Skip to main content

Advertisement

SpringerLink
Log in

Management and prognosis of acute traumatic cervical central cord syndrome: systematic review and Spinal Cord Society—Spine Trauma Study Group position statement

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

A Correction to this article was published on 20 November 2020

This article has been updated

Abstract

Purpose

Spinal Cord Society (SCS) and Spine Trauma Study Group (STSG) established a panel tasked with reviewing management and prognosis of acute traumatic cervical central cord syndrome (ATCCS) and recommend a consensus statement for its management.

Methods

A systematic review was performed according to the PRISMA 2009 guidelines. Delphi method was used to identify key research questions and achieve consensus. PubMed, Scopus and Google Scholar were searched for corresponding keywords. The initial search retrieved 770 articles of which 37 articles dealing with management, timing of surgery, complications or prognosis of ATCCS were identified. The literature review and draft position statements were compiled and circulated to panel members. The draft was modified incorporating relevant suggestions to reach consensus.

Results

Out of 37 studies, 15 were regarding management strategy, ten regarding timing of surgery and 12 regarding prognosis of ATCCS.

Conclusion

There is reasonable evidence that patients with ATCCS secondary to vertebral fracture, dislocation, traumatic disc herniation or instability have better outcomes with early surgery (< 24 h). In patients of ATCCS secondary to extension injury in stenotic cervical canal without fracture/fracture dislocation/traumatic disc herniation/instability, there is requirement of high-quality prospective randomized controlled trials to resolve controversy regarding early surgery versus conservative management and delayed surgery if recovery plateaus or if there is a neurological deterioration. Until such time decision on surgery and its timing should be left to the judgment of physician, deliberating on pros and cons relevant to the particular patient and involving the well-informed patient and relatives in decision making.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Change history

References

  1. Hayes KC, Hsieh JT, Wolfe DL et al (2000) Classifying incomplete spinal cord injury syndromes: algorithms based on the international standards for neurological and functional classification of spinal cord injury patients. Arch Phys Med Rehabil 81:644–652

    Article  CAS  PubMed  Google Scholar 

  2. Kretzer RM (2016) A clinical perspective and definition of spinal cord injury. Spine (Phila Pa 1976) 41(Suppl 7):S27. https://doi.org/10.1097/brs.0000000000001432

    Article  Google Scholar 

  3. McKinley W, Santos K, Meade M, Brooke K (2007) Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med 30:215–224

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schneider RC, Cherry G, Pantek H (1954) The syndrome of acute central cervical spinal cord injury. J Neurosurg 11:546–577. https://doi.org/10.3171/jns.1954.11.6.0546

    Article  CAS  PubMed  Google Scholar 

  5. Schneider RC, Thompson JM, Bebin J (1958) The syndrome of acute central cervical spinal cord injury. J Neurol Neurosurg Psychiatry 21:216–227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dai L, Jia L (2000) Central cord injury complicating acute cervical disc herniation in trauma. Spine (Phila Pa 1976) 25:331–336. https://doi.org/10.1097/00007632-200002010-00012

    Article  CAS  Google Scholar 

  7. Bose B, Northrup B, Osterholm J, Cotler J (1984) Reanalysis of central cervical cord injury management. 1–2

  8. Chen TY, Lee ST, Lui TN et al (1997) Efficacy of surgical treatment in traumatic central cord syndrome. Surg Neurol 48:435–441. https://doi.org/10.1016/S0090-3019(97)00037-2

    Article  CAS  PubMed  Google Scholar 

  9. Chen TY, Dickman CA, Eleraky M, Sonntag VK (1998) The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine (Phila Pa 1976) 23:2398–2403

    Article  CAS  Google Scholar 

  10. Guest J, Eleraky MA, Apostolides PJ et al (2002) Traumatic central cord syndrome: results of surgical management. J Neurosurg 97:25–32

    PubMed  Google Scholar 

  11. Yamazaki T, Yanaka K, Fujita K et al (2005) Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol 63:95–99. https://doi.org/10.1016/j.surneu.2004.03.020

