Summary
Evidence from three small retrospective cohort studies fails to clarify whether timing
of the surgery plays a definitive role in recovery and rehabilitation among subjects
undergoing surgical treatment for traumatic central cord syndrome (TCSS). There was
wide variation with regard to what was considered early versus delayed intervention.
Two studies found no difference in improvement of ASIA scores or walking ability between
patients undergoing surgery early (within 1 – 14 days) versus delayed (after 1 – 14
days) after injury presentation. One study did find that the interval between injury
and surgery was significantly associated with recovery rate. Studies with improved
methodology are needed to determine whether the timing of surgery is associated with
functional recovery. Since timing and type of treatment may have been influenced by
patient presentation and surgeon preferences, there is an opportunity for bias (confounding
by indication) as patient groups may be different. Retrospective cohort studies that
do not account for differences in patient population and other factors are likely
inadequate to address this issue. To provide adequate sample size, a multi-center
study could be considered.
