***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Using data from the Second National Acute Spinal Cord Injury Study ( NASCIS II ) , the authors sought to characterize the role of surgery in the management of traumatic spinal cord injury and to examine the interaction between pharmacological treatment and surgery .  Patients who did not undergo surgery  had more severe spinal cord injuries initially than those who had surgery .  However , no differences in neurological improvement at 1-year follow-up were found between those who underwent surgery and those who did not . The results suggest that either early surgery ( < or = 25 hours after injury ) or late surgery ( > 200 hours ) may be associated with increased neurological recovery , particularly motor function , but these results are equivocal . Surgery was not shown to interact with pharmacological treatments , indicating that the effect of drug treatment in NASCIS II , reported elsewhere , is not influenced by surgery . Other independent variables that best predicted improvement in motor score were age of 25 years or younger , incomplete injury , and lower baseline emergency department neurological scores . This study does not provide clinical ly relevant evidence concerning the efficacy of timing or the value of surgery in treating patients with spinal cord injuries . A r and omized study on the timing and efficacy of spinal cord surgery is needed to obtain valid comparisons of the efficacy of surgical treatments STUDY DESIGN A prospect i ve , longitudinal study of multiply injured patients treated with segmental instrumentation for spinal fractures with a minimum 2-year follow-up . OBJECTIVES To determine whether urgent stabilization of  spinal fractures in severely injured patients increases the risk of surgery compared with early treatment and historical results . SUMMARY AND BACKGROUND DATA Opinion in clinical studies is divided about whether operative treatment offers an advantage over nonoperative treatment in isolated spine fractures . Concomitant trauma is rarely discussed relative to decision making or surgical timing . Urgent stabilization of long-bone fractures improves survival and outcome in polytrauma patients . To date , urgent treatment of spine fractures in polytrauma patients has not been considered in the literature . METHODS Seventy-five consecutive patients treated with segmental instrumentation for spinal trauma  were observed prospect ively to assess perioperative and longterm outcome . Twenty-seven patients with severe polytrauma ( injury severity score , > 26 ) were separately analyzed . Perioperative and postoperative results were analyzed relative to timing of surgery , injury severity score , and surgical approach . Urgent treatment was defined as that provided within 24 hours of the spinal injury , and early treatment was defined as that provided between 24 and 72 hours after injury . RESULTS Twenty-five patients ( 93 % ) sustained two or more major injuries in addition to the spine fracture , and 17 of 27 ( 63 % ) had neurologic injury . The mean injury severity score approached or exceeded the LD50 ( 50 % expected mortality ) in each group--36.0 for the early-treatment group and 42.0 for the urgent group -- but only one patient in each group died . There were no deep venous thromboses , pulmonary emboli , neurologic injuries , decubiti , deep wound infections , or episodes of sepsis in either group . Blood loss for anterior procedures was significantly higher in the urgent group , but estimated blood loss for posterior procedures was similar for both groups . At 49 months ' mean follow-up , no revisions were necessitated by the urgent spinal treatment . CONCLUSIONS Urgent spinal stabilization is safe and appropriate in polytrauma patients when progressive neurologic deficit , thoracoabdominal trauma , or fracture instability increase the risks of delayed treatment Study Design . A prospect i ve analysis evaluating neurologic outcome after early versus late surgery for cervical spinal cord trauma . Objectives . The study was conducted to determine whether neurologic and functional outcome is improved in traumatic cervical spinal cord‐injured patients ( C3‐T1 , American Spinal Injury Association grade s A‐D ) who had early surgery ( < 72 hours after spinal cord injury ) compared with those patients who had late surgery ( > 5 days after spinal cord injury ) . Summary of Background Data . There is considerable controversy as to the appropriate timing of surgical decompression and stabilization for cervical spinal cord trauma . There have been numerous retrospective studies , but no prospect i ve studies , to determine whether neurologic outcome is best after early versus late surgical treatment for cervical spinal cord injury . Methods . Patients meeting appropriate inclusion criteria were r and omized to an early ( < 72 hours after spinal cord injury ) or late ( > 5 days after spinal cord injury ) surgical treatment protocol .  The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow‐up . Results . Comparison of the two groups showed no significant difference in length of acute postoperative intensive care stay , length of inpatient rehabilitation , or improvement in American Spinal Injury Association grade or motor score between early ( mean , 1.8 days ) versus late ( mena , 16.8 days ) surgery . Conclusions . The results of this study reveal no significant neurologic benefit when cervical spinal cord decompression after trauma is performed less than 72 hours after injury ( mean , 1.8 days ) as opposed to waiting longer than 5 days ( mean , 16.8 days ) OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Study Design . Experimental dog model of acute spinal cord injury . Objective . To compare the relative value of methylprednisolone , surgical decompression , or both for the treatment of traumatic spinal cord injury . Summary of Background Data . Acute spinal cord injury results from both primary damage to the spinal cord at the time of the initial injury as well as a deleterious secondary cascade of events , which leads to further damage . Surgical decompression is known to improve clinical outcomes , but the timing of surgical decompression remains controversial . Methods . A nylon tie was used to constrict the spinal cord in 18 adult male beagle dogs . The animals were then prospect ively r and omized to 3 groups : 1 ) surgical decompression at 6 hours and intravenous methylprednisolone ; 2 ) surgical decompression at 6 hours and intravenous saline ; and 3 ) intravenous methylprednisolone