Evidence-based management of central cord syndrome

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Near-Miss Discharge of an Older Adult Male With Central Cord Syndrome

“…Common pathological conditions can include unstable cervical fracture, cervical fracture with dislocation, acute disc herniation, and hyperextension injury in individuals with underlying spondylotic changes. The exact causes remain controversial since the condition was first reported in 1954 (Dahdaleh et al, 2013). Acute traumatic central cord syndrome can be a disabling condition, and unfavorable outcomes appear to be age dependent (Harrop et al, 2006), although one research team suggests that there are also regional variations to morbidity and mortality (Brodell, Jain, Elfar, & Mesfin, 2015).…”

“…The spectrum of clinical presentation findings range from mild paresthesias and motor weaknesses, predominantly in upper to lower extremities, to bladder function disruption, to burning sensation, to full quadriparesis (Dahdaleh et al, 2013). Moreover, the condition peaks in a bimodal population: younger (less than 30 years), who most likely house a congenital deficit or incur a high-velocity injury (e.g., motor vehicle collision); and older (more than 60 years), who sustain a lowvelocity injury such as hyperextension during a fall or collision.…”

Outcome of Delayed Surgery in Treatment of Acute Traumatic Central Cord Syndrome without Fracture or Instability: A Retrospective Study

“…With the advancement of anesthetic and surgical technique, the prevailing therapy has transformed from conservative treatment to surgical management [2][3][4] . For ATCCS secondary to spinal column fracture or instability, early decompression and stabilization has been universally approved for satisfactory neurologic recovery, decreased possibility of secondary injury, low rate of complications, and shorter length of hospitalization 5,6 . However, for patients suffering CCS without fracture or instability, up to now, controversy still exists on the optimal surgical timing 7 .…”

Effect of Surgery on Gait and Sensory Motor Performance in Patients With Cervical Spondylotic Myelopathy

“…Likewise, the spectrum of clinical presentations can vary from asymptomatic states (with or without objective neurological signs) to gait imbalance, quadriparesis, and severe disability. 2,3 CSM is known to affect motor control in the upper and lower extremities, resulting in symptoms reflecting balance and dexterity impairments. 4,5 These symptoms are often progressive in older adult patients.…”