Central cord syndrome in Ireland: the effect of age on clinical outcome

Abstract

Central cord syndrome is an incomplete spinal cord injury first described by Schneider et al. (J Neurosurg 11:546-547, 1954). The typical neurological deficit is symmetrical incomplete quadriplegia affecting the upper more than the lower limbs; sensory impairment is variable and urinary retention is common. Records of all patients with acute traumatic central cord syndrome admitted to the National Spinal Injuries Unit from 1999 to 2007 were compiled from a prospectively collected computerized spinal database. Data recorded included patient demographic profile, mechanism of injury, initial neurological deficit, treatment instituted, complications of treatment, and final neurological status. A total of 50 patients with acute traumatic central cord syndrome were identified accounting for 6.2% of all admissions to the spinal injuries unit. There were 42 men and 8 women. The mean age was 56.1 years with a range of 41-88 years. We stratified patients according to age at injury to determine the effect of age on clinical outcome. There were 13 patients <50 years of age, 24 aged 50-70, and 13 aged >70 years. The mean follow-up time was 42.2 months. More than one-third of patients were intoxicated with alcohol at the time of the injury. Both upper and lower limb motor scores and total sensory scores improved in all age groups. Absolute and relative improvements were greatest in patients <50 years of age. Sphincter disturbance was documented in 42% of all the patients on admission. At follow up 12% of patients had residual disturbance. At final follow up none of the patients under 70 years of age had residual sphincter disturbance while 60% of those aged >70 years group had. Both of these results reached statistical significance. In conclusion, central cord syndrome is a common cause of acute traumatic neurological deficit, with alcohol intoxication being a common confounder at the time of injury. The clinical outcomes are significantly worse in patients aged 70 years or older.

Fig. 1

ASIS Impairment Scale

Fig. 2

Total motor score

Fig. 3

Total sensory score