1
|
Bin-Alamer O, Qedair J, Abou-Al-Shaar H, Mallela AN, Balasubramanian K, Alnefaie N, Abou Al-Shaar AR, Plute T, Lu VM, McCarthy DJ, Fields DP, Agarwal N, Gerszten PC, Hamilton DK. Surgical intervention ≤ 24 hours versus > 24 hours after injury for the management of acute traumatic central cord syndrome: a systematic review and meta-analysis. J Neurosurg Spine 2024; 40:653-661. [PMID: 38335527 DOI: 10.3171/2023.11.spine23789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/16/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The objective was to evaluate the efficacy, outcomes, and complications of surgical intervention performed within 24 hours (≤ 24 hours) versus after 24 hours (> 24 hours) in managing acute traumatic central cord syndrome (ATCCS). METHODS Articles pertinent to the study were retrieved from PubMed, Scopus, Web of Science, and Cochrane. The authors performed a systematic review and meta-analysis of treatment procedures and outcomes according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines. RESULTS Seven articles comprising 488 patients were included, with 188 (38.5%) patients in the ≤ 24-hour group and 300 (61.5%) in the > 24-hour group. Significant differences were not found between groups in terms of demographic characteristics, injury mechanism, spinal cord compression level, neuroimaging features, and the American Spinal Injury Association (ASIA) motor score at admission. Both groups had a similar approach to surgery and steroid administration. The surgical complication rate was significantly higher in the > 24-hour group (4.5%) compared to the ≤ 24-hour group (1.2%) (p = 0.05). Clinical follow-up duration was similar at 12 months (interquartile range 3-36) for both groups (p > 0.99). The ≤ 24-hour group demonstrated a not statistically significant greater improvement in ASIA motor score, with a mean difference of 12 (95% CI -20.7 to 44.6) compared to the > 24-hour group. CONCLUSIONS The present study indicates potential advantages of early (≤ 24 hours) surgery in ATCCS patients, specifically in terms of lower complication rates. However, further research is needed to confirm these findings and their clinical implications.
Collapse
Affiliation(s)
- Othman Bin-Alamer
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jumanah Qedair
- 2College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hussam Abou-Al-Shaar
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arka N Mallela
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Nada Alnefaie
- 4Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Tritan Plute
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Victor M Lu
- 6Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida
| | - David J McCarthy
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daryl P Fields
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter C Gerszten
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - D Kojo Hamilton
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
2
|
Sattari SA, Antar A, Theodore JN, Hersh AM, Al-Mistarehi AH, Davidar AD, Weber-Levine C, Azad TD, Yang W, Feghali J, Xu R, Manbachi A, Lubelski D, Bettegowda C, Chang L, Witham T, Belzberg A, Theodore N. Early versus late surgical decompression for patients with acute traumatic central cord syndrome: a systematic review and meta-analysis. Spine J 2024; 24:435-445. [PMID: 37890727 DOI: 10.1016/j.spinee.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/08/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND CONTEXT The optimal decompression time for patients presenting with acute traumatic central cord syndrome (ATCCS) has been debated, and a high level of evidence is lacking. PURPOSE To compare early (<24 hours) versus late (≥24 hours) surgical decompression for ATCCS. STUDY DESIGN Systematic review and meta-analysis. METHODS Medline, PubMed, Embase, and CENTRAL were searched from inception to March 15th, 2023. The primary outcome was American Spinal Injury Association (ASIA) motor score. Secondary outcomes were venous thromboembolism (VTE), total complications, overall mortality, hospital length of stay (LOS), and ICU LOS. The GRADE approach determined certainty in evidence. RESULTS The nine studies included reported on 5,619 patients, of whom 2,099 (37.35%) underwent early decompression and 3520 (62.65%) underwent late decompression. The mean age (53.3 vs 56.2 years, p=.505) and admission ASIA motor score (mean difference [MD]=-0.31 [-3.61, 2.98], p=.85) were similar between the early and late decompression groups. At 6-month follow-up, the two groups were similar in ASIA motor score (MD= -3.30 [-8.24, 1.65], p=.19). However, at 1-year follow-up, the early decompression group had a higher ASIA motor score than the late decompression group in total (MD=4.89 [2.89, 6.88], p<.001, evidence: moderate), upper extremities (MD=2.59 [0.82, 4.36], p=.004) and lower extremities (MD=1.08 [0.34, 1.83], p=.004). Early decompression was also associated with lower VTE (odds ratio [OR]=0.41 [0.26, 0.65], p=.001, evidence: moderate), total complications (OR=0.53 [0.42, 0.67], p<.001, evidence: moderate), and hospital LOS (MD=-2.94 days [-3.83, -2.04], p<.001, evidence: moderate). Finally, ICU LOS (MD=-0.69 days [-1.65, 0.28], p=.16, evidence: very low) and overall mortality (OR=1.35 [0.93, 1.94], p=.11, evidence: moderate) were similar between the two groups. CONCLUSIONS The meta-analysis of these studies demonstrated that early decompression was beneficial in terms of ASIA motor score, VTE, complications, and hospital LOS. Furthermore, early decompression did not increase mortality odds. Although treatment decision-making has been individualized, early decompression should be considered for patients presenting with ATCCS, provided that the surgeon deems it appropriate.
