• Jérôme Paquet, Carly S Rivers, Dilnur Kurban, Joel Finkelstein, Jin W Tee, Vanessa K Noonan, Brian K Kwon, R John Hurlbert, Sean Christie, Eve C Tsai, Henry Ahn, Brian Drew, Christopher S Bailey, Daryl R Fourney, Najmedden Attabib, Michael G Johnson, Michael G Fehlings, Stefan Parent, Marcel F Dvorak, and RHSCIR Network.
• Laval University, 1401, 18e Rue, Sciences Neurologiques, Québec, QC G1J 1Z4, Canada. Electronic address: jerome_paquet@yahoo.ca.
• Spine J. 2018 Jan 1; 18 (1): 88-98.

Background ContextEmergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear, and classic definitions of CCS do not identify a unique population of patients.PurposeThe study aimed to test the authors' hypothesis that spine stability can identify a unique group of patients with regard to demographics, management, and outcomes, which classic CCS definitions do not.Study Design/SettingThis is a prospective observational study.Patient SampleThe sample included participants with cervical SCI included in a prospective Canadian registry.Outcome MeasuresThe outcome measures were initial hospitalization length of stay, change in total motor score from admission to discharge, and in-hospital mortality.MethodsPatients with cervical SCI from a prospective Canadian SCI registry were grouped into stable and unstable spine cohorts. Bivariate analyses were used to identify differences in demographic, injury, management, and outcomes. Multivariate analysis was used to better understand the impact of spine stability on motor score improvement. No conflicts of interest were identified.ResultsCompared with those with an unstable spine, patients with cervical SCI and a stable spine were older (58.8 vs. 44.1 years, p<.0001), more likely male (86.4% vs. 76.1%, p=.0059), and have more medical comorbidities. Patients with stable spine cervical SCI were more likely to have sustained their injury by a fall (67.4% vs. 34.9%, p<.0001), and have high cervical (C1-C4; 58.5% vs. 43.3%, p=.0009) and less severe neurologic injuries (ASIA Impairment Scale C or D; 81.3% vs. 47.5%, p<.0001). Those with stable spine injuries were less likely to have surgery (67.6% vs. 92.6%, p<.0001), had shorter in-hospital lengths of stay (median 84.0 vs. 100.5 days, p=.0062), and higher total motor score change (20.7 vs. 19.4 points, p=.0014). Multivariate modeling revealed that neurologic severity of injury and spine stability were significantly related to motor score improvement; patients with stable spine injuries had more motor score improvement.ConclusionsWe propose that classification of stable cervical SCI is more clinically relevant than classic CCS classification as this group was found to be unique with regard to demographics, neurologic injury, management, and outcome, whereas classic CCS classifications do not . This classification can be used to assess optimal management in patients where it is less clear if and when surgery should be performed.Copyright © 2017 Elsevier Inc. All rights reserved.

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