Authors: Hetshree Joshi; Jetan Badhiwala; Jefferson Wilson; Robert Grossman; Bizhan Aarabi; Michael Bracken; Michael Fehlings (Toronto Ontario, Canada)
Traumatic central cord syndrome (TCCS) is a clinical diagnosis often described by disproportionately greater upper than lower limb weakness following acute traumatic cervical spinal cord injury (SCI). TCCS has a bimodal distribution and typically occurs in the elderly following low-energy hyperextension neck injuries while it occurs in the younger population as following high-energy neck injuries. Given the increasing aging population, TCCS is expected to become the most common form of traumatic SCI and therefore optimal management strategies for TCCS is imperative. This study aims to elucidate patient, injury, and treatment characteristics associated with long-term motor recovery, functional outcomes, and quality of life in TCCS.
Three multicenter, international databases including NACTN, NASCIS, and STASCIS were used. Inclusion criteria consisted of patients ≥ 16 years with a diagnosis of TCCS. Advanced regression techniques were applied to evaluate possible predictors of outcomes, including demographics, neurological status, injury characteristics, and management strategies. Functional motor outcomes were measured by the functional independence measure (FIM) scale.
Baseline characteristics assessed included demographics, neurological status, and injury characteristics for the 170 patients meeting inclusion criteria. In the FIM motor-subscore, only 11% of patients were functionally independent. Univariate analysis showed significant improvement in FIM motor-subscore at one-year for initial ASIA motor score (AMS), presence of fracture, time to surgery, initial AIS grade, and Glasgow Coma Scale (GCS) score. A multivariate model including age, baseline AMS, time to surgery, and presence of fracture showed a significant effect of baseline AMS and time to surgery on improvement in functional outcomes.
According to our knowledge, this is the largest study to date suggesting that earlier surgery is correlated with better functional motor outcomes and should be encouraged in the management of TCCS.