Collapse
Affiliation(s)
- Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA.
| | - Albert Antar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - John N Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Abdel-Hameed Al-Mistarehi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Louis Chang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Allan Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 7-113, Baltimore, MD 21287, USA.
| |
Collapse
|
3
|
Zhou Q, He W, Lv J, Liu H, Yang H, Zhang J, Liu T. Benefits of Early Surgical Treatment for Patients with Multilevel Cervical Canal Stenosis of Acute Traumatic Central Cord Syndrome. Orthop Surg 2023; 15:3092-3100. [PMID: 37771121 PMCID: PMC10694011 DOI: 10.1111/os.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Currently, there exists considerable debate surrounding the optimal treatment approaches for different subtypes of patients with spinal cord injury (SCI). The purpose of this study was to conduct a comparative analysis of the benefits associated with conservative treatment and treatments with different surgical periods for patients diagnosed with acute traumatic central cord syndrome (ATCCS) and multilevel cervical canal stenosis (CCS). METHODS A retrospective cohort study was conducted, and 93 patients who met inclusion and exclusion criteria in our hospital between 2015 and 2020 were followed for a minimum duration of 2 years. Among them, 30 patients (Group A) received conservative treatment, 18 patients (Group B) received early surgery (≤7 days), and 45 patients (Group C) received late surgery (>7 days). The American Spinal Injury Association (ASIA) grade, Japanese Orthopedic Association (JOA) score, and recovery rate (RR) were evaluated. Multivariate linear regression was used to analyze prognostic determinants. Cost-utility analysis was performed based on the EQ-5D scale. RESULTS The ASIA grade, JOA score, and RR of all three groups improved compared with the previous evaluation (P < 0.05). During follow-up, the ASIA grade, JOA score, and RR of Group B were all better than for Group A and Group C (P < 0.05), while there was no significant difference between Group A and C (P > 0.05). The EQ-5D scale in Group B was optimal at the last follow-up. The incremental cost-utility ratio (ICUR) of Group A was the lowest, while that of Group B compared to Group A was less than the threshold of patients' willingness to pay. Age, initial ASIA grade, and treatment types significantly affected the outcomes. CONCLUSIONS Both conservative and surgical treatments yield good results. Compared with patients who received conservative treatment and late surgery, patients who received early surgery had better clinical function and living quality. Despite the higher cost, early surgery is cost-effective when compared to conservative treatment. Younger age, initial better ASIA grade, and earlier surgery were associated with better prognosis.
Collapse
Affiliation(s)
- Quan Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouChina
| | - Wei He
- Department of Orthopaedics, The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouChina
| | - Jiaheng Lv
- Department of Orthopaedics, The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouChina
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouChina
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouChina
| | - Junxin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouChina
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouChina
| |
Collapse
|
4
|
Kumar AA, Wong JYH, Pillay R, Nolan CP, Ling JM. Treatment of acute traumatic central cord syndrome: a score-based approach based on the literature. Eur Spine J 2023; 32:1575-1583. [PMID: 36912986 DOI: 10.1007/s00586-023-07626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/06/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Acute traumatic central cord syndrome (ATCCS) accounts for up to 70% of incomplete spinal cord injuries, and modern improvements in surgical and anaesthetic techniques have given surgeons more treatment options for the ATCCS patient. We present a literature review of ATCCS, with the aim of elucidating the best treatment option for the varying ATCCS patient characteristics and profiles. We aim to synthesise the available literature into a simple-to-use format to aid in the decision-making process. METHODS The MEDLINE, EMBASE, CENTRAL, Web of Science and CINAHL databases were searched for relevant studies and improvement in functional outcomes were calculated. To allow for direct comparison of functional outcomes, we chose to focus solely on studies which utilised the ASIA motor score and improvements in ASIA motor score. RESULTS A total of 16 studies were included for review. There were a total of 749 patients, of which 564 were treated surgically and 185 were treated conservatively. There was a significantly higher average motor recovery percentage amongst surgically-treated patients as compared to conservatively treated patients (76.1% vs. 66.1%, p value = 0.04). There was no significant difference between the ASIA motor recovery percentage of patients treated with early surgery and delayed surgery (69.9 vs. 77.2, p value = 0.31). Delayed surgery after a trial of conservative management is also an appropriate treatment strategy for certain patients, and the presence of multiple comorbidities portend poor outcomes. We propose a score-based approach to decision making in ATCCS, by allocating a numerical score for the patient's clinical neurological condition, imaging findings on CT or MRI, history of cervical spondylosis and comorbidity profile. CONCLUSIONS An individualised approach to each ATCCS patient, considering their unique characteristics will lead to the best outcomes, and the use of a simple scoring system, can aid clinicians in choosing the best treatment for ATCCS patients.
