Analysis of prognosis and influencing factors of surgical treatment for central cord syndrome

English Keywords:Central cord syndrome  Surgical treatment  Prognosis  Factors

English Abstract:

  【Abstract】 Objectives: To analyze the prognosis and influencing factors of surgical treatment for central cord syndrome(CCS). Methods: The CCS patients underwent surgical treatment at the Department of Orthopaedics of our hospital between January 2017 and December 2019 were retrospectively analyzed. Data including age, gender, cause of injury, and American Spinal Injury Association(ASIA) motor score, ASIA sensory(acupuncture) score, Japanese Orthopaedic Association(JOA) score, and intrinsic hand muscle strength score on admission, and preoperative imaging data such as prevertebral hyperintensity, posterior ligament complex, intervertebral disc herniation, ossification of posterior longitudinal ligament(OPLL), intramedullary hyperintensity range, sagittal diameter of the narrowest part of the spinal canal, the percentage of maximum canal compromise(MCC) at the narrowest part of spinal canal, and the percentage of maximum spinal cord compression(MSCC), and the time from injury to surgery, surgical method, length of hospital stay, and follow-up ASIA neurological score and JOA score for improvement evaluation of neurological function were collected; and the relevant factors affecting the prognosis of surgical treatment were analyzed by defining the improvement rate of JOA score>50% as good prognosis and ≤50% as poor prognosis. Results: 48 CCS patients were included, consisting of 36 males(75%) and 12 females(25%), with an average age of 54.76±9.78 years. The ASIA motor score was 67.23±21.98, sensory score was 96.58±13.39, JOA score was 9.19±3.08, and intrinsic hand muscle strength score was 7.04±4.50 on admission, and the presence of pathological signs accounted for 39.58%(19/48). The time from injury to surgery of the patients was 5.46±2.10d, and 21 cases received anterior surgery and 27 underwent posterior surgery. During the postoperative follow-up of 12-34 months, all the patients had no significant postoperative surgery-related complications or neurological deterioration. The follow-up motor score(89.67±13.65), sensory score(104.88±7.94), and JOA score(13.73±3.25) were all improved to varying degrees compared with the admission scores(P<0.05). Multiple regression analysis showed that the improvement rates of ASIA motor score, ASIA sensory score and JOA score were significantly correlated with OPLL(β=-0.447, P<0.001; β=0.524, P=0.001; β=-0.196, P<0.001) and ASIA sensory score on admission(β=0.526, P=0.011; β=0.894, P=0.02; β=-0.784, P<0.001). There were statistical differences between the good prognosis patients and poor prognosis patients in terms of age, prevertebral hyperintensity, OPLL, sagittal diameter of the narrowest part of the spinal canal, MCC percentage of the narrowest part of the spinal canal, and intrinsic hand muscle strength score, ASIA motor score and JOA score on admission(P<0.05), and multiple regression analysis showed age(β=5.889, P=0.015), prevertebral hyperintensity(β=15.799, P＜0.001), MCC percentage of the narrowest part of spinal canal(β=6.747, P=0.009), intrinsic hand muscle strength score(β=9.012, P=0.003), ASIA motor score(β=4.837, P=0.028), ASIA sensory score(β=5.205, P=0.023) and JOA score(β=6.446, P=0.011) affecting the prognosis. Receiver operating characteristic(ROC) curve also showed that no prevertebral hyperintensity[area under curve(AUC)=0.756, 95%CI 0.585-0.928, P=0.006)], the MCC percentage of the narrowest part of spinal canal <45.41%(AUC=0.731, 95%CI 0.566-0.896, P=0.010), the score of intrinsic hand muscle strength >11(AUC=0.77, 95%CI 0.628-0.913, P=0.003), and the motor score >75 on admission(AUC=0.804, 95%CI 0.683-0.924, P=0.001), and JOA score >8.59 on admission(AUC=0.755, 95%CI 0.614-0.897, P=0.005) could be used as the threshold of good prognosis. Conclusions: Surgical treatment for CCS is safe and effective. No prevertebral hyperintensity, low MCC percentage(<45.41%) of the narrowest part of spinal canal, high score of intrinsic hand muscle strength(>11), and high ASIA motor score(>75) and JOA score(>8.59) on admission are the predictors of good prognosis in CCS patients.