Safety and Efficacy of Therapeutic Hypothermia in Traumatic Spinal Cord In-jury Management: A Systematic Review and Meta Analysis

Abstract

Introduction: Therapeutic hypothermia as a neuroprotective strategy can reduce secondary injury after acute traumatic spinal cord injury(SCI). We conducted a systematic review and meta analysis to evaluate the impact of systemic or local hypothermia on neurological outcomes, mortality, and Intensive Care Unit (ICU) stay of SCI patients. Methods: A systematic search in PubMed, Scopus, Web of Science, Embase, and The Cochrane Central Register of Controlled Trials (CENTRAL) with no limitation of time and language was performed. Following PRISMA 2020 guidelines, two independent reviewers screened records across four databases up to 20 September 2025. Eligibility was determined using PICOS criteria: adults with acute traumaticSCI (P), receiving any hypothermic protocol(I), compared with standard normothermic management(C), with reported functional, sensory, or survival outcomes(O), and original human clinical designs(S). Data extraction and risk-of-bias evaluation were performed independently using the JoannaBriggsInstitute (JBI) checklist. Pooled relative risks(RR) or mean differences(MD) were calculated with random effects models using RevMan4.5.1 Results: From305initial records, sixhuman studies (156 patients) met inclusion criteria. There were threesystemic hypothermia trials and onelocal extradural protocol, plus twosupportive cohorts providing timing and assessment data, but only three studies met the minimum criteria for meta-analysis processes. Overall methodological quality of included studies was low to moderate and none of the studies were randomized. Intervention methods included surface, and endovascular techniques maintaining body temperature at 32-34Celsius for24-72hours, initiated between 1.6-70hours post injury. Pooled analyses showed decreased mortality with RR=0.57(95CI:0.05-5.88; p = 0.6883), improvement in Association Impairment Scale (AIS) with RR=2.96(95CI:0.01-939.31; p = 0.3098); and decrease in the ICU length of stay withMD=-1.27(95CI:-2.46to-0.07; p = 0.9658) days in SCI patients receiving hypothermia. Complications included pneumonia, hypotension, and bradycardia. No hypothermia related deaths were reported. Early initiation (<6hours) was consistently linked with superior functional improvement. Conclusion: The findings of six-human studiesreveal that therapeutic hypothermia may be a feasible, safe, and effective intervention in acute traumatic SCI. While current evidence cannot yet demonstrate mortality benefit, the observed results were directed toward neurological improvement, especially when therapy is initiated early and systemically, supporting ongoing investigation.