Introduction: Trauma to the cervical spine is a distressing injury with the promise of bad neurological complications. The optimal immobilization regimen and timing of operation remain controversial in contemporary trauma care. This study aimed to evaluate the association between different modes of immobilization, timing, and orthopedic intervention of neurological recovery among patients with cervical spine trauma. Methods & Materials: A 24-month prospective observational study among 100 patients with radiologically confirmed cervical spine trauma was conducted. Adults aged 18 years and older with radiologically confirmed cervical spine injuries were included. Detailed demographic, clinical, and treatment data were collected. Neurological outcomes were assessed using the ASIA impairment scale at admission and 6 months. Independent predictors of poor neurological outcomes (ASIA A-C) were defined by multivariable logistic regression analysis. Results: The mean age of the study population was 42.8±15.6 years, with a male dominance of 68%. Subaxial fractures (C3-C7) were most common (55%). Road traffic accidents accounted for 45% of the injuries. Fifty-five percent of patients had good neurological improvement (ASIA D or E) at 6 months. Multivariable analysis revealed that independent predictors of adverse outcomes were early ASIA A/B score (aOR 6.75, p72 hours (aOR 2.90, p=0.014), high-energy mechanism (aOR 3.12, p=0.003), age >60 years (aOR 2.45, p=0.027), and non-surgical treatment (aOR 2.40, p=0.028). Conclusion: Early surgery within 72 hours and careful patient selection greatly improve neurological recovery in cervical spine trauma. Initial nerve condition is the strongest predictor, while delays worsen outcomes—supporting the "time is spine" principle.