A review of surgical intervention in the setting of traumatic central cord syndrome

Stevens, Edwin A.; Marsh, Robert; Wilson, John A.; Sweasey, Thomas A.; Branch, Charles L.; Powers, Alexander K.

doi:10.1016/j.spinee.2010.07.388

Cited by 84 publications

(61 citation statements)

References 22 publications

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“…Some authors have thus subcategorized the syndrome to reflect this diversity in posttraumatic and predisposing anatomy. 6,17 Harrop et al (2006) conceptually divided patients with CCS into young patients (< 50 years old) with focal instability, young patients with focal disc herniation causing local cord compression, and elderly patients (> 50 years old) with spondylosis and no focal instability or fracture. 6 The latter category, known as "spondylotic CCS," is the most common form of CCS 8,16 and most commonly occurs as a result of low energy falls.…”

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confidence: 99%

Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome

Kepler

Kong

Schroeder

et al. 2015

SPI

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OBJECT The purpose of this study was to characterize changes in American Spinal Injury Association motor score (AMS) in the 1st week after traumatic central cord syndrome (CCS) to identify predictors of improved early outcome in patients treated with early versus delayed surgical intervention. METHODS All patients presenting to a regional spinal cord injury center between January 2004 and June 2009 were queried for those with a diagnosis of CCS. Patients treated conservatively were excluded. A prospectively maintained spinal cord injury database was used to track AMS throughout each patient’s hospitalization. Hospital records provided information regarding demographics, presenting neurological examination, imaging findings, comorbidities, timing and nature of surgical procedures, and length of stay (LOS) in the hospital and intensive care unit (ICU). Patients were separated into those who underwent early surgery, within 1 day of presentation (early group), and those who underwent surgery on a delayed basis (delayed group). Differences between groups were analyzed using the Student t-test and chi-square test. Predictors of outcome were identified using correlation analysis and multiple linear regression. RESULTS Of 426 patients in the database, 80 (18.8%) were diagnosed as having CCS, and 68 of them ultimately underwent surgical decompression. Nineteen (28%) of 68 patients underwent surgery within 1 day of presentation (early group) while the remaining 49 patients (72%) underwent surgery on a delayed basis (delayed group). The mean age in the early group was significantly younger than that of the delayed group (52 vs 59 years, p = 0.049). Other characteristics were similar between groups including sex, proportion of patients with cord edema on MRI (44% early vs 55% delayed, p = 0.47), and proportion of patients with cervical fracture (26% early vs 28% delayed, p = 0.98). Patients in the early group presented with an AMS of 62.5 versus 70.0 for the delayed group (p = 0.36). No difference in the change in AMS was seen at 7 days between the early group (-2.9 points) and the delayed group (-4.2 points) (p = 0.34). Additionally, the number of patients who had early improvement was similar between the early and delayed groups (50% vs 48%, respectively, p = 0.94). Neither time in the ICU (3.4 vs 3.4 days, p = 0.84) nor the overall LOS (10.5 vs 12.5 days, p = 0.59) was different in the early versus delayed groups, respectively. Correlation analysis and multiple linear regression demonstrated early surgery was not associated with change in AMS or AMS at Day 7. Age was identified as the only significant predictor of change in AMS and had a negative effect (coefficient = -0.34, p = 0.025). CONCLUSIONS Early treatment of patients with CCS remains controversial. Although some long-term neurological recovery is expected in patients with a CCS, surgeons and patients should not expect early neurological improvement with or without early operative intervention.

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confidence: 99%

Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome

Kepler

Kong

Schroeder

et al. 2015

SPI

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“…1,19 In our cohort we found that 64% of surgical patients (15 of 26 patients) underwent decompression within 24 hours. Conversely, a study examining patients from a similar time period by Aarabi et al indicated that 21% (9 of 42) of their patients with ATCCS underwent rapid surgical decompression within 24 hours.…”

Section: Other Interventionsmentioning

confidence: 75%

“…1 This was consistent with another retrospective study where 24% of ATCCS patients (16 of 67) who underwent decompressive surgery were treated within 24 hours. 19 Ultimately, the decision to perform surgery and the timing of surgery were dependent on the treating surgeon. Given the recent results of the Surgical Timing for Traumatic Cervical Spinal Cord Injury Study (STASCIS), which indicated the benefits of early decompression, we found this difference to be significant and noteworthy.…”

Section: Other Interventionsmentioning

confidence: 99%

“…5 Many recent studies on SCI and ATCCS have focused on the timing of surgical intervention and decompression and report mixed results, all citing the need for additional prospective studies. 19,24,26 These studies, along with recent prospective investigations, suggest that early surgical intervention (decompression within 24 hours of SCI) may improve long-term prognosis. 2,9,24 While the focus on surgical decompression, efficacy, and timing is an important aspect of ATCCS management, little focus has been placed on medical management and perfusion for these patients.…”

