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

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.