The Role of Surgery in Traumatic Central Cord Syndrome

Abstract

Central cord syndrome (CCS) is the most common form of incomplete cervical spinal cord injury. This clinical syndrome marked by a disproportionate weakness in the upper extremities compared with the lower extremities was originally described by Richard Schneider in 1954. After poor initial surgical results, Schneider deemed surgery “contraindicated” in the setting of CCS as a majority of patients managed medically made predictable recoveries. Since his time, the role of surgery in traumatic CCS has remained controversial despite numerous reports of its successful application. Surgical intervention has been advocated for persistent or worsening neurologic deficits and evidence of spinal cord compression on imaging. Including Schneider's report, only 2 out of 352 patients in the literature have been reported as having a neurologic decline after surgery for CCS. Reported benefits of surgery include earlier rehabilitation and neurologic recovery, decreased hospital length of stay, decreased risks of delayed neurologic deterioration, and a decrease in the risks associated with prolonged convalescence. These potential benefits must be weighed against surgical and anesthetic risks in the face of an acute spinal cord injury. The purpose of this article was to review the role of surgery in traumatic CCS.