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University ofMedical Sciences, Tehran, Iran.
authors.forename: Vafa
authors.initials: V
authors.lastname: Rahimi-Movaghar
authors.affiliation: Department ofMedicine, School ofMedicine, Tehran University ofMedical Sciences, Tehran, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Baikpour
authors.affiliation: Department of Intensive Care Nursing, School of Nursing andMidwifery, Tehran University ofMedical Sciences, Tehran, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Ghelichkhani
authors.affiliation: Pediatric Chronic Kidney Diseases Research Center, Children's HospitalMedical Center, Tehran University ofMedical Sciences, Tehran, Iran; Sina Trauma and Surgery Research Center, Tehran University ofMedical Sciences, Tehran, Iran.; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University ofMedical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Hosseini
authors.affiliation: Department of EmergencyMedicine, School ofMedicine, Bushehr University ofMedical Sciences, Bushehr, Iran.
authors.forename: AliMoghadas
authors.initials: A
authors.lastname: Jafari
authors.affiliation: The Persian Gulf TropicalMedicine Research Center, Bushehr University ofMedical Sciences, Bushehr, Iran.
authors.forename: Heidar
authors.initials: H
authors.lastname: Aziznejad
authors.affiliation: Department of Neurology, School ofMedicine, Imam Khomeini Hospital, Tehran University ofMedical Sciences, Tehran, Iran.; Iranian Center of Neurological Research, Tehran University ofMedical Sciences, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Tafakhori
keywords: Decompression; Early Surgical Decompression; Injured Spinal Cord; Late Surgery; Surgical