Early vs Late Surgical Decompression for Central Cord Syndrome

Area of Science:

• Neurosurgery
• Spinal Cord Injury Research
• Public Health

Background:

• Central cord syndrome (CCS) management is not well-defined.
• CCS is an increasing public health concern, particularly in aging populations.
• Optimal timing for surgical decompression in CCS is debated.

Purpose of the Study:

• To compare neurologic and functional outcomes of early (<24 hours) versus late (≥24 hours) surgical decompression for CCS.
• To evaluate the impact of surgical timing on motor recovery and functional independence in CCS patients.

Main Methods:

• A propensity score-matched cohort study included 186 patients with CCS from three international multicenter studies.
• Data were collected from December 1991 to March 2017, with analysis from March 2020 to January 2021.
• Primary outcome was 1-year motor recovery (upper and lower extremity motor scores, ASIA motor score); secondary outcomes included Functional Independence Measure scores.

Main Results:

• Early surgical decompression (n=93) showed significantly improved upper limb motor recovery compared to late surgery (n=93) (mean difference [MD], 2.3; P=.047).
• No significant difference in lower limb motor recovery was observed between early and late surgery groups (MD, 1.1; P=.30).
• In patients with ASIA Impairment Scale (AIS) grade C injury, early surgery led to greater overall motor score recovery (MD, 9.5; P=.04), while outcomes were similar for AIS grade D injuries.

Conclusions:

• Early surgical decompression is associated with improved upper limb motor function recovery at one year in CCS patients.
• These findings suggest that treatment paradigms for CCS should incorporate early surgical decompression as a neuroprotective strategy.
• Further research may refine optimal surgical timing based on injury severity (e.g., AIS grade).