Collapse
Affiliation(s)
- A Aravin Kumar
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.
| | - Joey Ying Hao Wong
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Robin Pillay
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Colum Patrick Nolan
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ji Min Ling
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| |
Collapse
|
5
|
Liu G, Liu L, Wang Y. Surgical Efficacy and Prognostic Factors for Acute Traumatic Central Cord Syndrome Without Fracture and Dislocation. Orthopedics 2022; 45:325-332. [PMID: 36098568 DOI: 10.3928/01477447-20220907-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study was undertaken to evaluate the effectiveness of surgical treatment of acute traumatic central cord syndrome (ATCCS) without fracture and dislocation and explore surgical timing and factors influencing postoperative recovery of spinal cord function. We retrospectively collected the general and clinical data of 112 patients with ATCCS (American Spinal Injury Association impairment scale grade C or D) without fracture and dislocation who underwent surgical treatment in our hospital from January 2013 to August 2019. We used statistical methods to evaluate the safety of the operation and explore the timing of surgery and the factors influencing postoperative recovery of spinal cord function. The mean age of the 112 patients was 60.64±12.91 years. The Japanese Orthopaedic Association score and the American Spinal Injury Association motor score (AMS) of the 112 patients were significantly higher at final follow-up than at admission. No significant difference in recovery of spinal cord function was seen between the early operation group (≤4 days) and the late operation group (>4 days). Comparison of patients with a good prognosis vs a poor prognosis showed that age, intrahand muscle strength at admission, maximum spinal cord compression, maximum canal compromise, length of high-intensity signal in the spinal cord on sagittal T2-weighted magnetic resonance imaging, AMS, and American Spinal Injury Association injury grade D/C at admission had a significant effect on recovery of spinal cord function. Surgical treatment of ATCCS without fracture and dislocation is safe and effective. Age, admission AMS and American Spinal Injury Association impairment scale score, intrinsic hand muscle strength, maximum canal compromise, maximum spinal cord compression, and length of high-intensity signal in the spinal cord can be used to predict postoperative recovery of spinal cord function. [Orthopedics. 2022;45(6):325-332.].
Collapse
|
6
|
Badhiwala JH, Wilson JR, Harrop JS, Vaccaro AR, Aarabi B, Geisler FH, Fehlings MG. Early vs Late Surgical Decompression for Central Cord Syndrome. JAMA Surg 2022; 157:1024-1032. [PMID: 36169962 PMCID: PMC9520438 DOI: 10.1001/jamasurg.2022.4454] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
Importance The optimal clinical management of central cord syndrome (CCS) remains unclear; yet this is becoming an increasingly relevant public health problem in the face of an aging population. Objective To provide a head-to-head comparison of the neurologic and functional outcomes of early (<24 hours) vs late (≥24 hours) surgical decompression for CCS. Design, Setting, and Participants Patients who underwent surgery for CCS (lower extremity motor score [LEMS] - upper extremity motor score [UEMS] ≥ 5) were included in this propensity score-matched cohort study. Data were collected from December 1991 to March 2017, and the analysis was performed from March 2020 to January 2021. This study identified patients with CCS from 3 international multicenter studies with data on the timing of surgical decompression in spinal cord injury. Participants were included if they had a documented baseline neurologic examination performed within 14 days of injury. Participants were eligible if they underwent surgical decompression for CCS. Exposures Early surgery was compared with late surgery. Main Outcomes and Measures Propensity scores were calculated as the probability of undergoing early compared with late surgery using the logit method and adjusting for relevant confounders. Propensity score matching was performed in a 1:1 ratio by an optimal-matching technique. The primary end point was motor recovery (UEMS, LEMS, American Spinal Injury Association [ASIA] motor score [AMS]) at 1 year. Secondary end points were Functional Independence Measure (FIM) motor score and complete independence in each FIM motor domain at 1 year. Results The final study cohort consisted of 186 patients with CCS. The early-surgery group included 93 patients (mean [SD] age, 47.8 [16.8] years; 66 male [71.0%]), and the late-surgery group included 93 patients (mean [SD] age, 48.0 [15.5] years; 75 male [80.6%]). Early surgical decompression resulted in significantly improved recovery in upper limb (mean difference [MD], 2.3; 95% CI, 0-4.5; P = .047), but not lower limb (MD, 1.1; 95% CI, -0.8 to 3.0; P = .30), motor function. In an a priori-planned subgroup analysis, outcomes were comparable with early or late decompressive surgery in patients with ASIA Impairment Scale (AIS) grade D injury. However, in patients with AIS grade C injury, early surgery resulted in significantly greater recovery in overall motor score (MD, 9.5; 95% CI, 0.5-18.4; P = .04), owing to gains in both upper and lower limb motor function. Conclusions and Relevance This cohort study found early surgical decompression to be associated with improved recovery in upper limb motor function at 1 year in patients with CCS. Treatment paradigms for CCS should be redefined to encompass early surgical decompression as a neuroprotective therapy.
