Comparison of outcomes between people with and without central cord syndrome

Abstract

Study design

Retrospective analysis of prospectively collected data.

Objective

Central cord syndrome (CCS) is reported to have better outcomes than other cervical lesions, especially for ambulation and bladder recovery. However, a formal comparison between patients with CCS and other incomplete cervical spinal cord injuries (iCSCI) is lacking. Aim of the study is to investigate the neurological and functional outcomes in patients with or without CCS.

Setting

European Multicenter Study.

Methods

Data following SCI were derived from the European Multicenter Study about Spinal Cord Injury Database. CCS was diagnosed based on a difference of at least ten points of motor score in favour of the lower extremities. Patients were evaluated at 30 days, 6 months and 1 year from injury. The neurological and functional data were collected at each time point based on the International Standards for Neurological Classification of Spinal Cord injury (ISNSCI) and Spinal Cord Independence Measure (SCIM). Patients were selected with a matching procedure based on lesion severity, neurological level of injury (NLI) and age. Evaluation of the outcomes was performed by means of two-way Anova for repeated measures.

Results

The matching produced 110 comparable dyads. At all time points, upper extremity motor scores remained lower than lower extremity motor scores in CCS compared with iCSCI. With regard to daily life independence, both cohorts achieved comparable improvements in self-care sub-scores between T0 and T2 (6.6 ± 6.5 in CCS vs 8.2 ± 6.9 in iCSCI, p = 0.15) but this sub-score was significantly lower in CCS compared with iCSCI (3.6 ± 5.2 in CCS vs 7.3 ± 7.0 in iCSCI at T0, 13.7 ± 6.2 vs 16.5 ± 5.7 at T2), while the other sub-scores were comparable.

Conclusions

In contrast to previous reports, people with CCS have poorer outcomes of self-care ability compared with iCSCI.

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Fig. 1
Fig. 2: Histograms representing number of cases with respect to lesion level and central myelopathy index.
Fig. 3: Boxplots of motor score recovery and histogram indicating number of cases with respect to central myelopathy index distinguishing SCI lesion severity.
Fig. 4: Course of recovery along time T1 (1 month), T2 (6 months), and T3 (12 months) after the lesion of neurological features.
Fig. 5: Course of recovery along time T1 (1 month), T2 (6 months), and T3 (12 months) after the lesion of Spinal Cord Injury Measure scores.
Fig. 6: Course of recovery along time T1 (1 month), T2 (6 months), and T3 (12 months) after the lesion of walking indices.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all patients who were willing to contribute to the EMSCI database and acknowledge those who collected data upon which the present study is based.

Funding

The manuscript is partially supported by the European Union’s HORIZON2020 grant no. 681094 to AC and by the ERANET-NEURON grant to GS.

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All authors equally contributed to the study

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Correspondence to Giorgio Scivoletto.

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Blasetti, G., Pavese, C., Maier, D.D. et al. Comparison of outcomes between people with and without central cord syndrome. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-0491-x

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