without surgical decompression . Each animal was evaluated by somatosensory-evoked potentials , daily neurologic assessment , and histologic examination at 2 weeks following injury . Results . Immediately following spinal cord constriction , all animals were paraplegic , incontinent , and the somatosensory-evoked potentials were abolished . Surgical decompression 6 hours after injury , with or without methylprednisolone , led to significantly better neurologic function at 2 weeks than methylprednisolone alone . Conclusion . In the setting of acute and persistent spinal cord compression in beagle dogs , surgical decompression 6 hours after injury , with or without methylprednisolone , is more effective for improving neurologic recovery than methylprednisolone alone Acute spinal cord injury ( SCI ) is a major public health problem for which there is still only limited treatment available . The National Acute Spinal Cord Injury Study -2 ( NASCIS-2 ) and -3 clinical trials demonstrated that the use of acute pharmacotherapy with methylprednisolone can attenuate the secondary injury cascade if administered within 8 hours of acute SCI . However , no trial has been performed to examine whether acute surgical decompressive procedures within this critical 8-hour time window can improve patients ' neurological outcome . The purpose of the current prospect i ve Surgical Treatment for Acute Spinal Cord Injury Study ( STASCIS ) pilot study was to determine the feasibility of obtaining a radiological diagnosis of spinal canal compromise of 25 % or more and to perform spinal cord ( C3-T1 ) decompressive procedures by 8 hours postinjury . One of the following three decompressive methods was used : 1 ) traction alone ; 2 ) traction and surgery ; or 3 ) surgery alone .  Twenty-six patients from eight North American centers were entered into the study between 1996 and 1997 . Significant difficulties were encountered in many centers in performing immediate magnetic resonance imaging examination in patients with acute SCI . Fewer than 10 % of acute cervical SCI patients could be enrolled into this protocol mainly because the combination of the required time for rescue , resuscitation , transport , imaging study , and surgical preparation exceeded the 8-hour injury-to-decompressive surgery window . Eleven patients underwent decompressive procedures initially by being placed in traction at a mean time of 10.9 hours postinjury . Those patients not undergoing this procedure underwent  decompressive surgery  at a mean time of 40.1 hours . However , the surgical decompressive procedure was completed within 12 hours in seven patients . As a result of these findings , several major changes have been made to the STASCIS protocol for early decompressive therapy BACKGROUND The effect of immediate surgical spinal cord decompression on neurologic outcome after spinal cord injury is controversial . Experimental models strongly suggest a beneficial effect of early decompression but there is little supportive clinical evidence . This study is design ed to evaluate the feasibility and outcome of an immediate spinal cord decompression treatment protocol for cervical spinal cord injury in a tertiary treatment center . METHODS To address this issue , 91 consecutive patients with acute , traumatic cervical spinal cord injury ( 1990 - 1997 ) were prospect ively studied . Sixty-six patients ( protocol group ) underwent emergency magnetic resonance imaging ( MRI ) to determine the presence of persistent spinal cord compression followed , if indicated , by immediate operative decompression and stabilization .  Twenty-five patients were managed outside the treatment protocol because of contraindication to magnetic resonance imaging , need for other emergency surgical procedures , or admitting surgeon preference ( reference group ) . The protocol and reference groups had similar sex and age distributions , admitting Frankel grade s , levels of neurologic injury , and Injury Severity Scores . RESULTS Twenty-seven percent of patients seen were not enrolled in the treatment protocol because of the need for other emergent surgical treatment , contraindication to MRI , and specific surgeon bias regarding the " futility " of emergent treatment . The neurologic outcome for the patients in the reference group were similar to that in the previously reported literature . Fifty percent of protocol patients , compared with only 24 % of reference patients , improved from their admitting Frankel grade . Eight protocol patients ( 12 % ) , but no reference patients , improved from complete motor quadriplegia ( Frankel grade A or B ) to independent ambulation ( Frankel grade D or E ) . Protocol patients required shorter intensive care unit stays , and shorter total hospital stays than reference patients . In the treatment protocol group , spinal cord decompression , confirmed by MRI , was achieved with immediate spinal column alignment and skeletal traction in 32 patients ( 46 % ) . Thirty-four patients ( 54 % ) required emergent operative spinal cord decompression because of MRI-documented persistent spinal cord compression . CONCLUSION We conclude that immediate spinal column stabilization and spinal cord decompression , based on magnetic resonance imaging , may significantly improve neurologic outcome . The feasibility of such a treatment protocol in a tertiary treatment center is well demonstrated . Additional multicenter trials are necessary to achieve definitive conclusions regarding clinical efficacy Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury , but whether any treatment is clinical ly effective remains uncertain . We evaluated the efficacy and safety of methylprednisolone and naloxone in a multicenter r and omized , double-blind , placebo-controlled trial in patients with acute spinal-cord injury , 95 percent of whom were treated within 14 hours of injury . Methylprednisolone was given to 162 patients as a bolus of 30 mg per kilogram of body weight , followed by infusion at 5.4 mg per kilogram per hour 
    Output:
    
Despite some discrepancies in the results of those pre- clinical studies , there is evidence for a biological rationale to support early decompression of the spinal cord .
A number of studies indicated that patients who undergo early surgical decompression can have similar outcomes to patients who received a delayed decompressive operation .
However , there is evidence to suggest that early surgical intervention is safe and feasible and that it can improve clinical and neurological outcomes and reduce health care costs .