Comparison of Delayed Versus Early Surgical Decompression for Traumatic Spinal Cord Injury: Experience from Northern Pakistan

Abstract

Objective: To compare the outcomes of early versus delayed surgical decompression in patients with traumatic spinal cord injury (SCI) at a tertiary care hospital.

Study Design and Setting: Randomized controlled trial conducted from August to December 2025 at Fauji Foundation Hospital, Rawalpindi.

Methodology: A total of 88 patients with traumatic SCI (AIS grades A–C) were enrolled and allocated to early (within 24 hours; n=44) or delayed (>24 hours; n=44) decompression groups according to the time of presentation after injury. Neurological outcome was assessed three months postoperatively using the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Improvement of at least two AIS grades from baseline was considered a good neurological outcome. Outcomes were compared using the chi-square test, with p<0.05 considered statistically significant.

Results: Overall, 24 of 88 patients (27.3%) achieved a good neurological outcome. Good recovery was observed in 15/44 (34.1%) patients in the early decompression group compared with 9/44 (20.5%) patients in the delayed decompression group. Although neurological recovery was more frequent following early decompression, the difference was not statistically significant (p=0.151).

Conclusion: Early surgical decompression was associated with a higher proportion of favorable neurological recovery than delayed decompression; however, the difference was not statistically significant. A consistent trend toward better neurological outcomes was observed with early decompression across the stratified analyses.