Neurologic and Functional Outcomes after Traumatic Central Cord Syndrome

Kyoung-Chul Song; Jae-Won You; Hyun-Hak Kim; Hong-Moon Sohn

doi:10.4055/jkoa.2014.49.1.50

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Song, You, Kim, and Sohn: Neurologic and Functional Outcomes after Traumatic Central Cord Syndrome

Original Article

Journal of the Korean Orthopaedic Association 2014; 49(1): 50-57.

Published online: 27 February 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.1.50

Neurologic and Functional Outcomes after Traumatic Central Cord Syndrome

Kyoung-Chul Song, M.D., Jae-Won You, M.D., Hyun-Hak Kim, M.D., Hong-Moon Sohn, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Correspondence to: Hong-Moon Sohn, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. TEL: +82-62-220-3147, FAX: +82-62-226-3379, hmsohn@chosun.ac.kr

Received 25 June 2013 Revised 5 September 2013 Accepted 18 October 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome.

Materials and Methods

A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes.

Results

The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up.

Conclusion

It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible.

Keywords: spinal cord injuries, central cord syndrome, cervical spine, treatment outcome

Figures and Tables

Figure 1

Sagittal T2-weighted magnetic resonance image shows parameters used for measurement of midsagittal diameter, maximum canal compromise (MCC), and maximum spinal cord compression (MSCC). The following measurements were obtained: spinal cord diameter one segment above the end of spinal stenosis (da), sagittal diameter of the spinal canal one segment above the stenotic segment (Da), sagittal diameter of the spinal cord (di) and spinal canal (Di) at the point of maximum compression, sagittal diameter of the spinal canal one segment below the stenotic segment (Db), the diameter of the spinal cord below the stenotic segment (db). MCC and MSCC were calculated according to the formulas. MCC=[1-Di/{1/2(Da+Db)}]×100, MSCC=[1-di/{1/2(da+db)}]×100.

Table 1

Characteristics of 28 Patients with Traumatic Central Cord Syndrome

Values are presented as number only or mean±standard deviation. ^*Symbol represents statistically significant difference (p<0.05). NASCIS, National Acute Spinal Cord Injury Study; MCC, maximum canal compromise; MSCC, maximum spinal cord compression; AMS, American Spinal Injury Association motor score, JOA, Japanese Orthopaedic Association; NDI, neck disability index; I: initial; F, final follow-up; G, gap.

Table 2

Mann-Whitney Test with Surgical Approach and Timing of Operation

Table 3

Univariate Regression Analysis with AMS (F), JOA Scale (F), NDI (F) Outcome Measures in the Operative Group

^*Symbol represents statistically significant difference (p<0.05). AMS, American Spinal Injury Association motor score; JOA, Japanese Orthopaedic Association; NDI, neck disability index; NASCIS, National Acute Spinal Cord Injury Study; MCC, maximum canal compromise; MSCC, maximum spinal cord compression; F, final follow-up; I, initial; G, gap.

Table 4

Univariate Regression Analysis with AMS (F), JOA Scale (F), NDI (F) Outcome Measures in the Conservative Group

Notes

This study was supported by research fund from Chosun University Hospital, 2012.

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