Effect of Surgical Timing on Neurological Outcome in Traumatic Thoracolumbar Spinal Cord Injury: A Systematic Review and Meta-Analysis

Background: In cervical traumatic spinal cord injury (tSCI), the beneficial effect of early intervention within 24 hours was recently emphasized, especially in complete cases. However, the optimal surgical timing in thoracic tSCI remains a subject of debate. This systematic review aims to assess neurological outcomes in thoracolumbar tSCI with respect to surgical timing. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted a systematic search of MEDLINE via PubMed from the database’s inception through September 20, 2025, with no language or date restrictions, for all studies that analyzed the timing of surgical decompression. We initially screened all records to identify articles that did not meet the predefined criteria. Finally, the full manuscripts were carefully reviewed to select eligible articles that reported early surgery, defined as a decompressive operation performed within 24 hours. The eligibility criteria include the following: primary studies that investigate the effect of early versus late surgery in patients with tSCI from T1 to L2. The outcome measure was the number of patients who improved their AIS (the American Spinal Injury Association Impairment Scale) grade or Frankel grade ≥1 at follow-up. We extracted baseline characteristics from all the included studies, and the risk of bias of each study was assessed by using the Newcastle–Ottawa Scale (NOS). All results presented in this review are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We applied a random-effects meta-analysis model and conducted a subgroup analysis to explore potential contributing factors. Results: Our comprehensive search yielded 13 studies conducted in 8 countries, involving a total of 1430 patients. Notably, based on the NOS, most studies were high quality (31%), 15% were low quality, and a small minority (15%) were moderate quality. The low, nonsignificant statistical heterogeneity across all included studies supported performing the meta-analysis. The results of the pooled meta-analysis of the 13 studies revealed that early surgical intervention can significantly enhance neurological recovery by 1.95 times more than late surgical intervention for thoracolumbar spinal cord injury. The narrow confidence interval of this result (1.37 to 2.78) confirms the precision of these findings. Conclusion: This study highlights the effect of early surgical intervention (hours) on neurological outcomes in patients with thoracolumbar tSCI. These results may help enhance surgical planning for patients with thoracolumbar tSCI.