INTRODUCTION: While there is increasing evidence for the efficacy of early surgical decompression for traumatic cervical spinal cord injury (tSCI), the impact of early surgery on motor and sensory complete (ASIA A) patients is still the subject of debate. To date, there have been no studies focusing specifically on ASIA A cervical tSCI patients. METHODS: Patients with cervical ASIA A injury were identified from 4 prospective, multi-center datasets (NACTN, STASCIS, NASCIS 3, and SYGEN). Patients who had a GCS <15 at baseline or were younger than 18 or older than 80 were excluded. We tabulated the number of functional motor levels gained below the neurological level of injury. A functional motor level was defined as a myotome with at least grade 3 power on the MRC scale. We defined a gain of greater than 2 functional motor levels at 1 year as a significant improvement. A-priori we isolated age, mechanism of injury, and use of steroids for multivariate analysis. Logistic regression models were used to calculate the Odds Ratio for significant improvement. RESULTS: We identified 365 cervical ASIA A tSCI patients with an average age of 33yrs and an average time to surgery of 168 hrs. Of those patients who had early surgery, 39.40% had a significant improvement in functional motor levels vs. 28.80% of those who did not have early surgery (P = 0.049). In Multi-variate analyses, early surgery was the only significant covariate associate with a significant impact on functional recovery (Odds Ratio of 1.65 ; p= 0.048). CONCLUSIONS: For the first time, we have shown a clear therapeutic benefit of early surgical decompression within 24 hrs in ASIA A tCSCI patients. These data further support the principle of early surgical intervention for all types of SCI, even those with clinically complete lesions at baseline.