Acute traumatic central cord syndrome—experience using surgical decompression with open-door expansile cervical laminoplasty

Uribe, Juan S.; Green, Barth A.; Vanni, Steven; Moza, Kapil; Guest, James D.; Levi, Allan D.

doi:10.1016/j.surneu.2004.09.037

Cited by 53 publications

(38 citation statements)

References 33 publications

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“…However, other authors challenged this theory. Using human autopsy material, Uribe et al 25 showed that the classic anatomical description of central cord hematomyelia is not absolute, as pathological analysis revealed in most cases a diffuse, dorsal, lateral, white matter injury, and this information correlated well with ante-and postmortem MR imaging findings. Levi et al 14 also stated that the main function of the corticospinal tract is to subserve fine motor movements to the distal musculature, especially the upper limbs.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of surgical treatment for traumatic central cord syndrome

Chen¹,

Yang²,

Tong-qi³

et al. 2009

SPI

105

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Object The authors undertook a study in patients with traumatic central cord syndrome (TCCS) who underwent surgical intervention. They retrospectively assessed the motor score improvement and functional status and identified prognostic predictors of improvement. Methods Between March 1999 and May 2004, 49 patients with TCCS were surgically treated. Motor scores were collected at admission and follow-up using the American Spinal Injury Association (ASIA) Impairment Scale. The 36-Item Short Form Health Survey (SF-36) was administered. Other parameters including walking index, spasticity, bladder management, and neuropathic pain scores were recorded. Patients were asked to assess their level of satisfaction with their final symptoms. Results The average ASIA score, converted into numeric values, was increased from 54.9 at admission to 81.9 and 89.6 at 6 months and final follow-up, respectively. Significant improvement of ASIA score was achieved within the first 6 months of surgery. No significant difference was found between patients who underwent surgery within 4 days of injury or after 4 days of injury, adopting different approaches (anterior, posterior, or a combination), or with different pathological entities (acute disc herniation, fracture or dislocation, or multilevel degeneration). The ASIA score improvement had a positive correlation with the age at injury (r = 0.505, p = 0.023). The SF-36 data at 6 months and final follow-up were not as satisfactory as the improvement in ASIA scores, and almost one-third of patients expressed dissatisfaction with their final symptoms. For patients who were older than 65 years at injury, the mean follow-up Walking Index for Spinal Cord Injury (WISCI) score was statistically lower than it was in younger patients. The presence of spasticity or neuropathic pain at follow-up was not related to age, sex, ASIA motor score, or WISCI outcome. Conclusions Surgical intervention can be safely applied in patients with TCCS. Significant improvement of ASIA score was achieved during the first 6-month period of follow-up. Factors including type of lesion, timing of surgery within or after 4 days of injury, and surgical approach were not significantly associated with final ASIA score. The improvement in the ASIA motor score was positively correlated with age at injury. No significant correlation was found between or among the presence of spasticity, neuropathic pain, and ASIA score at final visit. Almost one-third of patients were not satisfied with their final symptoms.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of surgical treatment for traumatic central cord syndrome

Chen¹,

Yang²,

Tong-qi³

et al. 2009

SPI

105

View full text Add to dashboard Cite

show abstract

“…Song et al 15 and Uribe et al 17 reported a good outcome of surgical treatment, but these reports were not compared with conservative treatment. In contrast, Pollard et al 12 reported that no evidence was found to support surgical decompression in stenotic patients without any fracture.…”

