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Alexander R Vaccaro - One of the best experts on this subject based on the ideXlab platform.
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management and prognosis of acute traumatic cervical Central Cord Syndrome systematic review and spinal Cord society spine trauma study group position statement
European Spine Journal, 2019Co-Authors: P Karthik K Yelamarthy, Harvinder Singh Chhabra, Alexander R Vaccaro, Rainer Abel, Gayatri Vishwakarma, P Kluger, Ankur Nanda, Wee Fu Tan, Brian Gardner, Sarat P ChandraAbstract:Spinal Cord Society (SCS) and Spine Trauma Study Group (STSG) established a panel tasked with reviewing management and prognosis of acute traumatic cervical Central Cord Syndrome (ATCCS) and recommend a consensus statement for its management. A systematic review was performed acCording to the PRISMA 2009 guidelines. Delphi method was used to identify key research questions and achieve consensus. PubMed, Scopus and Google Scholar were searched for corresponding keywords. The initial search retrieved 770 articles of which 37 articles dealing with management, timing of surgery, complications or prognosis of ATCCS were identified. The literature review and draft position statements were compiled and circulated to panel members. The draft was modified incorporating relevant suggestions to reach consensus. Out of 37 studies, 15 were regarding management strategy, ten regarding timing of surgery and 12 regarding prognosis of ATCCS. There is reasonable evidence that patients with ATCCS secondary to vertebral fracture, dislocation, traumatic disc herniation or instability have better outcomes with early surgery (< 24 h). In patients of ATCCS secondary to extension injury in stenotic cervical canal without fracture/fracture dislocation/traumatic disc herniation/instability, there is requirement of high-quality prospective randomized controlled trials to resolve controversy regarding early surgery versus conservative management and delayed surgery if recovery plateaus or if there is a neurological deterioration. Until such time decision on surgery and its timing should be left to the judgment of physician, deliberating on pros and cons relevant to the particular patient and involving the well-informed patient and relatives in decision making. These slides can be retrieved under Electronic Supplementary Material.
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the effect of increased t2 signal intensity in the spinal Cord on the injury severity and early neurological recovery in patients with Central Cord Syndrome
Journal of Neurosurgery, 2016Co-Authors: Gregory D. Schroeder, Alexander R Vaccaro, Nik Hjelm, Michael S Weinstein, Christopher K KeplerAbstract:OBJECTIVE The aim of this paper was to compare the severity of the initial neurological injury as well as the early changes in the American Spinal Injury Association (ASIA) motor score (AMS) between Central Cord Syndrome (CCS) patients with and without an increased T2 signal intensity in their spinal Cord. METHODS Patients with CCS were identified and stratified based on the presence of increased T2 signal intensity in their spinal Cord. The severity of the initial neurological injury and the progression of the neurological injury over the 1st week were measured acCording to the patient's AMS. The effect of age, sex, congenital stenosis, surgery within 24 hours, and surgery in the initial hospitalization on the change in AMS was determined using an analysis of variance. RESULTS Patients with increased signal intensity had a more severe initial neurological injury (AMS 57.6 vs 75.3, respectively, p = 0.01). However, the change in AMS over the 1st week was less severe in patients with an increase in T2 signal intensity (-0.85 vs -4.3, p = 0.07). Analysis of variance did not find that age, sex, Injury Severity Score, congenital stenosis, surgery within 24 hours, or surgery during the initial hospitalization affected the change in AMS. CONCLUSIONS The neurological injury is different between patients with and without an increased T2 signal intensity. Patients with an increased T2 signal intensity are likely to have a more severe initial neurological deficit but will have relatively minimal early neurological deterioration. Comparatively, patients without an increase in the T2 signal intensity will likely have a less severe initial injury but can expect to have a slight decline in neurological function in the 1st week.
