BACKGROUND The aim of this study was to investigate the clinical outcomes of early and delayed surgery in cervical spinal cord injury following whiplash in elderly patients. MATERIAL AND METHODS Our retrospective review identified elderly patients (≥65 years old) with spinal cord injury following whiplash injury from 2006 to 2015. The neck disability index (NDI), modify Japanese Orthopedics Association (mJOA) score, and visual analogue scale (VAS) score were used to evaluate clinical outcomes preoperatively and during follow-up. The angular range of motion (ROM) for C2-C7 was measured by dynamic flexion and extension lateral cervical radiographs at each observation follow-up time point. Treatment-related complication data were collected, and the complication rates analyzed. RESULTS Forty-six elderly patients (age range 65-82 years) with spinal cord injury following whiplash injury were enrolled in this study. Twenty-four patients underwent early surgery and twenty-two patients (age range 65-78 years) received delayed surgery after conservative treatment failure. During the follow-up period, both groups had significant post-operative improvement in NDI, mJOA, and VAS scores (p<0.05), although the early surgery group had better outcomes than the delayed surgery after unsuccessful conservative treatment group (p<0.05). However, on average, no significant differences in sagittal C2-C7 ROM between the two groups were found during follow-up. Comparison of the two groups showed the incidences of pneumonia and deep vein thrombosis were significantly higher in the delayed surgery group (p<0.05). CONCLUSIONS This study indicated that delayed surgery after unsuccessful conservative treatment provided excellent clinical results for elderly patients; however, timely surgical intervention is necessary for neurological symptom deterioration.