J Neurol Surg A Cent Eur Neurosurg 2020; 81(04): 318-323
DOI: 10.1055/s-0039-1691753
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Effect of Surgical Intervention on Neurologic Recovery in Patients with Central Cord Syndrome

Li Du
1   Department of Orthopaedics, Shanghai Fengxian Central Hospital, Shanghai, China
,
Shichang Zhao
2   Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
,
Zhongsheng Zhu
1   Department of Orthopaedics, Shanghai Fengxian Central Hospital, Shanghai, China
,
Feng Xue
1   Department of Orthopaedics, Shanghai Fengxian Central Hospital, Shanghai, China
,
Yadong Zhang
1   Department of Orthopaedics, Shanghai Fengxian Central Hospital, Shanghai, China
3   Department of Orthopaedics, Fengxian Hospital, Southern Medical University, China
› Author Affiliations
Funding This study was supported by the National Natural Science Foundation of China (51672191, 81871774) and the foundation of medical group of the Six People’s Hospital Affiliated to Shanghai Jiao Tong University (2018 Duli).
Further Information

Publication History

17 August 2018

06 February 2019

Publication Date:
15 April 2020 (online)

Abstract

To review the experience of managing central cord syndrome (CCS) surgically, we retrospectively reviewed 71 patients from October 2015 to April 2017. Deteriorating neurologic status with evidence of radiologic compression and spinal instability were absolute indications for surgery. The American Spinal and Injury Association (ASIA) motor scores (AMS) were recorded at the time of admission (aAMS), 3 days postoperatively (3dAMS), 1 month postoperatively(1mAMS), and at final follow-up (fAMS). Analysis of variance was performed to compare 3dAMS, 1mAMS, and fAMS. Surgery was successful in all 71 patients without re-injury of the spinal cord, infection, or other perioperative complications. The postoperative AMS at 3 days, 1 month, and at the final follow-up significantly improved over preoperative scores. ASIA sensory scores at fAMS were significantly better than 3dAMS and1mAMS scores. The ASIA motor and sensory scores at 1mAMS showed no significant improvements compared with the 3dAMS. Therefore, for patients diagnosed with CCS, combined with evidence of radiologic compression and spinal instability, surgery was beneficial in terms of gains in neurologic recovery.

