Last update 19 Sep 2024
Central Cord Syndrome
Last update 19 Sep 2024
Basic Info
Synonyms Central Cord Injury Syndrome, Central Cord Syndrome, Central Spinal Cord Syndrome + [12] |
Introduction A syndrome associated with traumatic injury to the cervical or upper thoracic regions of the spinal cord characterized by weakness in the arms with relative sparing of the legs and variable sensory loss. This condition is associated with ischemia, hemorrhage, or necrosis involving the central portions of the spinal cord. Corticospinal fibers destined for the legs are spared due to their more external location in the spinal cord. This clinical pattern may emerge during recovery from spinal shock. Deficits may be transient or permanent. |
Related
Axonal changes in acute Traumatic Central Cord Syndrome (ATCCS) before and after operation
Early surgical decompression ameliorates dysfunction of spinal motor neuron in patients with acute traumatic central cord syndrome
COSMIC: Conservative or Early Surgical Management of Incomplete Cervical Cord Syndrome Without Spinal Instability. Randomized Controlled Trial
100 Clinical Results associated with Central Cord Syndrome
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100 Translational Medicine associated with Central Cord Syndrome
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09 Feb 2024Journal of neurosurgery. Spine
Surgical intervention ≤ 24 hours versus > 24 hours after injury for the management of acute traumatic central cord syndrome: a systematic review and meta-analysis.
Article
Author: Othman Bin-Alamer ; Jumanah Qedair ; Hussam Abou-Al-Shaar ; Arka N Mallela ; Kishore Balasubramanian ; Nada Alnefaie ; Abdul Rahman Abou Al-Shaar ; Tritan Plute ; Victor M Lu ; David J McCarthy ; Daryl P Fields ; Nitin Agarwal ; Peter C Gerszten ; D Kojo Hamilton
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.
22 Jan 2024World neurosurgery
Surgical Outcomes in Octogenarians with Central Cord Syndrome: A Propensity-Score Matched Analysis.
Article
Author: Sam H Jiang ; Daniel Deysher ; Kaho Adachi ; Mounika Bhaskara ; Zayed Almadidy ; Morteza Sadeh ; Ankit I Mehta ; Nauman S Chaudhry
INTRODUCTION:
Central cord syndrome (CCS) is a traumatic cervical spine injury that is treated with surgical decompression. In octogenarians (80-89), surgeons often opt for conservative management instead due to fears of postoperative complications and prolonged recovery times. This study aims to assess the in-hospital complications and outcomes in octogenarians undergoing surgery compared to those undergoing non-surgical management for CCS.
METHODS:
The National Trauma Data Bank was queried from 2017 to 2019 for octogenarians with CCS. Patients who received surgical fusion or decompression were divided into the surgery group and the remaining into the non-surgical group. The surgery group was sampled and propensity score matched with the non-surgery group. Student's t-tests and Pearson's chi-squared tests were used to test for group differences.
RESULTS:
A total of 759 octogenarians with CCS were identified. Following sampling and propensity score matching, 225 patients were identified in each group. The surgery group experienced longer ICU (6.8 days vs. 3.21 days, p < 0.001) and hospital (13.79 days vs. 7.8 days, p < 0.001) lengths of stay (LOS) and higher rates of deep vein thrombosis (4.89% vs. 0.44%, p = 0.02) and ventilator-associated pneumonia (4% vs. 0%, p = 0.02). Patients did not otherwise differ in mortality rate, other hospital complications, and discharge disposition.
CONCLUSION:
Octogenarians undergoing surgery for CCS experience longer LOS and complications consistent with prolonged hospitalization, but otherwise have similar mortality, hospital complications, and discharge disposition compared to non-surgical treatment. Given the relative lack of short-term drawbacks, surgery should be considered first-line management when the long-term benefits are substantive.
10 Jan 2024Neurosurgery
Concomitant Traumatic Brain Injury Delays Surgery in Patients With Traumatic Spinal Cord Injury.
Article
Author: Tej D Azad ; Divyaansh Raj ; Kathleen R Ran ; Vikas N Vattipally ; Anmol Warman ; Micheal Raad ; John R Williams ; Daniel Lubelski ; Elliott R Haut ; Jose I Suarez ; Ali Bydon ; Timothy F Witham ; Christopher D Witiw ; Nicholas Theodore ; James P Byrne
BACKGROUND AND OBJECTIVES:
Growing evidence supports prompt surgical decompression for patients with traumatic spinal cord injury (tSCI). Rates of concomitant tSCI and traumatic brain injury (TBI) range from 10% to 30%. Concomitant TBI may delay tSCI diagnosis and surgical intervention. Little is known about real-world management of this common injury constellation that carries significant clinical consequences. This study aimed to quantify the impact of concomitant TBI on surgical timing in a national cohort of patients with tSCI.
METHODS:
Patient data were obtained from the National Trauma Data Bank (2007-2016). Patients admitted for tSCI and who received surgical intervention were included. Delayed surgical intervention was defined as surgery after 24 hours of admission. Multivariable hierarchical regression models were constructed to measure the risk-adjusted association between concomitant TBI and delayed surgical intervention. Secondary outcome included favorable discharge status.
RESULTS:
We identified 14 964 patients with surgically managed tSCI across 377 North American trauma centers, of whom 2444 (16.3%) had concomitant TBI and 4610 (30.8%) had central cord syndrome (CCS). The median time to surgery was 20.0 hours for patients without concomitant TBI and 24.8 hours for patients with concomitant TBI. Hierarchical regression modeling revealed that concomitant TBI was independently associated with delayed surgery in patients with tSCI (odds ratio [OR], 1.3; 95% CI, 1.1-1.6). Although CCS was associated with delayed surgery (OR, 1.5; 95% CI, 1.4-1.7), we did not observe a significant interaction between concomitant TBI and CCS. In the subset of patients with concomitant tSCI and TBI, patients with severe TBI were significantly more likely to experience a surgical delay than patients with mild TBI (OR, 1.4; 95% CI, 1.0-1.9).
CONCLUSION:
Concomitant TBI delays surgical management for patients with tSCI. This effect is largest for patients with tSCI with severe TBI. These findings should serve to increase awareness of concomitant TBI and tSCI and the likelihood that this may delay time-sensitive surgery.
17 Oct 2023
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