    Article  PubMed  Google Scholar 

  12. Lenehan B, Fisher CG, Vaccaro A et al (2010) The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976) 35:S180–S186. https://doi.org/10.1097/brs.0b013e3181f32a44

    Article  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  14. Picot J, Hartwell D, Harris P et al (2012) The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review. Health Technol Assess 16:1–316. https://doi.org/10.3310/hta16190

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Thorburn W (1887) Cases of injury to the cervical region of the spinal cord. Brain 9:510–543. https://doi.org/10.1093/brain/9.4.510

    Article  Google Scholar 

  16. Collignon F, Martin D, Lenelle J, Stevenaert A (2002) Acute traumatic central cord syndrome: magnetic resonance imaging and clinical observations. J Neurosurg 96:29–33

    Article  PubMed  Google Scholar 

  17. Schneider RC (1959) Chronic neurological sequelae of acute trauma to the spine and spinal cord. II. The syndrome of chronic anterior spinal cord injury or compression; herniated intervertebral discs. J Bone Joint Surg Am 41-A:449–456

    Article  CAS  PubMed  Google Scholar 

  18. Schneider RC (1960) Chronic neurological sequelae of acute trauma to the spine and spinal cord. Part V. The syndrome of acute central cervical spinal-cord injury followed by chronic anterior cervical-cord injury (or compression) syndrome. J Bone Joint Surg Am 42-A:253–260

    Article  CAS  PubMed  Google Scholar 

  19. Bosch A, Stauffer ES, Nickel VL (1971) Incomplete traumatic quadriplegia. A ten-year review. JAMA 216:473–478

    Article  CAS  PubMed  Google Scholar 

  20. Jin W, Sun X, Shen K et al (2017) Recurrent neurological deterioration after conservative treatment for acute traumatic central cord syndrome without bony injury: seventeen operative case reports. J Neurotrauma. https://doi.org/10.1089/neu.2016.4706

    Article  PubMed  Google Scholar 

  21. Rand RW, Crandall PH (1962) Central spinal cord syndrome in hyper-extension injuries of the cervical spine. J Bone Joint Surg Am 44-A:1415–1422

    Article  CAS  PubMed  Google Scholar 

  22. Shrosbree RD (1977) Acute central cervical spinal cord syndrome–aetiology, age incidence and relationship to the orthopaedic injury. Paraplegia 14:251–258. https://doi.org/10.1038/sc.1976.42

    Article  CAS  PubMed  Google Scholar 

  23. Maxted MJ, Dowd GSE (1982) Acute central cord syndrome without bony injury. Injury 14:103–106. https://doi.org/10.1016/S0020-1383(82)80022-3

    Article  CAS  PubMed  Google Scholar 

  24. Morse SD (1982) Acute central cervical spinal cord syndrome. Ann Emerg Med 11:436–439

    Article  CAS  PubMed  Google Scholar 

  25. Ishida Y, Tominaga T (2002) Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment. Spine (Phila Pa 1976) 27:1652–1658. https://doi.org/10.1097/00007632-200208010-00011(discussion 1658)

    Article  Google Scholar 

  26. Brodkey JS, Miller CF Jr, Harmody RM (1980) The syndrome of acute central cervical spinal cord injury revisited. Surg Neurol 14:251–257

    CAS  PubMed  Google Scholar 

  27. Song J, Mizuno J, Nakagawa H, Inoue T (2005) Surgery for acute subaxial traumatic central cord syndrome without fracture or dislocation. J Clin Neurosci 12:438–443. https://doi.org/10.1016/j.jocn.2004.04.008

    Article  PubMed  Google Scholar 

  28. Uribe J, Green BA, Vanni S et al (2005) Acute traumatic central cord syndrome - Experience using surgical decompression with open-door expansile cervical laminoplasty. Surg Neurol 63:505–510. https://doi.org/10.1016/j.surneu.2004.09.037

    Article  PubMed  Google Scholar 

  29. Pollard ME, Apple DF (2003) Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine (Phila Pa 1976) 28:33–39. https://doi.org/10.1097/01.brs.0000038180.84128.c4

