Effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures and dislocations of the cervical spine

Abstract

BACKGROUND: Acute central cord syndrome (ACCS) without fractures or dislocations is the most common form of incomplete spinal cord injury. OBJECTIVE: To evaluate the effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures or dislocations of the cervical spine. METHODS: A total of 164 patients with ACCS without fracture or dislocation of the cervical spine treated in our hospital from May 2018 to October 2019 were recruited and assigned to study group A and study group B according to different treatment modalities, with 82 cases in each group. Study group A underwent anterior cervical discectomy and fusion, and study group B was treated with posterior cervical laminectomy. The American Spinal Injury Association (ASIA) classification and motor scores of all cases at admission and at discharge were recorded, and the treatment outcomes of the two groups were compared. RESULTS: No significant differences were found in the ASIA classification and ASIA motor scores between the two groups at admission (P> 0.05). One year after surgery, the ASIA motor scores and sensory scores were not statistically significant between the two groups (P> 0.05) but showed significant improvement compared to the preoperative scores (P< 0.05). CONCLUSION: Both anterior cervical discectomy and fusion and posterior cervical laminectomy can improve the ASIA classification, ASIA motor scores, and sensory scores of ACCS patients without fractures or dislocations of the cervical spine. Therefore, surgical methods should be adopted based on the patients’ conditions.

Posterior spinal decompression in adults with spinal cord injury without traumatic compromise of the spinal canal: what is the data?

“…Similarly, laminoplasty and laminectomy appear equivalent as far as neurological outcome is concerned (17). In the study of Jia et al comparing 164 patients with acute central cord syndrome who underwent either the anterior cervical discectomy or posterior cervical laminectomy, the authors found similar results between the two approaches, with a slight superiority of the laminectomy technique (6). A more recent retrospective study by Yang et al regarding the management of patients with SCI also suggests that traumatic edema of the spinal cord is better resolved when an early laminoplasty is performed (20).…”

“…Central cord syndrome (CCS) is the most common type of incomplete spinal cord injury. The common setting of CCS without apparent osteoligamentous injury appears to be the closest analog of SCI without compromise of the spinal canal in adults ( 6 ). After the primary insult, a plethora of secondary events occur, with progressive edema and hemorrhage predominating and possibly being the cause of spinal cord compression ( 5 , 6 ).…”

“…The common setting of CCS without apparent osteoligamentous injury appears to be the closest analog of SCI without compromise of the spinal canal in adults ( 6 ). After the primary insult, a plethora of secondary events occur, with progressive edema and hemorrhage predominating and possibly being the cause of spinal cord compression ( 5 , 6 ). Treatment of such patients may be surgical or conservative depending on the type, the severity of injury, and the clinical status of the patient ( 7 , 8 ).…”

Laminectomy versus laminoplasty for treating multi-segmental cervical canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD):a retrospective study with a minimum follow-up period of two years

“…Conversely, posterior approaches are commonly regarded as more favorable for managing multi-segmental cervical canal stenosis due to their reduced incidence of complications, this may be attributed to factors such as reduced manipulation of vital structures like blood vessels and esophagus during surgery. Minimizing these risks can play a role in enhancing patient results and expediting the recovery process [11] . The techniques of laminectomy fusion xation and single open-door laminoplasty are widely employed among the posterior surgical options for cases of CCSWOFD.…”

Selection of Surgical Approach and Clinical Significance of Lower Cervical Spine Injuries Guided by SLIC Scoring System

“…However, for patients with SLIC score ≥ 4, there are few studies on whether the surgical approach should be anterior-posterior or anterior-posterior. Whether the quantitative score of SLIC for patients with lower cervical injury before surgery can be used as a guideline for clinical selection of surgical approaches remains to be clinically verified [4]. Based on this, this research group took 75 patients with lower cervical spine injury admitted to the First Affiliated Hospital of Hebei North University from January 2020 to November 2022 as the research object, and obtained evidence-based evidence by analyzing the correlation between preoperative SLIC score and surgical approach as well as postoperative efficacy, which provided scientific reference for the selection of surgical approach for cervical spine injury under correct clinical guidance.…”