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optimal timing of surgical decompression for acute traumatic Central Cord Syndrome a systematic review of the literature
Neurosurgery, 2015Co-Authors: Karen K Anderson, Michael G Fehlings, James S Harrop, Alexander R Vaccaro, Lindsay Tetreault, Mohammed F Shamji, Anoushka Singh, Rachel Vukas, Alan S Hilibrand, Paul M ArnoldAbstract:BACKGROUND Traumatic Central Cord Syndrome (TCCS) is an incomplete spinal Cord injury defined by greater weakness in upper versus lower extremities, variable sensory loss, and variable bladder, bowel, and sexual dysfunction. The optimal timing of surgery for TCCS remains controversial. OBJECTIVE To determine whether timing of surgery for TCCS predicts neurological outcomes, length of stay, and complications. METHODS Five databases were searched through March 2015. Articles were appraised independently by 2 reviewers, and the evidence synthesized acCording to Grading of Recommendation Assessment, Development and Evaluation principles. RESULTS Nine studies (3 prognostic, 5 therapeutic, 1 both) satisfied inclusion criteria. Low level evidence suggests that patients operated on 24 hours after injury. Moderate evidence suggests that patients operated on 2 weeks after injury. There is insufficient evidence that lengths of hospital or intensive care unit stay differ between patients who undergo early versus delayed surgery. Furthermore, there is insufficient evidence that timing between injury and surgery predicts mortality rates or serious or minor adverse events. CONCLUSION Surgery for TCCS <24 hours after injury appears safe and effective. Although there is insufficient evidence to provide a clear recommendation for early surgery (<24 hours), it is preferable to operate during the first hospital admission and <2 weeks after injury.
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early outcome and predictors of early outcome in patients treated surgically for Central Cord Syndrome
Journal of Neurosurgery, 2015Co-Authors: Christopher K Kepler, Gregory D. Schroeder, Alexander R Vaccaro, Christopher Kong, Nikolaus Hjelm, Amir Sayadipour, Greg D AndersonAbstract:OBJECT The purpose of this study was to characterize changes in American Spinal Injury Association motor score (AMS) in the 1st week after traumatic Central Cord Syndrome (CCS) to identify predictors of improved early outcome in patients treated with early versus delayed surgical intervention. METHODS All patients presenting to a regional spinal Cord injury center between January 2004 and June 2009 were queried for those with a diagnosis of CCS. Patients treated conservatively were excluded. A prospectively maintained spinal Cord injury database was used to track AMS throughout each patient’s hospitalization. Hospital reCords provided information regarding demographics, presenting neurological examination, imaging findings, comorbidities, timing and nature of surgical procedures, and length of stay (LOS) in the hospital and intensive care unit (ICU). Patients were separated into those who underwent early surgery, within 1 day of presentation (early group), and those who underwent surgery on a delayed basi...
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the effect of vertebral fracture on the early neurologic recovery in patients with Central Cord Syndrome
European Spine Journal, 2015Co-Authors: Gregory D. Schroeder, Alexander R Vaccaro, Christopher K Kepler, Nik Hjelm, Michael S WeinsteinAbstract:To compare early changes in the ASIA Motor Score (AMS) between patients with Central Cord Syndrome (CCS) from an acute fracture to patients without a fracture. Patients with CCS were identified and stratified based on the presence of a fracture. The AMS through the first week of the patients’ hospitalization was obtained. Initial injury severity as well as early neurologic recovery was measured using the AMS. Analysis of variance was performed to determine if age, gender, rectal tone at presentation, congenital stenosis, or surgery within 24 h significantly effected the change in AMS. A strong trend (p = 0.0504) towards a more severe initial neurologic injury in patients with a fracture (AMS 59.7) than in patients without a fracture (AMS 70.2) was identified. However, in the week after injury, patients with a fracture had an improvement in their neurologic function (ΔAMS +4.8) while patients without a fracture demonstrated neurologic decline (ΔAMS −5.9). The change in AMS between patients with and without a fracture was nearly significant (p = 0.06). Patients with Central Cord Syndrome present with similar symptoms, but injuries with and without a fracture may be associated with a different early neurologic recovery. Patients with a fracture have a more severe injury at initial presentation, but tend to have neurologic improvement in the first week; conversely patients without a fracture have a less severe initial neurologic injury, but tend to have a slight decline in neurologic function over the first week.
Bizhan Aarabi - One of the best experts on this subject based on the ideXlab platform.
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efficacy of early 24 hours late 25 72 hours and delayed 72 hours surgery with magnetic resonance imaging confirmed decompression in american spinal injury association impairment scale grades c and d acute traumatic Central Cord Syndrome caused by spi
Journal of Neurotrauma, 2021Co-Authors: Bizhan Aarabi, Noori Akhtardanesh, Marc J Simard, Timothy Chryssikos, Kathirkamanathan Shanmuganathan, Joshua Olexa, Charles A Sansur, Kenneth M Crandall, Aaron Wessell, Gregory CannarsaAbstract:The therapeutic significance of timing of decompression in acute traumatic Central Cord Syndrome (ATCCS) caused by spinal stenosis remains unsettled. We retrospectively examined a homogenous cohort...
