Association between surgical timing and neurological recovery after traumatic spinal cord injury

The ideal timing for treating traumatic spinal cord injury (tSCI) continues to be a subject of clinical debate. Our objective was to explore if early surgical decompression correlates with improved outcomes for tSCI individuals.

A comprehensive search was conducted across the Cochrane Library, Embase, and PubMed databases, covering the period from their inception until May 6th, 2024. The results were presented as odds ratios (OR), mean differences (MD), and 95% confidence intervals (CI). The detailed study protocol was published in PROSPERO (CRD42024536129).

This study included 28 research articles, consisting of 3 RCTs and 25 cohort studies, with a total of 3633. Compared to the late surgery group, the early surgery group had a significantly improved neurological recovery, with an increase of at least one ASIA grade (OR, 2.23; [95% CI 1.63-3.05]), an improvement of at least two ASIA grades (OR, 3.03; [95% CI 1.96-4.68]), and a higher total motor score (MD, 5.29; [95% CI 2.32-8.25]) at 12th month post-surgery. However, these differences were no longer observed after 2 years of follow-up. Early surgery was associated with a higher mortality rate in cervical tSCI (OR, 2.46; [95% CI 1.12-5.41]) and in Asian patients (OR, 2.60; [95% CI 1.25-5.42]).

These findings support the routine use of early surgery in patients with thoracolumbar tSCI, as it is associated with faster neurological recovery. However, due to the small sample size, this conclusion should be interpreted with caution.