Development of a Clinical Prediction Model for Central Cord Syndrome: An Evaluation of Motor Recovery and the Effectiveness of Early Surgery

Abstract

Abstract INTRODUCTION There remains a paucity of data on the outcomes of central cord syndrome (CCS) and their predictors in the modern era. Further, the efficacy of early surgical decompression, within 24 hr, for CCS remains unclear. In patients with CCS, we therefore sought to: 1) develop a clinical prediction model for neurological outcome; and 2) evaluate the effect of early surgery (<24 hr) on neurological recovery. METHODS Patients with CCS (AIS grade C or D; LEMS UEMS ≥5) were identified from two prospective, multi-center spinal cord injury (SCI) datasets (NACTN; STASCIS). A clinical prediction model was developed by multiple linear regression; the outcome was change in American Spinal Injury Association (ASIA) motor score (AMS) at 1-yr. Covariates were chosen a priori: age, baseline AMS, baseline AIS grade, time to surgery (early [<24 hr] vs late [≥24 hr]), and time to surgery AIS grade. Effect sizes were summarized by ß coefficients. Internal validation was performed by bootstrapping. The model was externally validated in a cohort of patients from the NASCIS III trial. RESULTS A total of 211 patients were eligible. ß coefficients were significant for all variables in the model: age (−0.12, P = .04); baseline AMS (−0.71, P < .01); AIS grade (9.69, P = .01); time to surgery (12.67, P < .01); AIS grade × time to surgery (−13.18, P < .01). The mean R2 value across bootstraps was 0.66. In patients with AIS C injury, early surgery resulted in significantly improved motor recovery (marginal mean: +12.7, 95% CI 5.8-19.6); there was no difference in recovery with early surgery in patients with AIS D injury (marginal mean: −0.5, 95% CI −4.4-3.3). The model showed good external validity (R2 = 0.65 in validation cohort, N = 38). CONCLUSION Motor recovery after CCS may be predicted by age, AMS, AIS grade, and time to surgery. Early surgery improves recovery, particularly in patients with more severe injury.