    Article  Google Scholar 

  30. Aito S, D’Andrea M, Werhagen L et al (2007) Neurological and functional outcome in traumatic central cord syndrome. Spinal Cord 45:292–297. https://doi.org/10.1038/sj.sc.3101944

    Article  CAS  PubMed  Google Scholar 

  31. Furlan JC, Noonan V, Cadotte DW, Fehlings MG (2011) Timing of decompressive surgery of spinal cord after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. J Neurotrauma 28:1371–1399. https://doi.org/10.1089/neu.2009.1147

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fehlings MG, Vaccaro A, Wilson JR et al (2012) Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in acute spinal cord injury study (STASCIS). PLoS ONE 7:e32037. https://doi.org/10.1371/journal.pone.0032037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. La Rosa G, Conti A, Cardali S et al (2004) Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach. Spinal Cord Off J Int Med Soc Paraplegia 42:503–512. https://doi.org/10.1038/sj.sc.3101627

    Article  Google Scholar 

  34. Umerani MS, Abbas A, Sharif S (2014) Clinical outcome in patients with early versus delayed decompression in cervical spine trauma. Asian Spine J 8:. https://doi.org/10.4184/asj.2014.8.4.427

  35. Wilson JR, Singh A, Craven C et al (2012) Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study. Spinal Cord 50:840–843. https://doi.org/10.1038/sc.2012.59

    Article  CAS  PubMed  Google Scholar 

  36. Fehlings MG, Rabin D, Sears W et al (2010) Current practice in the timing of surgical intervention in spinal cord injury. Spine (Phila Pa 1976) 35:S166–S173. https://doi.org/10.1097/brs.0b013e3181f386f6

    Article  Google Scholar 

  37. Chen L, Yang H, Yang T et al (2009) Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine 10:3–8. https://doi.org/10.3171/2008.9.SPI0822

    Article  PubMed  Google Scholar 

  38. Stevens EA, Marsh R, Wilson JA et al (2010) A review of surgical intervention in the setting of traumatic central cord syndrome. Spine J 10:874–880. https://doi.org/10.1016/j.spinee.2010.07.388

    Article  PubMed  Google Scholar 

  39. Aarabi B, Alexander M, Mirvis SE et al (2011) Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. J Neurosurg Spine 14:122–130. https://doi.org/10.3171/2010.9.SPINE09922

    Article  PubMed  Google Scholar 

  40. Anderson DG, Sayadipour A, Limthongkul W et al (2012) Traumatic central cord syndrome: neurologic recovery after surgical management. Am J Orthop (Belle Mead NJ) 41:E104–E108

    Google Scholar 

  41. Kepler CK, Kong C, Schroeder GD et al (2015) Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome. J Neurosurg Spine 23:490–494. https://doi.org/10.3171/2015.1.SPINE141013

    Article  PubMed  Google Scholar 

  42. Bartels RH, Hosman AJ, van de Meent H et al (2013) Design of COSMIC: a randomized, multi-centre controlled trial comparing conservative or early surgical management of incomplete cervical cord syndrome without spinal instability. BMC Musculoskelet Disord 14:52. https://doi.org/10.1186/1471-2474-14-52

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chikuda H, Ohtsu H, Ogata T, et al (2013) Optimal treatment for spinal cord injury associated with cervical canal stenosis (OSCIS): a study protocol for a randomized controlled trial comparing early versus delayed surgery. Trials [Electronic Resour. 14:245

  44. Samuel AM, Grant RA, Bohl DD et al (2015) Delayed surgery after acute traumatic central cord syndrome is associated with reduced mortality. Spine (Phila Pa 1976) 40:349–356. https://doi.org/10.1097/brs.0000000000000756

    Article  Google Scholar 

  45. Brodell DW, Jain A, Elfar JC, Mesfin A (2015) National trends in the management of central cord syndrome: an analysis of 16,134 patients. Spine J 15:435–442. https://doi.org/10.1016/j.spinee.2014.09.015

