Treatment of Atypical Central Cord Injury Without Fracture or Dislocation

In general, spinal cord injury without radiological abnormality (SCIWORA) with spondylosis is considered to be a central cord injury. This article describes the clinical features and surgical outcomes of atypical central cord injury in patients with spondylotic SCIWORA (ACCISS). Fifty-two patients were enrolled in the study from January 2006 to December 2011. Diagnoses were made from imaging (computed tomography, magnetic resonance imaging) and clinical findings. The neurologic status of patients was assessed using the American Spinal Injury Association (ASIA) score and Japanese Orthopaedic Association (JOA) score. Patients were divided into 3 groups with regard to the timing of surgery after injury: those undergoing early surgery (less than 24 hours after injury), those undergoing late surgery (more than 24 hours after injury but during initial admission to the hospital and within 3 weeks from injury), and those undergoing delayed surgery (during second admission to the hospital, within 3 months but later than 3 weeks from injury). Seventeen patients underwent early surgery, 22 underwent late surgery, and 13 underwent delayed surgery. Mean follow-up was 15 months (range, 5-33 months). Patients in all groups showed very good recovery after surgical treatment, with the recovery rate of ASIA and JOA scores being 68.6% and 60.2%, respectively. No significant difference in recovery rate was found between the groups with regard to the timing of surgery. This retrospective study supports the notion that surgical decompression is effective in the treatment of patients with ACCISS. Timing of surgery (less than 3 months) was not significantly associated with neurologic recovery.