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Timing of operative management in patient with traumatic Central Cord syndrome

Dimitar Haritonov, Svetoslav Kalevski, Nikolai Peev, Evgenia Kalevska

Abstract

Objectives:

Patients with traumatic central cord syndrome (TCCS) provide some of the most dramatic opportunities for neurological improvement when compared to other subgroups of SCI, particularly evident in young patients with TCCS. The purpose of this study is to review a series of patients with central cord syndrome and to corroborate the consensus about optimal treatment and surgical timing for decompression.

Materials and Methods:

Patients developing this suffering belong to two relative categories - the first group are relatively young patients with a high-energy injury that leads to fracture/subluxation or dislocation. The second category are older individuals who, due to a low-energy fall or cervical hyperextension injury present with TCCS that occurs in the presence of cervical spondylosis but without obvious injury to the spinal column. The main tool for refinement of the operative window was ASIA motor score.

Results:

Thirty-two patient were divided in two groups - patients with ASIA motor score less than or equal to 50 p. (mean - 42.4 p.) - 10, and patients with a score higher than 50 p. (mean - 67.45 p.) - 22. Patients with ASIA Mscores less than 50 p. were operated within 24 hours, but 2 patients from these - within 20 days. Patients with ASIA Mscore higher than 50 p. underwent decompression within 72 hours. All patients sustained improvement in neurological status with the exception of these two, who underwent late decompression.

Discussion:

These cases clearly demonstrate to what range should operative activity be targeted in patients with TCCS. Patients with ASIA Mscore 80 and above, with MRI fracture evidence and those who may have already experienced significant motor improvement between the time of injury and the moment of initial neurological evaluation, may undergo delayed surgical treatment.

Conclusions:

There was a recommendation based on low-quality evidence that early (as soon as feasible) surgical decompression for patients with TCCS and spondylosis should be recommended when their initial neurological impairment is significant.


Keywords

traumatic central cord syndrome; TCCS; treatment

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DOI: http://dx.doi.org/10.14748/ssm.v46i4.627

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About The Authors

Dimitar Haritonov
Medical University of Varna
Bulgaria

Departmment of Neurosurgery

University Hospital St. Anna Varna

Svetoslav Kalevski
Medical University of Varna
Bulgaria

Departmment of Neurosurgery

University Hospital St. Anna Varna

Nikolai Peev
Medical University of Varna

Departmment of Neurosurgery

University Hospital St. Anna Varna

Evgenia Kalevska

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