Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb;28(2):434-441.
doi: 10.1007/s00586-018-5796-5. Epub 2018 Oct 19.

Spondylotic traumatic central cord syndrome: a hidden discoligamentous injury?

Dietmar Krappinger  1 , Richard A Lindtner  1 , Michael J Zegg  1 , Benjamin Henninger  2 , Verena Kaser  2 , Anna Spicher  3 , Rene Schmid  1
Affiliations

Spondylotic traumatic central cord syndrome: a hidden discoligamentous injury?

Dietmar Krappinger et al. Eur Spine J. 2019 Feb.

Abstract

Purpose: To revisit the concept of spondylotic traumatic central cord syndrome (TCCS) by assessing the frequency of discoligamentous injury and to correlate magnetic resonance imaging (MRI) and intraoperative findings.

Methods: A retrospective analysis of twenty-three consecutive patients (mean age: 62.7 ± 14.8 years) with profound spondylotic TCCS after acute cervical hyperextension trauma but without signs of instability on initial CT scans who underwent anterior surgical decompression and fusion was performed. Sensitivity and specificity of MRI in the detection of anterior longitudinal ligament disruption were calculated. The topographic relations between surgically verified segmental instabilities and spinal cord signals on MRI were analyzed. The cervical MRI scans of all patients were evaluated by the radiologist on call at time of admission, re-assessed by a specialized MRI radiologist for the purpose of this study and compared with intraoperative findings.

Results: Intraoperative findings revealed 25 cervical spine segments with hyperextension instability in 22 of 23 (95.7%) patients. The radiologist on call correctly assessed segmental hyperextension instability in 15 of 25 segments (sensitivity: 0.60, specificity: 1.00), while the specialized MRI radiologist was correct in 22 segments (sensitivity: 0.88, specificity: 1.00). In 17 of 23 (73.9%) patients, the level of spinal cord signal on MRI matched the level of surgically verified segmental instability.

Conclusions: Our findings challenge the traditional concept of spondylotic TCCS as an incomplete cervical spinal cord injury without discoligamentous injury and emphasize the importance of MRI as well as the radiologist's level of experience for the assessment of segmental instability in these patients. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Central cord syndrome; Cervical spine injury; Discoligamentous injury; Hyperextension injury; Magnetic resonance imaging.

PubMed Disclaimer

References

    1. J Neurosurg. 2002 Jul;97(1 Suppl):25-32 - PubMed
    1. J Neurosurg. 1954 Nov;11(6):546-77 - PubMed
    1. J Bone Joint Surg Br. 1951 Nov;33-B(4):543-7 - PubMed
    1. Surg Neurol. 2005 Feb;63(2):95-9; discussion 99-100 - PubMed
    1. Spine (Phila Pa 1976). 2005 Oct 15;30(20):2303-11 - PubMed

Publication types

LinkOut - more resources