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efficacy of early 24 hours late 25 72 hours and delayed 72 hours surgery with magnetic resonance imaging confirmed decompression in american spinal injury association impairment scale grades c and d acute traumatic Central Cord Syndrome caused by spi
Journal of Neurotrauma, 2021Co-Authors: Bizhan Aarabi, Noori Akhtardanesh, Marc J Simard, Timothy Chryssikos, Kathirkamanathan Shanmuganathan, Joshua Olexa, Charles A Sansur, Kenneth M Crandall, Aaron Wessell, Gregory CannarsaAbstract:The therapeutic significance of timing of decompression in acute traumatic Central Cord Syndrome (ATCCS) caused by spinal stenosis remains unsettled. We retrospectively examined a homogenous cohort of patients with ATCCS and magnetic resonance imaging (MRI) evidence of post-treatment spinal Cord decompression to determine whether timing of decompression played a significant role in American Spinal Injury Association (ASIA) motor score (AMS) 6 months following trauma. We used the t test, analysis of variance, Pearson correlation coefficient, and multiple regression for statistical analysis. During a 19-year period, 101 patients with ATCCS, admission ASIA Impairment Scale (AIS) grades C and D, and an admission AMS of ≤95 were surgically decompressed. Twenty-four of 101 patients had an AIS grade C injury. Eighty-two patients were males, the mean age of patients was 57.9 years, and 69 patients had had a fall. AMS at admission was 68.3 (standard deviation [SD] 23.4); upper extremities (UE) 28.6 (SD 14.7), and lower extremities (LE) 41.0 (SD 12.7). AMS at the latest follow-up was 93.1 (SD 12.8), UE 45.4 (SD 7.6), and LE 47.9 (SD 6.6). Mean number of stenotic segments was 2.8, mean canal compromise was 38.6% (SD 8.7%), and mean intramedullary lesion length (IMLL) was 23 mm (SD 11). Thirty-six of 101 patients had decompression within 24 h, 38 patients had decompression between 25 and 72 h, and 27 patients had decompression >72 h after injury. Demographics, etiology, AMS, AIS grade, morphometry, lesion length, surgical technique, steroid protocol, and follow-up AMS were not statistically different between groups treated at different times. We analyzed the effect size of timing of decompression categorically and in a continuous fashion. There was no significant effect of the timing of decompression on follow-up AMS. Only AMS at admission determined AMS at follow-up (coefficient = 0.31; 95% confidence interval [CI]:0.21; p = 0.001). We conclude that timing of decompression in ATCCS caused by spinal stenosis has little bearing on ultimate AMS at follow-up.
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predictors of outcome in acute traumatic Central Cord Syndrome due to spinal stenosis
Journal of Neurosurgery, 2011Co-Authors: Bizhan Aarabi, Kathirkamanathan Shanmuganathan, Melvin Alexander, Stuart E Mirvis, David A Chesler, Christopher M Maulucci, Mark Iguchi, Carla Aresco, Tiffany BlacklockAbstract: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 ...
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hyperextension cervical spine injuries and traumatic Central Cord Syndrome
Neurosurgical Focus, 2008Co-Authors: Bizhan Aarabi, Michael T Koltz, David IbrahimiAbstract:Traumatic Central Cord Syndrome (TCCS), regardless of its biomechanics, is the most frequently encountered incomplete spinal Cord injury. Patients with TCCS present with disproportionate weakness of the upper extremities, and variable sensory loss and bladder dysfunction. Fractures and/or subluxations, forced hyperextension, and herniated nucleus pulposus are the main pathogenetic mechanisms of TCCS. Nearly 50% of patients with TCCS suffer from congenital or degenerative spinal stenosis and sustained their injuries during hyperextension as originally described by Schneider in 1954. Immunohistochemical and imaging studies indicate mild to moderate insult to axons and their ensheathing myelin in the lateral funiculi culminating in cytoskeletal injury and impaired conduction. More than one-half of these patients enjoy spontaneous recovery of motor weakness; however, as time goes on, lack of manual dexterity, neuropathic pain, spasticity, bladder dysfunction, and imbalance of gait render their activities of daily living nearly impossible. Based on the current level of evidence, there is no clear indication of the timing of decompression for relief of sustained spinal Cord compression in hyperextension injuries. Future research, taking advantage of validated digital imaging data such as maximum canal compromise, maximum spinal Cord compression, and lesion length on the CT and MR images, as well as more sensitive measures of bladder and hand function, spasticity, and neuropathic pain may help tailor surgery for a specific group of these patients.
