A review of surgical intervention in the setting of traumatic central cord syndrome

• Published in: The spine journal 2010-10, Vol.10 (10), p.874-880
• Main Authors: Stevens, E. Andrew, MD, Marsh, Robert, MD, PhD, Wilson, John A., MD, Sweasey, Thomas A., MD, Branch, Charles L., MD, Powers, Alexander K., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Central cord syndrome; Central Cord Syndrome - surgery; Cervical spine; Cervical Vertebrae - injuries; Female; Humans; Incomplete spinal cord injury; Intensive Care Units; Length of Stay; Male; Middle Aged; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Orthopedics; Postoperative Complications - epidemiology; Recovery of Function; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2010.07.388

Abstract Background context Surgical treatment in the setting of central cord syndrome (CCS) has become safer since Schneider’s original description. It is generally accepted that a decompressive surgical intervention is a valid treatment option in a patient with CCS and radiographic evidence of spinal cord compression. The optimal timing of surgical intervention for CCS remains controversial. Purpose To review a single institution’s experience managing CCS, with particular emphasis on surgical versus medical management, timing of surgery, neurologic outcomes, hospital length of stay, and complications. Study design Retrospective review. Patient sample One hundred twenty-six patients diagnosed with CCS were treated at Wake Forest University Baptist Medical Center between June 1985 and September 2006. Outcome measures Neurological outcomes were measured using the Frankel grading scale. Other outcome measures included hospital and intensive care unit (ICU) length of stay and complication profiles. Methods A retrospective chart review was performed on patients admitted to Wake Forest University Baptist Medical Center with the diagnosis of traumatic central cord injury from June 1985 to September 2006 with institutional review board approval. Neurologic status was recorded on presentation and at maximum follow-up using the Frankel classification. The surgical cohort was stratified into three subgroups with regard to the timing of surgical intervention after injury: surgery less than 24 hours after injury, surgery greater than 24 hours after injury but during the initial admission, and delayed operative intervention on a second hospital admission. Other variables collected included ICU and hospital length of stay and complication profiles. Data analyses were performed using SPSS (SPSS, Chicago, IL, USA) and Excel 2002 (Microsoft, Seattle, WA, USA). Results A total of 126 patients treated for CCS were reviewed. Sixty-seven patients received surgery compared with 59 patients managed nonoperatively. Of those managed operatively, 16 patients received surgery within 24 hours of the time of injury. There were 34 patients who received surgery greater than 24 hours after the time of injury but during their initial admission with a mean time to surgery of 6.4 days (5–52 days). There were 17 patients who received their operation on a second hospital admission with a mean time interval of 137 days between injury and surgery (3–209). Mean follow-up was 32 months (1–210 mon