Ultra-early surgical management of traumatic spinal injury in a resource-constrained setting: Outcomes and predictors of immediate recovery

Objective: To study the immediate outcome of ultra-early (<8 hours) surgical intervention for traumatic spinal cord injury and its predictors of good outcome. Methodology: We conducted a prospective observational cohort study at the Department of Neurosurgery, Punjab Institute of Neurosciences Hospital, Pakistan, from September 2025 to May 2026. This study included all the patients who underwent ultra-early surgical spine decompression with or without instrumentation. Descriptive statistics summarized the study variables, and a regression model analyzed the predictors of immediate neurological improvement. Results: This study included 104 patients, with a predilection towards males, 67.30% (70), and the commonly affected age group was 15-45 years, 73.10% (76). Road traffic accident (RTA) was the most common etiology, 39.46% (41). Neurological presentation with American Spinal Injury Association (ASIA) Impairment Scale (ASIA) E was in 37.50% (39) patients, followed by ASIA-D 20.20% (21) and ASIA-B 18.30% (19). The most common fracture type was AO A3 fracture, 35.60% (37), followed by A4, 21.20% (22). Fixation of the spine was done in 82.60% (86). Early clinical improvement was seen in 37.50% (39). The vulnerable zone of the spine and motor function were good predictors. The overall model showed a statistically significant distinction between those who improved and those who did not. Conclusion: Ultra-early spine surgery for appropriately selected patients improves the immediate postoperative recovery. The preservation of motor function at presentation is a good predictor of neurological outcome. Spinal decompression with fixation maintains integrity of the spine along with improvement in neurology.