Meta-Analysis on the Effect of Hypothermia in Acute Spinal Cord Injury

OBJECTIVE: Acute spinal cord injury (SCI) can result in debilitating motor, sensory, and autonomic dysfunction. As a treatment option, therapeutic hypothermia has been researched to inadequate pharmaceutical treatment, except for methylprednisolone. In this article, we systematically meta-analyzed to clarify the effect of hypothermia in acute SCI on neurological outcomes. METHODS: The PubMed, Embase, Web of Science, and Cochrane clinical trial databases were systematically searched until June 30, 2022. The proportion of cases with improved neurological status after hypothermia in acute SCI were pooled with a random-effects model. Subgroup analyses for the method of hypothermia and injury level were conducted. RESULTS: Eight studies with a total of 103 patients were included. Hypothermia in acute SCI improved neurological function by 55.8% (95% confidence interval [CI]: 39.4%–72.1%). The subgroup analysis revealed that the pooled proportion of cases showing neurological improvement was higher with systemic hypothermia (70.9%) (95% CI, 14.9%–100%) than with local hypothermia (52.5%) (95% CI, 40.4%–64.5%), although the subgroup difference was not statistically significant (p=0.53). Another subgroup analysis revealed that the proportion of cases with neurological improvement did not differ statistically between the cervical spine (61.4%) (95% CI, 42.2%–80.6%) and thoracic spine injury groups (59.4%) (95% CI, 34.8%–84.0%) (p=0.90). CONCLUSION: This meta-analysis identified that more than 50% of patients showed neurological improvement after hypothermia following acute SCI in general. A multicenter, randomized, double-blind study with larger sample size is necessary to validate the findings further.