    Article  PubMed  Google Scholar 

  46. Lenehan B, Street J, O’Toole P et al (2009) Central cord syndrome in Ireland: the effect of age on clinical outcome. Eur Spine J 18:1458–1463. https://doi.org/10.1007/s00586-009-1107-5

    Article  PubMed  PubMed Central  Google Scholar 

  47. Penrod LE, Hegde SK, Ditunno JF (1990) Age effect on prognosis for functional recovery in acute, traumatic central cord syndrome. Arch Phys Med Rehabil 71:963–968

    CAS  PubMed  Google Scholar 

  48. Dvorak MF, Fisher CG, Hoekema J et al (2005) Factors predicting motor recovery and functional outcome after traumatic central cord syndrome: a long-term follow-up. Spine (Phila Pa 1976) 30:2303–2311

    Article  Google Scholar 

  49. Roth EJ, Lawler MH, Yarkony GM (1990) Traumatic central cord syndrome: clinical features and functional outcomes. Arch Phys Med Rehabil 71:18–23

    CAS  PubMed  Google Scholar 

  50. Hohl JB, Lee JY, Horton JA, Rihn JA (2010) A novel classification system for traumatic central cord syndrome: the central cord injury scale (CCIS). Spine (Phila Pa 1976) 35:E238-43. https://doi.org/10.1097/brs.0b013e3181c15887

  51. Merriam WF, Taylor TK, Ruff SJ, McPhail MJ (1986) A reappraisal of acute traumatic central cord syndrome. J Bone Joint Surg Br 68:708–713

    Article  CAS  PubMed  Google Scholar 

  52. Miranda P, Gomez O, Alday R (2008) Acute traumatic central cord syndrome: analysis of clinical and radiological correlations. J Neurosurg Sci 52:107–112

    CAS  PubMed  Google Scholar 

  53. Schroeder GD, Kepler CK, Hjelm N et al (2015) The effect of vertebral fracture on the early neurologic recovery in patients with central cord syndrome. Eur Spine J 24:985–989. https://doi.org/10.1007/s00586-015-3865-6

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Spine Unit, Indian Spinal Injuries Centre, Sector C, VasantKunj, New Delhi, India

    P. K. Karthik Yelamarthy, H. S. Chhabra, Gayatri Vishwakarma & Ankur Nanda

  2. Department of Orthopaedic Surgery, Richard H. Rothman Hospital, Thomas Jefferson University Hospital, Philadelphia, USA

    Alex Vaccaro

  3. Berlin, Germany

    Patrick Kluger

  4. Department of Orthopaedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany

    Rainer Abel

  5. Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands

    Wee Fu Tan

  6. London, UK

    Brian Gardner

  7. Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India

    P. Sarat Chandra

  8. West Bengal Health University, Kolkata, India

    Sandip Chatterjee

  9. Anadolu Medical Centre, Istanbul, Turkey

    Serdar Kahraman

  10. Department of Neurosurgery, Umraniye Teaching and Research Hospital, Health Sciences University, Istanbul, Turkey

    Sait Naderi

  11. Park Clinic, Kolkata, India

    Saumyajit Basu

  12. Department of Orthopedics, University of Pretoria, Pretoria, South Africa

    Francois Theron

Authors
  1. P. K. Karthik Yelamarthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. S. Chhabra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alex Vaccaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gayatri Vishwakarma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Kluger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ankur Nanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rainer Abel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wee Fu Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Brian Gardner
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Sarat Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sandip Chatterjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Serdar Kahraman
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sait Naderi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Saumyajit Basu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Francois Theron
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. S. Chhabra.

Ethics declarations

Conflict of interest

There are no potential conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 627 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yelamarthy, P.K.K., Chhabra, H.S., Vaccaro, A. et al. Management and prognosis of acute traumatic cervical central cord syndrome: systematic review and Spinal Cord Society—Spine Trauma Study Group position statement. Eur Spine J 28, 2390–2407 (2019). https://doi.org/10.1007/s00586-019-06085-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06085-z

Keywords

Search

Navigation