Optimal timing of surgical decompression for acute cervical spinal cord injury: a systematic review and network meta-analysis of randomized clinical trials.

BACKGROUND

The optimal timing for surgical decompression in acute traumatic cervical spinal cord injury (SCI) remains a subject of intense clinical debate.

OBJECTIVE

To evaluate the comparative efficacy and safety of ultra-early (<24 h), early (<72 h), and delayed surgery using a network meta-analysis (NMA) framework.

METHODS

A systematic search of PubMed, Embase, and Web of Science identified randomized controlled trials (RCTs). Primary outcomes included American Spinal Injury Association (ASIA) Impairment Scale (AIS) improvement and ASIA motor score recovery. SUCRA (P-score) was used to rank treatment hierarchy.

RESULTS

Three RCTs involving 161 patients were included. Ultra-early surgery (<24 h) showed the highest clinical benefit trend for AIS improvement (OR: 2.08, 95% CI: 0.80-5.42) and motor recovery (MD: 11.22, 95% CI: -9.42 to 31.87). According to SUCRA, ultra-early surgery ranked first (68.8%), followed by early (61.5%) and delayed surgery (19.7%). Importantly, no significant increase in mortality (OR: 1.15) or complications (OR: 1.43) was observed with expedited intervention.

CONCLUSION

Although limited by sample size, evidence suggests that ultra-early surgery within 24 h provides the best probability of neurological recovery without compromising patient safety.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/recorddashboard, CRD420261371811.