Collapse
Affiliation(s)
- Jetan H. Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore
| | - Fred H. Geisler
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Zhang C, Lee VKH, Yu JML, Cheung JPY, Koljonen PA, Shea GKH. Length of Cervical Stenosis, Admission ASIA Motor Scores, and BASIC Scores Are Predictors of Recovery Rate Following Central Cord Syndrome. Spine (Phila Pa 1976) 2022; 47:212-219. [PMID: 34310538 DOI: 10.1097/brs.0000000000004178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE This study aims to determine whether quantitative magnetic resonance imaging (MRI) parameters and radiological scoring systems could be used as a reliable assessment tool for predicting neurological recovery trajectory following acute traumatic central cord injury syndrome (CCS). SUMMARY OF BACKGROUND DATA Controversy remains in whether CCS should be managed conservatively or by early surgical decompression. It is essential to understand how clinical and radiological parameters correlate with neurological deficits and how they predict recovery trajectories. METHODS We identified patients with CCS admitted between 2011 and 2018 with a minimum of 1-year follow-up. Cervical MRIs were analyzed for cord/canal dimensions, Brain and Spinal Injury Center (BASIC) scores and sagittal grading as ordinal scales of intraparenchymal cord injury. Japanese Orthopaedic Association (JOA) recovery rates (≥50% as good, < 50% as poor) were analyzed against these variables by logistic regression and receiver operator characteristic (ROC) curves. Additionally, we evaluated American Spinal Injury Association motor scale (AMS) scores/recovery rates. RESULTS Sixty patients were included, of which 30 were managed conservatively and 30 via surgical decompression. The average follow-up duration for the entire cohort was (51.1 ± 25.7) months. Upon admission, sagittal grading correlated with AMS and JOA scores (P < 0.01, β = 0.48). Volume of the C2 to C7 canal and axial cord area over the site of maximal compression correlated with AMS and JOA scores respectively (P = 0.04, β = 0.26; P = 0.01, β = 0.28). We determined admission AMS more than 61 to be a clinical cutoff for good recovery (area under the receiver operating curve [AUC] = 0.74, 95% confidence interval [CI]: 0.61-0.85, sensitivity 80.9%, specificity 69.2%, P < 0.01). Radiological cutoffs to identify patients with poor recovery rates were length of cervical spinal stenosis more than 3.9 cm (AUC = 0.76, 95% CI: 0.63-0.87, specificity 91.7%, sensitivity 52.2%, P < 0.01), BASIC score of more than 1 (AUC = 0.69, 95% CI: 0.56-0.81, specificity 80.5%, sensitivity 51.1%, P = 0.02). Surgical decompression performed as a salvage procedure upon plateau of recovery did not improve neurological outcomes. CONCLUSION Clinical and radiological parameters upon presentation were prognosticative of neurological recovery rates in CCS. Surgery performed beyond the acute post-injury period failed to improve outcomes.Level of Evidence: 3.
Collapse
Affiliation(s)
- Changmeng Zhang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| |
Collapse
|
8
|
Zhou Q, Zhang J, Liu H, Zhou X, He W, Jin Z, Yang H, Liu T. Comparison of Anterior and Posterior Approaches for Acute Traumatic Central Spinal Cord Syndrome with Multilevel Cervical Canal Stenosis without Cervical Fracture or Dislocation. Int J Clin Pract 2022; 2022:5132134. [PMID: 35685581 PMCID: PMC9159116 DOI: 10.1155/2022/5132134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This is a retrospective comparative study that aims to compare the benefits of different surgical approaches for patients with multilevel cervical canal stenosis (CCS) without cervical fracture or dislocation of acute traumatic central cord syndrome (ATCCS). METHODS From January 2015 to December 2018, 59 patients were included in the study. Among them, 35 patients (Group A) received anterior surgery and 24 patients (Group B) received posterior surgery. Primary outcome measures were American Spinal Cord Injury Association (Asia) grade, Japanese Orthopaedic Association (JOA) score, and recovery rate (RR). Secondary outcome measures included operation time, intraoperative blood loss, visual analogue scale (VAS) score, cervical sagittal parameters, and complications. Multivariate linear regression was used to analyze prognostic determinants. RESULTS Compared with Group B, Group A had longer operation time and more intraoperative blood loss (P < 0.05). However, the VAS score of Group B was higher than that of Group A at discharge (P < 0.05). There was no significant difference in cervical sagittal plane parameters between the two groups (P > 0.05). Postoperative complications were different in the two groups. During follow-up, the Asia grade, the JOA score, and RR of both groups improved (P < 0.05), but there were no significant differences between the two groups (P > 0.05). Younger age, earlier surgery, and better preoperative Asia grade were correlated with better prognosis. CONCLUSIONS For patients with multilevel CCS without cervical fracture or dislocation of ATCCS, both surgical approaches had good outcomes. Although no significant differences were found in the primary outcome measures between the two groups, there were different recommendations for the secondary outcome measures. Younger age, earlier surgery, and better preoperative Asia grade were protective factors for better prognosis.
