Diagnostic criteria of traumatic central cord syndrome. Part 3: Descriptive analyses of neurological and functional outcomes in a prospective cohort of traumatic motor incomplete tetraplegics

Abstract

Study design: Prospective multicenter cohort study. Objectives: To compare the neurological recovery and functional outcomes between traumatic central cord syndrome (TCCS) patients and motor incomplete tetraplegic patients. Setting: European Multicenter Study of human spinal cord injury. Methods: In 248 traumatic motor incomplete tetraplegics, initial phase (0-15 days) American Spinal Injury Association (ASIA) impairment grading, upper and lower extremity motor scores (UEMS and LEMS), upper and lower sensory scores and chronic phase (6 or 12 months) neurological outcomes were analyzed. In addition, chronic phase self-care and indoor mobility Spinal Cord Independence Measure (SCIM) items were studied. Tetraplegics were subdivided into three groups: (1) non-TCCS group (UEMSXLEMS), (2) intermediate-TCCS group (UEMS ¼ (1-9 points)oLEMS) and (3) TCCS group (UEMS ¼ (X10 points)oLEMS). Student's t-tests and w 2 -tests were applied. Results: A total of 89 non-TCCS subjects (AIS D, n ¼ 28), 62 int-TCCS (AIS D, n ¼ 43) and 97 TCCS (AIS D, n ¼ 80) subjects were analysed. Although minimal significant differences in chronic phase LEMS and UEMS outcomes were identified between TCCS and non-TCCS patients after stratification by the AIS grade, our data showed no significant differences in functional upper and lower extremity outcomes at 6 or 12 months post-injury. Conclusion: The AIS grading system, and not the diagnosis TCCS, continues to be the best available prognostic parameter for neurological and functional outcomes in motor incomplete tetraplegics. The authors recommend that for future outcome studies in motor incomplete tetraplegia, patients should not be selected based on, or stratified by, the diagnosis TCCS.

The translational dialogue in spinal cord injury research

“…38 Although different preclinical models can mimic the contusion like injury mechanism in humans (representing about 80% of the injuries), identifying equivalent animal models of the various human spinal cord syndromes is deficient. 39 These human SCI syndromes are characterized by unique patterns of sensorimotor impairment (specific spatial sensorimotor deficits), which have predictive value in acute traumatic SCI (ranking the cord syndromes from lowest to highest likelihood of recovery: complete cord, anterior cord, central cord, hemi cord 40 ). There are now upcoming injury models in animals (rodents and non-human primates) that are attempting to model these human cord syndromes (like lesion models of hemisection and cervical injuries), and will enable comparisons across species.…”

Light touch and pin prick disparity in the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI)

“…Other studies have tended to document higher LT than PP scores for SCI subjects but have not drawn attention to any systematic differences between the two modalities. [7][8][9] Further, they have not commented on similar differences in other reports and have not discussed any relevance or reasons why such discrepancy might occur. There may be more than one reason why LT should score differently to PP.…”

Design of COSMIC: a randomized, multi-centre controlled trial comparing conservative or early surgical management of incomplete cervical cord syndrome without spinal instability

“…Since its definition it was considered as a separate entity. Recently, it was shown that it is just a form of incomplete spinal cord lesion [1] therefore we abandoned the use of the term traumatic central cord syndrome.…”

“…Recently, it has been shown that the distinction of TCCS with an incomplete cervical spinal cord lesion (ICSCL) is artificial [1]. It is the most frequent incomplete traumatic spinal cord lesion.…”