Acute Traumatic Central Cord Syndrome: Early Decompression or Not?

Abstract

Objective: The purpose of this study is to compare the clinical outcomes of the patients with acute traumatic central cord syndrome (ATCCS) who were managed between early surgical treatment and conservative treatment. Methods: Between March 2004 and May 2007, 45 patients with ATCCS were treated. 27 patients were treated surgically and 18 patients were treated conservatively. Early decompressive surgery was performed within 24 hours after the trauma in all surgical patients. All patients were admitted within 8 hours of injury and high-dose methylprednisolone was administered. The clinical and radiological data were collected for each patient. Results: The significant improvement of American Spinal Injury Association (ASIA) score was achieved within the first 6 months of the surgery. There were statistically significant differences (p<0.05) between the surgical and conservatively treated patients at 1, 3 and 6 months follow-ups. However, there were no statistically significant differences of the improvements between two groups at 1 year. The ASIA score improvement had a positive correlation with the age at injury. The patients who were older than 65 years at injury showed statistically lower motor improvement than the patients who were younger than 65 years. The lengths of hospital stay were significantly shorter in patients with surgical treatments (p<0.05) than those in patients without surgery. Conclusion: Comparing with conservative treatment, early surgical decompression may be associated with rapid neurologic improvement, early mobilization, and shorter periods of hospitalization.