ULTRA-EARLY VERSUS EARLY SURGICAL DECOMPRESSION IN ACUTE TRAUMATIC SPINAL CORD INJURY: A SYSTEMATIC REVIEW FOCUSED ON THE INCREMENTAL NEUROLOGICAL BENEFIT OF SURGERY WITHIN THE FIRST EIGHT HOURS

Abstract

This article aimed to assess whether surgical decompression performed within the first eight hours after acute traumatic spinal cord injury provides additional neurological benefit compared with surgery performed between eight and 24 hours. A systematic review was conducted according to PRISMA 2020 principles, with narrative synthesis guided by SWiM when heterogeneity precluded meta-analysis. Comparative studies in adults undergoing surgical decompression with neurological or functional outcomes stratified by time to surgery were included. Direct evidence for ≤8 hours versus 8–24 hours was limited but predominantly favored ultra-early intervention. Jug et al. reported improvement of at least two AIS grades in 45.5% versus 10.0%; Lee et al. reported improvement of at least one AIS grade in 61.5% versus 30.0%; and Shimizu et al. demonstrated greater Motor Index Score recovery after propensity-score matching. It is concluded that ultra-early decompression may provide incremental neurological benefit, particularly in cervical injury, although observational evidence and outcome heterogeneity preclude establishing eight hours as a definitive biological cutoff.