Neurological and functional outcome in traumatic central cord syndrome

Aito, S; D'Andrea, M; Werhagen, Lars; Farsetti, L; Cappelli, Susanna; Bandini, Barbara; Donna, Valentina Di

doi:10.1038/sj.sc.3101944

Cited by 93 publications

(96 citation statements)

References 19 publications

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“…The presented data confirm that TCCS subjects are likely to have a less severe neurological deficit and therefore are often categorized as AIS grade D patients on admission. 4,[19][20][21] These findings show that most differences between TCCS and non-TCCS patients dissolve when stratified by AIS grade. Although TCCS patients showed significantly higher rates of upper extremity motor strength recovery compared with non-TCCS patients, non-TCCS patients showed significantly higher rates of lower extremity motor strength recovery.…”

Section: Discussionmentioning

confidence: 63%

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

et al. 2010

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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.

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Section: Discussionmentioning

confidence: 63%

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

et al. 2010

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“…Patients with traumatic central cord syndrome are generally older than the traumatic spinal cord injured patient population but often show improvement after discharge. Improvement in subjects \65 years was significantly better than for those [65 years in Aito's study [1].…”

Section: Discussionmentioning

confidence: 88%

“…Penrod et al [13] noted that older patients with central cord syndrome have a worse prognosis for ambulation (97 vs. 41%) relative to younger patients. Aito [1] showed patients \65 years had better outcomes with less neuropathic pain. Patients with traumatic central cord syndrome are generally older than the traumatic spinal cord injured patient population but often show improvement after discharge.…”

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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“…Aito et al 1 reported that 54% of patients suffered from spasticity and 72% of these patients rated spasticity as a problem in daily life. In 2005, Dvorak et al 10 indicated that spasticity was positively correlated with the final ASIA motor score and negatively correlated with functional status.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several authors have suggested potential benefits of early surgical intervention in selected cases, leading to controversy and wide variations in management. 1,4,6,8,24 Duh et al 9 have suggested that surgery provides 2 potential advantages over conservative treatment. First, improved neurological recovery achieved after early decompression of the cord and nerve roots may permit earlier rehabilitation; second, stable spinal fixation may prevent further SCI and subsequent neurological deterioration.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of surgical treatment for traumatic central cord syndrome

Chen¹,

Yang²,

Tong-qi³

et al. 2009

SPI

103

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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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Neurological and functional outcome in traumatic central cord syndrome

Cited by 93 publications

References 19 publications

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

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

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

Effectiveness of surgical treatment for traumatic central cord syndrome

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