Traumatic central cord syndrome: neurological and functional outcome at 3 years

• Published in: Spinal cord 2016-11, Vol.54 (11), p.1010-1015
• Main Authors: Stevenson, C M, Dargan, D P, Warnock, J, Sloan, S, Espey, R, Maguire, S, Eames, N
• Format: Article
• Language: English
• Subjects: 692/617; 692/698/1688/1366/1823; 692/699/578; Adult; Age Factors; Aged; Aged, 80 and over; Anatomy; Biomedical and Life Sciences; Biomedicine; Cross-Over Studies; Female; Human Physiology; Humans; Ireland; Longitudinal Studies; Male; Middle Aged; Motor Activity - physiology; Nervous System Diseases - diagnostic imaging; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Neurochemistry; Neurologic Examination; Neuropsychology; Neurosciences; original-article; Recovery of Function - physiology; Retrospective Studies; Spinal Cord Diseases - complications; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - epidemiology; Spinal Cord Diseases - surgery; Time Factors; Treatment Outcome
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2016.34

Study design: Retrospective cohort analysis with prospective follow-up. Objectives: To evaluate neurological and functional recovery following central cord syndrome. Setting: Northern Ireland, population 1.8 million. Methods: Twenty-seven cords were identified in 1 year. Five managed conservatively and 22 with surgery. American Spinal Injury Association (ASIA) motor scores (AMS) were calculated to assess neurological recovery. Rotterdam scores assessed functional independence at 3 years. Results: Average age was 62 years. Mechanism of injury was a fall with neck hyperextension in 81% patients. Average AMS in surgical patients improved from injury, preoperatively, postoperatively, 6 months and 3 years from 51, 81, 83, 90 to 96, respectively. Conservative patients improved from time of injury to day 10 from 57 to 86 and then fell to 84 at 6 months. By 3 years, this had recovered to 91. There was no statistical significant difference in AMS ( P =0.15)/change in AMS (ΔAMS) ( P =0.92) or percentage of motor deficit resolution ( P =0.23) between groups at 3 years. Two patients underwent surgery within 48 h and achieved full motor recovery by 3 years, but this was not significant ( P =0.2). ASIA score improvement had a positive correlation with age at injury. Patients treated with surgery had better Rotterdam scores at 3 years than those managed conservatively ( P =0.05). Conclusions: This study confirms the natural history of central cord syndrome. Although it demonstrates equivocal neurological recovery for both groups, patients treated with surgery regained a greater degree of functional independence.