Abstract
BackgroundIncomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subject of discussion. From a biological point of view early surgery could prevent secondary damage due to ongoing compression of the already damaged spinal cord. Historically, however, conservative treatment was propagated with good clinical results. Proponents for early surgery as well those favoring conservative treatment are still in debate. The proposed trial will contribute to the discussion and hopefully also to a decrease in the variability of clinical practice.Methods/DesignA randomized controlled trial is designed to compare the clinical outcome of early surgical strategy versus a conservative approach. The primary outcome is clinical outcome according to mJOA. This also measured by ASIA score, DASH score and SCIM III score. Other endpoints are duration of the stay at a high care department (medium care, intensive care), duration of the stay at the hospital, complication rate, mortality rate, sort of rehabilitation, and quality of life. A sample size of 36 patients per group was calculated to reach a power of 95%. The data will be analyzed as intention-to-treat at regular intervals, but the end evaluation will take place at two years post-injury.DiscussionAt the end of the study, clinical outcomes between treatments attitudes can be compared. Efficacy, but also efficiency can be determined. A goal of the study is to determine which treatment will result in the best quality of life for the patients. This study will certainly contribute to more uniformity of treatment offered to patients with a special sort of spinal cord injury.Trial RegistrationGov: NCT01367405
Highlights
Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family
It has been shown that the distinction of Traumatic Central Cord Syndrome (TCCS) with an incomplete cervical spinal cord lesion (ICSCL) is artificial [1]
A good recovery has been described after conservative treatment [3]
Summary
Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subject of discussion. It has been shown that the distinction of TCCS with an incomplete cervical spinal cord lesion (ICSCL) is artificial [1]. It is the most frequent incomplete traumatic spinal cord lesion. Conservative therapy was usually considered when a fracture or dislocation of the spine was absent It is often seen in hyperextension trauma in the elderly, with a degenerative spondylotic stenotic cervical spine.
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