Abstract Background: To assess outcome of surgery following a treatment algorithm in patients with acute traumatic central cord syndrome (ATCCS). Materials and Methods: Surgical outcomes were measured in terms of neurological status (American Spinal Injury Association ASIA motor and sensory scores), length of hospital stay, delay in surgery, duration of surgery, and blood loss. Functional outcomes were measured with the visual analog scale, modified Japanese Orthopedic Association score, Neck Disability Index, and Spinal Cord Independence Measure III. Radiological parameters noted were maximal canal compromise (MCC), maximal spinal cord compression (MSCC), extent of parenchymal damage, and segmental kyphosis. Patients of anterior and posterior surgery were compared based on the aforesaid measurements. Results: A total of 35 patients of ATCCS, 16 patients underwent anterior surgery, whereas 19 patients had posterior surgery. As compared to the anterior surgery group, the posterior surgery group had a longer surgery duration ( P value < 0.001) and more blood loss ( P value < 0.001). On regression analysis, there was a significant association between low ASIA scores ( P = 0.02), MCC ( P = 0.04), MSCC ( P = 0.02), and cord parenchymal damage ( P = 0.02) with poor neurological outcomes. Maximal spinal canal compromise, extent of parenchymal damage, and admission ASIA scores are independent risk factors for poor neurological outcomes. Conclusion: Patients with ATCCS with associated instability and/or persistent spinal cord compression can be effectively managed using an algorithm for surgical decision-making with an acceptable rate of complications. Also, surgical delay beyond 72 h may not have a significant impact on neurological recovery. Level of Evidence: III.
Sudhakar et al. (Fri,) studied this question.