Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis Clinical article

Object The objective of this study was to elucidate the relationship between admission demographic data validated injury severity measures on imaging studies, and clinical indicators on the American Spinal Injury Association (ASIA) motor score, Functional Independence Measure (FIM), manual dexterity, and dysesthetic pain at least 12 months after surgery for acute traumatic central cord syndrome (ATCCS) due to spinal stenosis Methods Over a 100-month period (January 2000 to April 2008) of 211 patients treated for ATCCS 59 cases were due to spinal stenosis and these patients underwent surgical decompression Five of these patients died 2 were lost to follow-up, 10 were not eligible for the study, and the remaining 42 were followed for at least 12 months Results In the cohort of 42 patients, mean age was 58 3 years, 83% of the patients were men, and 52 4% of the accidents were due to falls Mean admission ASIA motor score was 63 8 (upper extremities score 25 8 and lower extremities score 39 8) the spinal cord was most frequently compressed at skeletal segments C3-4 and C4-5 (71%) mean midsagittal diameter at the point of maximum compression was 5 6 mm maximum canal compromise (MCC) was 50 5% maximum spinal cord compression was 165%, and length of parenchymal damage on T2 weighted MR imaging was 29 4 mm Time after injury until surgery was within 24 hours in 9 patients 24-48 hours in 10 patients and more than 48 hours in 23 patients At the 1-year follow-up the mean ASIA motor score was 94 1 (upper extremities score, 45 7 and lower extremities score, 47 6), FIM was 111 1 manual dexterity was 64 4% of baseline and pain level was 3 5 Stepwise regression analysis of 10 independent variables indicated significant relationships between ASIA motor score at follow up and admission ASIA motor score (p = 0 003) MCC (p = 0 02) and midsagittal diameter (p = 0 02), FIM and admission ASIA motor score (p = 0 03) MCC (p = 0 02) and age (p = 0 02) manual dexterity and admission ASIA motor score (p = 0 0002) and length of parenchymal damage on T2-weighted MR imaging (p = 0 002) and pain level and age (p = 0 02) and length of parenchymal lesion on T2-weighted MR imaging (p = 0 04) Conclusions The main indicators of long-term ASIA motor score FIM manual dexterity and dysesthetic pain were admission ASIA motor score midsagittal diameter MCC length of parenchymal damage on T2-weighted MR imaging, and age but different domains of outcome were determined by different predictors (DOI 10 3171/2010 9 SPINE09922)