SynthesisFrontiers in neurology
Optimal timing of surgical decompression for acute cervical spinal cord injury: a systematic review and network meta-analysis of randomized clinical trials.
Synthesis in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
Background: The optimal timing for surgical decompression in acute traumatic cervical spinal cord injury (SCI) remains a subject of intense clinical debate. Objective: To evaluate the comparative efficacy and safety of ultra-early (<24 h), early (<72 h), and delayed surgery using a network meta-analysis (NMA) framework. Methods: A systematic search of PubMed, Embase, and Web of Science identified randomized controlled trials (RCTs). Primary outcomes included American Spinal Injury Association (ASIA) Impairment Scale (AIS) improvement and ASIA motor score recovery. SUCRA (P-score) was used to rank treatment hierarchy. Results: Three RCTs involving 161 patients were included. Ultra-early surgery (<24 h) showed the highest clinical benefit trend for AIS improvement (OR: 2.08, 95% CI: 0.80-5.42) and motor recovery (MD: 11.22, 95% CI: -9.42 to 31.87). According to SUCRA, ultra-early surgery ranked first (68.8%), followed by early (61.5%) and delayed surgery (19.7%). Importantly, no significant increase in mortality (OR: 1.15) or complications (OR: 1.43) was observed with expedited intervention. Conclusion: Although limited by sample size, evidence suggests that ultra-early surgery within 24 h provides the best probability of neurological recovery without compromising patient safety. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/recorddashboard, CRD420261371811.
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