Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 21. The safety and efficacy of early surgery for traumatic central cord syndrome

BACKGROUND CONTEXT The role of early surgical decompression in traumatic central cord syndrome (TCCS) remains controversial. With the aging population, TCCS is expected to become the most common form of acute traumatic spinal cord injury (SCI), making the identification of treatment strategies that mitigate disability in this vulnerable population a key public health priority. PURPOSE To evaluate the impact of time to surgery on clinical outcomes in patients with TCCS. STUDY DESIGN/SETTING Analysis of prospective data from two multicenter international acute traumatic SCI datasets: 1) the NACTN SCI Registry; and 2) the STASCIS dataset. PATIENT SAMPLE Patients with TCCS, defined by at least a 10-point difference between the initial ASIA upper extremity motor score (UEMS) and ASIA lower extremity motor score (LEMS) in favor of the lower limbs (LEMS–UEMS≥10). OUTCOME MEASURES Motor recovery and functional outcome, as evaluated by the ASIA total motor score (AMS) and functional independence measure (FIM) motor subscore, respectively. Outcomes were evaluated at 6 months. The primary outcome was change in AMS. Secondary outcomes were ASIA impairment scale (AIS) conversion (≥1 grade improvement), change in FIM motor subscore, and development of complications. METHODS Baseline characteristics and outcomes were compared in patients who underwent early ( t -test for means. Multiple linear regression was performed for change in AMS at 6 months with age, initial AMS, initial AIS, time to surgery, and instability (presence of fracture and/or dislocation) as independent variables. Interaction terms were included for time to surgery × initial AIS × instability based on a priori hypotheses that: (1) the potential for recovery with early surgical decompression differs between AIS C and D injuries, with the latter demonstrating a favorable recovery profile, regardless of intervention; and (2) injuries resulting from low-energy mechanisms, as manifested by absence of spinal column disruption, are more likely to respond favorably to early surgical decompression due to a less severe primary insult and more substantive role of secondary injury cascades in these cases. RESULTS Seventy-three patients met criteria, with 28 (38.4%) undergoing early surgery. Mean improvement in AMS at 6 months was greater in the early (30.4 points) than delayed (20.9 points) surgery group (P=.045). Early surgery was also associated with greater improvement in FIM motor subscore (38.2 vs. 20.3 points, P=.006). There was no significant difference in rates of AIS conversion (P=.265) or complications (P=.139).  On multiple linear regression, initial AMS (P CONCLUSIONS Early surgical decompression is safe and effective in patients with TCCS. Shorter time to surgery positively impacts motor recovery in TCCS; this effect is most pronounced in patients with AIS C injuries, those without instability, and especially in patients with stable AIS C injuries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.