Cervical Anterior Approaches In Treatment Of Central Cord Syndrome

Objective: To explore the results of anterior approaches, and investigate the riskfactors in treatment of traumatic central cord syndrome.Method: From January2010to April2012,25patients suffering from traumaticcentral cord syndrome were involved in this retrospective, including20males and5females with an average age of51years (range,33~77years old). Radiographicevaluation revealed different levels of spondylosis and disc herniation in all patients,cervical vertebral, spinous or lamina fracture in10, and ligament injury in14. Themechanism of injury was traffic in8cases, fall damage in12cases, injury by fallingfrom the height in5cases. The operation via anterior approach consisted of1-levelcorpectomy and2-level adjacent cervical discectomy and titanium mesh fusion withplate fixation in15,1-level discectomy and1-level box cage fusion with plate fixationin5,2-level discectomy and2-level box cages fusion with plate fixation in2,2-levelcorpectomy and2-level adjacent discectomy and autologus iliac graft fusion withplate fixation in3. The changes of spinal function between preoperative andpostoperative were observed by ASIA standards to assess the efficacy. The operativetiming, age, gender, fracture and ligament rupture were analyzed comparatively.Results：The average operative time was112min (range,90~155min), and theaverage intraoperative blood loss was169ml (range,50~500ml). All patients werefollowed up for11to39months. Anterior hematoma occurred in one patient. Urinarytract infection and Sepsis occurred in another patient. Pullout of a screw occurred ineighth day postoperatively in1case. They were all treated successfully. All cases ofspinal cord function had different levels of recovery. Compared with the initial AMSin admission, the AMS at final follow-up were increased significantly(t=6.108,P＜0.001). Regarding with the final AMS, no significant different was found between patients operated early (＜7days) or late (≥7days), with or without ligament ruptureor fracture, male or female(P＞0.05). At final follow-up, patients younger than51years old were prone to obtain higher AMS (t＝2.387, P＜0.05).Conclusions：1. It is effective and feasible for patients with TCCS to undergo anterior cervicaldecompression and fusion which decompressing and stabilizing the spine, promotingfunctional recovery of spinal cord according to the conditions of spinal cordcompression by traumatic disc herniation.2. Patients operated early (＜7days) can not get a better recovery of neurologicalfunction than patients operated late. Gender, ligament injury and fracture are notimportant prognostic factors.3. Age is an important prognostic. Elderly patients(≥51years old) may get a worseprognosis.