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Abstract：
Introduction: Symptomatic acute metastatic spinal epidural cord compression (MSCC) is an emergency that requires multimodal attention. However, there is no clear consensus on the appropriate timing for surgery. Therefore, to address this issue, we conducted a systematic review and meta-analysis of the literature to evaluate the outcomes of different surgery timings. Methods: We searched multiple databases for studies involving adult patients suffering from symptomatic MSCC who underwent decompression with or without fixation. We analyzed the data by stratifying them based on timing as emergent (≤24 h vs. >24 h) and urgent (≤48 h vs. >48 h). The analysis also considered adverse postoperative medical and surgical events. The rates of improved outcomes and adverse events were pooled through a random-effects meta-analysis. Results: We analyzed seven studies involving 538 patients and discovered that 83.0% (95% CI 59.0-98.2%) of those who underwent urgent decompression showed an improvement of ≥1 point in strength scores. Adverse events were reported in 21% (95% CI 1.8-51.4%) of cases. Patients who underwent emergent surgery had a 41.3% (95% CI 20.4-63.3%) improvement rate but a complication rate of 25.5% (95% CI 15.9-36.3%). Patients who underwent surgery after 48 h showed 36.8% (95% CI 12.2-65.4%) and 28.6% (95% CI 19.5-38.8%) complication rates, respectively. Conclusion: Our study highlights that a 48 h window may be the safest and most beneficial for patients presenting with acute MSCC and a life expectancy of over three months.
摘要：
简介：有症状的急性转移性脊髓硬膜外索压迫（MSCC）是一种需要多模式关注的紧急情况。然而,对于适当的手术时机没有明确的共识.因此,为了解决这个问题，我们对文献进行了系统回顾和荟萃分析,以评估不同手术时机的结局.方法：我们在多个数据库中搜索了涉及患有症状性MSCC的成年患者的研究，这些患者接受了有或没有固定的减压。我们通过根据紧急时机对数据进行分层来分析数据(≤24h与>24小时)和紧急(≤48小时vs.>48小时)。该分析还考虑了不良的术后医疗和手术事件。结果改善率和不良事件通过随机效应荟萃分析汇总。结果：我们分析了涉及538例患者的7项研究，发现接受紧急减压的患者中有83.0％（95％CI59.0-98.2％）的强度评分提高了≥1分。21%的病例报告了不良事件（95%CI1.8-51.4%）。接受紧急手术的患者改善率为41.3％（95％CI20.4-63.3％），但并发症发生率为25.5％（95％CI15.9-36.3％）。48h后接受手术的患者并发症发生率为36.8%（95%CI12.2-65.4%）和28.6%（95%CI19.5-38.8%），分别。结论：我们的研究强调，对于患有急性MSCC且预期寿命超过三个月的患者，48小时的窗口可能是最安全和最有益的。