James S Harrop - One of the best experts on this subject based on the ideXlab platform.
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optimal timing of surgical decompression for acute traumatic Central Cord Syndrome a systematic review of the literature
Neurosurgery, 2015Co-Authors: Karen K Anderson, Michael G Fehlings, James S Harrop, Alexander R Vaccaro, Lindsay Tetreault, Mohammed F Shamji, Anoushka Singh, Rachel Vukas, Alan S Hilibrand, Paul M ArnoldAbstract:BACKGROUND Traumatic Central Cord Syndrome (TCCS) is an incomplete spinal Cord injury defined by greater weakness in upper versus lower extremities, variable sensory loss, and variable bladder, bowel, and sexual dysfunction. The optimal timing of surgery for TCCS remains controversial. OBJECTIVE To determine whether timing of surgery for TCCS predicts neurological outcomes, length of stay, and complications. METHODS Five databases were searched through March 2015. Articles were appraised independently by 2 reviewers, and the evidence synthesized acCording to Grading of Recommendation Assessment, Development and Evaluation principles. RESULTS Nine studies (3 prognostic, 5 therapeutic, 1 both) satisfied inclusion criteria. Low level evidence suggests that patients operated on 24 hours after injury. Moderate evidence suggests that patients operated on 2 weeks after injury. There is insufficient evidence that lengths of hospital or intensive care unit stay differ between patients who undergo early versus delayed surgery. Furthermore, there is insufficient evidence that timing between injury and surgery predicts mortality rates or serious or minor adverse events. CONCLUSION Surgery for TCCS <24 hours after injury appears safe and effective. Although there is insufficient evidence to provide a clear recommendation for early surgery (<24 hours), it is preferable to operate during the first hospital admission and <2 weeks after injury.
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traumatic Central Cord Syndrome neurologic recovery after surgical management
American journal of orthopedics, 2012Co-Authors: David Greg Anderson, Amirali Sayadipour, Worawat Limthongkul, Niels D Martin, Alexander R Vaccaro, James S HarropAbstract:The purpose of this study was to evaluate neurologic recovery following an acute, traumatic Central Cord Syndrome (TCCS) injury. We retrospectively reviewed 69 patients who were treated surgically following an acute TCCS injury. The American Spinal Injury Association (ASIA) motor scores (AMS) were obtained from the time of presentation, from the time of hospital discharge, and from the most recent follow-up visit. The mean AMS was 63.2 ± 25.8 at presentation and 89.9 ± 14.6 at final follow-up (P<.001). Overall, 74% of the patients improved at least one ASIA impairment scale grade. Surgery was performed at a mean of 2.9 days (range, 0.25-24 days) following the injury using a posterior approach in 33 patients (48%), anterior approach in 22 patients (32%), and combined anterior-posterior approach in 14 patients (20%). Neither surgical timing nor approach appears to affect motor recovery. Adverse events were encountered in 24.6% of the patients. There were no deaths. A history of a loss of consciousness, decreased rectal tone at presentation, the presence of a fracture, the timing of surgery, and surgical approach did not have a significant impact on motor recovery.
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traumatic Central Cord Syndrome etiology management and outcomes
Topics in Spinal Cord Injury Rehabilitation, 2010Co-Authors: Sanjay Yadla, Paul Klimo, James S HarropAbstract:Traumatic Central Cord Syndrome, the most common spinal Cord injury Syndrome, typically presents in elderly patients after a hyperextension injury. It is a clinical diagnosis, defined by weakness involving the upper more than lower extremities following a hyperextension cervical injury. Its etiology has been the subject of various pathophysiological hypotheses. The neurologic outcome for this disease is generally favorable, with the majority of patients showing significant neurological improvement over time. There is, however, continued debate over the optimal timing of surgical intervention. This review focuses on the pathophysiology, surgical and medical management, and outcomes of traumatic Central Cord Syndrome.
