Effect of Early Surgical Intervention on Neurological Outcomes in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis.

Abstract

Spinal cord injury (SCI) represents a devastating condition with profound neurological consequences, and the optimal timing of surgical decompression remains controversial. This systematic review and meta-analysis evaluated the impact of early versus late surgical intervention on neurological outcomes and mortality in patients with SCI. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus, from 2000 to September 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing early surgical decompression (≤24 h) with delayed intervention (>24 h) in adult patients were included. Fourteen studies comprising 2,505 patients (1,115 early intervention, 1,390 delayed intervention) met the inclusion criteria, including three randomized controlled trials (RCTs) and 11 observational studies. The pooled analysis demonstrated a non-significant trend toward improved neurological recovery with early intervention, evidenced by a mean difference (MD) of 3.64 points in the American Spinal Injury Association (ASIA) Motor Score (AMS; 95% CI: -0.05 to 7.33; p = 0.05) and an OR of 1.37 for achieving at least one-grade improvement in ASIA classification (95% CI: 0.90 to 2.10; p = 0.14). Mortality rates showed no significant difference between groups (OR = 1.40, 95% CI: 0.74 to 2.68; p = 0.30). Despite not reaching statistical significance, the consistent directional trend favoring early intervention supports its consideration when medically feasible, as even modest neurological improvements may be clinically meaningful in this devastating condition. These findings suggest that early surgical decompression does not increase mortality risk and may confer neurological benefits, supporting the development of institutional protocols prioritizing expedited intervention while maintaining rigorous perioperative safety standards.