Impact of timing of surgery on traumatic central cord syndrome without fracture or dislocation

Abstract

ObjectiveThe management of acute traumatic central cord syndrome (ATCCS) remains controversial. The purpose of this study was to evaluate the impact of timing of surgery on patients with ATCCS without fracture or dislocation. MethodsForty-one patients with ATCCS without fracture or dislocation were identified and divided into three groups described as the conservative treatment group, early surgery group, and delayed surgery group. Clinical outcomes including ASIA Motor Score (AMS), Japanese Orthopaedic Association (JOA) score upon admission and follow-up, change in AMS, and JOA recovery rate were analyzed. Logistic regression analysis was performed to show the correlation between timing of surgery and clinical outcomes. ResultsAll patients received a minimum of 1-year follow-up and showed significant neurological recovery at the final follow-up. No statistical differences in final AMS and JOA scores were observed between the three groups. Patients who underwent early surgery achieved a faster motor recovery at the first 6-months postoperatively compared to conservative treatment(p < 0.01). There was a significant negative correlation between the timing of surgery and the change in AMS (r = -0.41, p = 0.02) in the initial 6-months postoperatively and throughout the follow-up period (r = -0.42, p = 0.02). ConclusionsThe present study indicated that both conservative and surgical treatments can lead to good neurological recovery in patients with ATCCS without fracture or dislocation. Early surgery allowed for rapid early motor recovery compared to conservative treatment. The choice of timing of surgery still requires individualized decision-making.