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Treatment of acute traumatic central cord syndrome: a score-based approach based on the literature

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A Correction to this article was published on 04 May 2023

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Abstract

Purpose

Acute traumatic central cord syndrome (ATCCS) accounts for up to 70% of incomplete spinal cord injuries, and modern improvements in surgical and anaesthetic techniques have given surgeons more treatment options for the ATCCS patient. We present a literature review of ATCCS, with the aim of elucidating the best treatment option for the varying ATCCS patient characteristics and profiles. We aim to synthesise the available literature into a simple-to-use format to aid in the decision-making process.

Methods

The MEDLINE, EMBASE, CENTRAL, Web of Science and CINAHL databases were searched for relevant studies and improvement in functional outcomes were calculated. To allow for direct comparison of functional outcomes, we chose to focus solely on studies which utilised the ASIA motor score and improvements in ASIA motor score.

Results

A total of 16 studies were included for review. There were a total of 749 patients, of which 564 were treated surgically and 185 were treated conservatively. There was a significantly higher average motor recovery percentage amongst surgically-treated patients as compared to conservatively treated patients (76.1% vs. 66.1%, p value = 0.04). There was no significant difference between the ASIA motor recovery percentage of patients treated with early surgery and delayed surgery (69.9 vs. 77.2, p value = 0.31). Delayed surgery after a trial of conservative management is also an appropriate treatment strategy for certain patients, and the presence of multiple comorbidities portend poor outcomes. We propose a score-based approach to decision making in ATCCS, by allocating a numerical score for the patient’s clinical neurological condition, imaging findings on CT or MRI, history of cervical spondylosis and comorbidity profile.

Conclusions

An individualised approach to each ATCCS patient, considering their unique characteristics will lead to the best outcomes, and the use of a simple scoring system, can aid clinicians in choosing the best treatment for ATCCS patients.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore

    A. Aravin Kumar, Robin Pillay, Colum Patrick Nolan & Ling Ji Min

  2. Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    Wong Joey Ying Hao

  3. Duke-NUS Medical School, Singapore, Singapore

    Colum Patrick Nolan

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  1. A. Aravin Kumar
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All authors contributed to the study conception and design. Data collection and analysis were performed by the first and second authors. All authors read and approved the final manuscript.

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Correspondence to A. Aravin Kumar.

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This project was accepted as an e-poster for the WFNS XVII World Congress of Neurosurgery in Bogota, Colombia from 13 to 18 March 2022.

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Kumar, A.A., Wong, J.Y.H., Pillay, R. et al. Treatment of acute traumatic central cord syndrome: a score-based approach based on the literature. Eur Spine J 32, 1575–1583 (2023). https://doi.org/10.1007/s00586-023-07626-3

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