Collapse
Affiliation(s)
- Quan Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Junxin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Xinfeng Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Wei He
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Zheyu Jin
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| |
Collapse
|
9
|
Bortz C, Dinizo M, Kummer N, Brown A, Alas H, Pierce KE, Janjua MB, Park P, Wang C, Jankowski P, Hockley A, Soroceanu A, De la Garza Ramos R, Sciubba DM, Frempong-Boadu A, Vasquez-Montes D, Diebo BG, Gerling MC, Passias PG. Same Day Surgical Intervention Dramatically Minimizes Complication Occurrence and Optimizes Perioperative Outcomes for Central Cord Syndrome. Clin Spine Surg 2021; 34:308-311. [PMID: 34292197 DOI: 10.1097/bsd.0000000000001234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The aim of this study was to investigate associations between time to surgical intervention and outcomes for central cord syndrome (CCS) patients. BACKGROUND As surgery is increasingly recommended for patients with neurological deterioration CCS, it is important to investigate the relationship between time to surgery and outcomes. MATERIALS AND METHODS CCS patients were isolated in Nationwide Inpatient Sample database 2005-2013. Patients were grouped by time to surgery: same-day, 1-day delay, 2, 3, 4-7, 8-14, and >14 days. Means comparison tests compared patient factors, perioperative complications, and charges across patient groups. Controlling for age, comorbidities, length of stay, and concurrent traumatic fractures, binary logistic regression assessed surgical timing associated with increased odds of perioperative complication, using same-day as reference group. RESULTS Included: 6734 CSS patients (64% underwent surgery). The most common injury mechanisms were falls (30%) and pedestrian accidents (7%). Of patients that underwent surgery, 52% underwent fusion, 30% discectomy, and 14% other decompression of the spinal canal. Breakdown by time to procedure was: 39% same-day, 16% 1-day, 10% 2 days, 8% 3 days, 16% 4-7 days, 8% 8-14 days, and 3% >14 days. Timing groups did not differ in trauma status at admission, although age varied: [minimum: 1 d (58±15 y), maximum: >14 d (63±13 y)]. Relative to other groups, same-day patients had the lowest hospital charges, highest rates of home discharge, and second lowest postoperative length of stay behind 2-day delay patients. Patients delayed >14 days to surgery had increased odds of perioperative cardiac and infection complications. Timing groups beyond 3 days showed increased odds of VTE and nonhome discharge. CONCLUSIONS CCS patients undergoing surgery on the same day as admission had lower odds of complication, hospital charges, and higher rates of home discharge than patients that experienced a delay to operation. Patients delayed >14 days to surgery were associated with inferior outcomes, including increased odds of cardiac complication and infection.
Collapse
Affiliation(s)
- Cole Bortz
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Michael Dinizo
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Nicholas Kummer
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Avery Brown
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Haddy Alas
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Katherine E Pierce
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Muhammad B Janjua
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, TX
| | - Paul Park
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, MI
| | - Charles Wang
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Pawel Jankowski
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Aaron Hockley
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Bassel G Diebo
- Deparment of Orthopedic Surgery, SUNY Downstate, New York, NY
| | - Michael C Gerling
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Peter G Passias
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| |
Collapse
|
10
|
Abstract
This article reviews the historical origins of central cord syndrome (CCS), the mechanism of injury, pathophysiology, and clinical implications. CCS is the most common form of incomplete spinal cord injury. CCS involves a spectrum of neurologic deficits preferentially affecting the hands and arms. Evidence suggests that in the twenty-first century CCS has become the most common form of spinal cord injury overall. In an era of big data and the need to standardize this particular diagnosis to unite outcome data, we propose redefining CCS as any adult cervical spinal cord injury in the absence of fracture/dislocation.
Collapse
Affiliation(s)
- Mauricio J Avila
- Department of Neurosurgery, University of Arizona, Banner University Medical Center, PO Box 245070, 1501 North Campbell Avenue, Room 4303, Tucson, AZ 85724-5070, USA
| | - R John Hurlbert
- Department of Neurosurgery, University of Arizona, Banner University Medical Center, PO Box 245070, 1501 North Campbell Avenue, Room 4303, Tucson, AZ 85724-5070, USA.
| |
Collapse
|
11
|
Ahuja CS, Badhiwala JH, Fehlings MG. "Time is spine": the importance of early intervention for traumatic spinal cord injury. Spinal Cord 2020; 58:1037-1039. [PMID: 32393795 PMCID: PMC7471096 DOI: 10.1038/s41393-020-0477-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Christopher S Ahuja
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Jetan H Badhiwala
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael G Fehlings
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
| |
Collapse
|
12
|
Xue D, Chen Q, Chen G, Zhuo W, Li F. Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise: A case report and literature review. Medicine (Baltimore) 2017; 96:e5841. [PMID: 28072744 PMCID: PMC5228704 DOI: 10.1097/md.0000000000005841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Multiple fractures of the atlas and axis are rare. The management of multiple fragment axis fractures and unstable atlas fractures is still challenging for the spinal surgeon. There are no published reports of similar fractures with 3-part fracture of axis associated with an unstable atlas fracture. CASE SUMMARY We present a patient with concurrent axis and atlas fractures, which have not been reported. The patient suffered hyperextension injury with neck pain and numbness of the bilateral upper extremity associated with weakness after a 2-m fall. The axis fractures included an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3. The atlas fracture was unstable. The neurological examination manifested as central canal syndrome, which was due to the hyperextension injury of cervical spine and spondylolisthesis of C2-C3. The patient was diagnosed as multiple unstable upper cervical fractures with spinal cord compromise. We performed posterior arthrodesis of C1-C3. Postoperatively, the patient showed neurological improvement, and C1-C3 had fused at the 3-month follow-up. CONCLUSION Posterior arthrodesis of C1-C3 could provide a stable fixation for the 3 parts of axis (an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3) combined an unstable atlas fracture. Both the patient and the doctor were satisfied with the results of the treatment. So posterior arthrodesis of C1-C3 is a suitable treatment option for the treatment of a concurrent unstable atlas fracture and multiple fractures of the axis.
