Acute Traumatic Cervical Central Cord Syndrome—Is Early Intervention Justified?

Abstract

AbstractThe clinical features suggestive of traumatic central cord syndrome (TCCS) were presented by Thorburn in his publication in 1887. Later in 1954, Schneider first mentioned the involvement of central cervical spinal cord after an acute cervical spine injury and described it as TCCS. This is generally caused due to an extreme hyperextension injury without vertebral damage and secondary to anteroposterior pinching or squeezing of the spinal cord. There exists a lot of controversy whether early surgical intervention is justified in these patients. It is to assess our own results that we decided to review 40 such cases treated by the senior author in the past 8 years. Twenty-four of these were managed with early surgical intervention (which we defined as within 48 hours), and 16 were treated conservatively. In all cases, the existence of fracture-dislocation, disc prolapse, as well as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and exact motor and sensory deficit were recorded. The numbers are too few, but there was definite evidence that patients with disc prolapse and fracture dislocation did better with surgery than with conservative treatment. Those with grade 0 power in the upper limbs however did significantly better with surgical treatment. Those with advanced pre-existing cervical spondylotic changes did better than those without these premorbid changes. However, the numbers are too small for meaningful statistical analysis. This is a retrospective study conducted as a pilot study to plan for a future randomized study, which is very necessary in our clinical practice. Currently, we still quote the pros and cons of surgical intervention to the relatives and go by their choice.