Objective: To investigate the timing of surgical decompression for acute traumatic cervical spinal cord injury. Methods: A total of 295 cases were extracted and assigned into 3 groups on the basis of the timing of surgery: the urgent group (within 8 h), the early group (8 to 48 h), and the delayed group (after 48 h). Neurological outcomes and medical complications before the operation, after the operation, at 6 months, and at 1 year were compared. Results: Patients in the urgent group derived immediate neurological benefits after surgery, whereas patients in the early group recovered gradually. The final neurological outcomes of both groups were the same. No neurological improvement was observed in the delayed group. The same morbidities of medical complications were observed after the operation. However, complications were seen less commonly in the urgent and the early groups than in the delayed group after 6 months and 1 year. Conclusions: Urgent and early surgical decompression can improve neurological outcomes and lower morbidities of complications, the former being more effective.