Collapse
|
13
|
Anderson DG, Sayadipour A, Limthongkul W, Martin ND, Vaccaro A, Harrop JS. Traumatic central cord syndrome: neurologic recovery after surgical management. Am J Orthop (Belle Mead NJ) 2012; 41:E104-E108. [PMID: 22900253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to evaluate neurologic recovery following an acute, traumatic central cord syndrome (TCCS) injury. We retrospectively reviewed 69 patients who were treated surgically following an acute TCCS injury. The American Spinal Injury Association (ASIA) motor scores (AMS) were obtained from the time of presentation, from the time of hospital discharge, and from the most recent follow-up visit. The mean AMS was 63.2 ± 25.8 at presentation and 89.9 ± 14.6 at final follow-up (P<.001). Overall, 74% of the patients improved at least one ASIA impairment scale grade. Surgery was performed at a mean of 2.9 days (range, 0.25-24 days) following the injury using a posterior approach in 33 patients (48%), anterior approach in 22 patients (32%), and combined anterior-posterior approach in 14 patients (20%). Neither surgical timing nor approach appears to affect motor recovery. Adverse events were encountered in 24.6% of the patients. There were no deaths. A history of a loss of consciousness, decreased rectal tone at presentation, the presence of a fracture, the timing of surgery, and surgical approach did not have a significant impact on motor recovery.
Collapse
Affiliation(s)
- D Greg Anderson
- Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Stevens EA, Marsh R, Wilson JA, Sweasey TA, Branch CL, Powers AK. A review of surgical intervention in the setting of traumatic central cord syndrome. Spine J 2010; 10:874-80. [PMID: 20869001 DOI: 10.1016/j.spinee.2010.07.388] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 06/14/2010] [Accepted: 07/26/2010] [Indexed: 02/03/2023]
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 months). An improvement in Frankel grade was seen in the overall operative cohort compared with those patients who received medical management alone. No statistically significant difference in neurologic outcome using Frankel grades was identified between the surgical subgroups with regard to timing of surgery. A trend toward decreased length of stay was seen in the surgical subgroup that received surgery during their initial admission. No statistically significant difference was identified between complication rates for the operative and nonoperative groups; however, a trend toward fewer complications and deaths was seen in those who received surgery in the first 24 hours or during the initial hospitalization. CONCLUSIONS Surgical treatment in the setting of CCS has become safer since Schneider's original description. Acknowledging its numerous limitations, this retrospective study supports surgical intervention in the setting of CCS as a safe effective management option. Improved Frankel grades were identified in those patients managed surgically compared with those receiving medical management alone. The data further shed light on the safety and potential benefits of early operative intervention for acute CCS compared with delayed surgical treatment. A prospective randomized controlled trial is needed to definitively compare surgical versus medical management and/or early versus delayed surgical treatment in the setting of traumatic CCS.
Collapse
|
15
|
Liu BF, Zhao J, Kang YF, Ma H, Zhang LH. [Therapeutic effect of staged surgery for central cord syndrome of the cervical spine]. Nan Fang Yi Ke Da Xue Xue Bao 2010; 30:1956-1958. [PMID: 20813714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the effect of staged surgical treatment on central cord syndrome of the cervical spine. METHODS A retrospective analysis was conducted in 36 cases of central cord syndrome of the cervical spine treated with staged surgery. The patients (aged 50 to 79 years, mean 56.9 years) were divided into group A (50 to 64 years old, n=20) and group B (above 65 years old, n=16), and each group was further divided into 2 subgroups according to the range of decompression in the second stage, namely A1, B1 and A2, B2. ASIA motor score (AMS) was analyzed before the first-stage surgery, before the second-stage surgery and at the last follow-up after the second-stage surgery. RESULTS All the surgeries were performed successfully. The patients were followed up for 12 to 32 months (mean 18.4 months) after the second-stage surgery. After the first-stage surgery, the AMS was 75.8-/+14.6 in group A, 73.2-/+13.1 in group B, 78.5-/+10.2 in group A1, 76.8-/+9.5 in group A2, 72.2-/+12.6 in group B1 and 77.4-/+18.3 in group B2. The AMS at the last follow-up was 90.7-/+10.5 in group A, 89.5-/+12.4 in group B, 91.3-/+13.2 in group A1, 90.7-/+14.8 in group A2, 88.5-/+11.2 in group B1 and 92.4-/+13.6 in group B2. There was no significant difference between groups A and B or between the subgroups A1 and A2 and groups B1 and group B2. The AMS was 75.8-/+14.6 after the first-stage surgery and 90.7-/+10.5 at the last follow-up in group A, significantly higher than those in group B (73.2-/+13.1 and 89.5-/+12.4, respectively, P<0.05). CONCLUSION Staged surgery is effective for treatment of central cord syndrome of the cervical spine, and the effect of the surgery is not related to the patients' age or the range of decompression.
