A Novel Classification System for Traumatic Central Cord Syndrome

Abstract

Retrospective study of 37 patients with traumatic central cord syndrome. The purpose of this study is to review a series of patients with central cord syndrome and to introduce a classification system that is predictive of functional outcome. Central cord syndrome is the most common incomplete spinal cord injury, yet a predictive classification system does not exist. Thirty-seven patients with traumatic central cord syndrome had 1-year results of the motor portion of the Functional Independence Measurement (FIM) Score. Ten factors were analyzed for their predictive effect on the 1-year Motor FIM Score. There were 8 women and 29 men with a mean age of 55.1 years. The mean injury motor FIM was 21.9 and mean 1-year Motor FIM: 70.2 (P < 0.001). The following had a predictive effect on 1-year Motor FIM: Injury ASIA Motor Score (P < 0.013) and magnetic resonance imaging evidence of abnormal signal intensity (P < 0.007). Points were assigned to these factors, and patients were categorized as Central Cord Injury Scale (CCIS) 1, 2, or 3. CCIS 1: n = 6, mean 1-year Motor FIM = 40.8; CCIS 2: n = 19 and FIM = 72.4; and CCIS 3: n = 12 and FIM = 81.5. Each classification had an increasing percentage of patients who could walk without ever using a wheelchair and had independence in bladder and bowel function. The CCIS is predictive of a patient's functional outcome at 1 year and has the potential to help patients and physicians establish realistic expectations for functional recovery based on ASIA Motor Score and magnetic resonance imaging findings.