The natural history of complete spinal cord injury: A pooled analysis of 1162 patients and a meta-analysis of modern data

Najib E. El Tecle, Nader S. Dahdaleh, Mohamad Bydon, Wilson Z. Ray, James C. Torner, Patrick W. Hitchon

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

OBJECTIVE The natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15%–20%; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease. METHODS The authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis. RESULTS Eleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1%, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3%, whereas that in thoracic injuries was 30.6%. Patients undergoing early surgery had a higher rate of conversion (46.1%) than patients undergoing late surgery (25%) (OR 2.31, 95% CI 1.08–4.96, p = 0.03). CONCLUSIONS The overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1%. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.

Original languageEnglish (US)
Pages (from-to)436-443
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume28
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Spinal Cord Injuries
Spinal Injuries
Meta-Analysis
Observational Studies
Wounds and Injuries
Randomized Controlled Trials
Thoracic Injuries
Biological Therapy
PubMed
MEDLINE
Spine
Research Design
Odds Ratio
Databases

Keywords

  • American spinal injury association
  • Asia
  • Complete spinal cord injury
  • Conversion
  • Meta-analysis

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

The natural history of complete spinal cord injury : A pooled analysis of 1162 patients and a meta-analysis of modern data. / El Tecle, Najib E.; Dahdaleh, Nader S.; Bydon, Mohamad; Ray, Wilson Z.; Torner, James C.; Hitchon, Patrick W.

In: Journal of Neurosurgery: Spine, Vol. 28, No. 4, 01.04.2018, p. 436-443.

Research output: Contribution to journalReview article

El Tecle, Najib E. ; Dahdaleh, Nader S. ; Bydon, Mohamad ; Ray, Wilson Z. ; Torner, James C. ; Hitchon, Patrick W. / The natural history of complete spinal cord injury : A pooled analysis of 1162 patients and a meta-analysis of modern data. In: Journal of Neurosurgery: Spine. 2018 ; Vol. 28, No. 4. pp. 436-443.
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abstract = "OBJECTIVE The natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15{\%}–20{\%}; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease. METHODS The authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis. RESULTS Eleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1{\%}, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3{\%}, whereas that in thoracic injuries was 30.6{\%}. Patients undergoing early surgery had a higher rate of conversion (46.1{\%}) than patients undergoing late surgery (25{\%}) (OR 2.31, 95{\%} CI 1.08–4.96, p = 0.03). CONCLUSIONS The overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1{\%}. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.",
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AU - Bydon, Mohamad

AU - Ray, Wilson Z.

AU - Torner, James C.

AU - Hitchon, Patrick W.

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N2 - OBJECTIVE The natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15%–20%; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease. METHODS The authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis. RESULTS Eleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1%, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3%, whereas that in thoracic injuries was 30.6%. Patients undergoing early surgery had a higher rate of conversion (46.1%) than patients undergoing late surgery (25%) (OR 2.31, 95% CI 1.08–4.96, p = 0.03). CONCLUSIONS The overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1%. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.

AB - OBJECTIVE The natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15%–20%; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease. METHODS The authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis. RESULTS Eleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1%, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3%, whereas that in thoracic injuries was 30.6%. Patients undergoing early surgery had a higher rate of conversion (46.1%) than patients undergoing late surgery (25%) (OR 2.31, 95% CI 1.08–4.96, p = 0.03). CONCLUSIONS The overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1%. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.

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