Background: Despite growing evidence for early surgical decompression for traumatic cervical spinal cord injury(tCSCI) patients, controversy surrounds the efficacy of early surgical decompression on patients with a complete (ASIA A) cervical injury. Methods: Patients with ASIA A cervical tCSCI were isolated from 4 prospective, multi-center datasets. Patients who had a Glasgow coma scale of less than 13, were over the age of 70 or under 16 were excluded. Significant gain was defined to include those that recovered more than two muscle groups (greater than 3/5 power) below their level of injury. Analysis of variance (ANOVA) was then done to compare significant gain over the 1 year follow-up period for patients with and without early decompressive surgery (<24hrs). Results: We identified 420 cervical ASIA A tCSCI patients. The mean number of muscle groups gained was 2.69 (SD 2.3.12) for those who had early surgery compared to 2.37 (SD 3.38) for those with late surgery. Of those patients who had early surgery 39.67% had a significant improvement vs. 28.76% of those who did not have early surgery (P = 0.030). Conclusions: For the first time, we have shown a clear therapeutic benefit of early surgical decompression within 24 hrs in ASIA A tCSCI patients.