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confidence: 93%

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Complications and outcomes of vasopressor usage in acute traumatic central cord syndrome

Readdy

Whetstone

Ferguson

et al. 2015

SPI

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OBJECT The optimal mean arterial pressure (MAP) for spinal cord perfusion after trauma remains unclear. Although there are published data on MAP goals after spinal cord injury (SCI), the specific blood pressure management for acute traumatic central cord syndrome (ATCCS) and the implications of these interventions have yet to be elucidated. Additionally, the complications of specific vasopressors have not been fully explored in this injury condition. METHODS The present study is a retrospective cohort analysis of 34 patients with ATCCS who received any vasopressor to maintain blood pressure above predetermined MAP goals at a single Level 1 trauma center. The collected variables were American Spinal Injury Association (ASIA) grades at admission and discharge, administered vasopressor and associated complications, other interventions and complications, and timing of surgery. The relationship between the 2 most common vasopressors—dopamine and phenylephrine—and complications within the cohort as a whole were explored, and again after stratification by age. RESULTS The mean age of the ATCCS patients was 62 years. Dopamine was the most commonly used primary vasopressor (91% of patients), followed by phenylephrine (65%). Vasopressors were administered to maintain MAP goals fora mean of 101 hours. Neurological status improved by a median of 1 ASIA grade in all patients, regardless of the choice of vasopressor. Sixty-four percent of surgical patients underwent decompression within 24 hours. There was no observed relationship between the timing of surgical intervention and the complication rate. Cardiogenic complications associated with vasopressor usage were notable in 68% of patients who received dopamine and 46% of patients who received phenylephrine. These differences were not statistically significant (OR with dopamine 2.50 [95% CI 0.82–7.78], p = 0.105). However, in the subgroup of patients > 55 years, dopamine produced statistically significant increases in the complication rates when compared with phenylephrine (83% vs 50% for dopamine and phenylephrine, respectively; OR with dopamine 5.0 [95% CI 0.99–25.34], p = 0.044). CONCLUSIONS Vasopressor usage in ATCCS patients is associated with complication rates that are similar to the reported literature for SCI. Dopamine was associated with a higher risk of complications in patients > 55 years. Given the increased incidence of ATCCS in older populations, determination of MAP goals and vasopressor administration should be carefully considered in these patients. While a randomized control trial on this topic may not be practical, a multiinstitutional prospective study for SCI that includes ATCCS patients as a subpopulation would be useful for examining MAP goals in this population.

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“…14,21,24 Modern radiological evaluation and classification schemes are often employed to aid in assigning spinal stability in cases of cervical fractures. Patients suffering from TCCS secondary to acute disc herniations, fractures, and/or instability are usually managed surgically.…”

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confidence: 99%

Evidence-based management of central cord syndrome

Dahdaleh¹,

Lawton²,

Ahmadieh³

et al. 2013

FOC

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Object Evidence-based medicine is used to examine the current treatment options, timing of surgical intervention, and prognostic factors in the management of patients with traumatic central cord syndrome (TCCS). Methods A computerized literature search of the National Library of Medicine database, Cochrane database, and Google Scholar was performed for published material between January 1966 and February 2013 using key words and Medical Subject Headings. Abstracts were reviewed and selected, with the articles segregated into 3 main categories: surgical versus conservative management, timing of surgery, and prognostic factors. Evidentiary tables were then assembled, summarizing data and quality of evidence (Classes I–III) for papers included in this review. Results The authors compiled 3 evidentiary tables summarizing 16 studies, all of which were retrospective in design. Regarding surgical intervention versus conservative management, there was Class III evidence to support the superiority of surgery for patients presenting with TCCS. In regards to timing of surgery, most Class III evidence demonstrated no difference in early versus late surgical management. Most Class III studies agreed that older age, especially age greater than 60–70 years, correlated with worse outcomes. Conclusions No Class I or Class II evidence was available to determine the efficacy of surgery, timing of surgical intervention, or prognostic factors in patients managed for TCCS. Hence, there is a need to perform well-controlled prospective studies and randomized controlled clinical trials to further investigate the optimal management (surgical vs conservative) and timing of surgical intervention in patients suffering from TCCS.

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A review of surgical intervention in the setting of traumatic central cord syndrome

Cited by 84 publications

References 22 publications

Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome

Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome

Complications and outcomes of vasopressor usage in acute traumatic central cord syndrome

Evidence-based management of central cord syndrome

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