Section: Discussionmentioning

confidence: 99%

“…The terminology regarding this type of injury remains confusing whereas, in addition, treatment with either surgery or conservative measures remains controversial. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Such cervical cord injury has previously been called 'Adult SCIWORA (Spinal cord injury without radiographic abnormality in adults, 10 or Spinal cord injury without radiological abnormality in adults 19 )'. However, this term is incorrect because the terminology 'SCIWORA (Spinal cord injury without radiographic abnormality)' was created before the development of computed tomography and magnetic resonance imaging (MRI), and only for children.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] This injury does not usually require surgery for the reconstruction of the spinal column but instead may require decompression for the narrowed spinal canal with laminoplasty, to achieve an improvement in the paralysis. Some surgeons have reported an improvement of paralysis, following decompression of the spinal cord, whereas others have concluded that the fate of an injured spinal cord cannot change by decompression surgery, as such spinal cord compression may have existed before the injury even though such patients had been asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study

et al. 2010

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Study design: A multicenter prospective study comparing the neurological outcome of patients treated by surgical intervention versus conservative treatment for cervical spinal cord injury (CSCI) without bone and disc injury. Objective: To evaluate the neurological outcome of decompression surgery for CSCI without bone and disc injury in patients with spinal cord compression with incomplete paralysis (AIS B, C). Setting: The Japan LHWO Spinal Injuries Center and the other 10 labor accident hospitals in Japan. Methods: Thirty-four patients with AIS B, C and cervical spinal cord compression were classified into either a surgical treatment group or a conservative treatment group. The 34 patients enrolled were equally divided between the groups. Patients with AIS B, C and mild spinal compression were enrolled into another group. Results: The neurological outcome of surgical treatment and conservative treatment for AIS B, C with spinal cord compression was found to be closely similar. In addition, the neurological outcome was also similar to that observed after conservative treatment for AIS B, C in patients presenting with mild spinal cord compression. Conclusions: Surgical treatment was not found to be superior to conservative treatment for CSCI patients without bone and disc injury suffering from spinal cord compression in the acute phase.

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“…In the stiff spondylitic spine altered segmental spinal cord mechanics, buckling of the ligamentum flavum combined with compression from anterior osteophytes results in acute focal spinal cord compression with resultant hemorrhage and spinal cord edema [16,17].…”

Section: Discussionmentioning

confidence: 99%

Central cord syndrome in Ireland: the effect of age on clinical outcome

et al. 2009

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Central cord syndrome is an incomplete spinal cord injury first described by Schneider et al. (J Neurosurg 11:546-547, 1954). The typical neurological deficit is symmetrical incomplete quadriplegia affecting the upper more than the lower limbs; sensory impairment is variable and urinary retention is common. Records of all patients with acute traumatic central cord syndrome admitted to the National Spinal Injuries Unit from 1999 to 2007 were compiled from a prospectively collected computerized spinal database. Data recorded included patient demographic profile, mechanism of injury, initial neurological deficit, treatment instituted, complications of treatment, and final neurological status. A total of 50 patients with acute traumatic central cord syndrome were identified accounting for 6.2% of all admissions to the spinal injuries unit. There were 42 men and 8 women. The mean age was 56.1 years with a range of 41-88 years. We stratified patients according to age at injury to determine the effect of age on clinical outcome. There were 13 patients \50 years of age, 24 aged 50-70, and 13 aged [70 years. The mean follow-up time was 42.2 months. More than onethird of patients were intoxicated with alcohol at the time of the injury. Both upper and lower limb motor scores and total sensory scores improved in all age groups. Absolute and relative improvements were greatest in patients \50 years of age. Sphincter disturbance was documented in 42% of all the patients on admission. At follow up 12% of patients had residual disturbance. At final follow up none of the patients under 70 years of age had residual sphincter disturbance while 60% of those aged [70 years group had. Both of these results reached statistical significance. In conclusion, central cord syndrome is a common cause of acute traumatic neurological deficit, with alcohol intoxication being a common confounder at the time of injury. The clinical outcomes are significantly worse in patients aged 70 years or older.

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Acute traumatic central cord syndrome—experience using surgical decompression with open-door expansile cervical laminoplasty

Cited by 53 publications

References 33 publications

Effectiveness of surgical treatment for traumatic central cord syndrome

Effectiveness of surgical treatment for traumatic central cord syndrome

Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study

Central cord syndrome in Ireland: the effect of age on clinical outcome

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