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  • The Role of Early Surgical Intervention After Acute Traumatic Central Cord Syndrome

    Final Number:
    1250

    Authors:
    Eduardo Martinez del Campo MD; Jakub Godzik MD; Corey Tyler Walker MD, BS; Samuel Kalb MD; Nikolay L. Martirosyan MD; Alexander E. Ropper MD; Nicholas Theodore M.D. F.A.A.N.S. F.A.C.S.

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: ATCCS is the most common type of spinal cord injury. The benefits of early surgical decompression remain controversial. Compare and evaluate the preoperative management, clinical outcomes, and complications of early (=24 hours) and delayed (>24 hours) surgical decompression in patients diagnosed with acute traumatic central cord syndrome (ATCCS).

    Methods: Between January 2011 and April 2015, 68 patients were diagnosed with central cord compression at a single institution; records for patients with relevant data who were treated surgically for ATCCS, either with early decompression (ED; =24 hours between admission and surgical intervention) or delayed decompression (DD; >24 hours), were analyzed and the two groups were compared.

    Results: Twenty-three patients were studied (21/23 males, 91.3%). Fifteen patients underwent ED and 8 underwent DD. The mean age was 61.2 years and mean number of comorbidities per patient was 1.7 (range 0-4); no significant between-group differences were found. Ground-level fall was the most common cause of ATCCS (15/23, 62.5%). At admission, the mean upper-extremity American Spinal Injury Association score was 25.4±13.4 (range 5-50), and lower-extremity score was 40.2±11.1 (range 17-50); the mean modified Japanese Orthopaedic Association score was 10.0±3.9 (range 5-16). Mean time to surgical intervention for the ED group was 21.6±4.9 hours and for the DD group it was 69.6±26.4 hours. Both patient groups experienced an overall improvement in neurological status (P<.01), with the ED group experiencing the largest improvement. For all 23 patients, the mean length of stay was 7.3±2.6 days, follow-up was 27.4±15.7 months, mortality rate was 0%, severe complication rate was 0%, and complication rate was 26.1%; no significant between-group differences were found.

    Conclusions: Early surgical decompression is a reasonable practice, with proven safety in medically stable patients, which allows for improved neurological outcomes at long-term follow-up.

    Patient Care: ATCCS is the most common type of spinal cord injury. The role of early surgical decompression is has proven safe and beneficial in medically stable patients.

    Learning Objectives: ATCCS is the most common type of spinal cord injury. The role of early surgical decompression is has proven safe and beneficial in medically stable patients.

    References:

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