 
  • References

  • 1 Harrop JS, Sharan A, Ratliff J. Central cord injury: pathophysiology, management, and outcomes. Spine J 2006; 6 (6, Suppl): 198S-206S
  • 2 Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg 1954; 11 (06) 546-577
  • 3 Aarabi B, Koltz M, Ibrahimi D. Hyperextension cervical spine injuries and traumatic central cord syndrome. Neurosurg Focus 2008; 25 (05) E9
  • 4 Dai L, Jia L. Central cord injury complicating acute cervical disc herniation in trauma. Spine 2000; 25 (03) 331-335 ; discussion 336
  • 5 Hayes KC, Askes HK, Kakulas BA. Retropulsion of intervertebral discs associated with traumatic hyperextension of the cervical spine and absence of vertebral fracture: an uncommon mechanism of spinal cord injury. Spinal Cord 2002; 40 (10) 544-547
  • 6 Penrod LE, Hegde SK, Ditunno Jr JF. Age effect on prognosis for functional recovery in acute, traumatic central cord syndrome. Arch Phys Med Rehabil 1990; 71 (12) 963-968
  • 7 Roth EJ, Lawler MH, Yarkony GM. Traumatic central cord syndrome: clinical features and functional outcomes. Arch Phys Med Rehabil 1990; 71 (01) 18-23
  • 8 Jimenez O, Marcillo A, Levi AD. A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome. Spinal Cord 2000; 38 (09) 532-537
  • 9 Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia. A ten-year review. JAMA 1971; 216 (03) 473-478
  • 10 Newey ML, Sen PK, Fraser RD. The long-term outcome after central cord syndrome: a study of the natural history. J Bone Joint Surg Br 2000; 82 (06) 851-855
  • 11 Dvorak MF, Fisher CG, Hoekema J. , et al. Factors predicting motor recovery and functional outcome after traumatic central cord syndrome: a long-term follow-up. Spine 2005; 30 (20) 2303-2311
  • 12 Anderson DG, Sayadipour A, Limthongkul W, Martin ND, Vaccaro A, Harrop JS. Traumatic central cord syndrome: neurologic recovery after surgical management. Am J Orthop 2012; 41 (08) E104-E108
  • 13 Stevenson CM, Dargan DP, Warnock J. , et al. Traumatic central cord syndrome: neurological and functional outcome at 3 years. Spinal Cord 2016; 54 (11) 1010-1015
  • 14 Wang Y, Xue Y, Zong Y. , et al. Treatment of atypical central cord injury without fracture or dislocation. Orthopedics 2015; 38 (06) e524-e528
  • 15 Samuel AM, Grant RA, Bohl DD. , et al. Delayed surgery after acute traumatic central cord syndrome is associated with reduced mortality. Spine 2015; 40 (05) 349-356
  • 16 Yoshihara H, Yoneoka D. Trends in the treatment for traumatic central cord syndrome without bone injury in the United States from 2000 to 2009. J Trauma Acute Care Surg 2013; 75 (03) 453-458
  • 17 Park MS, Moon SH, Lee HM. , et al. Delayed surgical intervention in central cord syndrome with cervical stenosis. Global Spine J 2015; 5 (01) 69-72
  • 18 Stevens EA, Marsh R, Wilson JA, Sweasey TA, Branch Jr CL, Powers AK. A review of surgical intervention in the setting of traumatic central cord syndrome. Spine J 2010; 10 (10) 874-880
  • 19 Wilson JR, Tetreault LA, Kwon BK. , et al. Timing of decompression in patients with acute spinal cord injury: a systematic review. Global Spine J 2017; 7 (3, Suppl): 95S-115S
  • 20 Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?. Spinal Cord 2006; 44 (09) 523-529
  • 21 Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. J Am Acad Orthop Surg 2009; 17 (12) 756-765
  • 22 Taylor AR, Blackwood W. Paraplegia in hyperextension cervical injuries with normal radiographic appearances. J Bone Joint Surg Br 1948; 30B (02) 245-248
  • 23 Quencer RM, Bunge RP, Egnor M. , et al. Acute traumatic central cord syndrome: MRI-pathological correlations. Neuroradiology 1992; 34 (02) 85-94
  • 24 Levi AD, Tator CH, Bunge RP. Clinical syndromes associated with disproportionate weakness of the upper versus the lower extremities after cervical spinal cord injury. Neurosurgery 1996; 38 (01) 179-183 ; discussion 183–185
  • 25 Bose B, Northrup BE, Osterholm JL, Cotler JM, DiTunno JF. Reanalysis of central cervical cord injury management. Neurosurgery 1984; 15 (03) 367-372
  • 26 Merriam WF, Taylor TK, Ruff SJ, McPhail MJ. A reappraisal of acute traumatic central cord syndrome. J Bone Joint Surg Br 1986; 68 (05) 708-713
  • 27 Fox JL, Wener L, Drennan DC, Manz HJ, Won DJ, Al-Mefty O. Central spinal cord injury: magnetic resonance imaging confirmation and operative considerations. Neurosurgery 1988; 22 (02) 340-347
  • 28 Shrosbree RD. Acute central cervical spinal cord syndrome—aetiology, age incidence and relationship to the orthopaedic injury. Paraplegia 1977; 14 (04) 251-258
  • 29 Liu Y, Wang Z, Yang S, Yang H, Zou J. The effect of surgical intervention for delayed cervical central cord syndrome. BioMed Res Int 2017; 2017: 7979850
  • 30 Jin W, Sun X, Shen K. , et al. Recurrent neurological deterioration after conservative treatment for acute traumatic central cord syndrome without bony injury: seventeen operative case reports. J Neurotrauma 2017; 34 (21) 3051-3057
  • 31 Yousefifard M, Rahimi-Movaghar V, Baikpour M. , et al. Early versus late spinal decompression surgery in treatment of traumatic spinal cord injuries; a systematic review and meta-analysis. Emergency (Tehran) 2017; 5 (01) e37
  • 32 Anderson KK, Tetreault L, Shamji MF. , et al. Optimal timing of surgical decompression for acute traumatic central cord syndrome: a systematic review of the literature. Neurosurgery 2015; 77 (Suppl. 04) S15-S32
  • 33 Fehlings MG, Rabin D, Sears W, Cadotte DW, Aarabi B. Current practice in the timing of surgical intervention in spinal cord injury. Spine 2010; 35 (21, Suppl): S166-S173
  • 34 Chen L, Yang H, Yang T, Xu Y, Bao Z, Tang T. Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine 2009; 10 (01) 3-8
  • 35 Molliqaj G, Payer M, Schaller K, Tessitore E. Acute traumatic central cord syndrome: a comprehensive review. Neurochirurgie 2014; 60 (1–2): 5-11
  • 36 Lukáš R, Barsa P, Pazour J, Šrám J. Timing of surgical intervention in acute spinal cord injury and post-operative neurological recovery [in Czech]. Acta Chir Orthop Traumatol Cech 2012; 79 (03) 233-237