Surgical decompression in acute spinal cord injury: earlier is better
Andrew I R Maas, Wilco Peul, Claudius Thomé
Decompressive surgery for acute spinal cord injury (SCI) potentially increases chances of recovery, but uncertainty exists on optimal timing and indications. In this issue of The Lancet Neurology, Jetan Badhiwala and colleagues
present a pooled analysis of individual patient data (n=1548) from four multicentre studies on SCI, done between 1991 and 2017. The authors found a significant greater recovery in patients who had early decompression (<24 h after spinal injury) compared with those who had late surgery (≥24 h after spinal injury), in terms of both motor and sensory function. Analysis of the effect of time represented as a continuous variable clearly showed that the earlier decompression was done, the greater the recovery in terms of total motor score. Nonetheless beneficial effects of earlier time of decompression persisted until approximately 36 h after injury, after which the effect of time plateaued. This study is notable as it shows the power and potential of pooled analyses of individual patient data across studies and has direct relevance to clinical practice.