Early versus Delayed Surgical Decompression in Spinal Cord Injury: A Systematic Review and Meta-Analysis

Spinal cord injury is a devastating clinical condition that causes secondary damage, which can be prevented with some treatments. Early surgical decompression may have a beneficial effect and lead to a better neurological outcome. This study aims to demonstrate the effectiveness of early compared with delayed surgical decompression to evaluate neurological improvement in patients with traumatic spinal cord injury. A systematic review and meta-analysis were conducted following the PRISMA-2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Until April 2024, PubMed, Scopus, Web of Science, and Embase were searched for randomized controlled clinical trials. The primary outcome is an improvement of one grade or more on the American Spinal Injury Association Impairment Scale at 12 months' follow-up. Secondary outcomes included hospital stay, postoperative complications, and mortality. Of the 4,101 records identified, 4 studies and 430 patients were included. A statistically significant difference was found in favor of the early surgical decompression group regarding neurological improvement (mean difference 0.88, 95% confidence interval [CI] = -0.03 to 1.73, p  = 0.04). Also, in patients with complete spinal cord injuries (relative risk [RR] 3.65, 95% CI = 1.10-12.17, p  = 0.03) reduction of postoperative complications was observed in the early group (RR 0.42; 95% CI = 0.20-0.88, p  = 0.02). Regarding hospital stay, there were no significant differences between the two groups (RR -7.95, 95% CI = -18.53 to 2.63, p  = 0.14) and mortality (RR = 1.27, 95% CI = 0.30-5.38, p  = 0.75). Our study demonstrates that early surgical decompression within the first 24 hours after spinal cord injury leads to better neurological outcomes with statistical significance. Furthermore, statistically significant results were found in favor of early surgical decompression in patients with complete spinal cord injuries and to statistically reduce the risk of complications in the early group.