TY - JOUR
T1 - Penetrating spinal cord injury
T2 - a systematic review and meta-analysis of clinical features and treatment outcomes
AU - Bin-Alamer, Othman
AU - Bhenderu, Lokeshwar S.
AU - Stuebe, Caren
AU - Sagoo, Navraj S.
AU - Palmisciano, Paolo
AU - Haider, Maryam
AU - Aoun, Salah G.
AU - Haider, Ali S.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to International Spinal Cord Society.
PY - 2022
Y1 - 2022
N2 - Objective: To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. Methods: PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). Results: We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16–70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3–1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64–2,06; I2 = 40%, p = 0.12). Conclusion: Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.
AB - Objective: To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. Methods: PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). Results: We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16–70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3–1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64–2,06; I2 = 40%, p = 0.12). Conclusion: Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.
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U2 - 10.1038/s41393-022-00813-x
DO - 10.1038/s41393-022-00813-x
M3 - Review article
C2 - 35606414
AN - SCOPUS:85130680106
SN - 1362-4393
JO - Spinal Cord
JF - Spinal Cord
ER -