The time-dependent efficacy of early surgical decompression in patients with traumatic spinal cord injury: A systematic review and meta-analysis

Numerous studies have demonstrated that early surgical intervention in patients with traumatic spinal cord injury leads to superior recovery of various indicators, including neurological function, compared to late surgical intervention. However, some relevant clinical randomized controlled trials have indicated that the motor function recovery of patients undergoing early surgical decompression does not show a significant advantage during initial follow-up periods. The benefits of early surgical decompression become more apparent as the follow-up duration extends. Therefore, this study aims to evaluate the prognosis of early versus late surgical intervention on traumatic spinal cord injury and to analyze whether the prognostic benefits of early surgical decompression in traumatic spinal cord injury patients are time-dependent. We performed a systematic review and meta-analysis by searching the PubMed, Embase, and Cochrane Library databases for randomized controlled trials and quasi-randomized controlled trials that addressed the timing of surgical intervention for traumatic spinal cord injury. The data extracted from all included studies were processed and analyzed utilizing the RevMan 5.4 software. Eight studies involving 702 patients were included in this analysis, with 345 patients in the early surgery group and 357 patients in the late surgery group. The results showed that the early surgery group had a significantly higher rate of improvement in AIS grade (OR = 1.50; 95% CI: 1.05–2.15; <i>p</i> = 0.03) and a shorter hospital stay (MD = −4.76; 95% CI: −9.19 – -0.32; <i>p</i> = 0.04) compared to the late surgery group. Although there was no significant difference in total motor scores between the two groups in the early postoperative period, the pooled data still favored the early surgery group (MD = 4.43; 95% CI: 1.23–7.63; <i>p</i> = 0.007). There was no significant difference in postoperative complications between the two groups (RR = 0.61; 95% CI: 0.30–1.22; <i>p</i> = 0.16). Early surgical decompression leads to better prognosis in patients with traumatic spinal cord injury and shows a trend of more obvious advantages in motor function recovery with longer follow-up time than late surgical intervention.