Impact of ultra-early, early and delayed decompression on neurological and clinical outcomes in spinal cord injury: A systematic review and meta-analysis

This study investigates the impact of various surgical timing strategies on neurological and clinical outcomes in patients with spinal cord injury (SCI) through a meta-analysis. Specifically, it compares the effectiveness of early, ultra-early, and delayed decompression surgeries in optimizing patient recovery. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science, to identify studies on surgical timing for SCI. Studies evaluating ultra-early surgery (≤8 h or ≤12 h), early surgery (≤24 h), and delayed surgery (>24 h) were included. A total of 16 studies were included, involving outcome indicators such as American Spinal Injury Association (ASIA) score, length of stay, complications, and mortality. Compared with delayed surgery, early surgery (≤24 h) significantly shortened the length of stay (MD = −2.31 days, 95% CI: −4.18, −0.43; P = 0.02) and reduced the risk of complications (OR = 0.70, 95% CI: 0.55, 0.89; P = 0.003), but there was no significant difference in the improvement of ASIA score. Ultra-early surgery (≤8 h) significantly improved the ASIA score (OR = 2.64, 95% CI: 1.29, 5.40; P = 0.008), but no statistical difference was found in the comparison of 12 h. Early or delayed surgery did not affect the mortality of patients. The timing of surgical intervention significantly influences recovery in SCI patients. Early and ultra-early surgery can shorten hospital stay, reduce the risk of complications, and improve neurological outcomes in some cases.