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.
