Abstract
Objectives: Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims to determine the efficacy of early surgical decompression (within 24 hours) of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases. Methods: 60 patients suffering from acute traumatic central cord syndrome with various neurological deficits were divided into 2 groups, group A (conservatively managed) and group B (surgically managed). Patients in group B were operated upon within 24 hr. of trauma by posterior decompression. Clinical assessment of each patient on admission, discharge and 3 months follow-ups was done using the ASIA Impairment Scale, FIM, Ashworth scale, bladder function, and neuropathic pain symptoms. Results: Data collected from both groups showed, group A (the conservative group) consisted of 22 male (73.3%) and 8 female subjects (26.6%) with a mean age of 57.5 years while in group B (surgical group) the sample consisted of 20 male (66.6%) and 10 female subjects (33.3%) with a mean age of 58.6 years. There was an improvement in our study—according to ASIA and FIM scales—in 8 patients of 30 (26.6%) in the conservative group. In the surgical group, improvement in 16 patients (53.3%). Conclusions: Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay.
Highlights
Traumatic central cord syndrome (CCS) is the most common type of acute incomplete cervical spinal cord injury (SCI) which has been described many years ago by Schneider et al in 1954 [1] [2]
This study aims to determine the efficacy of early surgical decompression of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases
Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay
Summary
Traumatic central cord syndrome (CCS) is the most common type of acute incomplete cervical spinal cord injury (SCI) which has been described many years ago by Schneider et al in 1954 [1] [2]. It’s often Happens in older people after experiencing a hyperextension injury that leads to a spinal cord contusion or edema [2]. It is characterized by disproportionately motoring deficit more on the arms, especially the hands, than the legs with bladder dysfunction and varying degrees of sensory loss below the lesion [3]. It occurs more frequently in patients with pre-existing anterior cervical spondylotic changes as bone spurs and in patients with thickened posterior ligamentum flavum [4]. More recent studies and expertise in this field, owing to changes in understanding of the pathophysiology indicate that conservative management and surgical decompression in some patients with persistent compression and neurological deficits can be both beneficial to the patients [7] [8] [9]
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