Evaluating the role of surgical timing on clinical outcomes in traumatic spinal cord injury: A systematic review and meta-analysis

Background: This systematic review and meta-analysis aimed to evaluate the impact of surgical timing on neurological and functional outcomes in patients with traumatic spinal cord injury (TSCI). Methods: A comprehensive literature search was conducted in PUBMED and ScienceDirect databases for studies published between 2015 and 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing surgical timing (≤12 h, ≤24 h, and >24 h) were included. Results: A total of 22 comparative studies comprising 2,395 patients were included. Among them, 346 underwent ultra-early decompression (≤12 h), 1,140 underwent early surgery (≤24 h), and 908 underwent delayed surgery (>24 h). Ultra-early surgery (≤12 h) significantly improved neurological outcomes compared to surgery after 12 h (odds ratio [OR] 2.30; 95% confidence interval [CI]: 1.69–3.14; P < 0.00001). Surgery within 24 h also outperformed surgery after 24 h (OR 1.49; 95% CI: 1.19–1.87; P < 0.0005). While the American Spinal Injury Association motor scores at 6 months were not significantly different (mean difference [MD] −3.30; 95% CI: −8.24–1.65; P = 0.19), scores at 1 year significantly favored the ≤24-h group (MD 4.90; 95% CI: 2.84–6.95; P < 0.00001). Early surgery reduced hospital stay duration (MD −4.94; 95% CI: −9.69–−0.20; P = 0.04), with no significant differences in mortality or major complications. Conclusion: Surgical decompression within 24 h, especially within 12 h, is associated with significantly better neurological recovery, improved long-term motor outcomes, and shorter hospitalization, without increased mortality or major complications. These findings underscore the critical role of timely surgical intervention in acute TSCI management.