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Journal of Neurosurgical Sciences 2021 August;65(4):442-9

DOI: 10.23736/S0390-5616.21.05078-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Elderly traumatic central cord syndrome in the USA: a review of management and outcomes

Ryan R. PHELPS 1, 2, John K. YUE 1, 2, Rachel E. TSOLINAS 3, Hansen DENG 4, Jennifer RIOS 1, Pavan S. UPADHYAYULA 5, 6, Cecilia L. DALLE ORE 1, 2, Young M. LEE 1, 2, Catherine G. SUEN 7, John F. BURKE 1, 2, Ethan A. WINKLER 1, 2, Sanjay S. DHALL 1

1 Department of Neurological Surgery, University of California, San Francisco, CA, USA; 2 Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; 3 School of Medicine, University of Utah, Salt Lake City, UT, USA; 4 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 5 Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA; 6 Department of Neurological Surgery, Columbia University Hospital, New York, NY, USA; 7 Department of Neurology, University of California San Francisco, San Francisco, CA, USA



INTRODUCTION: As the incidence of elderly spinal cord injury rises, improved understanding of risk profiles and outcomes is needed. This review summarizes clinical characteristics, management, and outcomes specific to the elderly (≥65-years) with acute traumatic central cord syndrome in the USA.
EVIDENCE AQUISITION: Literature review of the PubMed, Embase, and CINAHL databases (01/2007-03/2020) regarding elderly subjects with acute traumatic central cord syndrome.
EVIDENCE SYNTHESIS: Nine studies met inclusion criteria. Acute traumatic central cord syndrome was more common among married (50%), Caucasian (22-71%) males (63-86%) with an annual income <40,999 USA dollars (30%). Mechanisms consisted predominantly of traumatic falls (32-55%) and motor vehicle collisions (15-34%), with admission American Spinal Injury Association Impairment Scale grades D (25-79%) and C (21-51%). Mortality was 2-3%. American Spinal Injury Association Impairment Scale motor score, maximum canal compromise, and extent of parenchymal damage were predictors of one-year recovery. Greater comorbidities (heart failure, weight loss, coagulopathy, diabetes), lower income (<51,000 USA dollars), and age ≥80 were predictors of mortality. A substantial cohort underwent surgery (40-45%). Elderly patients were less likely to receive surgical intervention, and surgery timing had variable effects on recovery.
CONCLUSIONS: Elderly patients with acute traumatic central cord syndrome are uniquely at risk due to cumulative comorbidities, protracted recovery times, and unclear effects of surgical timing on outcomes. Prospective research should focus on validating age-specific risk factors, formalizing surgical indications, and delineating the impact of time to surgery on acute and long-term outcomes for this condition.


KEY WORDS: Central cord syndrome; Aged; Epidemiology; Risk factors; Spinal cord injuries

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