Ultra-early decompression and prevention of secondary injury in traumatic spinal cord injury: A single-center study

CONTEXT/OBJECTIVE: The optimal timing of surgical decompression for traumatic spinal cord injury (TSCI) remains uncertain. This study evaluated the association between ultra-early decompression and neurological outcomes, focusing on early post-injury time windows. DESIGN: Retrospective cohort study. SETTING: Single tertiary trauma center. PARTICIPANTS: Eighty-two adult patients with TSCI who underwent surgical decompression between January 2022 and August 2024 were included. Patients with central cord syndrome, penetrating injury, incomplete imaging, follow-up <3 months, or unreliable neurological assessment were excluded. INTERVENTIONS: Surgical decompression at varying time thresholds (≤8, ≤10, ≤12, and ≤24 h after injury). OUTCOME MEASURES: Neurological improvement, defined as an increase of at least one AIS grade at ≥3 months. RESULTS: In AIS A patients, decompression within 8 h was associated with a higher rate of neurological improvement (87.5% vs 29.4%; OR 16.80, 95% CI 1.62-174.52). Multivariable analysis showed a substantial but non-significant effect for ≤8 h (aOR 4.99, 95% CI 0.83-29.95). A strong adjusted association was observed at ≤10 h (aOR 4.92, 95% CI 1.15-20.97). Shock was associated with lower odds of improvement. The most consistent associations were observed within the 8-12 h window. CONCLUSION: Earlier decompression may be associated with improved neurological outcomes after TSCI. The findings suggest that the therapeutic window for neurological recovery may lie within the first 8-12 h, although causal inference cannot be established.