163 - Comparison of Neurological Improvements in Acute Traumatic Central Cor...

#163 Comparison of Neurological Improvements in Acute Traumatic Central Cord Syndrome Following Surgical and Non-surgical Interventions

Spine Tumors

Poster Presented by: N.S. Kumar

Author(s):

N.S. Kumar (1)
J. Tay (2)
S. Lee (2)
F. Han (2)
H.-K. Wong (2)

(1) National University Hospital, Orthopaedic Surgery, Singapore, Singapore
(2) National University Health System, Orthopaedic Surgery, Singapore, Singapore

Abstract

Background: Acute Traumatic Central Cord Syndrome (ATCCS) was first described by Schneider in 1954. Since then there were strong advocates for treatment by non-operative approaches. Recent studies have shown encouraging neurological improvements in patients treated surgically.

Our unit has treated patients with ATCCS both operatively and non-operatively.

Aim: The purpose of this study was to compare and evaluate functional neurological recovery between surgical or non-surgical intervention cohorts, following an ATCCS.

Material and Methods: We reviewed 59 patients who were treated at our hospital with a diagnosis of ATCCS from May 2005 to April 2011. Patients were identified using the Hospital Incidence Discharge Summaries (HIDS). There were 2 definite groups of patients identified- operatively and non-operatively managed. Clinical indicators used for assessing neurological outcomes were the American Spinal Injury Association (ASIA) motor score (AMS) and Neurological Level of Injury (NLI). These were obtained at the time of admission, in the immediate post-op period, and at the time from discharge from hospital.

The surgical cohort was further stratified into three subgroups with regards to the timing of surgical intervention after injury: surgery < 24 hours; surgery >24 hours till < 1 week; and surgery >1 week.

Results: The surgical cohort had 38 patients, in whom surgery was performed at a mean of 10.4 days (range, 0.6-150 days) following onset of injury. The majority of them (50.0%) were operated on between 24 hours and 1 week. The surgical approaches used were as follows: an anterior approach in 18 patients (47.4%), a posterior approach in 19 patients (50.0%), and a combined anterior-posterior approach in 1 patient (2.6%). The mean AMS was 52.2 at presentation and 65.8 at discharge; the mean improvement in AMS was 13.6, with 11 patients (29.0%) improving at least one ASIA impairment scale grade from time of admission to discharge.

Among the non-surgical cohort there were 21 patients, with a mean AMS of 75.9 at presentation and 85.5 at discharge; the mean improvement in AMS was 9.6, with 3 patients (14.3%) improving at least one ASIA impairment scale grade.

Discussion and Summary: Overall, the surgical cohort had a larger improvement in mean AMS as compared to those who received medical rehabilitation alone. This study also points to potential benefits of early surgical intervention; the ones having surgery less than 24 hours had the best neurological recovery. However recovery was also noticed for the other operative subgroups. Non-operative cohort also showed improvements but was not as impressive.