Therapeutic local hypothermia in the management of acute spinal cord injury: a systematic review and meta-analysis.

Abstract

Systematic Review. To evaluate the clinical safety and efficacy of local hypothermia in the management of acute spinal cord injury. The studies included in this review were conducted in Canada, the USA, and the UK. A comprehensive search of PubMed, Embase, and Web of Science was conducted for studies up to December 2024, in accordance with PRISMA guidelines. Our inclusion criteria encompassed human patients with ASCI treated with local hypothermia and reported neurological outcomes. A random-effects single-arm meta-analysis was used to calculate pooled neurological improvement rates. Five studies comprising 48 patients were included. The pooled proportion of patients who experienced neurological improvement following local hypothermia was 54.4% (95% CI: 39.9-68.2%) with no significant heterogeneity (I² = 0%). Subgroup analyses did not detect statistically significant differences in outcomes based on injury level (cervical vs thoracic), time to cooling (<8 vs ≥8 h), or cooling route (intradural vs extradural), although these analyses were likely underpowered. Reporting of complications was variable, with infections, decubitus ulcers, and respiratory complications being the most prevalent. Local hypothermia may represent a potential adjunctive neuroprotective strategy for acute spinal cord injury, with over half of patients demonstrating neurological improvement in this limited dataset. However, these findings are hypothesis-generating and should be interpreted with caution. Variability in study protocols and limited sample sizes preclude definitive conclusions. Larger, standardized clinical trials and improved methods of local delivery of hypothermia are warranted to validate its therapeutic potential and optimize treatment parameters.