Incomplete Spinal Cord Syndromes: Current Incidence and Quantifiable Criteria for Classification

Area of Science:

• Neurology
• Traumatology
• Epidemiology

Background:

• Demographics of acute traumatic spinal cord injury (SCI) are shifting, with older injury ages, more falls, and increased incomplete tetraplegia.
• Central cord syndrome (CCS), anterior cord syndrome (ACS), and Brown-Sequard syndrome (BSS) are key incomplete SCI types, but their current incidence is unclear due to inconsistent study methods.

Purpose of the Study:

• To determine the updated incidence and neurological characteristics of CCS, ACS, and BSS in traumatic SCI.
• To utilize newly proposed computable definitions for ACS and BSS, alongside an existing CCS definition, for accurate classification.

Main Methods:

• Retrospective analysis of 3639 individuals with new traumatic SCI from the Spinal Cord Injury Model Systems database (January 2011 - May 2020).
• Application of newly proposed computable definitions for ACS and BSS, and an existing quantitative definition for CCS.

Main Results:

• CCS, ACS, and BSS represented 14%, 6.5%, and 2% of all traumatic SCI cases, respectively.
• Among 1649 individuals with incomplete tetraplegia, CCS was most common (30%), followed by ACS (10%) and BSS (3%).
• These syndromes constitute approximately 22% of traumatic SCI and 44% of incomplete tetraplegia, with CCS incidence rising.

Conclusions:

• Updated incidence data for CCS, ACS, and BSS provide a clearer understanding of these SCI syndromes.
• Proposed quantifiable criteria enhance the ability to study the incidence and characteristics of these specific SCI types.
• Central cord syndrome shows an increasing trend, highlighting the need for continued research and monitoring.