Collapse
Affiliation(s)
- Bi-feng Liu
- Department of Orthopedics, Changhai Hospital, Shanghai 200433, China.
| | | | | | | | | |
Collapse
|
16
|
Abstract
Abstract
OBJECTIVE
Acute central cord syndrome (ACCS) is a well-known sequela to spinal trauma but has rarely been associated with nontraumatic etiologies. Spinal epidural abscess (SEA) and spinal osteomyelitis/discitis are also well characterized clinical entities. Neither SEA nor osteomyelitis leading to ACCS has been previously reported.
CLINICAL PRESENTATION
In this report, a patient presented with refractory neck pain after minor trauma followed by development of left hand weakness and paresthesia, which progressed to a classic central cord injury clinical pattern over a period of 4 weeks.
INTERVENTION
Imaging and laboratory studies were consistent with SEA and osteomyelitis. Motor evoked potentials obtained during surgery definitively corroborated the clinical diagnosis of ACCS and supported a long tract pathophysiology.
CONCLUSION
ACCS may be caused by SEA.
Collapse
Affiliation(s)
- Robert Trombly
- Department of Neurological Surgery, University of Miami, Miami, Florida 33136, USA
| | | |
Collapse
|
17
|
Abstract
BACKGROUND CONTEXT Cervical spinal trauma can result in a heterogeneous collection of spinal cord injury syndromes. Acute traumatic central cord syndrome is a common category of which no uniform consensus on the etiology, pathophysiology, and treatment exists. PURPOSE To evaluate and review potential pathophysiology, current treatment options, and management of central cord injuries. STUDY DESIGN Comprehensive literature review and clinical experience. METHODS A systematic review of Medline for articles related to central cord and spinal cord injury was conducted up to and including journal articles published in September 2005. CONCLUSIONS Central cord injuries is a clinical definition which is composed of a heterogeneous population for which medical management and surgical decompression and stabilization provide improved neurologic recovery.
Collapse
Affiliation(s)
- James S Harrop
- Department of Neurosurgery, Jefferson Medical College, 909 Walnut St., 2nd Floor, Philadelphia, PA 19107, USA.
| | | | | |
Collapse
|
18
|
Song J, Mizuno J, Nakagawa H, Inoue T. Surgery for acute subaxial traumatic central cord syndrome without fracture or dislocation. J Clin Neurosci 2005; 12:438-43. [PMID: 15925777 DOI: 10.1016/j.jocn.2004.04.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2003] [Accepted: 04/21/2004] [Indexed: 11/24/2022]
Abstract
Twenty-two patients with subaxial acute traumatic central cord syndrome (CCS) without fracture or dislocation who underwent surgery between 1995 and 2002 were reviewed, retrospectively. There were 13 males and nine females ranging in age from 24 to 84 years (mean 61.2). Falls were the most common injury (68%), followed by motor vehicle accidents (32%). All patients had dynamic cervical lateral radiographs and magnetic resonance imaging (MRI). Cord compression was present in all cases and cervical instability in 11. Associated pathology included disc herniation in seven patients, cervical spondylosis (CS) in 11 and ossification of the posterior longitudinal ligament (OPLL) in four. Anterior decompression and fusion was performed in 12 patients with 1- or 2-level lesions. Posterior decompression and fusion was performed for multilevel lesions in 11 patients, including one patient who required re-operation. The interval between injury and surgery ranged from 1 to 37 days (mean 8.0). Postoperatively, all patients improved clinically. We conclude that surgical management of subaxial acute traumatic CCS without fracture or dislocation improved neurological status and prevented delayed neurological deterioration in our patients.
Collapse
Affiliation(s)
- Joonsuk Song
- Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi-gun, Japan.
| | | | | | | |
Collapse
|
19
|
Yamazaki T, Yanaka K, Fujita K, Kamezaki T, Uemura K, Nose T. Traumatic central cord syndrome: analysis of factors affecting the outcome. ACTA ACUST UNITED AC 2005; 63:95-9; discussion 99-100. [PMID: 15680638 DOI: 10.1016/j.surneu.2004.03.020] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2003] [Accepted: 03/22/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND The indications and timing of treatment, as well as the best treatment method for traumatic central cord syndrome (CCS), remain controversial. The aims of this study are to determine the prognostic factors of traumatic CCS and to determine appropriate surgical indications. METHODS We reviewed the clinical and radiological data of 47 patients with this syndrome. The data collected included age, neurological status as measured on a scale defined by the Japanese Orthopaedic Association (JOA), anteroposterior (AP) diameter of the spinal canal on computed tomography, signal intensity change of the spinal cord on T2-weighted magnetic resonance imaging (MRI), associated spinal diseases, and the type of treatment received. The correspondence between the clinical and radiological findings and the neurological outcome was investigated. RESULTS The patient's age, JOA score on admission, signal intensity change of the spinal cord on MRI, and associated spinal diseases were not significant in predicting the patient's recovery. On the other hand, the AP diameter of the spinal canal (P = .0402) and the interval between injury and surgery (P < .0001) were factors predictive of excellent recovery. In the surgical treatment group, timely surgery was found to improve the outcome, while conservative treatment did not improve the outcome of patients with a low JOA score, a relatively small AP diameter of the spinal canal, or a positive signal intensity change of the spinal cord on T2-weighted MRI. CONCLUSION The AP canal diameter of the spinal canal and the interval between injury and surgery may be reliable predictors of excellent recovery in patients with CCS. We recommend timely surgery, preferably within 2 weeks of injury, to achieve a better functional outcome in selected patients.
