ReviewEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Is time really spine? Early versus delayed surgical decompression in traumatic spinal cord injury: a systematic review and meta-analysis.
Review in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
8 authors.
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Abstract
purposeTo evaluate whether earlier surgical decompression is associated with improved neurological and clinical outcomes compared with delayed decompression after traumatic spinal cord injury.
methodsMEDLINE, Scopus, Web of Science, CINAHL, the Cochrane Library and Google Scholar were searched from inception to February 2025. Comparative studies of early versus delayed decompression in adult or predominantly adult traumatic spinal cord injury cohorts were included. Three reviewers independently screened studies, extracted data and assessed risk of bias. Random-effects meta-analyses were performed where outcomes were sufficiently comparable. The primary outcomes were improvement of at least one grade and at least two grades on the American Spinal Injury Association (ASIA) Impairment Scale.
resultsSeventy-eight studies comprising 31,190 reported participants were included. Surgery within 24 h was the most common definition of early decompression, although thresholds and timing origins varied substantially. Seventeen studies contributed to the analysis of AIS improvement of at least one grade. Early decompression was associated with a greater likelihood of improvement than delayed decompression (risk ratio [RR] 1.46, 95% confidence interval [CI] 1.27-1.68; I² = 48.3%). Eleven studies contributed to the analysis of AIS improvement of at least two grades, which also favoured early decompression (RR 2.18, 95% CI 1.69-2.81; I² = 0.0%). Four studies were pooled for overall complications, with no clear difference between early and delayed decompression (RR 0.97, 95% CI 0.60-1.56; I² = 74.9%). Functional recovery, mortality, length of stay, intensive care, ventilation and cost outcomes were reported inconsistently and were synthesised narratively.
conclusionEarlier surgical decompression was associated with greater AIS-grade neurological recovery after traumatic spinal cord injury, particularly for improvement of at least two grades. However, most evidence was observational and limited by heterogeneous timing definitions, inconsistent outcome reporting and residual confounding. These findings support timely decompression when medically feasible, but do not establish that surgical timing alone determines neurological recovery. PROSPERO REGISTRATION: CRD420251000074.
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