Effectiveness of surgical treatment for traumatic central cord syndrome: Clinical article

Department of Orthopaedic Surgery, The First Affiliated Hospital of Suzhou University, Suzhou, People's Republic of China.
Journal of Neurosurgery Spine (Impact Factor: 2.38). 02/2009; 10(1):3-8. DOI: 10.3171/2008.9.SPI0822
Source: PubMed


The authors undertook a study in patients with traumatic central cord syndrome (TCCS) who underwent surgical intervention. They retrospectively assessed the motor score improvement and functional status and identified prognostic predictors of improvement.
Between March 1999 and May 2004, 49 patients with TCCS were surgically treated. Motor scores were collected at admission and follow-up using the American Spinal Injury Association (ASIA) Impairment Scale. The 36-Item Short Form Health Survey (SF-36) was administered. Other parameters including walking index, spasticity, bladder management, and neuropathic pain scores were recorded. Patients were asked to assess their level of satisfaction with their final symptoms.
The average ASIA score, converted into numeric values, was increased from 54.9 at admission to 81.9 and 89.6 at 6 months and final follow-up, respectively. Significant improvement of ASIA score was achieved within the first 6 months of surgery. No significant difference was found between patients who underwent surgery within 4 days of injury or after 4 days of injury, adopting different approaches (anterior, posterior, or a combination), or with different pathological entities (acute disc herniation, fracture or dislocation, or multilevel degeneration). The ASIA score improvement had a positive correlation with the age at injury (r = 0.505, p = 0.023). The SF-36 data at 6 months and final follow-up were not as satisfactory as the improvement in ASIA scores, and almost one-third of patients expressed dissatisfaction with their final symptoms. For patients who were older than 65 years at injury, the mean follow-up Walking Index for Spinal Cord Injury (WISCI) score was statistically lower than it was in younger patients. The presence of spasticity or neuropathic pain at follow-up was not related to age, sex, ASIA motor score, or WISCI outcome.
Surgical intervention can be safely applied in patients with TCCS. Significant improvement of ASIA score was achieved during the first 6-month period of follow-up. Factors including type of lesion, timing of surgery within or after 4 days of injury, and surgical approach were not significantly associated with final ASIA score. The improvement in the ASIA motor score was positively correlated with age at injury. No significant correlation was found between or among the presence of spasticity, neuropathic pain, and ASIA score at final visit. Almost one-third of patients were not satisfied with their final symptoms.

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    • "The debate about early versus late decompression is still not closed. Early has been defined rather broadly from less than 24 hours to less than 14 days [3,4,6]. "
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    ABSTRACT: Background Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subject of discussion. From a biological point of view early surgery could prevent secondary damage due to ongoing compression of the already damaged spinal cord. Historically, however, conservative treatment was propagated with good clinical results. Proponents for early surgery as well those favoring conservative treatment are still in debate. The proposed trial will contribute to the discussion and hopefully also to a decrease in the variability of clinical practice. Methods/Design A randomized controlled trial is designed to compare the clinical outcome of early surgical strategy versus a conservative approach. The primary outcome is clinical outcome according to mJOA. This also measured by ASIA score, DASH score and SCIM III score. Other endpoints are duration of the stay at a high care department (medium care, intensive care), duration of the stay at the hospital, complication rate, mortality rate, sort of rehabilitation, and quality of life. A sample size of 36 patients per group was calculated to reach a power of 95%. The data will be analyzed as intention-to-treat at regular intervals, but the end evaluation will take place at two years post-injury. Discussion At the end of the study, clinical outcomes between treatments attitudes can be compared. Efficacy, but also efficiency can be determined. A goal of the study is to determine which treatment will result in the best quality of life for the patients. This study will certainly contribute to more uniformity of treatment offered to patients with a special sort of spinal cord injury. Trial Registration Gov: NCT01367405
    BMC Musculoskeletal Disorders 01/2013; 14(1):52. DOI:10.1186/1471-2474-14-52 · 1.72 Impact Factor
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    • "To elaborate, the SCI literature has been historically variable on the definition of timing. Out of 22 studies attempting to define optimal timing for surgery after acute traumatic SCI, 9 utilized the 24 hour limit to define an early decompressive operation [35], [36], [37], [38], [39], [40], [41], [42], [43], 8 used 72 hours [18], [19], [44], [45], [46], [47], [48], [49], and 4 used other benchmarks such 8 hours, 48 hours or 4 days [50], [51], [52], [53]. Importantly, no study has associated adverse neurologic outcomes with early surgical intervention, regardless of a specific time cutoff. "
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    ABSTRACT: There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (<24 hours after injury) versus late (≥ 24 hours after injury) decompressive surgery after traumatic cervical SCI. We performed a multicenter, international, prospective cohort study (Surgical Timing In Acute Spinal Cord Injury Study: STASCIS) in adults aged 16-80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change in ASIA Impairment Scale (AIS) grade at 6 months follow-up. Secondary outcomes included assessments of complications rates and mortality. A total of 313 patients with acute cervical SCI were enrolled. Of these, 182 underwent early surgery, at a mean of 14.2(± 5.4) hours, with the remaining 131 having late surgery, at a mean of 48.3(± 29.3) hours. Of the 222 patients with follow-up available at 6 months post injury, 19.8% of patients undergoing early surgery showed a ≥ 2 grade improvement in AIS compared to 8.8% in the late decompression group (OR = 2.57, 95% CI:1.11,5.97). In the multivariate analysis, adjusted for preoperative neurological status and steroid administration, the odds of at least a 2 grade AIS improvement were 2.8 times higher amongst those who underwent early surgery as compared to those who underwent late surgery (OR = 2.83, 95% CI:1.10,7.28). During the 30 day post injury period, there was 1 mortality in both of the surgical groups. Complications occurred in 24.2% of early surgery patients and 30.5% of late surgery patients (p = 0.21). Decompression prior to 24 hours after SCI can be performed safely and is associated with improved neurologic outcome, defined as at least a 2 grade AIS improvement at 6 months follow-up.
    PLoS ONE 02/2012; 7(2):e32037. DOI:10.1371/journal.pone.0032037 · 3.23 Impact Factor
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    ABSTRACT: Central cord syndrome is the most common incomplete spinal cord injury, and it often occurs in patients suffering from a hyperextension injury. Early surgery has been advocated to improve the outcome and neurological function. However, extended spinal cord injury following anterior cervical discectomy and fusion for central cord syndrome rarely occurs and is seldom reported in the literature. We report a 61-year-old man who suffered from a hyperextension injury, which was diagnosed as traumatic central cord syndrome. Because of the ensuing instability and cord compression, he underwent anterior cervical discectomy and fusion. However, more severe myelopathy was observed postoperatively and extended cord injury was diagnosed based on the expansion of intramedullary high-intensity signal on T2-weighted magnetic resonance images. Patients and surgeons need to be informed of this uncommon but now recognized complication after anterior cervical discectomy and fusion for traumatic central cord syndrome.
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