Michael G Fehlings - One of the best experts on this subject based on the ideXlab platform.
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Management of Acute Traumatic Central Cord Syndrome: A Narrative Review
Global Spine Journal, 2019Co-Authors: Srikanth N. Divi, Madeline Tadley, Jetan H. Badhiwala, Wyatt L Ramey, F. Cumhur Oner, Frank Kandziora, John J. Mangan, Gregory D. Schroeder, Michael G Fehlings, Lorin Michael BennekerAbstract:Study Design:Narrative review.Objectives:To provide an updated overview of the management of acute traumatic Central Cord Syndrome (ATCCS).Methods:A comprehensive narrative review of the literature...
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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
The Spine Journal, 2018Co-Authors: Jetan H. Badhiwala, Jefferson R Wilson, Farshad Nassiri, Christopher D Witiw, Saleh A Almenawer, Robert G Grossman, Michael G FehlingsAbstract: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 ( 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.
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treatment of Central Cord Syndrome without associated spinal instability
Seminars in Spine Surgery, 2017Co-Authors: So Kato, Michael G FehlingsAbstract:Abstract Central Cord Syndrome (CCS) is a form of incomplete spinal Cord injury defined by more severe dysfunction in the upper extremities than the lower extremities. Although it is one of the most common entities encountered in the setting of acute trauma, various controversies still exist regarding its optimal treatment and decisions regarding surgery for the condition. In this article, we focus on the role of non-surgical treatment and the optimal timing of surgical decompression for CCS without spinal instability. Prognostic factors investigated in this specific population will be also discussed.
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optimal timing of surgical decompression for acute traumatic Central Cord Syndrome a systematic review of the literature
Neurosurgery, 2015Co-Authors: Karen K Anderson, Michael G Fehlings, James S Harrop, Alexander R Vaccaro, Lindsay Tetreault, Mohammed F Shamji, Anoushka Singh, Rachel Vukas, Alan S Hilibrand, Paul M ArnoldAbstract:BACKGROUND Traumatic Central Cord Syndrome (TCCS) is an incomplete spinal Cord injury defined by greater weakness in upper versus lower extremities, variable sensory loss, and variable bladder, bowel, and sexual dysfunction. The optimal timing of surgery for TCCS remains controversial. OBJECTIVE To determine whether timing of surgery for TCCS predicts neurological outcomes, length of stay, and complications. METHODS Five databases were searched through March 2015. Articles were appraised independently by 2 reviewers, and the evidence synthesized acCording to Grading of Recommendation Assessment, Development and Evaluation principles. RESULTS Nine studies (3 prognostic, 5 therapeutic, 1 both) satisfied inclusion criteria. Low level evidence suggests that patients operated on 24 hours after injury. Moderate evidence suggests that patients operated on 2 weeks after injury. There is insufficient evidence that lengths of hospital or intensive care unit stay differ between patients who undergo early versus delayed surgery. Furthermore, there is insufficient evidence that timing between injury and surgery predicts mortality rates or serious or minor adverse events. CONCLUSION Surgery for TCCS <24 hours after injury appears safe and effective. Although there is insufficient evidence to provide a clear recommendation for early surgery (<24 hours), it is preferable to operate during the first hospital admission and <2 weeks after injury.
Tiansi Tang - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of surgical treatment for traumatic Central Cord Syndrome
Journal of Neurosurgery, 2009Co-Authors: Liang Chen, Huilin Yang, Tongqi Yang, Zhaohua Bao, Tiansi TangAbstract:Object The authors undertook a study in patients with traumatic Central Cord Syndrome (TCCS) who underwent surgical intervention. They retrospectively assessed the motor score improvement and functional status and identified prognostic predictors of improvement. Methods Between March 1999 and May 2004, 49 patients with TCCS were surgically treated. Motor scores were collected at admission and follow-up using the American Spinal Injury Association (ASIA) Impairment Scale. The 36-Item Short Form Health Survey (SF-36) was administered. Other parameters including walking index, spasticity, bladder management, and neuropathic pain scores were reCorded. Patients were asked to assess their level of satisfaction with their final symptoms. Results The average ASIA score, converted into numeric values, was increased from 54.9 at admission to 81.9 and 89.6 at 6 months and final follow-up, respectively. Significant improvement of ASIA score was achieved within the first 6 months of surgery. No significant difference ...