A Novel Classification System for Traumatic Central Cord Syndrome The Central Cord Injury Scale (CCIS)

Study Design. Retrospective study of 37 patients with traumatic central cord syndrome. Objective. The purpose of this study is to review a series of patients with central cord syndrome and to introduce a classification system that is predictive of functional outcome. Summary of Background Data. Central cord syndrome is the most common incomplete spinal cord injury, yet a predictive classification system does not exist. Methods. Thirty-seven patients with traumatic central cord syndrome had 1-year results of the motor portion of the Functional Independence Measurement (FIM) Score. Ten factors were analyzed for their predictive effect on the 1-year Motor FIM Score. Results. There were 8 women and 29 men with a mean age of 55.1 years. The mean injury motor FIM was 21.9 and mean 1-year Motor FIM: 70.2 (P < 0.001). The following had a predictive effect on 1-year Motor FIM: Injury ASIA Motor Score (P < 0.013) and magnetic resonance imaging evidence of abnormal signal intensity (P < 0.007). Points were assigned to these factors, and patients were categorized as Central Cord Injury Scale (CCIS) 1, 2, or 3. CCIS 1: n = 6, mean 1-year Motor FIM = 40.8; CCIS 2: n = 19 and FIM = 72.4; and CCIS 3: n = 12 and FIM = 81.5. Each classification had an increasing percentage of patients who could walk without ever using a wheelchair and had independence in bladder and bowel function. Conclusion. The CCIS is predictive of a patient's functional outcome at 1 year and has the potential to help patients and physicians establish realistic expectations for functional recovery based on ASIA Motor Score and magnetic resonance imaging findings.