Chen Liang, Yang Huilin, Yang Tongqi, Xu Yaozeng, Bao Zhaohua, Tang Tiansi
Department of Orthopaedic Surgery, The First Affiliated Hospital of Suzhou University, Suzhou, People's Republic of China.
J Neurosurg Spine. 2009 Jan;10(1):3-8. doi: 10.3171/2008.9.SPI0822.
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.
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.
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 was found between patients who underwent surgery within 4 days of injury or after 4 days of injury, adopting different approaches (anterior, posterior, or a combination), or with different pathological entities (acute disc herniation, fracture or dislocation, or multilevel degeneration). The ASIA score improvement had a positive correlation with the age at injury (r = 0.505, p = 0.023). The SF-36 data at 6 months and final follow-up were not as satisfactory as the improvement in ASIA scores, and almost one-third of patients expressed dissatisfaction with their final symptoms. For patients who were older than 65 years at injury, the mean follow-up Walking Index for Spinal Cord Injury (WISCI) score was statistically lower than it was in younger patients. The presence of spasticity or neuropathic pain at follow-up was not related to age, sex, ASIA motor score, or WISCI outcome.
Surgical intervention can be safely applied in patients with TCCS. Significant improvement of ASIA score was achieved during the first 6-month period of follow-up. Factors including type of lesion, timing of surgery within or after 4 days of injury, and surgical approach were not significantly associated with final ASIA score. The improvement in the ASIA motor score was positively correlated with age at injury. No significant correlation was found between or among the presence of spasticity, neuropathic pain, and ASIA score at final visit. Almost one-third of patients were not satisfied with their final symptoms.
作者对接受手术干预的创伤性中央脊髓综合征（TCCS）患者进行了一项研究。他们回顾性评估了运动评分的改善情况和功能状态，并确定了改善的预后预测因素。
1999年3月至2004年5月期间，49例TCCS患者接受了手术治疗。入院时和随访时使用美国脊髓损伤协会（ASIA）损伤量表收集运动评分。进行了36项简短健康调查（SF-36）。记录了其他参数，包括步行指数、痉挛、膀胱管理和神经性疼痛评分。患者被要求评估他们对最终症状的满意度。
转换为数值后的平均ASIA评分分别从入院时的54.9提高到6个月时的81.9和最终随访时的89.6。手术后头6个月内ASIA评分有显著改善。在受伤后4天内或4天后接受手术、采用不同手术方式（前路、后路或联合手术）或不同病理类型（急性椎间盘突出、骨折或脱位、或多节段退变）的患者之间未发现显著差异。ASIA评分的改善与受伤时年龄呈正相关（r = 0.505，p = 0.023）。6个月时和最终随访时的SF-36数据不如ASIA评分的改善情况理想，近三分之一的患者对其最终症状表示不满意。对于受伤时年龄大于65岁的患者，平均随访脊髓损伤步行指数（WISCI）评分在统计学上低于年轻患者。随访时痉挛或神经性疼痛的存在与年龄、性别、ASIA运动评分或WISCI结果无关。
手术干预可安全应用于TCCS患者。随访的头6个月内ASIA评分有显著改善。包括损伤类型、受伤后4天内或4天后的手术时机以及手术方式等因素与最终ASIA评分无显著相关性。ASIA运动评分的改善与受伤时年龄呈正相关。最终随访时痉挛、神经性疼痛的存在与ASIA评分之间未发现显著相关性。近三分之一的患者对其最终症状不满意。
