Tommy Alfandy Nazwar, Farhad Bal'afif, Donny Wisnu Wardhana, Fachriy Bal'afif, Christin Panjaitan
Background: his systematic review and meta-analysis aimed to evaluate the impact of surgical timing on neurological and functional outcomes in patients with traumatic spinal cord injury (TSCI). Methods: A comprehensive literature search was conducted in PUBMED and ScienceDirect databases for studies published between 2015 and 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing surgical timing (≤12 h, ≤24 h, and >24 h) were included. Results: A total of 22 comparative studies comprising 2,395 patients were included. Among them, 346 underwent ultra-early decompression (≤12 h), 1,140 underwent early surgery (≤24 h), and 908 underwent delayed surgery (>24 h). Ultra-early surgery (≤12 h) significantly improved neurological outcomes compared to surgery after 12 h (odds ratio [OR] 2.30; 95% confidence interval [CI]: 1.69–3.14; P < 0.00001). Surgery within 24 h also outperformed surgery after 24 h (OR 1.49; 95% CI: 1.19–1.87; P < 0.0005). While the American Spinal Injury Association motor scores at 6 months were not significantly different (mean difference [MD] –3.30; 95% CI: –8.24–1.65; P = 0.19), scores at 1 year significantly favored the ≤24-h group (MD 4.90; 95% CI: 2.84–6.95; P < 0.00001). Early surgery reduced hospital stay duration (MD –4.94; 95% CI: –9.69––0.20; P = 0.04), with no significant differences in mortality or major complications. Conclusion: Surgical decompression within 24 h, especially within 12 h, is associated with significantly better neurological recovery, improved long-term motor outcomes, and shorter hospitalization, without increased mortality or major complications. These findings underscore the critical role of timely surgical intervention in acute TSCI management. ©2025 Published by Scientific Scholar on behalf of Surgical Neurology International. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Department of Surgery, Division of Neurosurgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, Indonesia
