Surgical outcomes and risk factors in traumatic central cord syndrome without fracture and dislocation

English Keywords:Traumatic central cord syndrome  Cervical stenosis  Cervical surgery

English Abstract:

  【Abstract】 Objectives: To evaluate the surgical outcome on the traumatic central cord syndrome(TCCS) without fracture and dislocation, and to discuss the risk factors for TCCS prognosis. Methods: 66 TCCS patients were received and reviewed from January 2007 to January 2014 in our hospital, and the ASIA score and JOA score at the time of 24 hours after injury, the day before surgery, 5 days after surgery and the final follow-up were recorded. Maximum canal compromise(MCC) and maximum spinal cord compression(MSCC) were used to measure the compression of the cannel and spinal cord due to stenosis. The relationships between prognosis(improvement ratio of JOA and ASIA score at final follow-up) and related risk factors(age, sex, operation way, the degree of stenosis, stenosis segment number and preoperative ASIA score) were evaluated respectively. All patients were divided into three groups according to the time between injury and surgery including less than 1 week(group A), 1 to 3 weeks(group B) and over 3 weeks(group C) to evaluate the neural function at these time points. Results: The ASIA score and JOA score at 5 days after surgery and final follow-up significantly increased compared with those at preoperation(P<0.05). The average score for MSCC and MCC was (26.71±13.27)% and (52.64±10.89)% respectively. The improvement ratio of JOA and MCCS showed a significantly negative correlation(P<0.05). Age was negtively related with the improvement ratio of JOA(P<0.05). Preoperative ASIA score was positively correlated with the final follow-up ASIA score(P<0.05). While gender, MCC, the number of stenosis segment and the surgical approach had no statistical correlation with the improvement ratio of JOA and the final follow-up ASIA score(P>0.05). Age, sex, operation way, preoperative ASIA score had no statistical difference among three groups at different time points. Group A′s JOA score and ASIA score were significantly higher than those of group B and C at final follow-up, the difference was statistically significant(P<0.05). The improvement ratio of JOA of group A, B, C groups at final follow-up was (78.4±6.7)%, (71.3±7.8)%, (63.2±9.1)% respectively(P<0.05). Conclusions: Operation is safe and effective for TCCS. Surgery within one week is beneficial for neurologi-cally functional recovery. Preoperative ASIA scoring, degree of stenosis caused by spinal cord compression and age may affect the prognosis of TCCS.