CLINICAL OUTCOMES FOLLOWING EARLY VERSUS DELAYED DECOMPRESSION IN PATIENTS WITH THORACOLUMBAR SPINE INJURIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction The timing of decompression in thoracic and/or lumbar spine injuries remains debated. This systematic review and meta-analysis assessed whether early decompression improves clinical outcomes compared to delayed intervention. Methods A systematic search of PubMed, Embase, Web of Science and Google Scholar was performed. Outcomes included neurological improvement, respiratory complications, perioperative mortality, length of stay (LOS) in hospital and ICU, and duration on mechanical ventilation. Log odds ratios (LOR) and mean differences (MD) were calculated. Subgroup analysis by timing thresholds (24, 48, 72 hours) and meta-regression for injury severity were conducted. Results 43 studies were included. Early decompression was associated with increased odds of neurological improvement (LOR = 0.82, p < 0.001), decreased LOS in hospital (MD = -3.19, p < 0.001) and ICU (MD = -3.21, p = 0.01), fewer respiratory complications (LOR = 0.58, p = 0.01), and shorter ventilation time (MD = -2.41, p = 0.01). No difference was observed in perioperative mortality (p = 0.52). Effects were greater in studies including severely injured patients. Subgroup analysis showed 48-hour cutoff provided optimal benefits for neurological recovery and ICU LOS. Discussion Early decompression offers neurological and systemic benefits. Reduced ICU and ventilation times may reflect earlier mobilisation and improved respiratory function. Benefits were amplified in severely injured patients, suggesting that timely intervention may mitigate the physiological impact of polytrauma. The lack of increased perioperative mortality supports the safety of early surgery. While heterogeneity exists in study designs and definitions of “early,” the consistent direction of benefit supports prioritising earlier intervention. Conclusion Early surgical decompression (<48 hours) in thoracolumbar spine injuries improves neurological and respiratory outcomes and reduces hospital resource use. Early intervention should be considered, especially in severe cases.