Collapse
Affiliation(s)
- Tomosato Yamazaki
- Department of Neurosurgery, Ibaraki Seinan Medical Center, Sashima 305-8575, Japan
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
STUDY DESIGN Case report. OBJECTIVE To present a patient with central cord syndrome injury after total hip arthroplasty performed under general endotracheal anesthesia. SUMMARY OF BACKGROUND DATA Central cord syndrome, a common injury usually sustained as a result of an extension injury to the cervical spine, often occurs in geriatric patients with underlying spondylotic changes. The injury results in weakness and sensory changes, which are more pronounced in the upper than in the lower extremities. Patients with this syndrome experience variable return of function, but some degree of residual deficit and spasticity is likely. METHODS The medical record, including the intraoperative anesthesia records, operative notes, progress notes, discharge summary, clinic notes, and radiology studies and reports, was reviewed. RESULTS The patient developed signs of central cord syndrome after total hip arthroplasty. Despite nonoperative intervention, including physiotherapy, the patient's upper and lower extremity weakness continued. Magnetic resonance imaging revealed evidence of cervical cord compression, and the patient underwent a cervical laminectomy, which produced mild improvement in his symptoms. CONCLUSIONS To avoid life-altering complications, it is important to evaluate the cervical spine (especially in the elderly), avoid neck extension during intubation, and use careful airway management in patients with suspected stenosis/spondylosis.
Collapse
Affiliation(s)
- Jacob M Buchowski
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
STUDY DESIGN Technical note, case report. and review of literature. OBJECTIVE Description of anterior transarticular internal fixation for traumatic C1-C2 instability. SUMMARY OF BACKGROUND DATA The currently effective posterior approaches for instrumentation of the C1-C2 junction require considerable soft tissue dissection and prone patient positioning. Some medical and anatomic conditions restrict the posterior approach. MATERIALS AND METHODS An odontoid screw and anterior transarticular C1-C2 screws were used to instrument an unstable injury at this junction. The lesion consisted of a type II dens fracture and C1 ring disruption. Two high-quality fluoroscopy machines, a radiolucent OSI fracture table, and the Synframe (Synthes, Paoli, PA) retraction system are used for this procedure. The implant of choice is the 4.0-mm cannulated titanium screw. RESULTS At 4-month follow-up, successful stabilization without failure of hardware is documented. The patient's neurologic status is stable, with a minor residual left upper extremity motor deficit. The patient has restricted C-spine rotation but no neck pain with movement. CONCLUSION Anterior stabilization through a standard Smith-Robinson approach of the C1-C2 junction with screws into the odontoid and the lateral masses of C1 is effective. Supine positioning and minimal soft tissue dissection are advantages of this method over standard posterior transarticular instrumentation. Knowledge of the local anatomy, strict adherence to the operative protocol, and high-quality fluoroscopy avoid potential surgical complications.
Collapse
Affiliation(s)
- Rudy Reindl
- McGill University Health Center, Montreal, Quebec, Canada
| | | | | |
Collapse
|
22
|
Dai L. Magnetic resonance imaging of acute central cord syndrome: correlation with prognosis. Chin Med Sci J 2001; 16:107-10. [PMID: 12901500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To report the magnetic resonance imaging (MR) findings of acute cervical central cord syndrome and to determine their correlation with the prognosis. METHODS MRI findings of 35 patients with acute central cord syndrome were studied and compared with the recovery rate of ASIA score at presentation and in follow-up. RESULTS MRI data demonstrated spinal cord compression for 32 patients, spinal cord swelling for 16 patients, and abnormal signal intensity within the spinal cord for 19 patients, including 14 with edema and 3 with hematoma. No significant difference of the recovery rate was noted between the patients treated nonoperatively and operatively (P > 0.05). There was a significant inverse correlation between the recovery rate and the degree of spinal cord compression as shown in MRI scans (P < 0.01). The presence of hematoma in MRI scans was associated with poor prognosis, as demonstrated by a significant difference of the recovery rate (P < 0.01) among the patients with normal intensity, edema and hematoma within the spinal cord. CONCLUSIONS MRI scans provide an efficient assistance for decision-making and accurate prognostic information regarding neurological function, and therefore should routinely be performed within the early phase of acute central cord syndrome.
Collapse
Affiliation(s)
- L Dai
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Second Medical University, Shanghai 200092
| |
Collapse
|